A retrospective multicenter cohort study compared two follow-up strategies for patients after curative resection of biliary tract cancer. The study found that structured follow-up resulted in more patients receiving palliative therapy after recurrence compared to pragmatic follow-up. Additionally, the median overall survival was significantly lower in the pragmatic group. However, patients who actually received chemotherapy […]
Category: HPB & Spleen
Advanced Surgical Treatment of Pancreatic Ductal Adenocarcinoma: Current Challenges and Opportunities
Recent advancements in chemo/radiotherapy have rendered previously inoperable patients with pancreatic ductal adenocarcinoma (PDAC) potentially resectable. This narrative review highlights the current state of surgical treatment for borderline resectable, locally advanced, and synchronous or metachronous oligometastatic PDAC. Neoadjuvant therapy (NAT) is recommended before surgery, although the best response rate is still limited. Methods for selecting […]
Individualized Age Cessation in IPMN Surveillance: A Cost-Effectiveness Analysis
Researchers conducted a simulation study to determine the optimal age to discontinue long-term surveillance of low-risk intraductal papillary mucinous neoplasms (IPMNs). Using a markov model and clinical cohort data, they calculated the cost-effectiveness of continued versus discontinued surveillance at different ages. They found that the optimal age to stop surveillance varied based on sex and […]
Indocyanine Green-Guided Laparoscopic RLPS: Safe and Feasible for Synchronous Liver Metastases
Laparoscopic right posterior sectionectomy (RLPS) with an extrahepatic Glissonian approach and modified hanging maneuver, guided by indocyanine green fluorescence imaging, proves safe and feasible for a patient with mid-rectum adenocarcinoma and synchronous liver metastases. The procedure involves selective clamping, indocyanine green injection, and precise parenchymal transection along a marked plane. Detaching a metastasis from the […]
Laparoscopic Portal Vein Ligation and Embolization Facilitate Safe Second Hepatectomy for Unresectable Colorectal Liver Metastases
Laparoscopic two-stage hepatectomy with portal vein embolization ensures safe completion of surgery for initially unresectable colorectal liver metastases. Three patients received chemotherapy followed by laparoscopic colorectal resection and limited hepatectomies. After right portal vein ligation, laparoscopic portal vein embolization using ethanol facilitated the second hepatectomy. No postoperative complications occurred in six surgeries, suggesting the safety […]
Adjuvant Therapy Trends Post Resection in Pancreatic Cancer
Approximately 25.2% of pancreatic cancer patients who underwent upfront resection did not receive adjuvant therapy (AT), according to a prospective observational study. The main reasons for AT omission were postoperative complications, oncologist’s choice, baseline comorbidities, patient’s choice, and early recurrence. Older age, comorbidities, and postoperative complications were the main factors associated with AT omission. Additionally, […]
Progress and Challenges in Distinguishing Malignant from Benign Causes of Liver Hilum Obstruction
This study retrospectively analyzed consecutive patients who underwent surgery for hilar obstruction and aimed to determine factors distinguishing benign from malignant causes and long-term outcomes after resection. Among 182 patients, 14% had benign disease. Significant differences were found in ca19-9 levels and cross-sectional imaging features between malignant and benign strictures. Preoperative biopsy had moderate accuracy. […]
Laparoscopic Left Hepatectomy Achieves Comparable Results to Open Surgery for Intrahepatic Cholangiocarcinoma
A 66-year-old male with stage II intrahepatic cholangiocarcinoma underwent a 240-minute laparoscopic left hepatectomy using a no-touch en bloc technique and lymphadenectomy skeletonization. The patient was discharged after 6 days without complications and received postoperative gemcitabine and cisplatin treatment. After 14 months of follow-up, there was no recurrence. This study demonstrates that skilled surgeons can […]
Increased Overall Survival Associated with Achieving Modified Textbook Outcome in Surgery for Colorectal Liver Metastases
Findings from a nationwide analysis revealed that achieving a modified textbook outcome (MTO) after surgery for colorectal liver metastases (CRLM) was associated with better overall survival (OS). Out of 6,525 eligible patients, 81% achieved MTO. Between 2014 and 2018, patients achieving MTO had a 5-year OS of 46.7% compared to 33.7% in non-MTO patients. Not […]
Implications of precursor lesions and early cancerous changes in the gallbladder and bile ducts
The study explores terminology, classification, and significance of dysplasia and early carcinoma in the gallbladder and bile ducts. Most precursor lesions and early cancerous changes are clinically undetectable. Low-grade dysplasia is challenging to define and lacks clinical significance, but additional sampling is required to exclude significant lesions. High-grade dysplasia (carcinoma in situ) necessitates complete sampling […]