Hpb最新文献

Background: Understanding the needs of early-career surgeons is essential for developing strategies for support. This study examined perceived needs of early-career HPB surgeons worldwide.

Methods: A self-administered web-based survey of early career HPB surgeons (aged ≤45 years old or practicing for ≤5 years) was conducted. A questionnaire was developed through items generation and reduction, followed by pilot testing. Quantitative data were reported with descriptive statistics and qualitative responses analysed using open coding.

Results: There were 282 respondents. Six main areas of challenges were identified: mentorship opportunities, continued skills acquisition and training, research and collaboration, leadership and career development, clinical knowledge exchange, and accessibility including financial barriers. Specifically, highest rated challenges were ebalancing work and personal life (mean 6.98, SD 2.92), research (mean 6.79, SD 2.50), career development/mentorship (mean 6.70, SD 2.30), networking/collaboration (mean 6.16, SD 2.71), leadership and (mean 6.09, SD 2.53). Rating of research as a challenge was higher in Africa and Central/South America (p = 0.01), and that of leadership was higher in Asia, Oceania, and the Middle East (p = 0.02).

Conclusions: This survey highlights the multiple challenges faced by early-career HPB surgeons worldwide. These results provide insights into how to better support early-career HPB surgeons to fully develop their specialty.

Background: Accurate assessment of the future liver remnant (FLR) is crucial for predicting the risk of post-hepatectomy liver failure (PHLF). This survey aims to evaluate the current practices of liver surgeons regarding FLR volumetry and its clinical use.

Methods: A cross-sectional survey was conducted among 212 liver surgeons to assess their use of FLR volumetry and associated methodologies. The survey consisted of 40 questions distributed in five sections covering multiple aspects of FLR volumetry.

Results: Ninety percent of respondents utilize preoperative FLR volumetry. However, there is significant variability in the methods used for FLR calculation and the thresholds for safe liver resection, which deviate from the proposed 20/30/40 % rule. Before right hepatectomy, 21 % of respondents indicated that they rarely or never utilise volumetry. Extended resections are the surgical procedures in which volumetry is most frequently employed. Furthermore, the kinetic growth rate is not widely adopted in clinical decision making.

Conclusion: This survey highlights the widespread use of FLR volumetry, but also reveals substantial variation in its application. This demonstrates a lack of evidence or guidelines regarding the appropriate use of FLR volumetry.

During its 2022 World Congress in New York the International Hepato-Pancreato-Biliary Association (IHPBA) launched the Legacy Initiative, aiming to create sustainable, positive impacts in host countries or regions by addressing critical healthcare challenges in the field of Hepato-Pancreato-Biliary surgery. The 2024 Legacy Initiative focused on hepatocellular carcinoma (HCC) in sub-Saharan Africa (SSA), a region disproportionately burdened by this disease due to a high incidence, limited healthcare infrastructure and resources, lack of screening programs, low awareness, and financial constraints. HCC, the sixth most common malignancy globally, is often diagnosed at advanced stages in SSA, leading to dismal outcomes. The initiative aims to improve management pathways and access to care through a multidisciplinary approach, emphasizing prevention, early diagnosis, curative treatments, potentially life-prolonging treatments, and palliative care. Key strategies include expanding healthcare infrastructure, implementing screening programs, raising awareness, and advocating for policy reforms. The IHPBA has partnered with the African Viral Hepatitis Convention and the African Palliative Care Association to address risk factors for developing HCC, in particular viral hepatitis, a major HCC risk factor. The initiative also highlights the need for capacity building, research, and collaboration with regional and international stakeholders. The 2024 Legacy Initiative aims to drive meaningful change, improve HCC outcomes, and reduce the disease burden in SSA, aligning with the IHPBA's mission to create long-lasting, positive impacts in global HPB healthcare.

Background: Patients with pancreatic ductal adenocarcinoma (PDAC) are at increased risk for severe COVID-19. Although COVID-19 vaccines are highly recommended for this population, studies on immunogenicity are lacking. We aimed to investigate the immunogenicity of COVID-19 vaccines in PDAC patients, compared to controls.

Methods: This observational study evaluated SARS-CoV-2 spike-specific IgG (S-IgG) levels after priming and booster vaccination in PDAC patients. Primary outcomes were seroprevalence and S-IgG levels compared to matched controls. Secondary outcomes included safety and the association of S-IgG levels with clinical and therapeutic characteristics.

Results: In 81 PDAC patients, a total of 86 matched S-IgG levels were available (33 post-priming; 53 post-booster). After priming, 88% (29/33) of PDAC patients were seropositive compared to 97% (32/33) of controls (P=0.16). After booster, seropositivity increased to 98% (52/53) in PDAC patients and to 53/53 (100%) in controls (P=0.31). Patients with active disease during booster vaccination had significantly lower S-IgG levels compared to patients with a history of PDAC (P=0.002). Cancer therapies were not associated with distinct S-IgG levels (P>0.05). No serious adverse events occurred.

Conclusion: Priming and booster COVID-19 vaccines are safe and immunogenic in PDAC patients, comparable to controls. The antibody response was effectively increased by the booster vaccination and not impaired by cancer therapies.

Introduction: The aim of the present study was to report epidemiological data on the incidence of acute pancreatitis (AP) in England between 2013 and 2023 and report contemporary post-AP outcomes.

Methods: A search of patients admitted with AP (2013-2023) was performed within the Hospital Episode Statistics (HES) which covers all admitted patients within England using diagnosis (ICD-10) code K85.

Results: A total of 260,009 patients (median age, 59 years; IQR, 30; F:M, 1.02:1) were identified from 185 NHS trusts (2013-2023), with an incidence of 456 cases per million and an annual increase of 2.6 %. A total of 8.0 % patients required ITU admission. The AP readmission rate was 30.2 % after a median follow-up time of 45 months (Q1-Q3, 17-80 months). The in-hospital mortality rate was 4.5 % (n = 11,711). The overall survival at 1, 2, 5 and 10 years was 88.9 [95%CI 88.7,89], 85.2 [85.1,85.4], 76.1 [75.9,76.3] and 63.9 [63.6,64.2]. Long-term survival (10-year) was higher with biliary aetiology (p < 0.01), younger age groups (p < 0.05) and those without ITU admission (p < 0.01).

Conclusions: The incidence of AP in England is increasing and in-hospital mortality rates remain significant. These findings have implications for resource allocation to mitigate risk factors for developing AP in addition to the need for long-term follow-up for at-risk groups.

Clinical trial registration: N/A.

Background: Adenosquamous Gallbladder Cancers (ASGBC) are rare variety of GBCs. Relative paucity of data with regards to the management of ASGBC exists.

Methods: Patients with diagnosis of ASGBC from January 2012 to March 2022 were categorised into 'Early', 'Locally advanced (LA)' and 'Metastatic (M)' ASGBC as per the predefined 'TMH Criteria'.

Results: A total of 196 patients included were categorised into early ASGBC (n = 19,9.7%), LA - ASGBC (n = 53,27%) and M - ASGBC (n = 124,63.3%) with median overall survival (OS) being worst for M - ASGBC (3.9 months) and best for early ASGBC (not reached). The 1-year and 3-year OS of LA-ASGBC patients who underwent surgery was significantly higher than those with non-surgical treatment (72.6%, 35.6% vs 25.1%, 0%, p <0.001). Although, the median OS of resected ASGBC was less as compared to resected gallbladder adenocarcinomas (GBACs) (40.8 vs. 56.1 months), it did not reach statistical significance (p=0.06). However, at higher stages of resected LA - ASGBC (Stage III), the median OS was significantly lower as compared to stage-matched resected GBACs (14.5 vs. 30.1 months, p= 0.006).

Conclusion: Multimodality treatment consisting of margin negative surgical resection with perioperative chemotherapy offers the best chance of long-term survival in ASGBC.

Introduction: We sought to characterize the impact of exocrine pancreatic insufficiency (EPI) on primary healthcare utilization and expenditures following partial pancreatectomy (PP).

Methods: Patients who underwent PP between 2004 and 2019 were identified using SEER-Medicare. Patients who developed EPI within 6 months following surgery were included in the EPI cohort and were followed for 1-year post-surgery. Differences in post-surgery PCP visit frequency and healthcare expenditures within 1-year were evaluated.

Results: Among 1119 patients, median age was 74 years (IQR: 69-78), about one-half were female (52.5%), and the majority were White (85.2%). Following PP, 22.4% of patients developed EPI. Patients with EPI were more likely to be concomitantly diagnosed with diabetes following PP (EPI: 11.6% vs. no EPI: 3.7%; p < 0.001). On multivariable analyses, EPI was associated with increased PCP visits (Ref. No EPI; percent difference [%diff]: 29.62, 95%CI 15.15-45.90) and higher healthcare costs (Ref. No EPI; total postoperative expenditure: %diff 37.01, 95%CI 12.89-66.29; p < 0.01) within 1-year following PP.

Conclusion: Roughly 1 in 4 patients experienced EPI after PP. EPI was associated with increased PCP utilization and higher healthcare expenditures.

Background: We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer.

Methods: Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications.

Results: A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10-30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg.

Conclusion: A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.

Background: The mortality rate of Hepatocellular cancer (HCC) in Louisiana is second worst in the United States. This has been linked to underutilization of curative treatment (CT). This study aimed to identify risk factors associated with underutilization of CT in Louisiana.

Methods: Patients with AJCC T1 HCC diagnosed from 2011 to 2020 were identified from the Louisiana Tumor Registry (LTR) using site and histology codes. Patients who underwent CT (ablation, resection, and transplantation) were compared to those who did not undergo CT. Logistic regression was performed and results reported as adjusted odds ratios.

Results: CT was utilized in 462 (37 %) of 1247 patients with T1 HCC. There were no significant differences observed in age, race, BMI, poverty, or rurality between CT and non-CT patients. The percentage of cirrhosis was similar in both groups (35.3 % vs. 37.7 %, NS). On multivariant analysis, lack of CT was independently associated with low socioeconomic status (SES; p = 0.040), treatment outside a COC center (p < 0.001), and lack commercial/private insurance (p < 0.001).

Conclusion: Utilization of CT is driven not by comorbidities, but by insurance type, low SES, and treatment facility indicating the profound effect that care disparities have on HCC treatment.