Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience

Science China Life Sciences, Sep 2016

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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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. - 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). (...truncated)


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Binhao Zhang, Wei Dong, Hongping Luo, Xuanru Zhu, Lin Chen, Changhai Li, Peng Zhu, Wei Zhang, Shuai Xiang, Wanguang Zhang, Zhiyong Huang, Xiao-Ping Chen. Surgical treatment of hepato-pancreato-biliary disease in China: the Tongji experience, Science China Life Sciences, 2016, pp. 995-1005, Volume 59, Issue 10, DOI: 10.1007/s11427-016-5104-8