Clinical Surgery for Hepato-Pancreato-Biliary (HPB) Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: 15 December 2024 | Viewed by 1357

Special Issue Editors


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Guest Editor
1. Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, 20090 Milan, Italy
2. Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089 Milan, Italy
Interests: pancreatic cancer; pancreatic cysts; pancreatic diseases; pancreatic surgery; distal cholangiocarcinoma; ampullary cancer; periampullary diseases
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E-Mail Website
Guest Editor
Pancreatic Surgery Department, Humanitas Research Hospital (IRCCS), 20089 Milan, Italy
Interests: pancreatic cancer; pancreatic cysts; pancreatic diseases; pancreatic surgery; distal cholangiocarcinoma; ampullary cancer; periampullary diseases

Special Issue Information

Dear Colleagues,

Hepato-biliary and pancreatic (HPB) malignancies still represent one of the most complex challenges for surgeons, both from a technical and oncological point of view. HPB malignancies range from liver ones (intrahepatic cholangiocarcinoma, Klatskin tumor, hepatocellular carcinoma, metastases from other solid neoplasms) to pancreas (pancreatic ductal adenocarcinoma, metastases from other solid malignancies, neuroendocrine neoplasms, degenerated cysts), bile duct (distal cholangiocarcinoma, Todani’s cysts) and Vater papilla (ampullary cancer) ones. Each of these malignancies require a complex multidisciplinary approach, involving gastroenterologists, endoscopists, oncologists, radiologists, pathologists and surgeons. From a surgical point of view, the treatment of these malignancies often requires a large complex procedure, exposing the patients to a high risk in terms of morbidity and mortality. However, despite their complexity, currently, many procedures can be performed via a minimally invasive approach. Despite many efforts over the last few decades, the majority of these malignancies continue to have a bad prognosis.

The aim of this Special Issue is to collect different experiences regarding the multidisciplinary management of the most frequent and important HPB diseases.    

Dr. Gennaro Nappo
Dr. Michele Pagnanelli
Guest Editors

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Keywords

  • pancreatic malignancies
  • HPB malignancies
  • pancreatic ductal adenocarcinoma
  • liver cholangiocarcinoma
  • HPB surgery
  • liver resection
  • pancreatic resection

Published Papers (2 papers)

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Research

15 pages, 270 KiB  
Article
Study International Multicentric Pancreatic Left Resections (SIMPLR): Does Surgical Approach Matter?
by Sara Acciuffi, Mohammed Abu Hilal, Clarissa Ferrari, Sara Al-Madhi, Marc-Anthony Chouillard, Nouredin Messaoudi, Roland S. Croner and Andrew A. Gumbs
Cancers 2024, 16(5), 1051; https://doi.org/10.3390/cancers16051051 - 05 Mar 2024
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Abstract
Background: Minimally invasive surgery is increasingly preferred for left-sided pancreatic resections. The SIMPLR study aims to compare open, laparoscopic, and robotic approaches using propensity score matching analysis. Methods: This study included 258 patients with tumors of the left side of the pancreas who [...] Read more.
Background: Minimally invasive surgery is increasingly preferred for left-sided pancreatic resections. The SIMPLR study aims to compare open, laparoscopic, and robotic approaches using propensity score matching analysis. Methods: This study included 258 patients with tumors of the left side of the pancreas who underwent surgery between 2016 and 2020 at three high-volume centers. The patients were divided into three groups based on their surgical approach and matched in a 1:1 ratio. Results: The open group had significantly higher estimated blood loss (620 mL vs. 320 mL, p < 0.001), longer operative time (273 vs. 216 min, p = 0.003), and longer hospital stays (16.9 vs. 6.81 days, p < 0.001) compared to the laparoscopic group. There was no difference in lymph node yield or resection status. When comparing open and robotic groups, the robotic procedures yielded a higher number of lymph nodes (24.9 vs. 15.2, p = 0.011) without being significantly longer. The laparoscopic group had a shorter operative time (210 vs. 340 min, p < 0.001), shorter ICU stays (0.63 vs. 1.64 days, p < 0.001), and shorter hospital stays (6.61 vs. 11.8 days, p < 0.001) when compared to the robotic group. There was no difference in morbidity or mortality between the three techniques. Conclusion: The laparoscopic approach exhibits short-term benefits. The three techniques are equivalent in terms of oncological safety, morbidity, and mortality. Full article
(This article belongs to the Special Issue Clinical Surgery for Hepato-Pancreato-Biliary (HPB) Cancer)
12 pages, 1396 KiB  
Article
Survival Comparison of Different Operation Types for Middle Bile Duct Cancer: Bile Duct Resection versus Pancreaticoduodenectomy Considering Complications and Adjuvant Treatment Effects
by Soo Yeun Lim, Hani Jassim Alramadhan, HyeJeong Jeong, Hochang Chae, Hyeong Seok Kim, So Jeong Yoon, Sang Hyun Shin, In Woong Han, Jin Seok Heo and Hongbeom Kim
Cancers 2024, 16(2), 297; https://doi.org/10.3390/cancers16020297 - 10 Jan 2024
Viewed by 651
Abstract
Background: Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to [...] Read more.
Background: Margin status is one of the most significant prognostic factors after curative surgery for middle bile duct (MBD) cancer. Bile duct resection (BDR) is commonly converted to pancreaticoduodenectomy (PD) to achieve R0 resection. Additionally, adjuvant treatment is actively performed after surgery to improve survival. However, the wider the range of surgery, the higher the chance of complications; this, in turn, makes adjuvant treatment impossible. Nevertheless, no definitive surgical strategy considers the possible complication rates and subsequent adjuvant treatment. We aimed to investigate the appropriate surgical type considering the margin status, complications, and adjuvant treatment in MBD cancer. Materials and Methods: From 2008 to 2017, 520 patients diagnosed with MBD cancer at the Samsung Medical Center were analyzed retrospectively according to the operation type, margin status, complications, and adjuvant treatment. The R1 group was defined as having a carcinoma margin. Results: The 5-year survival rate for patients who underwent R0 and R1 resection was 54.4% and 33.3%, respectively (p = 0.131). Prognostic factors affecting the overall survival were the age, preoperative CA19-9 level, T stage, and N stage, but not the operation type, margin status, complications, or adjuvant treatment. The complication rates were 11.5% and 29.8% in the BDR and PD groups, respectively (p < 0.001). We observed no significant difference in the adjuvant treatment ratio according to complications (p = 0.675). Patients with PD who underwent R0 resection and could not undergo chemotherapy because of complications reported better survival rates than those with BDR who underwent R1 resection after adjuvant treatment (p = 0.003). Conclusion: The survival outcome of patients with R1 margins who underwent BDR did not match those with R0 margins after PD, even after adjuvant treatment. Due to improvements in surgical techniques and the ability to resolve complications, surgical complications exert a marginal effect on survival. Therefore, surgeons should secure R0 margins to achieve the best survival outcomes. Full article
(This article belongs to the Special Issue Clinical Surgery for Hepato-Pancreato-Biliary (HPB) Cancer)
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