Hepatobiliary Pancreat Dis Int

	2024 Vol. 23 No. 5
	Published: 2024-10-15


	Pages 441-550
	REVIEW ARTICLES ORIGINAL ARTICLES/Transplantation ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas CLINICAL IMAGE LETTERS TO THE EDITOR VIEWPOINTS

REVIEW ARTICLES

	441	Iesari S, Nava FL, Zais IE, Coubeau L, Ferraresso M, Favi E, Lerut J
		Advancing immunosuppression in liver transplantation: A narrative review ^Hot!
		Immunosuppression is essential to ensure recipient and graft survivals after liver transplantation (LT). However, our understanding and management of the immune system remain suboptimal. Current immunosuppressive therapy cannot selectively inhibit the graft-specific immune response and entails a significant risk of serious side effects, i.e., among others, de novo cancers, infections, cardiovascular events, renal failure, metabolic syndrome, and late graft fibrosis, with progressive loss of graft function. Pharmacological research, aimed to develop alternative immunosuppressive agents in LT, is behind other solid- organ transplantation subspecialties, and, therefore, the development of new compounds and strategies should get priority in LT. The research trajectories cover mechanisms to induce T-cell exhaustion, to in- hibit co-stimulation, to mitigate non-antigen-specific inflammatory response, and, lastly, to minimize the development and action of donor-specific antibodies. Moreover, while cellular modulation techniques are complex, active research is underway to foster the action of T-regulatory cells, to induce tolerogenic den- dritic cells, and to promote the function of B-regulatory cells. We herein discuss current lines of research in clinical immunosuppression, particularly focusing on possible applications in the LT setting.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 441-448 . [Abstract] ( 116 ) [HTML 1KB] [PDF 0KB] ( 94 )

	449	Duan P, Sun L, Kou K, Li XR, Zhang P
		Surgical techniques to prevent delayed gastric emptying after pancreaticoduodenectomy ^Hot!
		Background: Delayed gastric emptying (DGE) is one of the most common complications after pancreatico- duodenectomy (PD). DGE represents impaired gastric motility without significant mechanical obstruction and is associated with an increased length of hospital stay, increased healthcare costs, and a high read- mission rate. We reviewed published studies on various technical modifications to reduce the incidence of DGE. Data sources: Studies were identified by searching PubMed for relevant articles published up to December 2022. The following search terms were used: “pancreaticoduodenectomy”, “pancreaticojejunos- tomy”,“pancreaticogastrostomy”, “gastric emptying”, “gastroparesis” and “postoperative complications”. The search was limited to English publications. Additional articles were identified by a manual search of references from key articles. Results: In recent years, various surgical procedures and techniques have been explored to reduce the incidence of DGE. Pyloric resection, Billroth II reconstruction, Braun’s enteroenterostomy, and antecolic reconstruction may be associated with a decreased incidence of DGE, but more high-powered studies are needed in the future. Neither laparoscopic nor robotic surgery has demonstrated superiority in preventing DGE, and the use of staplers is controversial regarding whether they can reduce the incidence of DGE. Conclusions: Despite many innovations in surgical techniques, there is no surgical procedure that is su- perior to others to reduce DGE. Further larger prospective randomized studies are needed.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 449-457 . [Abstract] ( 155 ) [HTML 1KB] [PDF 0KB] ( 75 )

	458	Tian Y, Huang Q, Ren YT, Jiang X, Jiang B
		Visceral adipose tissue predicts severity and prognosis of acute pancreatitis in obese patients
		Acute pancreatitis is a common systemic inflammatory disease, manifested by a spectrum of severity, ranging from mild in the majority of patients to severe acute pancreatitis. Patients with severe acute pancreatitis suffer from severe local and systemic complications and organ failure, leading to a poor prognosis. The early recognition of the severe condition is important to improve prognosis. Obesity has risen in tandem with an increase in the severity of acute pancreatitis in recent years. Studies have revealed that adipose tissue, particularly visceral adipose tissue is associated with the prognosis of acute pancreatitis. This review discussed the role of visceral adipose tissue in obese patients with acute pancreatitis and explored the possible mechanism involved.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 458-462 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 65 )

ORIGINAL ARTICLES/Transplantation

	463	Nie Y, Huang JB, He SJ, Chen HD, Jia JJ, Li JJ, He XS, Zhao Q
		Validation and performance of three scoring systems for predicting primary non-function and early allograft failure after liver transplantation ^Hot!
		Background: Primary non-function (PNF) and early allograft failure (EAF) after liver transplantation (LT) seriously affect patient outcomes. In clinical practice, effective prognostic tools for early identifying recip- ients at high risk of PNF and EAF were urgently needed. Recently, the Model for Early Allograft Function (MEAF), PNF score by King’s College (King-PNF) and Balance-and-Risk-Lactate (BAR-Lac) score were developed to assess the risks of PNF and EAF. This study aimed to externally validate and compare the prognostic performance of these three scores for predicting PNF and EAF. Methods: A retrospective study included 720 patients with primary LT between January 2015 and December 2020. MEAF, King-PNF and BAR-Lac scores were compared using receiver operating characteristic (ROC) and the net reclassification improvement (NRI) and integrated discrimination improvement (IDI) analyses. Results: Of all 720 patients, 28 (3.9%) developed PNF and 67 (9.3%) developed EAF in 3 months. The overall early allograft dysfunction (EAD) rate was 39.0%. The 3-month patient mortality was 8.6% while 1-year graft-failure-free survival was 89.2%. The median MEAF, King-PNF and BAR-Lac scores were 5.0 (3.5–6.3), -2.1 (-2.6 to -1.2), and 5.0 (2.0–11.0), respectively. For predicting PNF, MEAF and King-PNF scores had excellent area under curves (AUCs) of 0.872 and 0.891, superior to BAR-Lac (AUC = 0.830). The NRI and IDI analyses confirmed that King-PNF score had the best performance in predicting PNF while MEAF served as a better predictor of EAD. The EAF risk curve and 1-year graft-failure-free survival curve showed that King-PNF was superior to MEAF and BAR-Lac scores for stratifying the risk of EAF. Conclusions: MEAF, King-PNF and BAR-Lac were validated as practical and effective risk assessment tools of PNF. King-PNF score outperformed MEAF and BAR-Lac in predicting PNF and EAF within 6 months. BAR-Lac score had a huge advantage in the prediction for PNF without post-transplant variables. Proper use of these scores will help early identify PNF, standardize grading of EAF and reasonably select clinical endpoints in relative studies.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 463-471 . [Abstract] ( 143 ) [HTML 1KB] [PDF 0KB] ( 71 )

	472	Li JY, Feng TS, Gao J, Yang XX, Li XC, Deng ZH, Xia YX, Wu ZS
		Differentiation and immunosuppressive function of CD19+CD24hiCD27+ regulatory B cells are regulated through the miR-29a-3p/NFAT5 pathway
		Background: Regulatory B cells (Bregs) is an indispensable element in inducing immune tolerance after liver transplantation. As one of the microRNAs (miRNAs), miR-29a-3p also inhibits translation by degrad- ing the target mRNA, and yet the relationship between Bregs and miR-29a-3p has not yet been fully explored. This study aimed to investigate the impact of miR-29a-3p on the regulation of differentiation and immunosuppressive functions of memory Bregs (mBregs) and ultimately provide potentially effective therapies in inducing immune tolerance after liver transplantation. Methods: Flow cytometry was employed to determine the levels of Bregs in peripheral blood mononuclear cells. TaqMan low-density array miRNA assays were used to identify the expression of different miRNAs, electroporation transfection was used to induce miR-29a-3p overexpression and knockdown, and dual luciferase reporter assay was used to verify the target gene of miR-29a-3p. Results: In patients experiencing acute rejection after liver transplantation, the proportions and immunosuppressive function of mBregs in the circulating blood were significantly impaired. miR-29a-3p was found to be a regulator of mBregs differentiation. Inhibition of miR-29a-3p, which targeted nuclear factor of activated T cells 5 (NFAT5), resulted in a conspicuous boost in the differentiation and immuno- suppressive function of mBregs. The inhibition of miR-29a-3p in CD19+ B cells was capable of raising the expression levels of NFAT5, thereby promoting B cells to differentiate into mBregs. In addition, the observed enhancement of differentiation and immunosuppressive function of mBregs upon miR-29a-3p inhibition was abolished by the knockdown of NFAT5 in B cells. Conclusions: miR-29a-3p was found to be a crucial regulator for mBregs differentiation and immunosuppressive function. Silencing miR-29a-3p could be a potentially effective therapeutic strategy for inducing immune tolerance after liver transplantation.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 472-480 . [Abstract] ( 112 ) [HTML 1KB] [PDF 0KB] ( 68 )

ORIGINAL ARTICLES/Liver

	481	Huang X, Lu Q, Zhang YW, Zhang L, Ren ZZ, Yang XW, Liu Y, Tang R
		Intrahepatic portal venous systems in adult patients with cavernous transformation of portal vein: Imaging features and a new classification
		Background: Cavernous transformation of the portal vein (CTPV) due to portal vein obstruction is a rare vascular anomaly defined as the formation of multiple collateral vessels in the hepatic hilum. This study aimed to investigate the imaging features of intrahepatic portal vein in adult patients with CTPV and establish the relationship between the manifestations of intrahepatic portal vein and the progression of CTPV. Methods: We retrospectively analyzed 14 CTPV patients in Beijing Tsinghua Changgung Hospital. All patients underwent both direct portal venography (DPV) and computed tomography angiography (CTA) to reveal the manifestations of the portal venous system. The vessels measured included the left portal vein (LPV), right portal vein (RPV), main portal vein (MPV) and the portal vein bifurcation (PVB). Results: Nine males and 5 females, with a median age of 40.5 years, were included in the study. No significant difference was found in the diameters of the LPV or RPV measured by DPV and CTA. The visualization in terms of LPV, RPV and PVB measured by DPV was higher than that by CTA. There was a significant association between LPV/RPV and PVB/MPV in term of visibility revealed with DPV (P = 0.01), while this association was not observed with CTA. According to the imaging features of the portal vein measured by DPV, CTPV was classified into three categories to facilitate the diagnosis and treatment. Conclusions: DPV was more accurate than CTA for revealing the course of the intrahepatic portal vein in patients with CTPV. The classification of CTPV, that originated from the imaging features of the portal vein revealed by DPV, may provide a new perspective for the diagnosis and treatment of CTPV.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 481-486 . [Abstract] ( 102 ) [HTML 1KB] [PDF 0KB] ( 61 )

ORIGINAL ARTICLES/Biliary

	487	Acehan F, Camli H, Kalkan C, Tez M, Demir BF, Altiparmak E, Ates I
		Red cell distribution width-to-albumin ratio is a simple promising prognostic marker in acute cholangitis requiring biliary drainage ^Hot!
		Background: It is crucial to assess the severity of acute cholangitis (AC). There are currently several prognostic markers. However, the accuracies of these markers are not satisfied. The present study aimed to investigate the predictive value of the red cell distribution width (RDW)-to-albumin ratio (RAR) for the prognosis of AC. Methods: We retrospectively evaluated consecutive patients diagnosed with AC between May 2019 and March 2022. RAR was calculated, and its predictive ability for in-hospital mortality, intensive care unit (ICU) admission, bacteremia, and the length of hospitalization were analyzed. Results: Out of 438 patients, 34 (7.8%) died. Multivariate analysis showed that malignant etiology [odds ratio (OR) = 4.816, 95% confidence interval (CI): 1.936-11.980], creatinine (OR = 1.649, 95% CI: 1.095- 2.484), and RAR (OR = 2.064, 95% CI: 1.494-2.851) were independent risk factors for mortality. When ad- justed for relevant covariates, including age, sex, malignant etiology, Tokyo severity grading (TSG), Charlson comorbidity index, and creatinine, RAR significantly predicted mortality (adjusted OR = 1.833, 95% CI: 1.280-2.624). When the cut-offof RAR was set to 3.8, its sensitivity and specificity for mortality were 94.1% and 56.7%, respectively. Patients with an RAR of > 3.8 had a 20.9-fold (OR = 20.9, 95% CI: 4.9-88.6) greater risk of mortality than the remaining patients. The area under the curve value of RAR for mortality was 0.835 (95% CI: 0.770-0.901), which was significantly higher than that of TSG and the other prognostic markers, such as C-reactive protein-to-albumin ratio, and procalcitonin-to-albumin ratio. Lastly, RAR was not inferior to TSG in predicting ICU admission, bacteremia, and the length of hospitalization. Conclusions: RAR successfully predicted the in-hospital mortality, ICU admission, bacteremia, and the length of hospitalization of patients with AC, especially in-hospital mortality. RAR is a promising marker that is more convenient than TSG and other prognostic markers for predicting the prognosis of patients with AC.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 487-494 . [Abstract] ( 170 ) [HTML 1KB] [PDF 0KB] ( 79 )

	495	Jia JJ, Cheng YF, Feng MB, Liu L, Shuai MQ, Shen XD, Tang XF, Zheng SS
		Diagnosis and treatment of biliary mucinous cystic neoplasms: A single-center experience
		Background: Biliary mucinous cystic neoplasms (BMCNs) are rare hepatobiliary cystic tumors, which can be divided into noninvasive and invasive types. This study aimed to investigate the diagnosis, treatment, and prognosis of BMCNs in a large single center. Methods: We analyzed 49 patients with BMCNs confirmed by postoperative pathology at the First Affili- ated Hospital, Zhejiang University School of Medicine between January 2007 and December 2021. Results: Among the 49 patients, 37 were female (75.5%), and the average age was 57.04 years. Common symptoms included abdominal discomfort, jaundice and fever, while 22 patients (44.9%) had no symptoms. Serum carbohydrate antigen (CA) 19-9 and CA125 concentrations were elevated in 34.8% and 19.6% of patients, respectively. Forty-eight patients had tumors in the intrahepatic bile ducts and only one had a tumor in the extrahepatic bile duct. Forty-eight patients with noninvasive intrahepatic BMCNs were further analyzed in terms of pathological features: 34 (70.8%) had low-grade intraepithelial neoplasms (LGINs), and 14 (29.2%) had high-grade intraepithelial neoplasms (HGINs). The potential immunohisto- chemical markers of BMCNs were cytokeratin (CK) 19, CK7, estrogen receptor and progesterone receptor. Follow-up data for 37 patients with intrahepatic BMCNs were obtained. The median overall survival (OS) of BMCNs was not reached. The longest survival time was 137 months.The 5- and 10-year OS rates were 100% and 85.4%, respectively. The 5- and 10-year recurrence-free survival (RFS) rates were 93.9% and 80.2%, respectively. Conclusions: BMCNs are rare cystic neoplasms that commonly occur in middle-aged females. BMCNs can only be diagnosed and classified by postoperative pathology, as there are no specific clinical presentations, serological indicators or imaging modalities for preoperative diagnosis. Complete surgical resection is necessary for BMCNs, and the postoperative prognosis is favorable.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 495-501 . [Abstract] ( 132 ) [HTML 1KB] [PDF 0KB] ( 99 )

ORIGINAL ARTICLES/Pancreas

	502	Villasenor-Echavarri R, Melchor-Ruan J, Aranda-Audelo M, Arredondo-Saldana G, Volkow-Fernandez P, Manzano-Robleda MDC, Padilla-Rosciano AE, Vilar-Compte D
		Surgical site infection following pancreaticoduodenectomy in a referral cancer center in Mexico
		Background: Pancreaticoduodenectomy is the standard treatment for resectable periampullary cancer. Surgical site infections (SSI) are common complications with increased morbidity. The study aimed to describe the prevalence, risk factors, microbiology, and outcomes of SSI among patients undergoing pancreaticoduodenectomy. Methods: We conducted a retrospective study in a referral cancer center between January 2015 and June 2021. We analyzed baseline patient characteristics and SSI occurrence. Culture results and susceptibility patterns were described. Multivariate logistic regression was used to determine risk factors, proportional hazards model to evaluate mortality, and Kaplan-Meier analysis to assess long-term survival. Results: A total of 219 patients were enrolled in the study; 101 (46%) developed SSI. Independent factors for SSI were diabetes mellitus, preoperative albumin level, biliary drainage, biliary prostheses, and clinically relevant postoperative pancreatic fistula. The main pathogens were Enterobacteria and Enterococci. Multidrug-resistance rate in SSI was high but not associated with increased mortality. Infected patients had higher odds of sepsis, longer hospital stay and intensive care unit stay, and readmission rate. Neither 30-day mortality nor long-term survival was significantly different between infected and non-infected patients. Conclusions: SSI prevalence among patients undergoing pancreaticoduodenectomy was high and largely caused by resistant microorganisms. Most risk factors were related to preoperative instrumentation of the biliary tree. SSI was associated with greater risk of unfavorable outcomes; however, survival was unaffected.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 502-508 . [Abstract] ( 108 ) [HTML 1KB] [PDF 0KB] ( 129 )

	509	Garcrs-Duran R, Monino L, Deprez PH, Piessevaux H, Moreels TG
		Endoscopic treatment of biliopancreatic pathology in patients with Whipple’s pancreaticoduodenectomy surgical variants: Lessons learned from single-balloon enteroscopy-assisted ERCP
		Background: Endoscopic treatment of biliopancreatic pathology is challenging due to surgically altered anatomy after Whipple’s pancreaticoduodenectomy. This study aimed to evaluate the feasibility and safety of single-balloon enteroscopy-assisted endoscopic retrograde cholangiopancreatography (SBE-ERCP) to treat biliopancreatic pathology in patients with Whipple’s pancreaticoduodenectomy surgical variants. Methods: We retrospectively analyzed 106 SBE-ERCP procedures in 46 patients with Whipple’s variants. Technical and clinical success rates and adverse events were evaluated. Results: Biliary SBE-ERCP was performed in 34 patients and pancreatic SBE-ERCP in 17, including 5 with both indications. From a total of 106 SBE-ERCP procedures, 76 were biliary indication with technical suc- cess rate of 68/76 (90%) procedures and clinical success rate of 30/34 (88%) patients. Mild adverse event rate was 8/76 (11%), without serious adverse events. From a total of 106 SBE-ERCP procedures, 30 were pancreatic indication with technical success rate of 24/30 (80%) procedures ( P = 0.194 vs. biliary SBE- ERCP) and clinical success rate of 11/17 (65%) patients ( P = 0.016 vs. biliary SBE-ERCP). Mild adverse event rate was 6/30 (20%) ( P = 0.194 vs. biliary SBE-ERCP), without serious adverse events. After SBE-ERCP failure, endoscopic ultrasound-guided drainage, percutaneous drainage and redo surgery were alternative therapeutic options. Conclusions: Biliopancreatic pathology after Whipple’s pancreaticoduodenectomy variants can be treated using SBE-ERCP without serious adverse events. Technical and clinical success rates are high for biliary indications, whereas clinical success rate of pancreatic indications is significantly lower. SBE-ERCP can be considered as first-line treatment option in this patient group with surgically altered anatomy.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 509-514 . [Abstract] ( 103 ) [HTML 1KB] [PDF 0KB] ( 67 )

VIEWPOINTS

	515	Yang WG, Peng YF, Yang YB, Li B, Wei YG, Liu F
		Timing of hepatectomy following the Omicron variant infection for vaccinated-patients: A retrospective cohort study
		Many previous studies suggested that severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]. Uncertainty about perioperative safety puts off the progress of elective surgery [8]. The Omicron variant has recently become the dominant variant causing prevalence in several countries [9]. Although a high rate of patients with Omicron presented asymptomatic status [10], it is still unclear whether Omicron infection would raise the risk of postoperative complications.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 515-520 . [Abstract] ( 121 ) [HTML 1KB] [PDF 0KB] ( 74 )

	521	Tao FZ, Jiang RL, Jin SF
		Implementation of gastrointestinal function protection in severe acute pancreatitis
		Severe acute pancreatitis (SAP) is a serious systemic disease associated with strong local inflammatory reactions and serious systemic pathophysiological disorders caused by trypsin spillover. Patients with SAP are prone to exhibit gastrointestinal dysfunction. Meanwhile, gastrointestinal dysfunction further aggravates the systemic inflammatory response and metabolic abnormalities, resulting in a more critical condition of SAP. Gastrointestinal dysfunction is considered to be the “trigger” of multiple organ dysfunction syndrome [1]. Thus, it is important to maintain gastrointestinal homeostasis in the treatment of SAP.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 521-522 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 67 )

CLINICAL IMAGE

	523	Chen YX, Deng ZH, Zhao H, Zhou BY, Guo JJ, Zeng G, Qian JX
		Bronchobiliary fistula in a patient with liver cancer
		Bronchobiliary fistula (BBF) is a pathologic channel between the biliary tract and bronchial tree. In general, congenital BBF is relatively rare in adult patients. There are a few case reports suggesting that BBF is mainly secondary to hepatobiliary diseases, such as biliary obstruction, tumor, surgery, or liver abscess, and liver tumor is the predominant causative factor [1]. In addition, with the increasing number of liver and biliary surgeries and interventional therapies in recent years, more cases of BBF were reported as a postoperative complication [2,3]. In this case, we presented a patient who underwent interventional treatment for liver tumor and was treated for his respiratory symptoms but diagnosed with BBF finally. Here, we summarized the clinical features and main diagnostic procedures of the case, aiming to provide evidence for early identification and diagnosis of BBF.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 523-525 . [Abstract] ( 93 ) [HTML 1KB] [PDF 0KB] ( 60 )

	526	Fancellu A, Maiore M, Grasso L, Ferrara M, Porcu A
		Retroaortic left renal vein associated to variations of liver vasculature and biliary system in a patient submitted to total pancreatectomy
		Total pancreatectomy (TP) is a surgical procedure which includes the complete removal of the pancreatic gland, the spleen, the duodenum, the gallbladder, and the distal part of the stomach. TP represents the curative treatment of pancreatic cancer which simultaneously involves the head and the body/tail of the pancreas. Other possible indications for TP comprise multifocal parenchymal diseases, such as intraductal papillary mucinous neoplasms, pancreatic neuroendocrine tumors, multiple endocrine neoplasms, and chronic pancreatitis. Sometimes, TP is carried out in patients scheduled for pancreaticoduodenectomy (where only the head of the pancreas is removed) when a cancer located in the pancreatic head is intraoperatively found to also extend to the pancreatic body [1].
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 526-529 . [Abstract] ( 98 ) [HTML 1KB] [PDF 0KB] ( 66 )

LETTERS TO THE EDITOR

	530	Alhaskawi A, Dong YZ, Zou XD, Hasan Abdullah Ezzi S, Wang ZW, Zhou HY, Abdalbary SA, Lu H
		Advanced hepatocellular carcinoma in a patient with neurofibromatosis type 1 and malignant peripheral nerve sheath tumor
		Neurofibromatosis type 1 (NF-1), or Von Recklinghausen disease, is a genetic disorder inherited in an autosomal dominant pattern. It is caused by a mutation in the neurofibromin gene located on chromosome 17, accounting for 96% of all neurofibromatosis cases. This condition can affect multiple systems and often leads to the formation of tumors along the nervous system [1]. Patients with NF-1 may exhibit various symptoms, including Lisch nodules, neurofibromas, scoliosis, café au lait spots, learning disabilities, vision disorders, and epilepsy. There is also an increased risk of malignancy, 5%-15% of individuals with NF-1 developing tumors, most commonly connective tissue and brain tumors [2]. Malignant peripheral nerve sheath tumor (MPNST) is a rare cancer that affects the connective tissue surrounding nerves. Several cases have a history of NF-1 due to the shared mutation on chromosome 17 [3,4]. Recent studies [5,6] suggest that the link between HCC and NF-1 may be attributed to the neurofibromin gene, which negatively regulates the Ras signaling pathway. When this gene is mutated, there is excessive activation of Ras, leading to abnormal guanosine triphosphatase (GTPase) activity which is associated with hepatocarcinogenesis. Here we reported a patient with NF-1 who presented with both MPNST and HCC, providing valuable insight into the rare co-occurrence of these conditions in one individual
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 530-532 . [Abstract] ( 119 ) [HTML 1KB] [PDF 0KB] ( 63 )

	533	Ho KKY, Sin SL, Au KP, Lee HHY, Chan DTL, Chan A
		Inferior vena cava reconstruction in extended right hepatectomy
		Barcelona Clinic Liver Cancer (BCLC) Stage C hepatocellular carcinoma (HCC) with vascular invasion has been considered unresectable. However, the curative rate from systemic treatment is rather dismal. Even with the use of immunotherapy, complete remission is less than 10% [1]. On the contrary, recent advances in transplant oncology, especially in the application of liver transplant-related surgical techniques in complex liver resections, make the operation possible for patients with locally advanced HCC who were previously considered to be unresectable [2]. We hereby present the surgical management of a patient with giant HCC in right liver lobe with inferior vena cava (IVC) invasion.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 533-534 . [Abstract] ( 97 ) [HTML 1KB] [PDF 0KB] ( 76 )

	535	Shao LF, Shen XM, Yu W
		Fat necrosis of liver in a patient with mixed type liver cirrhosis
		Fatty liver diseases, including nonalcoholic fatty liver disease and alcohol related fatty liver disease, have become a major public health concern [1,2]. Fatty liver diseases have been shown to progress through various stages, from steatosis or necrosis with inflammation and hepatocyte damage to the development of fibrosis and eventual cirrhosis with an increased risk of carcinoma [2,3]. Fat necrosis is a type of benign, non-suppurative inflammation of adipose tissue [4–6]. To date, however, there have been few reports on clinical manifestations of fat necrosis in the liver. The present study describes a very rare case of liver fat necrosis in a patient with mixed type liver cirrhosis.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 535-537 . [Abstract] ( 100 ) [HTML 1KB] [PDF 0KB] ( 69 )

	538	Li W, Lin W, Xiao L
		A rare case of hepatic vein-portal vein fistula with hepatolithiasis presenting as cholangiocarcinoma
		We sincerely applaud the work by Tang et al., in which they described caudate lobe-sparing subtotal hepatectomy as treatment for intrahepatic arterioportal fistulas [1]. Compared to intrahepatic arterioportal fistulas, portal vein-hepatic vein fistulas are rarely reported. Patients typically lack clinical symptoms such as hyperammonemia, cholestatic jaundice, and hypoglycemia, unless the shunt becomes relatively large [2,3]. Herein, we describe partial hepatectomy as a treatment for cases of left portal vein-middle hepatic vein fistulas.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 538-540 . [Abstract] ( 108 ) [HTML 1KB] [PDF 0KB] ( 68 )

	541	Wan DL, Tong RL, Tong XY, Hu C, Ke QH, Yang X, Wu J
		Laparoscopic enucleation for pancreatic lipomatous hamartoma
		Pancreatic hamartoma is an extremely rare and benign disease and accounts for less than 1% of all pancreatic tumors [1] . Pancreatic lipomatous hamartoma (PLH), a distinct variant of pancreatic hamartoma, is always easily misdiagnosed as other pancreatic tumors with lipomatous components, including pancreatic lipoma, liposarcoma, teratoma and malignant tumors with fatty degeneration. Here, we report a case of laparoscopic enucleation for the pancreatic head lipomatous hamartoma and provide new treatment strategies for surgeons who encounter similar diseases in the future.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 541-544 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 154 )

	545	Xu JR, Wu XN, Si YQ, Yang JP, Liu XS
		Pancreatic cancer with gastrointestinal obstruction as an initial symptom
		Pancreatic cancer is the fourth leading cause of cancer mortality in the United States [1,2]. Risk factors of pancreatic cancer include smoking, family history of chronic pancreatitis, advanced age, male, diabetes mellitus, and obesity [1] . Most of patients have no obvious symptoms in the early stage, and are often diagnosed in the late stage and accompanied by invasion of surrounding tissues and distant metastasis, such as local lymph nodes, liver, lung and peritoneum [ 1 , 3 ]. Therefore, the prognosis is poor. The first manifestations of pancreatic cancer are mainly abdominal pain, weight loss, and upper abdominal mass [1] . Currently, the screening measures for pancreatic cancer usually include preoperative carbohydrate antigen 19-9 (CA19-9), ultrasound and computed tomography (CT). And the diagnosis depends on cytological diagnosis which is made with endoscopic ultrasound or CT-guided fine needle aspiration. These methods still have many shortcomings, such as low efficiency, poor specificity and small coverage. Pancreatic cancer with upper and lower digestive tract obstruction as the first manifestation is rare. We herein reported two patients, one of them was initially diagnosed with adenocarcinoma by duodenal biopsy and the other with adenocarcinoma by colon biopsy, and both were later diagnosed with pancreatic cancer. The treatments of pancreatic cancer include chemotherapy, radiation, and surgery, but they have a low success rate.
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 545-547 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 79 )

	548	Pacilio CA, Cucchetti A, Ercolani G
		Local recurrence rate as quality indicator in surgery for pancreatic cancer?
		As we all know, even with the current advancements regarding novel chemotherapy regimens, patients affected by pancreatic cancer (PC) have an extremely dismal prognosis (5-year survival rate 12% for all stages in the National Cancer Institute SEER database). Among the patients undergoing surgical treatment, the prognosis is mostly affected by recurrence. PC after surgery has mainly four patterns of recurrence, isolated or variously associated with each other: local, lymph nodal, peritoneal or distant (liver, lung, other sites). While distant recurrence can be reasonable mainly attributed to biological aggressiveness of the disease, the same statement is more debatable for the other types of recurrence, involving a possible role for surgical practice (Fig. 1). Regarding peritoneal recurrence, the role of surgery can be partially ruled out by performing peritoneal cytology lavage before any manipulation, in order to highlight if any occult peritoneal dissemination was present at the moment of surgery. Lymph nodal recurrence should not be attributed to surgery if we perform standard lymphadenectomy recommended in 2014 by the International Study Group on Pancreatic Surgery [1] . We guess that local recurrence for any oncologic surgeon of any site of digestive tract (or even human body) is something troublesome to accept. In a systematic review published by Kalisvaart et al. in 2020 [2] , local recurrence after pancreaticoduodenectomy (PD) for PC is reported to be as high as 28% (range 1%−28%) when it was the only site of recurrence and raises to 52% (range 1%−52%) when associated with other sites of recurrence. Regarding PC of the bodytail, a secondary analysis of the ESPAC-4 trial reported a local only recurrence rate of 20%, raised to 25% when associated to distant recurrence [3].
		Hepatobiliary Pancreat Dis Int. 2024; 23(5): 548-550 . [Abstract] ( 105 ) [HTML 1KB] [PDF 0KB] ( 111 )

Forgot your password?

Enter your e-mail address to receive an e-mail with your account information.

Submission Guidance

Top cited articles

- Most Cited Hepatobiliary & Pancreatic Diseases International Articles

- Most Downloaded Hepatobiliary & Pancreatic Diseases International Articles

more>>

Top downloaded articles

more>>

Services

Web feed

hbpdint@126.com

hbpdje@zju.edu.cn

Copyright © Official Publication of First Affiliated Hospital
Official Publication of First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
浙ICP备05050873号-1