Статті в журналах: "Hepato Pancreato Biliary Cancers"

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Coppola, Alessandro, Michele Fiore, Vincenzo La Vaccara, Tommaso Farolfi, Damiano Caputo, and Sara Ramella. "Special Issue “Hepatobiliary and Pancreatic Cancers: Novel Strategies for of Diagnosis and Treatments”." Journal of Clinical Medicine 11, no. 13 (July 2, 2022): 3849. http://dx.doi.org/10.3390/jcm11133849.

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Lee-Ying, Richard, Osama Ahmed, Shahid Ahmed, Shahida Ahmed, Oliver F. Bathe, Bryan Brunet, Laura Dawson, et al. "Report from the 21st Annual Western Canadian Gastrointestinal Cancer Consensus Conference; Calgary, Alberta; 20–21 September 2019." Current Oncology 28, no. 5 (September 21, 2021): 3629–48. http://dx.doi.org/10.3390/curroncol28050310.

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The 21st annual Western Canadian Gastrointestinal Cancer Consensus Conference (WCGCCC) was held in Calgary, Alberta, 20–21 September 2019. The WCGCCC is an interactive multi-disciplinary conference attended by health care professionals from across Western Canada (British Columbia, Alberta, Saskatchewan, and Manitoba) involved in the care of patients with gastrointestinal cancer. Surgical, medical, and radiation oncologists, pathologists, radiologists, and allied health care professionals such as dietitians and nurses participated in presentation and discussion sessions to develop the recommendations presented here. This consensus statement addresses current issues in the management of hepato-pancreato-biliary (HPB) cancers.

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Okamoto, Takeshi. "Malignant biliary obstruction due to metastatic non-hepato-pancreato-biliary cancer." World Journal of Gastroenterology 28, no. 10 (March 14, 2022): 985–1008. http://dx.doi.org/10.3748/wjg.v28.i10.985.

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Colavita, Paul D., Victor B. Tsirline, Igor Belyansky, Ryan Z. Swan, Amanda L. Walters, Amy E. Lincourt, David A. Iannitti, and B. Todd Heniford. "Regionalization and Outcomes of Hepato-pancreato-biliary Cancer Surgery in USA." Journal of Gastrointestinal Surgery 18, no. 3 (January 16, 2014): 532–41. http://dx.doi.org/10.1007/s11605-014-2454-z.

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Wuraola, F., O. Olasehinde, O. Alatise, A. Adisa, and O. Arowolo. "Delayed Presentation for Oncological Care among Patients with Hepato-pancreato-Biliary Cancers in Ile-Ife, Nigeria." HPB 23 (2021): S397. http://dx.doi.org/10.1016/j.hpb.2020.11.1023.

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Begum, Saleema, and Muhammad Rizwan Khan. "Surgical management of hepato-pancreato-biliary cancers in Covid-19 pandemic: perspective from the developing world." Sri Lanka Journal of Surgery 38, no. 2 (August 31, 2020): 62. http://dx.doi.org/10.4038/sljs.v38i2.8699.

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Tanaka, Shinji. "Cancer stem cells as therapeutic targets of hepato-biliary-pancreatic cancers." Journal of Hepato-Biliary-Pancreatic Sciences 22, no. 7 (April 14, 2015): 531–37. http://dx.doi.org/10.1002/jhbp.248.

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Maharjan, N., B. Ghimire, P. Kansakar, R. S. Bhandari, and P. J. Lakhey. "Association of Preoperative Sarcopenia with Postoperative Complications Following Hepato-pancreato-biliary Cancer Surgery." HPB 23 (2021): S395—S396. http://dx.doi.org/10.1016/j.hpb.2020.11.1018.

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Klompmaker, Sjors, Jony van Hilst, Sarah L. Gerritsen, Mustapha Adham, M. Teresa Albiol Quer, Claudio Bassi, Frederik Berrevoet, et al. "Outcomes After Distal Pancreatectomy with Celiac Axis Resection for Pancreatic Cancer: A Pan-European Retrospective Cohort Study." Annals of Surgical Oncology 25, no. 5 (March 12, 2018): 1440–47. http://dx.doi.org/10.1245/s10434-018-6391-z.

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Abstract Background Western multicenter studies on distal pancreatectomy with celiac axis resection (DP-CAR), also known as the Appleby procedure, for locally advanced pancreatic cancer are lacking. We aimed to study overall survival, morbidity, mortality and the impact of preoperative hepatic artery embolization (PHAE). Methods Retrospective cohort study within the European-African Hepato-Pancreato-Biliary-Association, on DP-CAR between 1-1-2000 and 6-1-2016. Primary endpoint was overall survival. Secondary endpoints were radicality (R0-resection), 90-day mortality, major morbidity, and pancreatic fistulae (grade B/C). Results We included 68 patients from 20 hospitals in 12 countries. Postoperatively, 53% of patients had R0-resection, 25% major morbidity, 21% an ISGPS grade B/C pancreatic fistula, and 16% mortality. In total, 82% received (neo-)adjuvant chemotherapy and median overall survival in 62 patients with pancreatic ductal adenocarcinoma patients was 18 months (CI 10–37). We observed no impact of PHAE on ischemic complications. Conclusions DP-CAR combined with chemotherapy for locally advanced pancreatic cancer is associated with acceptable overall survival. The 90-day mortality is too high and should be reduced. Future studies should investigate to what extent increasing surgical volume or better patient selection can improve outcomes.

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Shevchuk, M. P., M. O. Dudchenko, M. I. Kravtsiv, D. M. Ivashchenko, R. A. Prykhidko, and S. M. Zaiets. "FEATURES OF DECOMPRESSION OF THE BILIARY TRACT IN PATIENTS WITH OBTURATION OF THE DISTAL PART OF THE COMMON BILE DUCT OF TUMOR ORIGIN." Medical and Ecological Problems 26, no. 3-4 (August 31, 2022): 30–33. http://dx.doi.org/10.31718/mep.2022.26.3-4.04.

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We conducted a retrospective and prospective analysis of the examination and treatment of 89 patients with cancer of the hepato-pancreato-duodenal zone complicated by mechanical jaundice. Cancer of the head of the pancreas was found in 69 patients, cancer of the major duodenal papilla was detected in 10 patients, cancer of the extrahepatic bile ducts – in 9 patients, and cancer of the duodenum – in 1 case. All patients were divided into 3 groups depending on the degree of jaundice. Operative treatment was performed in 86 patients. Of them, 13 were operated on at the height of jaundice, and 73 – after previous minimally invasive decompression of the biliary system. Postoperative complications were observed in 17 (19.1%) patients, 12 (16.4%) of whom were operated on at the height of jaundice, and 5 (6.8%) – after previous biliary decompression (second-stage operations). In 6 patients with severe jaundice who were operated on at the height of jaundice, complications occurred even after minor palliative operations. Thus, in the presence of severe jaundice with bilirubin level > 200 μmol/l, radical and palliative operations should be performed only in two stages, after preliminary decompression of the bile ducts. Decompression of the bile ducts allows the reduction of the preoperative period by 2–3 weeks.

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Bagante, Fabio, Gaya Spolverato, Andrea Ruzzenente, Claudio Luchini, Diamantis I. Tsilimigras, Tommaso Campagnaro, Simone Conci, et al. "Artificial neural networks for multi-omics classifications of hepato-pancreato-biliary cancers: towards the clinical application of genetic data." European Journal of Cancer 148 (May 2021): 348–58. http://dx.doi.org/10.1016/j.ejca.2021.01.049.

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Komici, Klara, Micaela Cappuccio, Andrea Scacchi, Roberto Vaschetti, Giuseppe Delli Carpini, Vito Picerno, Pasquale Avella, et al. "The Prevalence and the Impact of Frailty in Hepato-Biliary Pancreatic Cancers: A Systematic Review and Meta-Analysis." Journal of Clinical Medicine 11, no. 4 (February 20, 2022): 1116. http://dx.doi.org/10.3390/jcm11041116.

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Background: Frailty has been associated with increased mortality among hepatobiliary pancreatic (HBP) cancer patients. Nevertheless, estimates of frailty prevalence in HBP cancers and the precise average effect regarding mortality remains uncertain. The present systematic review and meta-analysis aimed to quantify: (1) the prevalence of frailty in patients with liver and pancreatic cancers and (2) the impact of frailty on mortality in patients affected by liver and pancreatic cancers. Methods: MEDLINE/PubMed database search was conducted from inception until 1 November 2021, the pooled prevalence and relative risk (RR) estimate were calculated. Results: A total of 34,276 patients were identified and the weighted prevalence of frailty was 39%; (95% [C.I.] 23–56; I2 = 99.9%, p < 0.0001). Frailty was significantly associated with increased mortality RR 1.98 (95% [C.I.] 1.49–2.63; I2 = 75.9%, p = 0.006). Conclusions: Frailty prevalence is common among HBP cancer patients and exerts a significant negative impact on survival. These findings are characterized by significant heterogeneity and caution is warranted on their interpretation. However, stratification of patients with HBP cancer by frailty status may provide prognostic information and may inform priorities for decision-making strategy.

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FONTES, Paulo Roberto Ott, Fábio Luiz WAECHTER, Mauro NECTOUX, José Artur SAMPAIO, Uirá Fernandes TEIXEIRA, and Luiz PEREIRA-LIMA. "LOW MORTALITY RATE IN 97 CONSECUTIVE PANCREATICODUODENECTOMIES: the experience of a group." Arquivos de Gastroenterologia 51, no. 1 (March 2014): 29–33. http://dx.doi.org/10.1590/s0004-28032014000100007.

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Context Pancreaticoduodenectomy is the procedure of choice for resectable cancer of the periampullary region. These tumors account for 4% of deaths from cancer, being referred to as one of the lowest survival rates at 5 years. Surgery remains a complex procedure with substantial morbidity and mortality. Despite reports of up to 30% mortality rates, in centers of excellence it have been identified as less than 5%. Recent studies show that pancreaticojejunostomy represents the “Achilles’ heel” of the procedure. Objective To evaluate the post-operative 30 days morbidity and mortality rates. Methods Retrospective analysis of 97 consecutive resected patients between July, 2000 and December, 2012. All patients were managed by the same group, and data were obtained from specific database service. The main objective was to evaluate the 30-day mortality rate, but we also studied data of surgical specimen, need for vascular resection and postoperative complications (gastric stasis, pancreatic fistula, pneumonia and reoperation rate). Results Thirty-day mortality rate was 2.1% (two patients). Complete resection with no microscopic residual tumor was obtained in 93.8% of patients, and in 67.3% of cases pathology did not detected metastatic nodes. Among postoperative complications were reported 6% of prolonged gastric stasis, 10.3% of pneumonia, 10.3% of pancreatic fistula and 1% of infection in the drain pathway. Two patients underwent reoperation due to bleeding and infected hematoma caused by pancreatic fistula, and another for intestinal obstruction because of adhesions at postoperative day 12. Conclusions The pancreaticoduodenectomy as treatment procedure for periampullary cancers has a low morbidity and mortality rate in services with experience in Hepato-Pancreato-Biliary surgery, remaining as first-line treatment in resectable patients.

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Tansa, Rizqy, M. Iqbal Rivai, and Avit Suchitra. "Correlation of Malignancy in the Hepato-Pancreato-Biliary System with Serum Bilirubin Levels in Extrahepatic Cholestasis Patients." Bioscientia Medicina : Journal of Biomedicine and Translational Research 6, no. 9 (June 22, 2022): 2108–14. http://dx.doi.org/10.37275/bsm.v6i9.566.

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Background: The incidence of hepato-pancreato-biliary system cancer is increasing worldwide, which has been recognized as a disease that is difficult to diagnose early and has a poor prognosis. No research has yet been conducted in areas with limited resources and health facilities. There is an urgent need for diagnostic methods to recommend further diagnostic modalities in the selection of curative or palliative management. Methods: Retrospective data from all cholestatic patients at Dr. M. Djamil General Hospital were collected during the period July 2020-May 2022. The data included demographic characteristics such as age, gender, preoperative, results of bilirubin fraction, and final diagnosis. Data analysis was done by bivariate and multivariate. Results: A total of 132 patients were included in this study. 35.6% of them are HPB system malignancies, with Pancreatic Adenocarcinoma being the most common diagnosis (34.4%), more in males (51.06%), and in the age group, 50 years (61.71%) is the most. Only 52.27% of patients underwent preoperative radiological imaging. Bivariate analysis showed a significant relationship between HPB system malignancies with age >50 years (p=0.024) and all bilirubin fractions (p<0.001). Multivariate analysis showed that only the bilirubin fraction was significant for the diagnosis of malignant HPB (p<0.001). Conclusion: The bilirubin fraction is a good initial indicator for predicting malignancy in the HPB system in order to increase the effectiveness of the diagnostic modality and reduce the referral duration.

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Hayashi, Kazuhiro, Yukihiro Yokoyama, Hiroki Nakajima, Masato Nagino, Takayuki Inoue, Motoki Nagaya, Keiko Hattori, Izumi Kadono, Satoru Ito, and Yoshihiro Nishida. "Preoperative 6-minute walk distance accurately predicts postoperative complications after operations for hepato-pancreato-biliary cancer." Surgery 161, no. 2 (February 2017): 525–32. http://dx.doi.org/10.1016/j.surg.2016.08.002.

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Spolverato, Gaya, Yuhree Kim, Georgios A. Margonis, Martin Makary, Christopher Lee Wolfgang, Matthew J. Weiss, Kenzo Hirose, John L. Cameron, and Timothy M. Pawlik. "Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary cancers." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 378. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.378.

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378 Background: Neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) may be indicative of the immune response around the time of surgery. We sought to determine whether NLR or PLR were associated with outcomes of patients undergoing surgery for a hepatopancreatico-biliary (HPB) malignancy. Methods: Between 2010-2011, 289 patients who underwent an HPB procedure for a malignant indication were identified. Clinicopathological characteristics, NLR and PLR, as well as short- and long-term outcomes were analyzed. High NLR and PLR were classified using a cut-off value of 3 and 150, respectively, based on ROC analysis. Results: Median patient age was 63 years and 52.3% were female. The majority of tumors were pancreatic in origin (67.2%), while a subset were primary (10.3%) or secondary (22.5%) liver tumors. Patients with low vs. high NLR and PLR had similar baseline characteristics with regard to performance status and tumor stage (all P>0.05). Operative interventions included pancreaticoduodenectomy (55.0%), ≤hemi-hepatectomy (29.1%), or extended hepatectomy (2.4%). Within 90-days of surgery, 143 patients experienced a complication for a morbidity of 49.5% (pancreas: 54.9% vs. liver: 40.0%). Patients with either an elevated NLR (OR=1.72) or PLR (OR=2.15) were at higher risk of a postoperative complication (both P<0.05). Among patients with a pancreatic, primary or secondary liver tumor, 3-year survival was 38.6%, 43.0%, and 65.0%, respectively. While elevated NLR was not associated with long-term outcome (HR=1.36)(P=0.14), patients with an elevated PLR had a higher risk of death (HR=2.14)(P=0.01). Conclusions: Patients with a high NLR or PLR had an increased risk of a perioperative complication. Elevated PLR was also a predictor of worse survival among patients with HPB malignancy undergoing resection.

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Aiba, Keisuke, Kazuo Tamura, Toshiaki Saeki, Hideo Baba, Yuko Kitagawa, Kazuhiro Yoshida, Junji Furuse, Yoshihiro Kakeji, and Go Wakabayashi. "Patterns and severity of chemotherapy-induced nausea (CIN) in patients with gastrointestinal cancers associated with highly to moderately emetogenic chemotherapy (HEC and MEC)." Journal of Clinical Oncology 33, no. 3_suppl (January 20, 2015): 24. http://dx.doi.org/10.1200/jco.2015.33.3_suppl.24.

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24 Background: Chemotherapy-induced nausea and vomiting (CINV) is well controlled recently thanks to novel antiemetic therapy, but the incidence of nausea remained high in patients receiving either HEC or MEC. The aim of the study is to investigate patterns and severity of CIN in cancer patients who are to receive chemotherapy for the first time. Methods: A nationwide survey on CINV was conducted by the CINV study group of Japan. A 7-day diary for CINV was provided to the patient prior to chemotherapy to record daily occurrence and severity of CINV. CIN was measured using visual analog scales(VAS) of 10cm length scales. Acute and delayed CINV were defined as nausea and vomiting which developed within or after 24 hours after the start of chemotherapy, respectively. Results: A total of 2,068 patients were registered and 1,910 patients were analyzed. A mean age was 62 (range:19-87) and there were 873 males and 1,037 females. MEC was given to 715 as was HEC to 1,195 patients. Underlying diseases were esophageal (192 patients), gastric (152), colorectal (90), hepato-biliary-pancreatic (100), lung (426) and breast cancer (429), and gynecological (214) and hematological malignancy (197). Comparing patients with various cancers treated with similar emetogenic agents or regimens, we easily could find that there are several patterns of CIN severity. Firstly, temporal profiles of CIN severity of esophageal, gastric and lung cancers were similar, having daily increased delayed nausea up to Day 7. The reason of this phenomenon seems due to a single high dose of CDDP. Colorectal and hepato-biliary-pancreatic cancer had a similar mild CIN pattern over 7days, probably due to mild emetogenic nature of oxaliplatin and moderate dose of CDDP. Conclusions: Temporal profile and severity of CIN patterns seem to be divided into several groups and delayed CIN remained to be high and needs further investigation.

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Karakaya, Fatih, Zihni Karaeren, and Sibel Perçinel. "Persistent Elevation of CA 19-9 Levels in the Long-term Follow-up before Laryngeal Cancer." Euroasian Journal of Hepato-Gastroenterology 7, no. 1 (2017): 92–94. http://dx.doi.org/10.5005/jp-journals-10018-1222.

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ABSTRACT Introduction CA 19-9 is used as a tumor marker in colon, pancreas, biliary, and gastric cancers. Laryngeal cancer is the most common malignant epithelial tumor among head and neck cancers and has no specific tumor marker. Case report A 66-year-old male patient had severe reflux symptoms during 5 years and had an isolated CA 19-9 elevation. Follow-up analysis revealed that he had larynx cancer and after laryngectomy, CA 19-9 levels decreased to normal range. Discussion Currently, CA 19-9 is not a marker for malignancy. Laryngeal carcinoma has no specific tumor marker, but laryngeal squamous cell carcinoma may be manifested by elevated CA 19-9 levels. How to cite this article Özkan H, Karakaya F, Karaeren Z, Perçinel S. Persistent Elevation of CA 19-9 Levels in the Long-term Follow-up before Laryngeal Cancer. Euroasian J Hepato-Gastroenterol 2017;7(1):92-94.

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Miyazaki, Masaru, Masayuki Ohtsuka, Shuichi Miyakawa, Masato Nagino, Masakazu Yamamoto, Norihiro Kokudo, Keiji Sano, et al. "Classification of biliary tract cancers established by the Japanese Society of Hepato-Biliary-Pancreatic Surgery: 3rdEnglish edition." Journal of Hepato-Biliary-Pancreatic Sciences 22, no. 3 (February 17, 2015): 181–96. http://dx.doi.org/10.1002/jhbp.211.

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van der Willik, Kimberly D., Liliana P. Rojas-Saunero, Jeremy A. Labrecque, M. Arfan Ikram, Sanne B. Schagen, Bruno H. Stricker, and Rikje Ruiter. "Pathology-confirmed versus non pathology-confirmed cancer diagnoses: incidence, participant characteristics, and survival." European Journal of Epidemiology 35, no. 6 (December 20, 2019): 557–65. http://dx.doi.org/10.1007/s10654-019-00592-5.

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AbstractCancer diagnoses which are not confirmed by pathology are often under-registered in cancer registries compared to pathology-confirmed diagnoses. It is unknown how many patients have a non pathology-confirmed cancer diagnosis, and whether their characteristics and survival differ from patients with a pathology-confirmed diagnosis. Participants from the prospective population-based Rotterdam Study were followed between 1989 and 2013 for the diagnosis of cancer. Cancer diagnoses were classified into pathology-confirmed versus non pathology-confirmed (i.e., based on imaging or tumour markers). We compared participant characteristics and the distribution of cancers at different sites. Furthermore, we investigated differences in overall survival using survival curves adjusted for age and sex. During a median (interquartile range) follow-up of 10.7 (6.3–15.9) years, 2698 out of 14,024 participants were diagnosed with cancer, of which 316 diagnoses (11.7%) were non pathology-confirmed. Participants with non pathology-confirmed diagnoses were older, more often women, and had a lower education. Most frequently non pathology-confirmed cancer sites included central nervous system (66.7%), hepato-pancreato-biliary (44.5%), and unknown primary origin (31.2%). Survival of participants with non pathology-confirmed diagnoses after 1 year was lower compared to survival of participants with pathology-confirmed diagnoses (32.6% vs. 63.4%; risk difference of 30.8% [95% CI 25.2%; 36.2%]). Pathological confirmation of cancer is related to participant characteristics and cancer site. Furthermore, participants with non pathology-confirmed diagnoses have worse survival than participants with pathology-confirmed diagnoses. Missing data on non pathology-confirmed diagnoses may result in underestimation of cancer incidence and in an overestimation of survival in cancer registries, and may introduce bias in aetiological research.

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Al-Hajeili, Marwan, Maryam Alqassas, Astabraq Alomran, Bashaer Batarfi, Bashaer Basunaid, Reem Alshail, Shahad Alaydarous, Rana Bokhary, and Mahmoud Mosli. "The Diagnostic Accuracy of Cytology for the Diagnosis of Hepatobiliary and Pancreatic Cancers." Acta Cytologica 62, no. 4 (2018): 311–16. http://dx.doi.org/10.1159/000489549.

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Objective: Although cytology testing is considered a valuable method to diagnose tumors that are difficult to access such as hepato-biliary-pancreatic (HBP) malignancies, its diagnostic accuracy remains unclear. We therefore aimed to investigate the diagnostic accuracy of cytology testing for HBP tumors. Study Design: We performed a retrospective study of all cytology samples that were used to confirm radiologically detected HBP tumors between 2002 and 2016. The cytology techniques used in our center included fine needle aspiration (FNA), brush cytology, and aspiration of bile. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated in comparison to histological confirmation. Results: From a total of 133 medical records, we calculated an overall sensitivity of 76%, specificity of 74%, a negative likelihood ratio of 0.30, and a positive likelihood ratio of 2.9. Cytology was more accurate in diagnosing lesions of the liver (sensitivity 79%, specificity 57%) and biliary tree (sensitivity 100%, specificity 50%) compared to pancreatic (sensitivity 60%, specificity 83%) and gallbladder lesions (sensitivity 50%, specificity 85%). Cytology was more accurate in detecting primary cancers (sensitivity 77%, specificity 73%) when compared to metastatic cancers (sensitivity 73%, specificity 100%). FNA was the most frequently used cytological technique to diagnose HBP lesions (sensitivity 78.8%). Conclusion: Cytological testing is efficient in diagnosing HBP cancers, especially for hepatobiliary tumors. Given its relative simplicity, cost-effectiveness, and paucity of alternative diagnostic methods, cytology should still be considered as a first-line tool for diagnosing HBP malignancies.

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Kiselev, N. M., G. G. Gorokhov, V. A. Belskiy, N. A. Bobrov, Sh Kh Mukhanzaev, and V. E. Zagainov. "The results of surgical treatment in patients with liver alveococcosis in a hepato-pancreato-biliary center (a 10-years’ experience)." Almanac of Clinical Medicine 46, no. 6 (November 29, 2018): 609–17. http://dx.doi.org/10.18786/20720505-2018-46-6-609-617.

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Background: Aggressive course of liver alveococcosis makes it possible to designate it as a “parasitic liver cancer”. The main treatment method for the disease is surgery. The parasitic mass is resected according to R0 principles, with concomitant plastic surgery of the major vessels and bile ducts to increase resectability.Aim: To assess the potential of surgical treatment in patients with advanced liver alveococcosis using transplantation techniques.Materials and methods: We retrospectively analyzed in- and outpatient medical files of 62 subjects with confirmed liver alveococcosis, who had been treated in the Volga District Medical Centre (Nizhny Novgorod, Russia) from 2008 to 2018. Thirty two (32) patients had advanced liver alveococcosis with involvement of afferent and efferent vasculature and biliary tract. Surgical procedures were used in 50/62 patients (or 4.2% of the total number of liver resections performed during this time interval, n = 1197). Complications occurred in 46% (23 / 50) of the cases. Twenty nine (29, or 58%) patients had been operated before (mostly cytoreductive resections and/or explorative laparotomies). Distant lung metastases were found in 2 (4%) patients.Results: Fifty (50) patients had curative surgical procedures: liver resections in 45, deceased donor orthotopic liver transplantations in 5. Most common were extensive liver resections (more than 4 segments). Resection and reconstruction of the main vessels were necessary in 50% (25 cases) of the patients, including v. cava inferior in 25 cases and the portal vein in 24 cases. In 31 patients, resection and reconstruction of extra-hepatic bile ducts was performed, and in 17 (33%) patients resections of the neighboring organs, such as diaphragm, lung, right adrenal, duodenum, stomach, and colon. In 4 cases, resections were performed ex situ ex vivo, followed by auto-transplantation, including 2 cases with reverse auto-transplantation of the left lateral sector to the right. The incidence of liver failure events grade A and B (by International Study Group of Liver Surgery, ISGLS) did not exceed 10% (4 patients). Complications were seen in 25 cases, including Clavien – Dindo Grade II in 5, Grade IIIb in 13, Grade IVb in 2, and Grade V in 5. The number of bile leakage events (ISGLS) class B was 6 and class C 10. All patients underwent obligatory adjuvant anti-parasitic therapy.Conclusion: At present, surgical treatment of liver alveococcosis remains a method of choice, that requires that the hepato-pancreato-biliary center would have in place a well-developed transplantation program, adequate equipment and well-trained surgical and anesthetic teams.

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Di Giacomo, Silvia, Marco Gullì, Roberta Facchinetti, Marco Minacori, Romina Mancinelli, Ester Percaccio, Caterina Scuderi, Margherita Eufemi, and Antonella Di Sotto. "Sorafenib Chemosensitization by Caryophyllane Sesquiterpenes in Liver, Biliary, and Pancreatic Cancer Cells: The Role of STAT3/ABC Transporter Axis." Pharmaceutics 14, no. 6 (June 14, 2022): 1264. http://dx.doi.org/10.3390/pharmaceutics14061264.

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A combination of anticancer drugs and chemosensitizing agents has been approached as a promising strategy to potentiate chemotherapy and reduce toxicity in aggressive and chemoresistant cancers, like hepatocellular carcinoma (HCC), cholangiocarcinoma (CCA), and pancreatic ductal adenocarcinoma (PDAC). In the present study, the ability of caryophyllane sesquiterpenes to potentiate sorafenib efficacy was studied in HCC, CCA, and PDAC cell models, focusing on the modulation of STAT3 signaling and ABC transporters; tolerability studies in normal cells were also performed. Results showed that the combination of sorafenib and caryophyllane sesquiterpenes synergized the anticancer drug, especially in pancreatic Bx-PC3 adenocarcinoma cells; a similar trend, although with lower efficacy, was found for the standard ABC transporter inhibitors. Synergistic effects were associated with a modulation of MDR1 (or Pgp) and MRP transporters, both at gene and protein level; moreover, activation of STAT3 cascade and cell migration appeared significantly affected, suggesting that the STAT3/ABC-transporters axis finely regulated efficacy and chemoresistance to sorafenib, thus appearing as a suitable target to overcome drawbacks of sorafenib-based chemotherapy in hepato-biliary-pancreatic cancers. Present findings strengthen the interest in caryophyllane sesquiterpenes as chemosensitizing and chemopreventive agents and contribute to clarifying drug resistance mechanisms in HCC, CCA, and PDAC cancers and to developing possible novel therapeutic strategies.

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Jurado, Matias, Luis Chiva, Giovanni Tinelli, Juan Luis Alcazar, and Dennis S. Chi. "The role of oncovascular surgery in gynecologic oncology surgery." International Journal of Gynecologic Cancer 32, no. 4 (January 12, 2022): 553–59. http://dx.doi.org/10.1136/ijgc-2021-003129.

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Oncovascular surgery is a new term used to define tumor resection with simultaneous reconstruction of the great vessels when the tumor infiltrates or firmly adheres to such vessels. The benefit of oncovascular surgery has been widely described in patients with hepato-biliary-pancreatic cancers, retroperitoneal soft tissue sarcoma, and in other areas of gynecologic oncology, such as the lateral compartment of the pelvis, retroperitoneum, and hepato-biliary-pancreatic region, with an increase in complete resections and without increasing the morbidity and mortality rates. In the latter decades of the past century, several advances and accumulating scientific evidence led gynecologic oncologists to perform more thorough cytoreductive surgeries that included multivisceral resections. But to our knowledge, published studies on the frequency and relevance of vascular surgery in gynecological oncology are scarce. Gynecologic oncologists still do not receive formal training in vascular surgery and additionally, with the current reduction in experience with pelvic and para-aortic lymphadenectomy, as well as other types of radical abdominal and pelvic surgeries, trainees will encounter fewer vascular injuries and the opportunity to deal with a variety of management types required. Well-organized collaboration between each subspecialty with a multidisciplinary approach and adequate pre-operative planning are pivotal. The aim of this review is to pave the way towards the understanding that patients with suspicion of great vessels' infiltration or encasement by tumor require personalized and specialized treatment with the need to form an oncovascular surgery team, and that it is necessary for gynecologic oncology surgeons to take a step forward in surgical training.

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Yamaguchi, Tomohiro, Nozomu Machida, Akiyoshi Kasuga, Hideaki Takahashi, Kentaro Sudo, Tomohiro Nishina, Kazutoshi Tobimatsu, Kenji Ishido, Junji Furuse, and Narikazu Boku. "Multicenter retrospective analysis of systemic chemotherapy in poorly differentiated neuroendocrine carcinoma of the digestive system." Journal of Clinical Oncology 30, no. 4_suppl (February 1, 2012): 274. http://dx.doi.org/10.1200/jco.2012.30.4_suppl.274.

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274 Background: Poorly differentiated neuroendocrine carcinoma (PDNEC) is a rare and aggressive disease. No standard regimen has yet been established for advanced PDNEC, although regimens for small-cell lung carcinoma such as irinotecan + cisplatin (IP) or etoposide + cisplatin (EP), are usually adopted. The aim of this study was to investigate the outcomes according to the patient’s characteristics and treatment regimens for patients with PDNEC of the digestive system. Methods: Data was collected from the medical records of patients at 23 hospitals. The selection criteria were as follows: 1) histologically proven PDNEC, small cell carcinoma, mixed endocrine-exocrine carcinoma with a PDNEC component, or histologically proven neuroendocrine tumor with rapidly progressive clinical course; 2) primary tumor arising from the gastrointestinal tract (GI) or the hepato-biliary-pancreatic system (HBP); and 3) inoperable or recurrent disease treated with systemic chemotherapy between April 2000 and March 2011. Results: There were 258 patients (pts). The median age was 62.5 years (range, 26-81); male/female, 182/76 pts; the primary site was the esophagus/stomach/small bowel/colorectum/hepato-biliary system/pancreas in 85/70/6/31/31/35 pts. According to these primary sites, the median overall survival period (mOS) was 13.4/13.3/29.7/7.6/7.9/8.5 months, respectively. The most commonly used regimen was IP (160 pts, 62%), followed by EP (46 pts, 18%). For the patients treated with IP/EP, the response rates (RR) were 50%/27%, the progression free survival periods (mPFS) were 5.2/4.0 months, and mOS were 13.0/7.3 months. The subgroup outcome data for patients with HBP or GI cancers are shown in Table. A multivariate analysis demonstrated that a primary HBP cancer (HR=1.96, p=0.002), and a poor PS (HR=2.33, p=0.01) were independent unfavorable prognostic factors. Conclusions: PDNEC of the HBP has a poorer prognosis than GI. IP was the most commonly selected treatment regimen, and seemed to have a favorable treatment outcome. [Table: see text]

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Paganelli, Alessia, Paolo Magistri, Shaniko Kaleci, Johanna Chester, Claudia Pezzini, Barbara Catellani, Silvana Ciardo, et al. "De Novo Skin Neoplasms in Liver-Transplanted Patients: Single-Center Prospective Evaluation of 105 Cases." Medicina 58, no. 10 (October 13, 2022): 1444. http://dx.doi.org/10.3390/medicina58101444.

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Background and Objectives: Solid-organ transplant recipients (SOTRs) are notably considered at risk for developing cutaneous malignancies. However, most of the existing literature is focused on kidney transplant-related non-melanoma skin cancers (NMSCs). Conflicting data have been published so far on NMSC incidence among liver transplant recipients (LTRs), and whether LTRs really should be considered at lower risk remains controversial. The aim of the present study was to prospectively collect data on the incidence of cutaneous neoplasms in an LTR cohort. Materials and Methods: All LTRs transplanted at the Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit of Modena University Hospital from October 2015 to June 2021 underwent a post-transplant periodic skin check at the Dermatology Unit according to our institutional integrated care pathway. Data on the presence of cutaneous malignant and premalignant lesions were collected at every timepoint. Results: A total of 105 patients were enrolled in the present study. Nearly 15% of the patients developed cutaneous cancerous and/or precancerous lesions during the follow-up period. Almost half of the skin cancerous lesions were basal cell carcinomas. Actinic keratoses (AKs) were observed in six patients. Four patients developed in situ squamous cell carcinomas, and one patient was diagnosed with stage I malignant melanoma. Otherwise, well-established risk factors for the occurrence of skin tumors, such as skin phototype, cumulative sun exposure, and familial history of cutaneous neoplasms, seemed to have no direct impact on skin cancer occurrence in our cohort, as well as an immunosuppressive regimen and the occurrence of non-cutaneous neoplasms. Conclusions: Close dermatological follow-up is crucial for LTRs, and shared protocols of regular skin checks in this particular subset of patients are needed in transplant centers.

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Wei, Alice Chia-chi, Natalie G. Coburn, Carol-anne Moulton, Sean P. Cleary, Calvin Law, Paul David Greig, and Steven Gallinger. "A phase II multicenter study of metastasectomy for intra- and extra-hepatic metastases from colorectal cancer." Journal of Clinical Oncology 31, no. 4_suppl (February 1, 2013): 482. http://dx.doi.org/10.1200/jco.2013.31.4_suppl.482.

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482 Background: Metastasectomy for liver limited metastases from colorectal cancer (CRC) provides excellent 5-year overall survival (OS) rates. The presence of extra-hepatic metastases (EHM) has traditionally been a contraindication to surgery. On this basis, as many as 80% of patients are deemed ineligible for liver resection. Due to the improved safety of hepatic surgery, there is a growing interest in multi-site metastasectomy for patients with intra-hepatic and extra-hepatic metastases (IHM, and EHM). The objective of this study was to evaluate the results of complete metastasectomy for patients with IHM and EHM from CRC. Methods: A phase II study of metastasectomy for both IHM and EHM from CRC was conducted at 2 high volume hepato-pancreato-biliary (HPB) centers. Eligible patients with any number resectable IHM and up to 3 foci of EHM, resectable with RO intent were offered metastasectomy. Clinical and survival data was analyzed using standard statistical methods. Results: Twenty-five patients were enrolled with a median age of 57 (32-84) years; 14/25 (56%) patients presented with synchronous disease. The median number of IHM, EHM and combined sites were 2, 1 and 3, respectively. The lung was the most common site of EHM (12/25, 48%). Protocol surgery was completed in 18/25 (72%) including 11/25 (44%) planned sequential resections. Perioperative morbidity and mortality was 11/25 (44%) and 1/25 (4%), respectively. The median disease free survival was 6 months. The median OS from the time of CRC diagnosis, first metastasectomy and completion metastasectomy was 47, 27 and 23 months, respectively. Conclusions: Complete metastasectomy of multi-site CRC is feasible and safe. However, disease will recur in the majority of patients. The impact to aggressive multi-site metastasectomy is modest but may provide OS benefit in selected patients.

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Dayem Ullah, Abu Z. M., Lavanya Sivapalan, Hemant M. Kocher, and Claude Chelala. "COVID-19 in patients with hepatobiliary and pancreatic diseases: a single-centre cross-sectional study in East London." BMJ Open 11, no. 4 (April 2021): e045077. http://dx.doi.org/10.1136/bmjopen-2020-045077.

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ObjectiveTo explore risk factors associated with COVID-19 susceptibility and survival in patients with pre-existing hepato–pancreato–biliary (HPB) conditions.DesignCross-sectional study.SettingEast London Pancreatic Cancer Epidemiology (EL-PaC-Epidem) Study at Barts Health National Health Service Trust, UK. Linked electronic health records were interrogated on a cohort of participants (age ≥18 years), reported with HPB conditions between 1 April 2008 and 6 March 2020.ParticipantsEL-PaC-Epidem Study participants, alive on 12 February 2020, and living in East London within the previous 6 months (n=15 440). The cohort represents a multi-ethnic population with 51.7% belonging to the non-White background.Main outcome measureCOVID-19 incidence and mortality.ResultsSome 226 (1.5%) participants had confirmed COVID-19 diagnosis between 12 February and 12 June 2020, with increased odds for men (OR 1.56; 95% CI 1.2 to 2.04) and Black ethnicity (2.04; 1.39 to 2.95) as well as patients with moderate to severe liver disease (2.2; 1.35 to 3.59). Each additional comorbidity increased the odds of infection by 62%. Substance misusers were at more risk of infection, so were patients on vitamin D treatment. The higher ORs in patients with chronic pancreatic or mild liver conditions, age >70, and a history of smoking or obesity were due to coexisting comorbidities. Increased odds of death were observed for men (3.54; 1.68 to 7.85) and Black ethnicity (3.77; 1.38 to 10.7). Patients having respiratory complications from COVID-19 without a history of chronic respiratory disease also had higher odds of death (5.77; 1.75 to 19).ConclusionsIn this large population-based study of patients with HPB conditions, men, Black ethnicity, pre-existing moderate to severe liver conditions, six common medical multimorbidities, substance misuse and a history of vitamin D treatment independently posed higher odds of acquiring COVID-19 compared with their respective counterparts. The odds of death were significantly high for men and Black people.

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Yu, Jingru, Erle Refsum, Lise M. Helsingen, Trine Folseraas, Alexander Ploner, Paulina Wieszczy, Ishita Barua, et al. "Risk of hepato‐pancreato‐biliary cancer is increased by primary sclerosing cholangitis in patients with inflammatory bowel disease: A population‐based cohort study." United European Gastroenterology Journal 10, no. 2 (February 2, 2022): 212–24. http://dx.doi.org/10.1002/ueg2.12204.

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Nevarez, Nicole M., Brian C. Brajcich, Jason Liu, Ryan Ellis, Clifford Y. Ko, Henry A. Pitt, Michael I. D'Angelica, and Adam C. Yopp. "Cefoxitin versus piperacillin–tazobactam as surgical antibiotic prophylaxis in patients undergoing pancreatoduodenectomy: protocol for a randomised controlled trial." BMJ Open 11, no. 3 (March 2021): e048398. http://dx.doi.org/10.1136/bmjopen-2020-048398.

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IntroductionAlthough antibiotic prophylaxis is established in reducing postoperative surgical site infections (SSIs), the optimal antibiotic for prophylaxis in pancreatoduodenectomy (PD) remains unclear. The study objective is to evaluate if administration of piperacillin–tazobactam as antibiotic prophylaxis results in decreased 30-day SSI rate compared with cefoxitin in patients undergoing elective PD.Methods and analysisThis study will be a multi-institution, double-arm, non-blinded randomised controlled superiority trial. Adults ≥18 years consented to undergo PD for all indications who present to institutions participating in the National Surgical Quality Improvement Program Hepato-Pancreato-Biliary (NSQIP HPB) Collaborative will be included. Data collection will use the NSQIP HPB Collaborative Surgical Clinical Reviewers. Patients will be randomised to either 1–2 g intravenous cefoxitin or 3.375–4.5 g intravenous piperacillin–tazobactam within 60 min of surgical incision. The primary outcome will be 30-day postoperative SSI rate following PD. Secondary outcomes will include 30-day postoperative mortality; specific postoperative complication rate; and unplanned reoperation, length of stay, and hospital readmission. A subset of patients will have bacterial isolates and sensitivities of intraoperative bile cultures and SSIs. Postoperative SSIs and secondary outcomes will be analysed using logistic regression models with the primary predictor as the randomised treatment group. Additional adjustment will be made for preoperative biliary stent presence. Additionally, bacterial cultures and isolates will be summarised by presence of bacterial species and antibiotic sensitivities.Ethics and disseminationThis study is approved by the Institutional Review Board at Memorial Sloan Kettering Cancer Center. This trial will evaluate the effect of piperacillin–tazobactam compared with cefoxitin as antibiotic prophylaxis on the hazard of postoperative SSIs. The results will be disseminated regardless of the effect of the intervention on study outcomes. The manuscript describing the effect of the intervention will be submitted to a peer-reviewed journal when data collection and analyses are complete.Trial registration numberNCT03269994.

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López Marcano, Aylhin, Mario Serradilla Martin, José M. Ramia Ángel, Ana Palomares Cano, Roberto De la Plaza Llamas, Cristina Vallejo Berna, José R. Oliver Guillén, and Alejandro Serrablo Requejo. "Hepatocarcinoma en hígado no cirrótico: serie bicéntrica de 19 casos." Revista Argentina de Cirugía 111, no. 4 (December 1, 2019): 236–44. http://dx.doi.org/10.25132/raac.v111.n4.1417.es.

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Background: Hepatocellular carcinoma is the most common type of primary liver cancer and is the third cause of cancer related deaths; 80% of the HCC are associated with cirrhotic livers or chronic liver diseases, which constitute the main risk factor. Chronic inflammation, necrosis and regeneration due to these conditions produce genetic mutation and development of tumor cells. Yet, 10% develop in non-cirrhotic healthy livers without precipitating factors. Material and methods: We conducted a retrospective analysis of the characteristics and survival of patients with diagnosis of hepatocellular carcinoma in non-cirrhotic liver and absence of a history of liver cirrhosis or chronic liver disease undergoing surgery in two hepato-pancreato-biliary units between January 2007 and January 2016. Results: Mean age was 65 years and 13 patients were men. Abdominal pain was the most common clinical presentation. Liver panel was normal in 60% of the cases and alpha-fetoprotein was elevated in only 16%. The diagnosis was made by imaging tests in 61% of the cases. Mean tumor size was 110.6 cm. All the patients underwent surgery. Complications were observed in 36.8% of the patients and survival at 5 years was 62.3%. Conclusion: hepatocellular carcinoma is usually diagnosed as a large lesion in imaging tests ordered due to abdominal pain. Surgery provides curative treatment, and large resections can be safely performed, with low perioperative morbidity and mortality and low incidence of postoperative liver failure,since the liver remnant is healthy and liver function is maintained.

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Jia, Zhen-Yi, Jun Yang, Da-Nian Tong, Jia-Yuan Peng, Zhong-Wei Zhang, Wei-Jie Liu, Yang Xia, and Huan-long Qin. "Screening of Nutritional Risk and Nutritional Support in General Surgery Patients: A Survey from Shanghai, China." International Surgery 100, no. 5 (May 1, 2015): 841–48. http://dx.doi.org/10.9738/intsurg-d-14-00245.1.

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To determine the prevalence of nutritional risk in surgical departments and to evaluate the impact of nutritional support on clinical outcomes. The nutritional risk in different surgical diseases and the different way of nutritional support on clinical outcomes in patients at nutritional risk remain unclear. Hospitalized patients from general surgical departments were screened using the Nutritional Risk Screening (NRS) 2002 questionnaire on admission. Data were collected on nutritional risk, complications, and length of stay (LOS). Overall, 5034 patients were recruited; the overall prevalence of nutritional risk on admission were 19.2%. The highest prevalence was found among patients with gastric cancer. At-risk patients had more complications and longer LOS than nonrisk patients. Of the at-risk patients, the complication rate was significantly lower and LOS was significantly shorter in the nutritional-support group than in the no-support group (20.9 versus 30.0%, P < 0.05). Subgroup analysis showed reduced complication rates and LOS only in patients with gastric cancer, colorectal cancer, and hepato-pancreato-biliary (HPB) cancer. Significantly lower complication rates relative to nonsupported patients were found among patients who received enteral nutrition or who received support for 5 to 7 days, or daily support entailing 16 to 25 kcal/kg of nonprotein energy. Different surgical diseases have different levels of nutritional risk. The provision of nutritional support was associated with a lower complication rate and a shorter LOS for gastric, colorectal, and HPB cancer patients at nutritional risk. The improper use of nutritional support may not improve outcomes for at-risk patients.

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Abdalla, Eddie K. "Advances in hepato–pancreato biliary surgery." Expert Review of Gastroenterology & Hepatology 5, no. 4 (July 2011): 457–60. http://dx.doi.org/10.1586/egh.11.39.

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Hashimoto, Koji. "Hepato-Pancreato-Biliary and Transplant Surgery." Digestive Disease Interventions 04, no. 01 (March 2020): 001–2. http://dx.doi.org/10.1055/s-0040-1709433.

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Anand, Madhur, Noor Topno, Ranendra Hajong, Anoop J. Baruah, Donkupar Khongwar, and Swati Agarwal. "Surgical manifestations and management of gastrointestinal and hepato-pancreato-biliary ascariasis: an observational study." International Surgery Journal 7, no. 11 (October 23, 2020): 3620. http://dx.doi.org/10.18203/2349-2902.isj20204660.

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Background: Ascaris lumbricoides is the largest intestinal nematode parasite of humans. This study describes different presentations and management patterns of gastrointestinal and hepato-pancreato-biliary ascariasis presenting to a tertiary centre of North-eastern India.Methods: This was a prospective observational study aimed to study the presentations and management patterns of Ascaris related surgical diseases including intestinal obstruction, pancreatitis and cholangitis in a tertiary centre of Northeast India. All consenting cases of gastrointestinal and hepato-pancreato- biliary ascariasis admitted in our hospital were included.Results: Ninty patients with Ascaris sequeale were included, which included biliary ascariasis without cholangitis: 36, pancreatitis: 30, cholangitis: 18 and sub-acute intestinal obstruction: 6. Ultrasound was the most useful diagnostic investigation followed by stool examination and endoscopy. Hepato-pancreato-biliary ascariasis was managed conservatively and the progress monitored with sonography. The surgical management choledocho-duodenostomy was done for three patients having biliary ascariasis with unresolving obstructive jaundice and recurrent cholangitis on conservative management and 6 patients underwent therapeutic endoscopic worm removal. There were no deaths. No patient needed ICU care.Conclusions: Sonography can be helpful in diagnosing the presence of worms, its complications and in evaluating response to treatment. Hepato-pancreato-biliary ascariasis can be managed conservatively for majority of the patients.

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Koh, Su-Jin, Ho Jung An, Hyun Jung Jun, Sang Hoon Chun, Kyung Hee Lee, Hee Kyung Ahn, Hyun Ae Jung, Kim Ju Hee, and Min-Ho Kim. "A feasibility study of the Physician Orders for Life-Sustaining Treatment for patients with terminal cancer." Journal of Clinical Oncology 36, no. 34_suppl (December 1, 2018): 8. http://dx.doi.org/10.1200/jco.2018.36.34_suppl.8.

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8 Background: Terminally ill patients can decide end-of-life preferences with physicians in Physician Orders for Life-Sustaining Treatment (POLST) form. We did multi-center, prospective study to assess the feasibility of completing the POLST form in real oncologic practice. Methods: The inclusion criteria were patients with terminal cancer, age ≥20, and sufficient to communicate. The primary end point was the completion rate of the POLST. The questionnaire about the barriers from physicians or patients was asked to whom refused the POLST discussion. Results: From June to December 2017, 336 patients were enrolled from seven hospitals. The median age was 66 (20–94) years, 52.7% were male, 60.4% showed ECOG 3/4, and hepato-pancreato-biliary (26.2%) was the most common origin, followed by lung (23.2%) and gastro-intestinal (19.9%). Patients were in various situations: hospice care (41.2%), after progression (37.9%), under active treatment (15.8%), or just diagnosed as cancer (5.1%). The expected survival duration was 10.6 ±7.3 months. The POLST forms were introduced in 60.1%, and 31.3% signed the form. The barriers from physicians were reluctance of family members (49.7%), lack of rapport (44.8%), patients’ denial of prognosis (34.3%); lack of time (22.7%), guilty feeling (21.5%), prognostic (21.0%) or time (16.6%) uncertainty. The barriers from patients were lack of knowledge/understanding in 41.3% for each, denial of prognosis (14.3%), emotional discomfort (63.5%), and difficulty in making decision by themselves (66.7%). Conclusions: One-third of patients completed the POLST forms, and various barriers were found. To overcome those barriers, social engagement, education, and systemic support might be necessary.

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Mody, Kabir, Rebecca Feldman, Sandeep K. Reddy, Gina A. Reynolds, Jessica M. McMillan, and Elizabeth Johnson. "PD-1/PD-L1 expression and molecular associations in HPB malignancies." Journal of Clinical Oncology 34, no. 4_suppl (February 1, 2016): 289. http://dx.doi.org/10.1200/jco.2016.34.4_suppl.289.

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289 Background: Cholangiocarcinoma (CC), hepatocellular carcinoma (HCC), and pancreatic ductal adenocarcinoma (PDAC) are all devastating malignancies. Limited data exists about PD-1 and PDL1 expression in these cancers. We assessed expression of PD1/PDL1 in a large cohort of patients with hepato-pancreatico-biliary (HPB) cancers and explored the existence of accompanying genomic mutations associated with expression of PD-1/PD-L1. Methods: 524 patients with HPB cancers (354 PDAC, 58 HCC, 54 intrahepatic (ICC), 18 extrahepatic (ECC), and 40 gallbladder (GBC)) were included in the study and tumors tested centrally at a CLIA lab (Caris Life Sciences, Phoenix, AZ). Tests included one or more of the following: gene sequencing (next generation sequencing, Illumina TruSeq), protein expression (immunohistochemistry [IHC]) and gene amplification). PD-1 (SP142 antibody) and PD-L1 (MRQ-22 antibody) status was tested in all samples. Two-tailed Fisher's exact test was performed to test where proportions of positive results were different by subgroup (p²0.05). Results: Among those with PDAC, HCC, ICC, ECC, and GBC, rates of PD1 expression on tumor infiltrating lymphocytes (TILs) and PD-L1 expression on tumor cells is detailed in the Table. In PD-1+, compared with PD-1- HPB cancers, mutations in the following were more prevalent, though not statistically significant: BRCA2, ATM, CTNNB1, and PIK3CA. Among all theranostic biomarkers tested, TOP2A expression (IHC) was significantly increased in PD-L1+ versus PD-L1- tumors (82% vs 60%; p=0.0083). Conclusions: HPB tumors express PD-L1 at a frequency of 4-18%, and PD-1 at a frequency of 29-45%. A statistically significant association of mutations with PD-1+ or PD-L1+ tumors was not identified in this group of tumors. PD-L1 expression associates with TOP2a expression, a marker of proliferation and also anthracycline sensitivity. Further evaluation of this correlation and PDL1/PD-1 + anthracycline combination therapy may be warranted. [Table: see text]

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Mukherjee, S., and R. P. Symonds. "The Role of Radiotherapy in the Management of Upper Gastrointestinal and Hepato-biliary and Pancreatic Cancers: Current Status and Future Directions." Clinical Oncology 26, no. 9 (September 2014): 519–21. http://dx.doi.org/10.1016/j.clon.2014.06.006.

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Park, I. Y. "Laparoscopic Ultrasonography in Hepato-pancreato-Biliary Surgery." HPB 23 (2021): S392. http://dx.doi.org/10.1016/j.hpb.2020.11.1007.

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Edwards, Janet, Alexsander Bressan, Navjit Dharampal, Sean Grondin, Indraneel Datta, Elijah Dixon, Sean Cleary, Jeffrey Barkun, Jean Butte, and Chad Ball. "Hepato-pancreato-biliary surgery workforce in Canada." Canadian Journal of Surgery 58, no. 3 (June 1, 2015): 212–15. http://dx.doi.org/10.1503/cjs.011414.

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Strasberg, S. "The American Hepato-Pancreato-Biliary Association (AHPBA)." Journal of Gastrointestinal Surgery 6, no. 2 (April 2002): 271. http://dx.doi.org/10.1016/s1091-255x(02)00010-0.

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Strasberg, S. "The American Hepato-Pancreato-Biliary Association (AHPBA)." Journal of Gastrointestinal Surgery 6, no. 5 (October 2002): 784–85. http://dx.doi.org/10.1016/s1091-255x(02)00048-3.

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Wigmore, Stephen J. "Perioperative analgesia in hepato-pancreato-biliary surgery." Lancet Gastroenterology & Hepatology 1, no. 2 (October 2016): 87–89. http://dx.doi.org/10.1016/s2468-1253(16)30017-6.

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Scarborough, John E., Ricardo Pietrobon, Kyla M. Bennett, Bryan M. Clary, Paul C. Kuo, Douglas S. Tyler, and Theodore N. Pappas. "Workforce Projections for Hepato-Pancreato-Biliary Surgery." Journal of the American College of Surgeons 206, no. 4 (April 2008): 678–84. http://dx.doi.org/10.1016/j.jamcollsurg.2007.11.016.

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Lee, Jay Soong-Jin, Hsou Mei Hu, Anthony L. Edelman, Chad M. Brummett, Michael J. Englesbe, Jennifer F. Waljee, Jeffrey B. Smerage, et al. "New Persistent Opioid Use Among Patients With Cancer After Curative-Intent Surgery." Journal of Clinical Oncology 35, no. 36 (December 20, 2017): 4042–49. http://dx.doi.org/10.1200/jco.2017.74.1363.

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Purpose The current epidemic of prescription opioid misuse has increased scrutiny of postoperative opioid prescribing. Some 6% to 8% of opioid-naïve patients undergoing noncancer procedures develop new persistent opioid use; however, it is unknown if a similar risk applies to patients with cancer. We sought to define the risk of new persistent opioid use after curative-intent surgery, identify risk factors, and describe changes in daily opioid dose over time after surgery. Methods Using a national data set of insurance claims, we identified patients with cancer undergoing curative-intent surgery from 2010 to 2014. We included melanoma, breast, colorectal, lung, esophageal, and hepato-pancreato-biliary/gastric cancer. Primary outcomes were new persistent opioid use (opioid-naïve patients who continued filling opioid prescriptions 90 to 180 days after surgery) and daily opioid dose (evaluated monthly during the year after surgery). Logistic regression was used to identify risk factors for new persistent opioid use. Results A total of 68,463 eligible patients underwent curative-intent surgery and filled opioid prescriptions. Among opioid-naïve patients, the risk of new persistent opioid use was 10.4% (95% CI, 10.1% to 10.7%). One year after surgery, these patients continued filling prescriptions with daily doses similar to chronic opioid users ( P = .05), equivalent to six tablets per day of 5-mg hydrocodone. Those receiving adjuvant chemotherapy had modestly higher doses ( P = .002), but patients with no chemotherapy still had doses equivalent to five tablets per day of 5-mg hydrocodone. Across different procedures, the covariate-adjusted risk of new persistent opioid use in patients receiving adjuvant chemotherapy was 15% to 21%, compared with 7% to 11% for those with no chemotherapy. Conclusion New persistent opioid use is a common iatrogenic complication in patients with cancer undergoing curative-intent surgery. This problem requires changes to prescribing guidelines and patient counseling during the surveillance and survivorship phases of care.

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Serrano Aybar, Pablo Emilio, Christopher Griffiths, Jessica Bogach, Leyo Ruo, Julie Hallet, and Marko Simunovic. "Simultaneous resection of colorectal cancer with synchronous liver metastases: A survey-based analysis." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): e15073-e15073. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.e15073.

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e15073 Background: Patients with colorectal cancer and synchronous liver metastases may undergo simultaneous or staged resection. Methods: We electronically surveyed members of the Society of Surgical Oncology, Canadian Hepato-Pancreato-Biliary Association and the College of Physicians and Surgeons of Ontario with a pilot-tested questionnaire. Four clinical scenarios were presented. Perceived outcomes of and barriers to simultaneous resection were assessed on a Likert scale using Mann-Whitney U and Chi-square tests for ordinal and categorical variables, respectively. We compared results between general and hepatobiliary surgeons. We sought to determine surgeons’ attitudes and perceived barriers to simultaneous resection and compare them between general and hepatobiliary surgeons. Results: The response rate of 20% (234/1166) included 50 general and 134 hepatobiliary surgeons. A high likelihood score (Likert ≥5-7) for support of simultaneous resection among general and hepatobiliary surgeons, respectively, included the following: for minor liver and low complexity colon, 83% and 98% (p < 0.001); for minor liver and rectal resection, 57% and 73% (p = 0.042); for complex liver and low complexity colon resection, 26% and 24% (p = 0.858); and, for complex liver and rectal resection, 11% and 7.0% (p = 0.436). Among hepatobiliary surgeons, the most common barriers for simultaneous resections were patient comorbidities and extrahepatic disease, whereas general surgeons additionally identified transferring care to another facility. Lack of information regarding non-responders is relevant given our relatively low response rate. Our respondents mostly worked in academic settings, which may not be representative of the majority of surgeons who manage colorectal cancer. Conclusions: Surgeon support for simultaneous resection increased with less complex surgery and was similar among hepatobiliary and general surgeons. Surgeons’ perceived practice patterns and barriers to simultaneous resection should inform clinical trials and disease care pathways.

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Ricker, Ansley Beth, and David A. Iannitti. "Irreversible electroporation as treatment option within a multidisciplinary approach for locally advanced pancreatic cancer." Journal of Clinical Oncology 41, no. 4_suppl (February 1, 2023): 727. http://dx.doi.org/10.1200/jco.2023.41.4_suppl.727.

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727 Background: The treatment plan for patients diagnosed with locally advanced pancreatic cancer (LAPC) is developed by a multidisciplinary team by which systemic chemotherapy is employed followed by surgical resection. Strategies that provide local control in LAPC patients who demonstrate stability/regression without metastasis have gained increasing attention. Irreversible electroporation (IRE) is a non-thermal ablative approach that employs short, high-voltage electrical pulses to create permanent nano-defects in the tumor cell membrane resulting in lethal disruption of tumor cell homeostasis while preserving the integrity of the underlying vascular architecture. This study sought to review IRE outcomes at a high-volume, single institution hepato-pancreato-biliary surgical center. Methods: After obtaining institutional review board approval, data for patients treated with IRE was retrieved from the electronic medical record from 2013-2022. IRE in situ is defined as non-thermal ablation to a tumor without resection. Margin enhancement IRE is defined as non-thermal ablation to residual tumor that could not be resected in its entirety within the adventitial plane. IRE assisted resection is defined as non-thermal ablation to a tumor encasing surrounding structures to allow for complete resection. Results: A total of 101 IREs have been performed at our institution from 2013-2022. Demographics for our cohort include 48 (47.5%) female patients, an average age of 63 years (range 43 – 84), and an average BMI of 26.4 kg/m2 (range 17 – 47). Of these IRE operations, 27 (26.7%) were in-situ, 35 (34.7%) were margin enhancement, and 50 (49.5%) were assisted resections. 2.0% and 11.9% died within 30 and 90 days of the operation, respectively. Median disease-free survival for our patient cohort was 15 months (range 0 to 74). 1-year, 3-year, 5-year, and overall survival for the three cohorts are shown. Conclusions: Using IRE in patients presenting with LAPC provides additional treatment options to the standard treatment pathway. Further classifying IRE use to in situ, margin enhancement, and assisted resection and incorporating these procedures into a multidisciplinary treatment approach has the potential to improve survival rates for appropriately selected LAPC patients. [Table: see text]

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Wei, Alice Chia-chi, Katharine Sarah Devitt, Mahrosh Ahmed, Beverly Barretto, Anna Kacikanis, and Steven Gallinger. "Development of an evidence-based clinical pathway for patients undergoing pancreaticoduodenectomy." Journal of Clinical Oncology 32, no. 30_suppl (October 20, 2014): 130. http://dx.doi.org/10.1200/jco.2014.32.30_suppl.130.

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130 Background: Pancreas cancer is the 4th cause of cancer death. Surgical resection is the optimal treatment. But pancreaticoduodenectomy (PD) is complex with high perioperative morbidity. Complications following PD have a negative effect on quality of life and survival. Clinical pathways (CPW) are quality improvement (QI) tools that standardize the processes of care. Our aim was to develop and implement an evidence-based CPW for PD in the province of Ontario, Canada. Methods: A CPW following PD was developed using the Knowledge-to-Action framework. All 9 high volume Hepato-Pancreato-Biliary (HPB) centers in Ontario were invited to participate in a needs assessments workshop to promote awareness and early agreement for a CPW. Enthusiasm for a CPW was confirmed. End user input was incorporated into a multidisciplinary CPW. Barriers and enablers to implementation were assessed. Evidentiary support for CPW elements was integrated into the final product. An active implementation strategy that addressed key barriers was developed to promote CPW adoption and adherence. Pilot testing was undertaken. CPW uptake, compliance, and impact on clinical outcomes were evaluated. Pilot results were used to design the final CPW product and implementation strategy. Results: The needs assessment confirmed variability of perioperative processes at all sites. Participants expressed interest for a CPW and consensus was obtained on essential CPW components. During a 15 month pilot phase, 83/122 (68%) of eligible patients were initiated on CPW. Subjects able to achieve the goals of the CPW had a shorter length of stay (7 vs 11 days), lower in-hospital complications (9, 22% vs 19, 45%) and readmission (6, 15% vs 11, 26%) compared to those who were unable to achieve CPW targets. The majority of CPW users reported that the CPW was easy to use (26, 93%) and did not adversely affect workload (20, 71%). Pilot data were used to finalize the strategy used to implement the CPW at all Ontario HPB centers. Conclusions: We report that introduction of a standardized CPW for complex cancer surgery is possible with early engagement of stakeholders. Initial results suggest that this standardized approach is safe and positively impact quality of surgical care.

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Zuckerman, Jesse, Natalie Coburn, Jeannie Callum, Alyson Mahar, Victoria Zuk, Yulia Lin, Robin McLeod, et al. "Declining use of red blood cell transfusions for gastrointestinal cancer surgery: A population-based analysis." Journal of Clinical Oncology 38, no. 4_suppl (February 1, 2020): 802. http://dx.doi.org/10.1200/jco.2020.38.4_suppl.802.

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802 Background: Perioperative anemia is common in gastrointestinal (GI) cancer surgery patients and is often treated with red blood cell transfusion (RBCT), which carries risks for inferior oncologic outcomes. Despite level-1 evidence for restrictive transfusion strategies, RBCT use is often not consistent with guidelines leading to a high rate of unnecessary transfusions. Understanding of RBCT use at the population-level is necessary to develop system-level efforts to minimize perioperative RBCT for cancer. We sought to evaluate the secular trends of transfusion in a large North American population. Methods: We conducted a population-based retrospective cohort study of patients undergoing GI cancer resection between 2007-2018 using linked administrative health datasets in Ontario, Canada. Primary outcome was administration of any RBCT during the hospitalization. Temporal RBCT trends were analyzed with Cochran-Armittage tests for trend. Modified Poisson regression assessed trends while controlling for potential confounders. Results: Of 79,764 patients undergoing GI cancer resection, median age was 69 (IQR: 60-78) years old and 55.5% were male. The most frequent cancer site was colorectal cancer (n = 63,243), followed by esophago-gastric (n = 7,307), hepato-pancreato-biliary (n = 6,510), and small bowel (n = 2,704). 30% of patients received RBCT. The proportion of patients transfused decreased from 26.5% in 2007 to 18.9% in 2018 (p < 0.001). This trend remained consistent when stratified by sex, age, cancer type, operative approach, procedure setting, and institution teaching status. After adjusting for patient and institution factors, the time period was associated with receipt of RBCT with a relative risk of 0.94 (95% CI 0.91-0.96) for 2011-14 and 0.75 (95% CI 0.73-0.78) for 2015-2018 compared to the period of 2007-10. Conclusions: Over the 11-year study period, we observed a decrease in RBCT for GI cancer resection. These findings may reflect the dissemination of clinical guidelines and implementation of patient blood management programs. An evaluation of institutional variation and the relationship with outcomes is warranted to identify opportunities for further improvement.

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Kim, Jin Kyong, Seung Yoon Yang, Sung Hyun Kim, and Hyoung-Il Kim. "Application of robots in general surgery." Journal of the Korean Medical Association 64, no. 10 (October 10, 2021): 678–87. http://dx.doi.org/10.5124/jkma.2021.64.10.678.

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Background: Application of robotic surgery in the field of general surgery has been increasing. This paper is an overview of the current uses and future perspectives of robotic surgery in four major divisions—endocrine, upper gastrointestinal, hepato-biliary-pancreatic (HBP), and colorectal surgery.Current Concepts: In endocrine surgery, cosmetic advantage is the highest priority when selecting a surgical approach for thyroidectomy. Currently, the transaxillary route is the most common approach. The introduction of the single-port system could maximize the advantages of this technique. In upper gastrointestinal surgery, the use of robots has the advantage of better retrieval of lymph nodes, less bleeding, earlier discharge, and less complications than the laparoscopic approach. However, a more prospective comparative trial is required to confirm those findings. In the HBP field, the indications of robotic surgery have expanded, starting with cholecystectomy to more challenging procedures, such as donor hepatectomy and pancreaticoduodenectomy. Meticulous dissection using robots could provide benefits to patients. In colorectal surgery, robotic surgery is an excellent technical tool for minimally invasive surgeries for rectal cancers, especially in male patients with narrow, deep pelvises. However, further studies are required to confirm the impact of robotic surgery on rectal cancers.Discussion and Conclusion: Robots are used to provide optimal surgical outcomes. Investigating new technologies and innovative surgical procedures is the highly important for a surgeon in the era of minimally invasive surgery.

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