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Special Issue "Surgical Advances in Pancreaticobiliary Diseases"

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Guest Editor

1. Department of Gastroenterological Surgery, Yokohama City University School of Medicine, Yokohama 236-0004, Japan
2. Division of Surgical Oncology, Department of Surgery, The Urban Meyer III and Shelley Meyer Chair for Cancer Research, James Comprehensive Cancer Center, Wexner Medical Center, The Ohio State University, Columbus, OH 43210, USA
Interests: hepato-pancreato-biliary cancer; surgical outcome; risk calculator; minimally invasive surgery; prediction model

Special Issue Information

Dear Colleagues,

Pancreaticobiliary diseases mainly consist of pancreatic diseases, including pancreatic ductal adenocarcinoma and intraductal papillary mucinous tumors as well as biliary tract cancers such as intrahepatic and hilar cholangiocarcinoma. Although patients with advanced pancreaticobiliary diseases have a dismal prognosis, surgery remains a mainstay as a potentially curative treatment for patients with early stage pancreaticobiliary diseases. In recent decades, robotic and laparoscopic pancreaticobiliary surgery has been increasingly utilized, and several studies noted that minimally invasive surgeries for pancreaticobiliary diseases are associated with shorter hospital stays, reduced blood loss, and equivalent complication rates compared with open surgery. In addition, patients with locally advanced or distant metastatic pancreaticobiliary cancers have a chance to receive resection by a strategy of neoadjuvant therapy and conversion surgery, resulting in relatively high R0 resection rates and favorable prognosis versus unresectable diseases. As such, these surgical advances combined with perioperative chemoradiotherapy have steadily contributed to a better prognosis for patients with pancreaticobiliary diseases.

The Special Issue aims to present established, advanced, and novel insights for preventing or treating pancreaticobiliary diseases, thus improving patients’ quality of life and increasing life expectancy.

Dr. Kota Sahara
Guest Editor

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Keywords

robotic surgery
laparoscopic surgery
postoperative pancreatic fistula
bile leakage
failure to rescue
long-term outcome
neoadjuvant chemotherapy
adjuvant chemotherapy
combined vascular resection
conversion surgery

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Open AccessEditorial

Editorial: Surgical Advances in Pancreaticobiliary Diseases

Kota Sahara

J. Clin. Med. 2023, 12(4), 1268; https://doi.org/10.3390/jcm12041268 - 06 Feb 2023

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Abstract

Pancreaticobiliary diseases include malignant tumors arising in organs with a complex anatomy, such as the pancreas and bile ducts, often presenting as locally advanced or metastatic lesions, and they frequently have a poor prognosis [...] Full article

(This article belongs to the Special Issue Surgical Advances in Pancreaticobiliary Diseases)

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Open AccessArticle

Pancreaticobiliary Diseases with Severe Complications as a Rare Indication for Emergency Pancreaticoduodenectomy: A Single-Center Experience and Review of the Literature

Maximilian Fickenscher

and

J. Clin. Med. 2023, 12(17), 5760; https://doi.org/10.3390/jcm12175760 - 04 Sep 2023

Viewed by 361

Abstract

The pancreaticobiliary system is a complex and vulnerable anatomic region. Small changes can lead to severe complications. Pancreaticobiliary disorders leading to severe complications include malignancies, pancreatitis, duodenal ulcer, duodenal diverticula, vascular malformations, and iatrogenic or traumatic injuries. Different therapeutic strategies, such as conservative, interventional (e.g., embolization, stent graft applications, or biliary interventions), or surgical therapy, are available in early disease stages. Therapeutic options in patients with severe complications such as duodenal perforation, acute bleeding, or sepsis are limited. If less invasive procedures are exhausted, an emergency pancreaticoduodenectomy (EPD) can be the only option left. The aim of this study was to analyze a single-center experience of EPD performed for benign non-trauma indications and to review the literature concerning EPD. Between January 2015 and January 2022, 11 patients received EPD due to benign non-trauma indications at our institution. Data were analyzed regarding sex, age, indication, operative parameters, length of hospital stay, postoperative morbidity, and mortality. Furthermore, we performed a literature survey using the PubMed database and reviewed reported cases of EPD. Eleven EPD cases due to benign non-trauma indications were analyzed. Indications included peptic duodenal ulcer with penetration into the hepatopancreatic duct and the pancreas, duodenal ulcer with acute uncontrollable bleeding, and penetration into the pancreas, and a massive perforated duodenal diverticulum with peritonitis and sepsis. The mean operative time was 369 min, and the median length of hospital stay was 35.8 days. Postoperative complications occurred in 4 out of 11 patients (36.4%). Total 90-day postoperative mortality was 9.1% (1 patient). We reviewed 17 studies and 22 case reports revealing 269 cases of EPD. Only 20 cases of EPD performed for benign non-trauma indications are reported in the literature. EPD performed for benign non-trauma indications remains a rare event, with only 31 reported cases. The data analysis of all available cases from the literature revealed an increased postoperative mortality rate of 25.8%. If less invasive approaches are exhausted, EPD is still a life-saving procedure with acceptable results. Performed by surgeons with a high level of experience in hepatobiliary and pancreatic surgery, mortality rates below 10% can be achieved. Full article

(This article belongs to the Special Issue Surgical Advances in Pancreaticobiliary Diseases)

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Open AccessArticle

Neoadjuvant Therapy for Extrahepatic Biliary Tract Cancer: A Propensity Score-Matched Survival Analysis

and

J. Clin. Med. 2023, 12(7), 2654; https://doi.org/10.3390/jcm12072654 - 02 Apr 2023

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Abstract

Background: Although surgery is the mainstay of curative-intent treatment for extrahepatic biliary tract cancer (EBTC), recurrence following surgery can be high and prognosis poor. The impact of neoadjuvant therapy (NAT) relative to upfront surgery (US) among patients with EBTC remains unclear. Methods: The Surveillance, Epidemiology, and End Results (SEER) databases was utilized to identify patients who underwent surgery from 2006 to 2017 for EBTC, including gallbladder cancer (GBC) and extrahepatic cholangiocarcinoma (ECC). Trends in NAT utilization were investigated, and the impact of NAT on prognosis was compared with US using a propensity score-matched (PSM) analysis. Results: Among 6582 EBTC patients (GBC, n = 4467, ECC, n = 2215), 1.6% received NAT; the utilization of NAT for EBTC increased over time (P_trend = 0.03). Among patients with lymph node metastasis, the lymph node ratio was lower among patients with NAT (0.18 vs. 0.40, p < 0.01). After PSM, there was no difference in overall survival (OS) and cancer-specific survival (CSS) among patients treated with NAT versus US (5-year OS: 24.0% vs. 24.6%, p = 0.14, 5-year CSS: 38.0% vs. 36.1%, p = 0.21). A subgroup analysis revealed that NAT was associated with improved OS and CSS among patients with stages III–IVA of the disease (OS: HR 0.65, 95%CI 0.46–0.92, p = 0.02, CSS: HR 0.62, 95%CI 0.41–0.92, p = 0.01). Conclusions: While NAT did not provide an overall benefit to patients undergoing surgery for EBTC, individuals with advanced-stage disease had improved OS and CSS with NAT. An individualized approach to NAT use among patients with EBTC may provide a survival benefit. Full article

(This article belongs to the Special Issue Surgical Advances in Pancreaticobiliary Diseases)

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