Fireworks to bring in the New Year in the January Edition of HPB

Bringing in the New Year in style is the January issue of HPB, which contains a veritable firework display of important articles. Delpero and colleagues present a large prospective multicenter study examining resection margin status in patients undergoing surgical resection for pancreatic cancer using uniform criteria for pathological evaluation.  The study is thrown in to sharp focus by an Editorial by a leading pancreas cancer pathologist, Caroline Verbeke from the Karolinska Institute  and a leading pancreas cancer surgeon, our own Professor Mark Callery in Boston.  The principle finding of the study is of a high R1 positive margin rate using standardized pathological criteria and a positive margin of

The January issue also features the reporting of the much-awaited series of patients from Dublin, Duignan et al, who underwent neoadjuvant chemoradiotherapy prior to liver transplantation for hilar cholangiocarcinoma.  The authors followed the Mayo Clinic protocol for selection and treatment of patients. 27 patients were entered into the protocol and 20 underwent liver transplantation showing no progression after neoadjuvant chemoradiotherapy. A fifth of these patients died early after transplantation however of the 16 survivors, 94% were alive at 1 year and 61% at 4 years after liver transplantation. The study acknowledges that its survival outcomes were not as good as the previously reported Mayo series however they are not that bad either! This is undoubtedly very aggressive treatment for a very challenging  cancer. This is however an important paper and there is certainly room for optimism for further expansion of this approach within the constraints of a World-wide shortage of organ donors.

Two systematic reviews and meta-analyses are presented in this of HPB. The first from Toso et al, looks at the use of fibrin sealants in patients undergoing pancreatic resection. There was a hope that fibrin sealants might play a role in reducing complications of pancreatic resection particularly pancreatic fistula however, this manuscript shows that this is not the case and the authors conclude that there is no significant benefit from the routine use of fibrin sealants in pancreatic resection surgery. The second systematic review is from Richardson and colleagues from Sydney, Australia and explores the potential benefit of giving preoperative steroid treatment to patients undergoing liver resection. They found 5 randomized controlled trials incorporating almost 400 patients and steroid treatment was associated with a lower interleukin-6 and serum bilirubin concentration on day one postoperative but this did not translate into any statistically significant clinical benefit in terms of post-operative complications or other outcomes.

This summary represents just a selection of the many excellent articles covering all aspects of hepatic, pancreatic and biliary surgery featured in this edition of HPB. It also serves to highlight why HPB continues to be essential reading for all HPB surgeons.

Please click here to review the table of contents for the January issue

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