Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)
The Korean Association of Hepato-Biliary-Pancreatic Surgery (Korean H)
- Quarterly
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- 2508-5778(pISSN)
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- 2508-5859(eISSN)
Aim & Scope
Annals of Hepato-Biliary-Pancreatic Surgery (Ann Hepatobiliary Pancreat Surg, AHBPS), the official publication of The Korean Association of Hepato-Biliary-Pancreatic Surgery, The Korean Pancreas Surgery Club, The Korean Association of Liver Surgery, and Korean Study Group on Minimal Invasive Pancreatic Surgery, is an international, peer-reviewed open access journal. This journal publishes original basic and clinical research on diseases of the liver, biliary system and pancreas. The aim of this journal is to make contribution to saving lives of patients with hepatobiliary pancreatic diseases through active communication and exchange of study information on hepatobiliary pancreatic diseases and provision of education and training on the diseases.
KSCI KCI SCOPUSVolume 12 Issue 3
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Nam, Kyung-Hee;Hwang, Yoon-Jin;Cheon, Jae-Min;Kim, Sang-Geol;Yeun, Young-Guk 156
Purpose: Concomitant splenectomy in cirrhotic patients is known to ameliorate the tendency to bleed and it decreases the portal venous pressure (PVP). However, the direct measurement of the change in the PVP after concomitant splenectomy has not yet been reported. We tried to measure the change of the PVP before and after splenectomy. Methods: From March 2000 to May 2006, 18 patients underwent anatomical liver resection with concomitant splenectomy. All the patients had liver cirrhosis, thrombocytopenia and/or esophageal varix. Through the 5 French feeding tube, which was inserted into the right gastroepiploic vein after laparotomy, we directly measured the PVP before and after splenectomy, and also under portal triad clamping (PTC). Results: After splenectomy, the PVP decreased significantly from$261.11{\pm}45.87$ mm$H_{2}O$ to$221.11{\pm}38.48$ mm$H_{2}O$ (p<0.05). Under PTC, the PVP decreased significantly from$605.00{\pm}116.48$ mm$H_{2}O$ to$513.89{\pm}70.56$ mm$H_{2}O$ (p<0.05). Conclusion: Concomitant splenectomy in patients with liver cirrhosis resulted in a significant reduction of the PVP. -
Kim, Bong-Wan;Bae, Byong-Ku;Park, Yong-Keun;Won, Jae-Hwan;Bae, Jae-Ik;Xu, Wei-Guang;Wang, Hee-Jung;Kim, Myung-Wook 162
Background: To find the patients who have a significant chance of cure with living donor liver transplantation (LDLT) among the patients suffering with beyond-Milan hepatocellular carcinoma (HCC), we retrospectively analyzed the tumor factors that could affect a good prognosis after LDLT for patients who suffer with beyond Milan HCC. Methods: Between March 2005 and May 2007, 18 cases of LDLT for beyond Milan HCC were performed. None of the patients had preoperative radiological evidence of vascular invasion. Excluding the 3 cases of in-hospital mortality, we analyzed the survival, the disease-free survival and the prognostic factors for recurrence in 15 beyond Milan HCC patients. The mean follow-up period was$18.8^{\circ}{\pm}8.8$ months (range: 4-34 months). Results: The two-year survival and disease-free survival rates after LDLT were 61.7% and 31.1%, respectively, in 15 beyond-Milan patients. Among them, 9 patients had recurrence of HCC during follow-up. The one-year survival rate after tumor recurrence was 55.5%. An alphafetoprotein (AFP) level < 400 ng/mL, Edmonson-Steiner histology grade I and II and the presence of graft rejection were analyzed as the good prognostic factors of disease-free survival after LDLT for beyond-Milan HCC (p < .05). The patients with negative preoperative positron emission tomography (PET) findings (n = 5) showed a better prognosis than the PET-positive patients (n = 10) with statistical significance (p = .05). Conclusion: Allowing that HCC patients exceed the Milan criteria, we can find the potentially curable candidates for LDLT with using tumor biologic markers such as a serum AFP level < 400 ng/mL, negative PET uptake or low grade histology, as assessed by preoperative needle biopsy. Further investigation is needed to evaluate the relation between graft rejection and tumor recurrence after liver transplantation. -
Comparative Clinical Analysis of 111 Laparoscopic Cholecystectomy Cases Converted to Open ProceduresBang, Ji-Sung;Choi, Yu-Sin;Kim, Beom-Gyu;Cha, Sung-Jae;Chi, Kyung-Choun;Lee, Jung-Hyo;Chang, In-Taik 168
Purpose: While laparoscopic cholecystectomy can be successfully performed in the majority of patients, conversion to open procedure is still necessary in certain cases. The purpose of this study was to identify the discerning factors that helped to predict the need for conversion to open cholecystectomy. Methods: A retrospective review was conducted on the data for 2,523 laparoscopic cholecystectomies performed at Chung-Ang University Hospital between January 2002 and July 2007. Patient sex, age, height, weight, body mass index (BMI), duration of preoperative hospital stay, preoperative physical examination, laboratory data, radiologic findings, and reasons for conversion to open procedure were evaluated. Results: Adhesion was perceived to be the most critical factor for conversion in 56 of 111 total cases (50.5%). Bleeding (22.5%), bile duct injury (11.7%), inflammation (9.0%), and uncertain anatomy (6.3%) followed sequentially in incidence. Factors found to significantly increase the risk of conversion on univariate analysis were patient age >70 years, male sex, previous abdominal operation, preoperative common bile duct stone, tenderness in the right upper quadrant, distended shape of the gallbladder, and pericholecystic fluid collection. On multivariate analysis, the following factors were found to be associated with a higher risk: patient age >70 years (p=0.002), male sex (p=0.012), previous abdominal operation (p<0.0001), and preoperative common bile duct stone (p=0.041). Conclusion: In the case of operations with such discerning factors, surgeons should be more cautious and delicate in all procedures throughout the operative period. Furthermore, to reduce the risk of additional severe complications, surgeons need to decide early on if they will perform a conversion. -
Kang, Shin-Yong;Lee, Seon-Ki;Kim, Jong-Yeol;Hwang, Yoon-Jin;Kim, Dong-Sun;Kim, Sung-Hee;Kim, Sang-Geol;Yeun, Young-Guk 173
Purpose: The prognosis of gallbladder carcinoma is unfavorable, and the depth of invasion, the T-factor, is the most important prognostic factor. T2 tumors are not easily diagnosed preoperatively, and they have unpredictable behavior. In this study, we reviewed the clinicopathologic features of pT2 gallbladder carcinoma and identified prognostic factors. Methods: We enrolled 64 pT2 gallbladder carcinoma patients who underwent surgery in Kyungpook National University Hospital between January 1992 and July 2006. The clinicopathologic features were retrospectively reviewed, and univariate and multivariate analyses were performed using the Kaplan-Meyer method and Cox regression hazard model to identify factors influencing long-term survival. Results: Twenty-one patients (32.8%) were asymptomatic, with seven tumors (10.9%) found incidentally. The gallbladder body was the most commonly involved site (45.3%, 29/64). Although CA19-9 was not sensitive, it was helpful for predicting recurrence. The 5-year diseasespecific survival rate in R0 resection was 75.9%, whereas no patients in the R1 or R2 resection groups survived more than 18 months.$\ddot{A}$ None of the clinicopathologic factors was prognostic. The unfavorable prognostic effect associated with lymph node involvement highlights the importance of complete lymph node dissection. Partial liver resection favorably affected survival, but not to a statistically significant degree. Conclusion: Absence of symptoms and specific imaging findings in patients with considerable pT2 gallbladder carcinoma warrants high disease suspicion, and every effort should be taken to achieve R0 resection with extensive lymph node dissection, since it may improve long-term survival in pT2 carcinoma patients. -
Hur, Chan-Young;Kim, Sang-Won;Kim, Jin-Soo;Kim, Kwang-Hee;Park, Jeong-Ik;Choi, Chang-Soo;Choi, Young-Kil 180
Purpose: The purpose of this study was to evaluate the effect of combination intraluminal brachytherapy (ILBT) and external beam radiotherapy (EBRT) on patient survival and stent patency after metallic biliary stent placement in patients with unresectable hilar cholangiocarcinoma. Methods: We retrospectively analyzed the data of 29 patients with unresectable hilar cholangiocarcinoma who presented between January 2002 and December 2006. Fifteen patients were treated with metallic stents alone (RT (-) group), and 14 patients were treated with ILBT and EBRT after metallic stent placement (RT (+) group). ILBT was performed using a 192Ir source at a dose of 15 Gy in 3 fractions. The EBRT dose was 45 Gy in 25 fractions. Results: The 1- and 3-year patient survival rates in the RT (+) group were 51.9% and 8.7%, respectively, and those in the RT (-) group were 46.7% and 38.9%, respectively. However, there was no statistically significant difference in the survival rates between the two groups (p=0.38). The 1- and 2-year stent patency rates for the RT (+) group were numerically higher than those in the RT (-) group (74.0%, 74.0%, respectively vs. 59.9%, 39.9%, respectively), but not to a statistically significant degree (p=0.11). The median stent patency was 10 months in the RT (+) group and 8 months in the RT (-) group. All of the stents obstructed at 31 months in the RT (+) group and at 26 months in the RT (-) group. Four patients showed minor complications, including gastrointestinal discomfort and dermatitis after radiation therapy, but all of them responded well to conservative treatment. Conclusion: Although combined ILBT and EBRT for unresectable hilar cholangiocarcinoma was safely carried out after biliary stent insertion with minor complications, it did not have a significant role in improving the survival and stent patency rates. -
Kang, Mee-Joo;Lee, Seung-Eun;Hwang, Dae-Wook;Lim, Chang-Sup;Jang, Jin-Young;Lee, Kuhn-Uk;Kim, Sun-Whe 186
Purpose: The pancreatic uncinate process is defined as the portion of the pancreatic head that lies behind the SMV and SMA. In spite of its peculiar anatomical characteristics, there are few reports addressing the clinicopathologic features of uncinate process carcinoma (UPCa). The purpose of this study was to explore the clinical characteristics of UPCa and to compare them with the characteristics of carcinomas located in other parts of the pancreatic head (non-UPCa). Methods: We retrospectively reviewed the medical records of 380 patients (127 UPCa and 253 non-UPCa) treated for pancreatic head cancer at Seoul National University Hospital between January 2002 and December 2007. The patient demographics, clinical presentation, radiologic details, surgical data, and long-term survival rates were evaluated. The clinical characteristics were analyzed according to tumor location. Results: Jaundice was less common in UPCa (56/127, 44.1% vs. 150/253, 59.3%; p=0.006). Duodenal obstruction (12/127, 9.4% vs. 11/253, 4.3%; p =0.049) and SMA invasion (56/127, 44.1% vs. 58/253, 23.0%; p<0.001) were more frequent in UPCa. Resectability (38/127, 30.0% vs. 117/253, 46.2%; p=0.002) and curative resection rate (29/127, 22.8% vs. 90/253, 35.6%; p=0.001) were significantly lower in UPCa. The overall 3-year survival rate (7.7% vs. 17.9%; p=0.019) and 3-year survival rate after curative resection (0% vs. 35.9%; p=0.012) were lower in UPCa. Conclusion: UPCa less frequently caused jaundice, but more frequently caused duodenal obstruction. Frequent invasion into the SMA led to lower resectability and curative resection rates. Even in cases of R0 resection, long-term survival in the setting of UPCa was lower than that seen in the setting of non-UPCa, which suggests other unknown prognostic factors. -
Ahn, Sang-Hyun;Han, Ho-Seong;Yoon, Yoo-Seok;Cho, Jai-Young;Ahn, Keun-Soo 191
Purpose: Distal pancreatectomy has historically been accompanied by splenectomy, due to the proximity and common blood supply of the pancreas and spleen. However, spleen-preserving distal pancreatectomy was introduced in order to prevent postoperative sepsis. The aim of this study was to evaluate the feasibility and outcomes of spleen and splenic vessel preservation during laparoscopic distal pancreatectomy (LDP). Methods: Between June 2004 and March 2007, 30 patients underwent LDP for pancreatic neoplasms. Preservation of both the spleen and splenic vessels was pursued for benign and borderline malignant tumors. Results: There were 11 male and 19 female patients, with a mean age of 47 years (range; 24~79 years). In 4 patients with suspicious malignancy, the spleen and its vessels were sacrificed. Preservation of the spleen and its vessels was successfully performed in 20 of 26 patients (76.9%) in whom it was initially sought. The mean tumor size was 4.3 cm (range; 1.5~11 cm), the mean operation time was 231 min (range; 70~490 min), and the mean blood loss was 316.67 ml (range; 50~1000 ml). During LDP, no conversion to open surgery occurred. The mean hospital stay was 11 days (range; 6~23 days). There was no mortality or reoperation. Postoperative complications occurred in 9 patients (30%), but all patients recovered after conservative management. Conclusion: LDP is a relatively safe and feasible procedure for the management of benign or borderline malignant tumors of the distal pancreas. Preservation of the spleen and splenic vessels may be feasibly pursued during LDP. -
Kim, Kuk-Jin;Hong, Soon-Won;Park, Joon-Seong;Hwang, Ho-Kyung;Kim, Jae-Keun;Kim, Kyung-Sik;Choi, Jin-Sub;Yoon, Dong-Sup;Lee, Woo-Jung;Chi, Hoon-Sang 196
Purpose: Ampulla of Vater cancer has a more favorable prognosis and survival than other malignant periampullary tumors. The pathologic staging of ampulla of Vater carcinoma is a key determinant of the patient's prognosis. However, we have often encountered patients in whom the course of their disease differed substantially from what would be predicted based on their clinical staging, which highlights the need to consider additional predictive factors. We applied an immunohistochemical technique to examine the expression of Ki-67 and VEGF in radically-resected ampulla of Vater carcinomas, and then compared the status of expression with several clinicopathologic factors. Methods: Sixty-four patients who underwent curative resection for ampulla of Vater cancer between January 1992 and December 2006 at the Yonsei University College of Medicine were reviewed. The relationships between the expression of molecular markers and clinicopathologic factors were determined. Results: There was no relationship between the clinicopathologic characteristics and the expression of molecular markers in patients with ampulla of Vater cancer. Among the clinicopathologic characteristics, lymph node metastasis was identified as an independent factor of survival after curative resection for ampulla of Vater carcinoma. Conclusion: Measurement of Ki-67 and VEGF in patients with ampulla of Vater carcinoma may have an important role in identifying the poor prognostic group. -
Kang, Sung-Il;Kang, Bong-Su;Ahn, Chang-Wook;Ko, Hyun-Seok;Lee, Sung-Bae;Koo, Hye-Young;Chung, Chul-Woon 203
A 57-year-old man with severe abdominal pain was admitted to our hospital. Chest PA and simple abdominal X-ray revealed no specific findings, but the abdominal-pelvis CT scan showed a 5cm sized multiloculated cystic tumor originating from the pancreatic head and a 3.2cm sized hepatic lesion that was suspected to be a metastic lesion. A radical operation was not able to be performed because of peritoneal metastasis and gastrocolonal infiltration. Only open lymph node biopsy was done and it revealed metastatic small cell carcinoma. Long-acting octreotide and gemcitabine was administered to the patient, but there was no therapeutic response. The tumor grew very rapidly to 26cm in size and the patient died 2 months later from his first hospital day. Necropsy was performed, and the pathologic finding of the resected mass was confirmed to be small cell carcinoma, the same as the result of the previous lymph node biopsy. -
Kim, Joong-Suck;Yun, Min-Young;Choi, Yun-Mi;Lee, Kun-Young;Ahn, Seung-Ick 207
Gallbladder torsion, also known as volvulus, is a rare condition that can be fatal unless surgery is performed expediently.$\ddot{A}$ We report a case of gallbladder torsion. A 92-year-old woman presented with acute abdominal pain. Laboratory parameters were all within normal limits, with the exception of leukocytosis. Plain abdominal radiography showed no remarkable findings. Abdominal CT revealed an abnormal gallbladder with wall thickening, suggesting the presence of acute cholecystitis. At operation, the gallbladder was twisted, and the wall of was thickened with acute inflammation. We report the details of this case along with a review of the literature. -
Kim, Gang-Mi;Choi, Gi-Hong;Kim, Dong-Hyun;Kang, Chang-Moo;Lee, Woo-Jung 210
Squamous cell carcinoma of the extrahepatic bile duct is very rare. Only limited information is available concerning its pathogenesis and prognosis, although it is reported to be associated with choledocolithiasis, recurrent pyogenic cholangitis, clonorchiasis, choledochal cyst formation, and primary sclerosing cholangitis. Therefore, we present a case of squamous cell carcinoma of the distal common bile duct. A 64-year-old male patient presented with abdominal pain and obstructive jaundice. Computed tomography and endoscopic retrograde cholangiography showed thickening of the wall and a segmental stricture of the distal common bile duct, and the biopsy confirmed poorly differentiated carcinoma with marked squamous differentiation. The patient underwent a pylorus-preserving pancreaticoduodencetomy. Histological examination revealed that the tumor invaded the pancreas and metastasized to regional lymph nodes (pT3N1M0). The patient developed multiple liver metastases 30 days later and died of rapidly progressive metastatic disease to the liver 5 months following resection. Squamous cell carcinoma of the distal bile duct with lymph node metastasis had a very poor prognosis, even though curative resection was performed. -
Moon, Deok-Bog;Lee, Sung-Gyu;Kim, Ki-Hun;Ahn, Chul-Soo;Ha, Tae-Yong;Song, Gi-Won;,;Ryu, Je-Ho;Kim, Kwan-Woo;Ko, Kyoung-Hoon;Choi, Nam-Kyu 214
Ex situ resection and hepatic auto-transplantation as devised by Pichlmayr may be an answer for a lesion that has close proximity to or has invade the major hepatic veins. We report here on a 31-year-old female patient with a leiomyosarcoma extending from the suprahepatic vena cava to the bifurcation of the common iliac vein, and this tumor was deemed not accessible by the conventional in situ surgical techniques. The liver and retrohepatic inferior vena cava was removed en bloc and taken to the back-table where the neoplasm invading the cava wall was removed together with the inferior vena cava. The inferior vena cava was then replaced by a 26- mm Dacron graft proximally and a 20-mm ringed polytetrafluoroethylene (PTFE) graft distally, and the outflows of the liver was reconstructed to a single opening with using longitudinally-opened autogenous great saphenous vein fencing. The liver was then autotransplanted by the Piggyback technique. Both renal veins were not reconstructed because both gonadal veins were preserved during the operation. The postoperative course was uneventful and the patient is in good health until now.