HPB Blog: February 2016

As excitement builds for our long-awaited April IHPBA World Congress in São Paolo, Brazil, our HPB readership can enjoy a terrific February issue packed with impressive articles. Certainly we hope to receive a high volume of original manuscripts as a result of the World Congress, and we encourage authors to submit early. Our Editorial Board and loyal ad-hoc reviewers will for sure have a busy spring and summer, so we offer our deep gratitude in advance.

On Wednesday April 20th, experts from around the world will convene in São Paolo for the IHPBA State of the Art Conference on Minimally Invasive Pancreatic Resection. As noted in my Highlight this month, one article sure to capture attention is that of Rooij et al summarizing the Pan-European survey on the implementation of minimally invasive pancreatic surgery. With 203 surgeons responding from 27 European countries, we learn that MIS distal pancreatectomy enjoys broad deployment, despite some lingering concerns regarding its efficacy for cancer. MIS pancreaticoduodenectomy remains an uncommon procedure, and evolution to robotic-assisted MIS pancreatic surgery is quite slow. The results will certainly stimulate discussion at the conference.

Massimo Falconi’s team from Italy evaluate an ERAS protocol for pancreaticoduodenectomy in the elderly (>75 years), and indicate that it is both feasible and safe. It is a very nice study to read, and reveals the nuts and bolts of an effective ERAS protocol as compared to a more historical standard protocol. Postoperative outcomes did not change for the elderly because of ERAS. That is not surprising given the established high quality of this pancreatic unit, and the limited number of patients evaluated. We do have further proof that enhancing and simplifying post-operative care in pancreatic surgery makes sense across all age groups.

Jawad and colleagues from the HPB Unit at London’s Hammersmith hospital provide a fine systematic review of 5 published studies to assess outcomes of chronic pancreatitis patients undergoing duodenum preserving pancreatic head resection (DPPHR). After comparing outcomes across the variants of DPPHR (Beger vs Frey, for example), the authors reveal no significant difference in short or long term outcomes, and no real differences in pain control.

Another excellent systematic review, offered by Jeroen Hagendoorn’s team from the Netherlands, evaluates robotic-assisted laparoscopic liver resection. The review pivots from 12 observational and typically retrospective studies available for 363 patients, with data being pooled for analysis. The authors evaluated 3 subgroups representing minor to major resections. We learn that the robotic-assisted approach is safe and feasible across all sub-groups of hepatectomy in terms of operative times, blood loss, and an impressive and low need for conversion to open laparotomy. There was zero mortality for these 363 patients!

The emphasis on minimally invasive surgery continues with a detailed report from Joel Lewin and colleagues in Brisbane evaluating long term survival in laparoscopic versus open resection for colorectal liver metastases (CLM). While we know of the short term advantages of laparoscopic hepatectomy, it turns out there are few available studies that examine longer term outcomes. The Brisbane team evaluates such outcomes from 14 years of open and laparoscopic CLM resections using an approach to control for selection bias. Laparoscopic hepatectomy for CLM appears to be oncologically equivalent to open resection with no differences in long term survival. As the authors conclude “Laparoscopic liver surgery for malignancy is here to stay”!

And so, enjoy your February HPB issue, and get excited for the São Paolo 2016 IHPBA World Congress, an event truly years in the making!

Mark P. Callery, MD, FACS
Editor, HPB
Professor of Surgery
Harvard Medical School
Boston, Massachusetts
USA

CLICK HERE for the Table of Contents

CLICK HERE for more information about the 12th IHPBA World Congress

CLICK HERE for more information about the IHPBA State of the Art Conference on MIPR

Published on

Corporate Partners

Angiodynamics logo
Baxter logo

If you are interested in becoming a Corporate Partner of the IHBPA please contact industry@ihpba.org

Find out more