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Cancers
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An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers
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An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers

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

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 15083

Special Issue Editors

Dr. Nikolaos Machairas

E-Mail Website
Guest Editor
2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
Interests: HPB surgery; surgical oncology; minimally invasive surgery
Special Issues, Collections and Topics in MDPI journals
Dr. Stylianos Kykalos

E-Mail Website
Co-Guest Editor
2nd Department of Propaedeutic Surgery, National and Kapodistrian University of Athens, Athens, Greece
Interests: surgery; hepatobiliary; pancreas; transplantation; colon cancer; hernia
Special Issues, Collections and Topics in MDPI journals
Dr. Dimitrios Schizas

E-Mail Website
Co-Guest Editor
First Department of Surgery, Laikon General Hospital, National and Kapodistrian University of Athens, Athens, Greece
Interests: esophageal cancer; gastric cancer; pancreatic cancer; immunotherapy; personalized medicine; surgery; medical education
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Significant progress has been noted over the past few decades in the field of surgical management of hepato-pancreatobiliary (HPB) cancers. Through an improved understanding of the functions and anatomy of the liver and pancreas, combined with progress in surgical techniques and accumulation of surgical experience, both short- and long-term outcomes following surgical treatments have improved dramatically. More challenging liver and pancreatic resections with the use of traditional and cutting-edge techniques are now feasible in the context of multidisciplinary team management.

The objective of this Special Issue is to provide an update in the field of surgical treatment of primary and metastatic hepatobiliary as well as pancreatic tumors, and on future challenges to provide a thorough overview of the field as it presently stands. Our issue aims to review outcomes from traditionally used surgical interventions, as well as novel surgical techniques that are emerging in modern clinical practice. We further aim to inspire, inform, and provide both direction and guidance to surgeons and researchers in the field. We strongly encourage authors to submit high-quality research articles focusing on emerging surgical strategies and innovative multidisciplinary treatment protocols for the management of HPB tumors. Original articles as well as review articles, meta-analyses, how-to, and opinion articles are welcome.

You may choose our Joint Special Issue in Current Oncology.

Dr. Nikolaos Machairas
Dr. Stylianos Kykalos
Dr. Dimitrios Schizas
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatocellular carcinoma
  • cholangiocarcinoma
  • klatskin
  • intrahepatic
  • pancreatic
  • ductal adenocarcinoma
  • gallbladder cancer
  • surgery

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Published Papers (6 papers)

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Research

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14 pages, 1232 KiB  
Article
Hepatectomy versus Chemotherapy for Resectable Colorectal Liver Metastases in Progression after Perioperative Chemotherapy: Expanding the Boundaries of the Curative Intent
by Simone Famularo, Flavio Milana, Matteo Cimino, Fabio Procopio, Guido Costa, Jacopo Galvanin, Elisa Paoluzzi Tomada, Francesca Margherita Bunino, Angela Palmisano, Matteo Donadon and Guido Torzilli
Cancers 2023, 15(3), 783; https://doi.org/10.3390/cancers15030783 - 27 Jan 2023
Cited by 3 | Viewed by 1831
Abstract
Disease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy in cases of [...] Read more.
Disease progression (PD) at neoadjuvant chemotherapy for patients with colorectal liver metastases (CLMs) is considered a contraindication to hepatic resection. Our aim was to estimate the overall survival (OS) in patients undergoing surgery compared with those treated exclusively with chemotherapy in cases of PD. Patients from a single centre with PD were analyzed and subdivided into two groups: hepatectomy (HEP) versus chemotherapy (CHT). An Inverse Probability Weighting (IPW) was run to balance the baseline differences between the two groups. A Cox regression was carried out on identifying factors predicting mortality. From 2010 to 2020, 105 patients in PD to at least one line of chemotherapy were analyzed. Of these, 27 (25.7%) underwent hepatic resection. After a median follow-up of 30 (IQR 14–46) months, 61.9% were dead. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 95 and 46.8% for HEP (p < 0.001). After IPW, two balanced pseudopopulations were obtained: HEP = 85 and CHT = 103. The OS values at 1 and 3 years were 54.4 and 10.6% for CHT, and 97.8 and 49.3% for HEP (HR 0.256, 95%CI: 0.08–0.78, p = 0.033). After IPW, in the multivariate model, surgery resulted in the only protective variable (HR 0.198, 95%CI: 0.08–0.48, p = 0.0016). Our results show that hepatic resection could offer a chance of a longer OS than the prosecution of chemotherapy only in originally resectable patients. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
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Review

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16 pages, 1481 KiB  
Review
Current Perioperative Care in Pancreatoduodenectomy: A Step-by-Step Surgical Roadmap from First Visit to Discharge
by Tommaso Giuliani, Giampaolo Perri, Ravinder Kang and Giovanni Marchegiani
Cancers 2023, 15(9), 2499; https://doi.org/10.3390/cancers15092499 - 26 Apr 2023
Cited by 7 | Viewed by 3840
Abstract
Pancreaticoduodenectomy (PD) is a mainstay in the management of periampullary tumors. Treatment algorithms increasingly employ a multimodal strategy, which includes neoadjuvant and adjuvant therapies. However, the successful treatment of a patient is contingent on the execution of a complex operation, whereby minimizing postoperative [...] Read more.
Pancreaticoduodenectomy (PD) is a mainstay in the management of periampullary tumors. Treatment algorithms increasingly employ a multimodal strategy, which includes neoadjuvant and adjuvant therapies. However, the successful treatment of a patient is contingent on the execution of a complex operation, whereby minimizing postoperative complications and optimizing a fast and complete recovery are crucial to the overall success. In this setting, risk reduction and benchmarking the quality of care are essential frameworks through which modern perioperative PD care must be delivered. The postoperative course is primarily influenced by pancreatic fistulas, but other patient- and hospital-associated factors, such as frailty and the ability to rescue from complications, also affect the outcomes. A comprehensive understanding of the factors influencing surgical outcomes allows the clinician to risk stratify the patient, thereby facilitating a frank discussion of the morbidity and mortality of PD. Further, such an understanding allows the clinician to practice based on the most up-to-date evidence. This review intends to provide clinicians with a roadmap to the perioperative PD pathway. We review key considerations in the pre-, intra-, and post-operative periods. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
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19 pages, 8773 KiB  
Review
Pushing the Limits of Surgical Resection in Colorectal Liver Metastasis: How Far Can We Go?
by Francisco Calderon Novoa, Victoria Ardiles, Eduardo de Santibañes, Juan Pekolj, Jeremias Goransky, Oscar Mazza, Rodrigo Sánchez Claria and Martín de Santibañes
Cancers 2023, 15(7), 2113; https://doi.org/10.3390/cancers15072113 - 1 Apr 2023
Cited by 11 | Viewed by 3119
Abstract
Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of [...] Read more.
Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
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15 pages, 7279 KiB  
Review
Meta-Analysis of Repeat Hepatectomy versus Radiofrequency Ablation for Recurrence of Hepatocellular Carcinoma
by Nikolaos Machairas, Dimitrios Papaconstantinou, Panagiotis Dorovinis, Diamantis I. Tsilimigras, Myrto D. Keramida, Stylianos Kykalos, Dimitrios Schizas and Timothy M. Pawlik
Cancers 2022, 14(21), 5398; https://doi.org/10.3390/cancers14215398 - 2 Nov 2022
Cited by 4 | Viewed by 1766
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer-related death in both the developed and developing world. Recurrent HCC (rHCC) develops in a significant proportion of patients even following curative-intent resection. In the absence of a [...] Read more.
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer-related death in both the developed and developing world. Recurrent HCC (rHCC) develops in a significant proportion of patients even following curative-intent resection. In the absence of a structured treatment algorithm, a number of treatment options including repeat hepatectomy (RH) and radiofrequency ablation (RFA) have been utilized in select patients with rHCC. The aim of this systematic review and meta-analysis was to compare short- and long-term outcomes of patients undergoing RHR versus RFA for rHCC. Four electronic databases were screened until September 2022. A total of 17 studies were included in the meta-analysis. Overall and disease-free survival were comparable among the two groups. Patients undergoing RH were less likely to develop a second recurrence (RR 0.89, 95% C.I. 0.81 to 0.98, p = 0.02). Overall and major morbidity were significantly increased in the RH group (RR 3.01, 95% C.I. 1.98 to 4.56, p < 0.001 and RR 3.65, 95% C.I. 2.07 to 6.43, p < 0.001, respectively), while mortality was similar between RFA and RH. The data demonstrated that RFA is a safe and efficient alternative to RH for selected patients with rHCC. Nevertheless, despite higher morbidity associated with RH, repeat resection remains the preferred treatment option whenever feasible, as it allows for better local disease control. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
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Other

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11 pages, 269 KiB  
Systematic Review
Robotic Parenchymal-Sparing Pancreatectomy: A Systematic Review
by Richard Zheng, Elie Ghabi and Jin He
Cancers 2023, 15(17), 4369; https://doi.org/10.3390/cancers15174369 - 1 Sep 2023
Cited by 1 | Viewed by 1105
Abstract
Background: Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of postoperative pancreatic insufficiency. The robotic platform is increasingly being used for these procedures. We sought to evaluate robotic parenchymal-sparing pancreatectomy and assess [...] Read more.
Background: Parenchymal-sparing approaches to pancreatectomy are technically challenging procedures but allow for preserving a normal pancreas and decreasing the rate of postoperative pancreatic insufficiency. The robotic platform is increasingly being used for these procedures. We sought to evaluate robotic parenchymal-sparing pancreatectomy and assess its complication profile and efficacy. Methods: This systematic review consisted of all studies on robotic parenchymal-sparing pancreatectomy (central pancreatectomy, duodenum-preserving partial pancreatic head resection, enucleation, and uncinate resection) published between January 2001 and December 2022 in PubMed and Embase. Results: A total of 23 studies were included in this review (n = 788). Robotic parenchymal-sparing pancreatectomy is being performed worldwide for benign or indolent pancreatic lesions. When compared to the open approach, robotic parenchymal-sparing pancreatectomies led to a longer average operative time, shorter length of stay, and higher estimated intraoperative blood loss. Postoperative pancreatic fistula is common, but severe complications requiring intervention are exceedingly rare. Long-term complications such as endocrine and exocrine insufficiency are nearly nonexistent. Conclusions: Robotic parenchymal-sparing pancreatectomy appears to have a higher risk of postoperative pancreatic fistula but is rarely associated with severe or long-term complications. Careful patient selection is required to maximize benefits and minimize morbidity. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
17 pages, 2965 KiB  
Systematic Review
Downstaging Therapies for Patients with Hepatocellular Carcinoma Awaiting Liver Transplantation: A Systematic Review and Meta-Analysis on Intention-to-Treat Outcomes
by Marcello Di Martino, Alessandro Vitale, Daniele Ferraro, Marilisa Maniscalco, Donatella Pisaniello, Giuseppe Arenga, Federica Falaschi, Alfonso Terrone, Alessandro Iacomino, Alfonso Galeota Lanza, Ciro Esposito, Umberto Cillo and Giovanni Vennarecci
Cancers 2022, 14(20), 5102; https://doi.org/10.3390/cancers14205102 - 18 Oct 2022
Cited by 9 | Viewed by 2448
Abstract
Background: Locoregional therapies (LRTs) are commonly used to increase the number of potential candidates for liver transplantation (LT). The aim of this paper is to assess the outcomes of LRTs prior to LT in patients with hepatocellular carcinoma (HCC) beyond the listing criteria. [...] Read more.
Background: Locoregional therapies (LRTs) are commonly used to increase the number of potential candidates for liver transplantation (LT). The aim of this paper is to assess the outcomes of LRTs prior to LT in patients with hepatocellular carcinoma (HCC) beyond the listing criteria. Methods: In accordance with the PRISMA guidelines, we searched the Medline and Web of Science databases for reports published before May 2021. We included papers assessing adult patients with HCC considered for LT and reporting intention-to-treat (ITT) survival outcomes. Two reviewers independently identified and extracted the data and evaluated the papers. Outcomes analysed were drop-out rate; time on the waiting list; and 1, 3 and 5 year survival after LT and based on an ITT analysis. Results: The literature search yielded 3,106 records, of which 11 papers (1874 patients) met the inclusion criteria. Patients with HCC beyond the listing criteria and successfully downstaged presented a higher drop-out rate (OR 2.05, 95% CI 1.45–2.88, p < 0.001) and a longer time from the initial assessment to LT than those with HCC within the listing criteria (MD 1.93, 95% CI 0.91–2.94, p < 0.001). The 1, 3 and 5 year survival post-LT and based on an ITT analysis did not show significant differences between the two groups. Patients with HCC beyond the listing criteria, successfully downstaged and then transplanted, presented longer 3 year (OR 3.77, 95% CI 1.26–11.32, p = 0.02) and 5 year overall survival (OS) (OR 3.08, 95% CI 1.15–8.23, p = 0.02) in comparison with those that were not submitted to LT. Conclusions: Patients with HCC beyond the listing criteria undergoing downstaging presented a higher drop-out rate in comparison with those with HCC within the listing criteria. However, the two groups did not present significant differences in 1, 3 and 5 year survival rates based on an ITT analysis. Patients with HCC beyond the listing, when successfully downstaged and transplanted, presented longer 3 and 5-year OS in comparison with those who were not transplanted. Full article
(This article belongs to the Special Issue An Update on Surgical Treatment for Hepato-Pancreato-Biliary Cancers)
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