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Resection and reconstruction in high-grade pancreatic head injuries

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World Journal of Gastrointestinal surgery 2024年第5期16卷 1467-1469页

作者： Jake Krige Eduard Jonas Andrew John Nicol Pradeep Harkson Navsaria hpb surgery University of Cape Town Health Sciences FacultyCape Town 7925Western CapeSouth Africa Trauma Center Department of SurgeryGroote Schuur HospitalCape Town 7925Western CapeSouth Africa Department of surgery Trauma CenterGroote Schuur HospCape Town 7925Western CapeSouth Africa

This study by Chui et al adds further important evidence in the treatment of highgrade pancreatic injuries and endorses the concept of the model of pancreatic trauma care designed to optimize treatment,minimize morbidity and enhance survival in patients with complex pancreatic injuries.Although the authors have demonstrated favorable outcomes based on their limited experience of 5 patients who underwent a pancreaticoduodenectomy(PD),including 2 patients who were“unstable”and did not have damage control surgery(DCS),we would caution against the general recommendations promoting index PD without DCS in“unstable”grade 5 pancreatic head injuries.

关键词： Pancreas Injury surgery Pancreaticoduodenectomy

Current interventional options for palliative care for patients with advanced-stage cholangiocarcinoma

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World Journal of Clinical Oncology 2024年第3期15卷 381-390页

作者： Maryam Makki Malak Bentaleb Mohammed Abdulrahman Amal Abdulla Suhool Salem Al Harthi Marcelo AF Ribeiro Jr Department of surgery Division of TraumaCritical Care and Acute Care SurgerySheikh Shakhbout Medical CityAbu Dhabi 11001United Arab Emirates Department of surgery College of Medicine and Health SciencesKhalifa UniversityAbu Dhabi 11001United Arab Emirates Department of surgery Division of Hepato-Pancreato-Biliary(HPB)SurgerySheikh Shakhbout Medical CityAbu Dhabi 91888United Arab Emirates

Primary biliary tract tumors are malignancies that originate in the liver,bile ducts,or gallbladder.These tumors often present with jaundice of unknown etiology,leading to delayed diagnosis and advanced disease.Currently,several palliative treatment options are available for primary biliary tract tumors.They include percutaneous transhepatic biliary drainage(PTBD),biliary stenting,and surgical interventions such as biliary diversion.Systemic therapy is also commonly used for the palliative treatment of primary biliary tract tumors.It involves the administration of chemotherapy drugs,such as gemcitabine and cisplatin,which have shown promising results in improving overall survival in patients with advanced biliary tract tumors.PTBD is another palliative treatment option for patients with unresectable or inoperable malignant biliary obstruction.Biliary stenting can also be used as a palliative treatment option to alleviate symptoms in patients with unresectable or inoperable malignant biliary obstruction.Surgical interventions,such as biliary diversion,have traditionally been used as palliative options for primary biliary tract tumors.However,biliary diversion only provides temporary relief and does not remove the tumor.Primary biliary tract tumors often present in advanced stages,making palliative treatment the primary option for improving the quality of life of patients.

关键词： Cholangiocarcinoma Palliative care Endoscopic treatment surgery Complications Interventional radiology

Hepatolithiasis:Epidemiology,presentation,classification and management of a complex disease

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World Journal of Gastroenterology 2024年第13期30卷 1836-1850页

作者： Rodrigo V.Motta Francesca Saffioti Vasileios K Mavroeidis Translational Gastroenterology and Liver Unit Nuffield Department of MedicineUniversity of OxfordOxford OX39DUUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustJohn Radcliffe HospitalOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health and Sheila Sherlock Liver Unit Royal Free Hospital and University College LondonLondon NW32QGUnited Kingdom Department of hpb surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Transplant surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom Department of Gastrointestinal surgery North Bristol NHS TrustSouthmead HospitalBristol BS105NBUnited Kingdom

The term hepatolithiasis describes the presence of biliary stones within the intrahepatic bile ducts,above the hilar confluence of the hepatic ducts.The disease is more prevalent in Asia,mainly owing to socioeconomic and dietary factors,as well as the prevalence of biliary parasites.In the last century,owing to migration,its global incidence has increased.The main pathophysiological mechanisms involve cholangitis,bile infection and biliary strictures,creating a self-sustaining cycle that perpetuates the disease,frequently characterised by recurrent episodes of bacterial infection referred to as syndrome of“recurrent pyogenic cholangitis”.Furthermore,long-standing hepatolithiasis is a known risk factor for development of intrahepatic cholangiocarcinoma.Various classifications have aimed at providing useful insight of clinically relevant aspects and guidance for treatment.The management of symptomatic patients and those with complications can be complex,and relies upon a multidisciplinary team of hepatologists,endoscopists,interventional radiologists and hepatobiliary surgeons,with the main goal being to offer relief from the clinical presentations and prevent the development of more serious complications.This comprehensive review provides insight on various aspects of hepatolithiasis,with a focus on epidemiology,new evidence on pathophysiology,most important clinical aspects,different classification systems and contemporary management.

关键词： Cholelithiasis Intrahepatic stones Cholangiocarcinoma Biliary parasites Recurrent pyogenic cholangitis Oriental cholangiohepatitis Hepatectomy Cholangioscopy Liver transplant Paediatric

Dynamics and cytokinic regulation of immune cell infiltration in genetically engineered mouse models of pancreatic cancer dictate the sensitivity to immunotherapy

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Cancer Communications 2024年第1期44卷 178-182页

作者： Okan Safak Shenghan Wang Carmen Mota Reyes Ibrahim Halil Gürcinar Sergey Tokalov Nedim Can Cevik Kivanc Görgülü Bengi Su Yilmaz Emre Erdogan Linhan Ye Qiaolin Li Elif Arik Sever SamedÖzer Güldal Süyen Helmut Friess Güralp Onur Ceyhan Rouzanna Istvanffy Hana Algül Ihsan Ekin Demir Department of surgery Klinikum rechts der IsarTechnical University of MunichSchool of MedicineMunichBavariaGermany Department of General surgery HPB-UnitSchool of MedicineAcibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Comprehensive Cancer Center München Klinikum rechts der IsarTechnical University of MunichSchool of MedicineMunichBavariaGermany Department of Hematology Oncology and Tumor ImmunologyCharitéUniversity Medicine BerlinCampus Virchow ClinicBerlinBerlinGermany Graduate School of Health Sciences Acibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Department of Physiology Acibadem Mehmet Ali Aydinlar UniversityIstanbulIstanbulTurkey Else Kröner Clinician Scientist Professorship for Translational Pancreatic surgery MunichGermany Neural Influences in Cancer(NIC)International Research Consortium MunichGermany

Dear Editor,Targeting the immune compartment in pancreatic duc-tal adenocarcinoma(PDAC)holds promise for prognostic improvement,yet our knowledge on the spatial and tem-poral dynamics and the molecular modulators of t... 详细信息

关键词： immune adenocarcinoma immunotherapy

Pancreatic surgery and tertiary pancreatitis services warrant provision for support from a specialist diabetes team

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World Journal of Diabetes 2024年第4期15卷 598-605页

作者： Vasileios K Mavroeidis Jennifer Knapton Francesca Saffioti Daniel L Morganstein Department of hpb surgery Bristol Royal InfirmaryUniversity Hospitals Bristol and Weston NHS Foundation TrustBristol BS28HWUnited Kingdom Department of Gastrointestinal surgery Southmead HospitalNorth Bristol NHS TrustBristol BS105NBUnited Kingdom Department of Academic surgery Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom Department of Gastroenterology and Hepatology Oxford University Hospitals NHS Foundation TrustOxford OX39DUUnited Kingdom UCL Institute for Liver and Digestive Health University College LondonLondon NW32PFUnited Kingdom Department of Endocrinology Chelsea and Westminster Hospital NHS Foundation TrustLondon SW109NHUnited Kingdom Department of Gastrointestinal Unit Royal Marsden NHS Foundation TrustLondon SW36JJUnited Kingdom

Pancreatic surgery units undertake several complex operations,albeit with consi-derable morbidity and mortality,as is the case for the management of complicated acute pancreatitis or chronic pancreatitis.The centralisation of pancreatic surgery services,with the development of designated large-volume centres,has contribu-ted to significantly improved outcomes.In this editorial,we discuss the complex associations between diabetes mellitus(DM)and pancreatic/periampullary disease in the context of pancreatic surgery and overall management of complex pancreatitis,highlighting the consequential needs and the indispensable role of specialist diabetes teams in support of tertiary pancreatic services.Type 3c pan-creatogenic DM,refers to DM developing in the setting of exocrine pancreatic disease,and its identification and management can be challenging,while the glycaemic control of such patients may affect their course of treatment and outcome.Adequate preoperative diabetes assessment is warranted to aid identification of patients who are likely to need commencement or escalation of glucose lowering therapy in the postoperative period.The incidence of new onset diabetes after pancreatic resection is widely variable in the literature,and depends on the type and extent of pancreatic resection,as is the case with pancreatic parenchymal loss in the context of severe pancreatitis.Early involvement of a specialist diabetes team is essential to ensure a holistic management.In the current era,large volume pancreatic surgery services commonly abide by the principles of enhanced recovery after surgery,with inclusion of provisions for optimisation of the perioperative glycaemic control,to improve outcomes.While various guidelines are available to aid perioperative management of DM,auditing and quality improvement platforms have highlighted deficiencies in the perioperative management of diabetic patients and areas of required improvement.The need for perioperative support of diabetic patients by specialist diabetes teams is uniform

关键词： Pancreatectomy Pancreatoduodenectomy Whipple’s Pancreatitis Diabetes specialist Type 3c pancreatogenic diabetes mellitus

Liver transplantation for hepatocellular carcinoma in India: Are we ready for 2040?

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World Journal of Transplantation 2024年第1期14卷 141-153页

作者： Hirak Pahari Amruth Raj Ambreen Sawant Dipak S Ahire Raosaheb Rathod Chetan Rathi Tushar Sankalecha Sachin Palnitkar Vikram Raut Department of Liver Transplant and hpb surgery Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Liver Transplant Anaesthesia Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210India Department of Gastroenterology and Hepatology Medicover HospitalsNavi Mumbai 410210MaharashtraIndia Department of Gastroenterology and Hepatology Medicover HospitalsAurangabad 431003India Department of Gastroenterology and Hepatology Medicover HospitalsNashik 422009India Department of Gastroenterology and Hepatology Medicover HospitalsPune 411026India

BACKGROUND Liver transplantation(LT)for hepatocellular carcinoma(HCC)has been widely researched and is well established worldwide.The cornerstone of this treatment lies in the various criteria formulated by expert consensus and experience.The variations among the criteria are staggering,and the short-and long-term outcomes are controversial.AIM To study the differences in the current practices of LT for HCC at different centers in India and discuss their clinical implications in the future.METHODS We conducted a survey of major centers in India that performed LT in December 2022.A total of 23 responses were received.The centers were classified as high-and low-volume,and the current trend of care for patients undergoing LT for HCC was noted.RESULTS Of the 23 centers,35%were high volume center(>500 Liver transplants)while 52%were high-volume centers that performed more than 50 transplants/year.Approximately 39%of centers had performed>50 LT for HCC while the percent distribution for HCC in LT patients was 5%–15%in approximately 73%of the patients.Barring a few,most centers were divided equally between University of California,San Francisco(UCSF)and center-specific criteria when choosing patients with HCC for LT,and most(65%)did not have separate transplant criteria for deceased donor LT and living donor LT(LDLT).Most centers(56%)preferred surgical resection over LT for a Child A cirrhosis patient with a resectable 4 cm HCC lesion.Positron-emission tomography-computed tomography(CT)was the modality of choice for metastatic workup in the majority of centers(74%).Downstaging was the preferred option for over 90%of the centers and included transarterial chemoembolization,transarterial radioembolization,stereotactic body radiotherapy and atezolizumab/bevacizumab with varied indications.The alphafetoprotein(AFP)cut-off was used by 74%of centers to decide on transplantation as well as to downstage tumors,even if they met the criteria.The criteria for successful downstaging varied,but most centers conformed to the UCSF or

关键词： Hepatocellular carcinoma Liver transplant India Downstaging Survey Milan University of California,San Francisco Portal vein tumor thrombus Expanded criteria

Is hpb robotic-assisted surgery an evolution or a revolution in laparoscopy?

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Hepatobiliary surgery and Nutrition 2023年第1期12卷 84-87页

作者： Jun Cao Yajin Chen Department of Hepatobiliary surgery Sun Yat-sen Memorial HospitalSun Yat-sen UniversityGuangzhouChina

Robotic-assisted surgery technology demonstrates a new prospect for surgery.Its advantages are particularly prominent in specific surgery divisions or for specific surgical procedures,which has set off a new wave of surgical technology following laparoscopic surgery.Looking back at the history of surgical development over the past century,there have been many technological waves,some of which have become classics and standards,some of which are constantly evolving,and some of which have been gradually abandoned in practice.In the context of the increasingly mature and accurate laparoscopic surgery,which has become a standard operation of many types of surgery,the government,medical institutions and surgeons should carefully consider the role and future development of robotic-assisted surgery.

关键词： Robotic-assisted surgery laparoscopy evolution revolution

Intraoperative pancreas stump perfusion assessment during pancreaticoduodenectomy:A systematic scoping review

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世界胃肠外科杂志:英文版(电子版) 2023年第8期15卷 1799-1807页

作者： Francis P Robertson Harry V M Spiers Wei Boon Lim Benjamin Loveday Keith Roberts Sanjay Pandanaboyana Department of hpb and Transplant surgery Freeman HospitalNewcastle Upon Tyne NE77DNUnited Kingdom Department of hpb surgery Addenbrookes HospitalCambridge CB20QQUnited Kingdom Department of General surgery Royal Melbourne HospitalMelbourne VIC 3050Australia Department of hpb surgery University Hospitals Birmingham NHS Foundation TrustBirmingham BG152GWUnited Kingdom

BACKGROUND Post-operative pancreatic fistula(POPF)is the primary cause of morbidity following pancreaticoduodenectomy.Rates of POPF have remained high despite well known risk factors.The theory that hypoperfusion of the pancreatic stump leads to anastomotic failure has recently gained interest.AIM To define the published literature with regards to intraoperative pancreas perfusion assessment and its correlation with POPF.METHODS A systematic search of available literature was performed in November 2022.Data extracted included study characteristics,method of assessment of pancreas stump perfusion,POPF and other post-pancreatic surgery specific complications.RESULTS Five eligible studies comprised two prospective non-randomised studies and three case reports,total 156 patients.Four studies used indocyanine green fluorescence angiography to assess the pancreatic stump,with the remaining study assessing pancreas perfusion by visual inspection of arterial bleeding of the pancreatic stump.There was significant heterogeneity in the definition of POPF.Studies had a combined POPF rate of 12%;intraoperative perfusion assessment revealed hypoperfusion was present in 39%of patients who developed POPF.The rate of POPF was 11%in patients with no evidence of hypoperfusion and 13%in those with evidence of hypoperfusion,suggesting that not all hypoperfusion gives rise to POPF and further analysis is required to analyse if there is a clinically relevant cut off.Significant variance in practice was seen in the pancreatic stump management once hypoperfusion was identified.CONCLUSION The current published evidence around pancreas perfusion during pancreaticoduodenectomy is of poor quality.It does not support a causative link between hypoperfusion and POPF.Further well-designed prospective studies are required to investigate this.

关键词： Pancreatico-duodenectomy Post-operative pancreatic fistula Perfusion Indocyanine green Post pancreatectomy pancreatitis

Role of neoadjuvant therapy for nonmetastatic pancreatic cancer:Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第6期15卷 911-924页

作者： Gianluca Cassese Ho-Seong Han Yoo-Seok Yoon Jun Suh Lee Boram Lee Antonio Cubisino Fabrizio Panaro Roberto Ivan Troisi Department of Clinical Medicine and surgery Division of Minimally Invasive HPB Surgery and Transplantation ServiceFederico II University HospitalNaples 80131Italy Department of surgery Seoul National University College of MedicineSeongnam 13620Gyeonggi-doSouth Korea Department of hpb surgery and Transplantation Beaujon HospitalClichy 92110France Department of Digestive surgery and Liver Transplantation CHU MontpellierMontpellier 34100France

Pancreatic adenocarcinoma(PDAC)is one of the most common and lethal human cancers worldwide.surgery followed by adjuvant chemotherapy offers the best chance of a long-term survival for patients with PDAC,although only approximately 20%of the patients have resectable tumors when diagnosed.Neoadjuvant chemotherapy(NACT)is recommended for borderline resectable pancreatic cancer.Several studies have investigated the role of NACT in treating resectable tumors based on the recent advances in PDAC biology,as NACT provides the potential benefit of selecting patients with favorable tumor biology and controls potential micro-metastases in high-risk patients with resectable PDAC.In such challenging cases,new potential tools,such as ct-DNA and molecular targeted therapy,are emerging as novel therapeutic options that may improve old paradigms.This review aims to summarize the current evidence regarding the role of NACT in treating non-metastatic pancreatic cancer while focusing on future perspectives in light of recent evidence.

关键词： Pancreatic cancer Pancreatic duct adenocarcinoma Neoadjuvant chemotherapy Borderline resectable Locally advanced pancreatic cancer