HPB Blog: July 2016

Thought provoking research in this month’s HPB

On the back of the recent jump in HPB’s impact factor, it would seem that this month’s issue is likely to propel that higher in future years. There are a number of articles that ask, answer and raise interesting questions across the field of surgical HPB. Two systematic reviews cover robotic vs. laparoscopic distal pancreatectomy and secondly the effect of para-aortic nodal involvement in patients undergoing pancreaticoduodenectomy. For further information both are covered in this months editorial highlights . Perhaps the most thought provoking paper in the pancreatic section comes from de Reuver et al.  Here the authors report on the significance of intra-operative peri-pancreatic fluid amylase levels. They found that elevated levels of amylase in this fluid subsequently correlated with clinically relevant post-operative pancreatic fistula (POPF). This novel finding has many implications. It should change our thinking around the timing and potential etiology of POPF.

Within the liver field, Bhutani et al  describe the outcomes for those patients with advanced cirrhosis and HCC treated with irreversible electroporation (IRE) or microwave ablation (MWA). IRE is the new kid on the block and its true indications are still being worked out. However in this group of high risk patients it seemed to provide similar success as ablation, being better tolerated and delivering similar short term outcomes.

For patients being treated with neoadjuvant therapy for colorectal liver metastases the question of timing of surgery is important. Many have questioned the role of neoadjuvant therapy in those with resectable disease but a group of patients would seem to require this additional intervention to achieve resectability. In a useful addition to the evidence base, Lim et al  have shown that progression after cessation of surgery is likely and can be rapid with a significantly shorter doubling time than is normally associated with colorectal cancer. Thus for those patients with not much room to move timing may be everything.

I would strongly recommend this month’s HPB for any upcoming journal club. We are bound to hear more about many of the topics highlighted here. They are very much relevant to our surgcial practice and one could imagine that several of these papers are likely to be highly cited in the future.

Saxon Connor, HPB Editor

Click here for the July Table of Contents

 

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