HPB Blog: April 2016

Challenging the dogma of HPB

A sign of good research is that it often generates more questions than answers. In this month’s issue several papers challenge HPB dogma and should generate significant debate amongst the HPB community.

In terms of pancreatic cancer, the volume –outcome relationship remains a hotly debated topic. Van der Geest et al on behalf of the Dutch Pancreatic Cancer Group show that the outcomes continue to improve with increasing volumes above 40 pancreaticoduodenectomies per year. For small high density countries super centralisation may seem the logical step but for large low density countries that are dependent on maintaining surgeons with skills for non-cancer pathology within local hospitals this solution may seem counterintuitive. A small gain in outcome for patients with pancreatic cancer may come at a significant cost to other patients in the population.

The second issue relating to pancreatic cancer is the significance of the R1 margin following pancreaticoduodenectomy for malignant disease. It is not hard to see why this remains an area of significant equipoise. The degree of heterogeneity identified by Butler et al gives significant insight into why the literature is so disparate and challenges HPB surgeons to come to a consensus and standardise reporting. Perhaps the most confronting article is that by Kim et al which showed a statistical increase in survival for 35 patients who underwent palliative resection for stage IV pancreatic cancer as compared to 115 patients who underwent bypass. This paper is definitely worth a read and presentation at journal club. Significant discussion is bound to result.

The liver and bile duct also feature with a systematic review by Navadgi et al analysing the effect of bile duct thrombus on outcomes for patients with HCC. Olthof et al make an important point with regard to post-operative management of the biliary drain post resection for hilar cholangiocarcinoma. Bile should not be drained externally in the post-operative period as it seems to be associated with increased rates of post-operative liver failure and does not reduce anastomotic leak.

Saxon Connor

Click here for the table of contents

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