Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience
October
Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience
Binhao Zhang 0
Wei Dong 0
Hongping Luo 0
Xuanru Zhu 0
Lin Chen 0
Changhai Li 0
Peng Zhu 0
Wei Zhang 0
Shuai Xiang 0
Wanguang Zhang 0
Zhiyong Huang 0
Xiao-Ping Chen 0
0 Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology; Hubei Province for the Clinical Medicine Research Center of Hepatic Surgery; Key Laboratory of Organ Transplantation, Ministry of Education and Ministry of Public Health; Wuhan 430030 , China
Hepato-pancreato-biliary (HPB) tumors are common in China. However, these tumors are often diagnosed at intermediate/advanced stages because of the lack of a systemic surveillance program in China. This situation creates many technical challenges for surgeons and increases the incidence of postoperative complications. Therefore, Dr. Xiao-Ping Chen has made many important technical improvements, such as Chen's hepatic portal occlusion method, the anterior approach for liver resection of large HCC tumors, the modified technique of Belghiti's liver-hanging maneuver, inserting biliary-enteric anastomosis technique, and invaginated pancreaticojujunostomy with transpancreatic U-sutures. These techniques are simple, practical, and easy to learn. Owing to these advantages, complicated surgical procedures can be simplified, and the curative effects are greatly improved. These improved techniques have been widely applied in China and will benefit many additional patients. In this review, we introduce our experience of surgically treating intermediate/advanced hepatocellular carcinoma (HCC), hilar cholangiocarcinoma (HC), and pancreatic carcinoma, mainly focusing on technical innovations established by Dr. Chen in HPB surgery.
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Citation:
INTRODUCTION
Hepato-pancreato-biliary (HPB) tumors are very common
diseases in China. These tumors are usually aggressive and
have poor prognosis. Surgery is the only potential curative
therapy for these malignancies. The most common form of
tumor in the liver is hepatocellular carcinoma (HCC), which
commonly results from hepatitis B virus infection and is
prone to be diagnosed at intermediate/advanced stages
owing to the lack of a systemic surveillance program in China.
Intermediate/advanced HCC, particularly a huge HCC
tumor, creates many technical challenges for surgeons. Hilar
cholangiocarcinoma and pancreatic head carcinoma are
extremely malignant tumors, which usually cause obstruction
of the bile duct, leading to deterioration in the patient’s
general condition. Surgery is technically challenging for
these tumors. Therefore, technical innovations for surgical
treatment of these malignant tumors are urgently needed to
improve the operative safety and long-term outcomes of
these diseases in China.
A recent national survey in China (unpublished data,
research code 201043901), involving 75 hospitals and 30,536
patients with HCC, found that 43.1% of patients had a
tu© The Author(s) 2016. This article is published with open access at link.springer.com
mor larger than 5 cm and 22.5% had a tumor larger than
10 cm in diameter at their first visit to a doctor. About
one-third of patients with a large HCC tumor displayed
portal hypertension or invasion of the portal vein by the
tumor. In such cases, nonsurgical treatment, such as
transcatheter arterial chemoembolization (TACE) and/or
systemic treatment, results in poor long-term survival rates.
However, studies have shown that liver resection improves
the long-term survival of patients with large HCC tumors or
intermediate/advanced HCC. Over the past few decades,
liver resection for HCC has evolved to become safe, with a
low operative mortality rate, and at the Hepatic Surgery
Center of Tongji Hospital, liver resection is routinely
recommended to patients with large HCC tumors, irrespective
of the size of the tumor or the presence of portal
hypertension or portal vein tumor thrombosis (PVTT). Patients who
undergo surgery show significant improvements in their
long-term survival rate compared with patients who receive
non-surgical treatment.
Malignancies at the hepatic hilus and the head of the
pancreas have poor prognoses. Surgery is the only possible
curative treatment that may prolong survival. However, the
rate of postoperative complications is very high. Bile duct
or pancreas reconstruction with intestine is the major
intraoperative difficulty as well as the main reason for
postoperative complications, including bleeding, infection, liver
failure, bile leakage, and pancreatic fistula. Chen
recommends minor hepatic resection and applies an inserting
biliary-enteric anastomosis technique for HC. The long-term
survival was comparable, while postoperative complications
were significantly reduced. For pancreatic cancer, we used
Chen’s invaginated pancreaticojejunostomy with
transpancreatic U-sutures, a simple technique that reduced
postoperative pancreatic fistula (POPF).
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