Journal of Clinical Medicine

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Special Issue Editor

Prof. Dr. Christian Graeb

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Guest Editor

Department of Visceral and Abdominal Surgery, Sana Klinikum Hof GmbH, Eppenreuther Str. 9, 95032 Hof, Bavaria, Germany
Interests: pancreatitis; HPB surgery; liver cancer; pancreatic cancer

Special Issue Information

Dear Colleagues,

Hepatobiliary and pancreatic surgery is probably the most versatile and demanding surgery in upper GI procedures. Although survival has improved dramatically in the past decade, complication rates remain at rather high levels. The introduction of minimally invasive surgery in pancreatic surgery, mainly triggered by improvements in robotic surgery, has demonstrated its feasibility but failed to decrease the rate of pancreatic fistula, bile leakage, and vascular complication rates. Nonetheless, surgical techniques have consistently improved, resulting in increased survival in pancreatic cancer patients and emergency Whipple procedures.

The improvement in outcomes in HPB patients, despite the improvements in surgery, is mainly driven by the development of interventional techniques in gastroenterology and radiology. When comparing low- to high-volume institutions, it becomes quite clear that the differences in mortality rates are mainly triggered by a failure to rescue rather than by fewer complications in high-volume centers.

It becomes obvious that HPB surgery should only be carried out in institutions that provide 24/7 access to experienced interventional radiologists and gastroenterologists in order to treat HPB complications such as bile leakages, pseudoaneurysm, fluid collection from bile, or pancreatic fistulas.

From a surgical point of view, there are high expectations regarding the future development of robotic-assisted surgery in HPB procedures. Improvements in surgical techniques and further developments in engineering will lead to more sophisticated instruments and devices for this innovative type of surgery.

Especially for cancer patients, the latest developments in molecular targeted therapies and transarterial approaches for organ-specific perfusion/occlusion techniques will further improve survival in patients suffering from these rather aggressive tumors, such as HCC, CCC, and pancreatic adeno-carcinoma.

This Special Issue of the Journal of Clinical Medicine aims to attract original research articles and reviews on the latest aspects of HPB surgery, especially in terms of clinical experiences, improvements for HPB cancer patients, and innovative treatment options in order to reduce or treat perioperative complications to improve long-term survival.

Prof. Dr. Christian Graeb
Guest Editor

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Keywords

HPB surgery
liver cancer
pancreatic cancer
minimally invasive surgery
robotic-assisted surgery
targeted therapy
interventional radiology
interventional gastroenterology
complications management in HPB surgery

Published Papers (2 papers)

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Research

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13 pages, 991 KiB

Open AccessArticle

The Pancreas as a Target of Metastasis from Renal Cell Carcinoma: Is Surgery Feasible and Safe? A Single-Center Experience in a High-Volume and Certified Pancreatic Surgery Center in Germany

by Sara Al-Madhi, Sara Acciuffi, Frank Meyer, Maximilian Dölling, Asmus Beythien, Mihailo Andric, Mirhasan Rahimli, Roland S. Croner and Aristotelis Perrakis

J. Clin. Med. 2024, 13(7), 1921; https://doi.org/10.3390/jcm13071921 - 26 Mar 2024

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Abstract

Background: Secondary malignant tumors of the pancreas are rare, representing 2–5% of all pancreatic malignancies. Nevertheless, the pancreas is one of the target organs in cases of metastatic clear cell renal cell carcinoma (CCRCC). Additionally, recurrent metastasis may occur. Surgical resection remains the best and prognostically most favorable therapeutic option in cases of solitary pancreatic metastasis. Aim: To review retrospectively the clinical tumor registry of the University Hospital of Magdeburg, Germany, for this rare entity, performing a clinical systematic single-center observational study (design). Methods: A retrospective cohort analysis of consecutive patients who had undergone pancreatic resection for metastatic CCRC was performed in a single high-volume certified center for pancreatic surgery in Germany from 2010 to 2022. Results: All patients (n = 17) included in this study had a metachronous metastasis from a CCRCC. Surgery was performed at a median time interval of 12 (range, 9–16) years after primary resection for CCRCC. All 17 patients were asymptomatic at the time of diagnosis. Three of those patients (17.6%) presented with recurrent metastasis in a different part of the pancreas during follow-up. In a total of 17 patients, including those with recurrent disease, a surgical resection was performed; Pancreatoduodenectomy was performed in 6 patients (35%); left pancreatectomy with splenectomy was performed in 7 patients (41%). The rest of the patients underwent either a spleen-preserving pancreatic tail resection, local resection of the tumor lesion or a total pancreatectomy. The postoperative mortality rate was 6%. Concerning histopathological findings, seven patients (41%) had multifocal metastasis. An R0 resection could be achieved in all cases. The overall survival at one, three and five years was 85%, 85% and 72%, respectively, during a median follow-up of 43 months. Conclusions: CCRC pancreatic metastases can occur many years after the initial treatment of the primary tumor. Surgery for such a malignancy seems feasible and safe; it offers very good short- and long-term outcomes, as indicated. A repeated pancreatic resection can also be safely performed. Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Management and Future Opportunities)

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Review

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10 pages, 1048 KiB

Open AccessReview

Median Arcuate Ligament Syndrome (MALS) in Hepato-Pancreato-Biliary Surgery: A Narrative Review and Proposed Management Algorithm

by Lawrence Y. Lu, Jacques G. Eastment and Yogeesan Sivakumaran

J. Clin. Med. 2024, 13(9), 2598; https://doi.org/10.3390/jcm13092598 - 28 Apr 2024

Viewed by 332

Abstract

Median arcuate ligament syndrome (MALS) is an uncommon condition characterized by the compression of the celiac trunk by the median arcuate ligament. Due to the anatomical proximity to the foregut, MALS has significant implications in hepato-pancreato-biliary (HPB) surgery. It can pose complications in pancreatoduodenectomy and orthotopic liver transplantation, where the collateral arterial supply from the superior mesenteric artery is often disrupted. The estimated prevalence of MALS in HPB surgery is approximately 10%. Overall, there is consensus for a cautious approach to MALS when embarking on complex foregut surgery, with a low threshold for intraoperative median arcuate ligament release or hepatic artery reconstruction. The role of endovascular intervention in the management of MALS prior to HPB surgery continues to evolve, but more evidence is required to establish its efficacy. Recognizing the existing literature gap concerning optimal management in this population, we describe our tertiary center experience as a clinical algorithm to facilitate decision-making. Research question: What is the significance and management of median arcuate ligament syndrome in patients undergoing hepato-pancreato-biliary surgery? Full article

(This article belongs to the Special Issue Hepatobiliary and Pancreatic Surgery: Management and Future Opportunities)

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