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 4
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Kim, Gang-Mi;Choi, Gi-Hong;Han, Dai-Hoon;Kim, Dong-Hyun;Kang, Chang-Moo;Choi, Jin-Sub;Park, Jun-Yong;Kim, Do-Yong;Han, Kwang-Hyub;Chon, Chae-Yoon;Park, Young-Nyun;Lee, Woo-Jung 222
Purpose: Intrahepatic recurrent HCC has been classified according to location, the time to recurrence and the pattern of presentation. The purpose of this study is to classify intrahepatic recurrent HCCs into subgroups that have relatively similar recurrent patterns and to identify the risk factors for each recurrent type. Methods: A total of 353 patients were retrospectively studied. Intrahepatic recurrent HCC was classified into nodular recurrence (<4 nodules; type I), multinodular-diffuse recurrence (${\geq}$ 4 nodules; type II) and infiltrative recurrence (type III). The cut-off time between early and late recurrence was chosen to be 12 months following hepatectomy. Results: Among the 134 patients with only intrahepatic recurrence, 94 were type I, 27 were type II and 13 were type III. The median survival time following the recurrence of types I, II and III were 55, 16 and 8 months, respectively. As determined by multivariate analysis, perioperative transfusion and indocyanine green retention at 15 minutes (ICG R 15 >10%) were the independent risk factors for type I; an ICG R 15>10%, microvessel invasion and intrahepatic metastasis were the independent risk factors for type II; an ICG R 15>10% and microscopic portal vein invasion were the independent risk factors for type III. Multivariate analysis revealed that the prognosis of patients with IHR was associated with the recurrent types, the time to recurrence and the serum albumin level at the initial presentation. Following multivariate analysis, an ICG R 15>10% and intrahepatic metastasis were the independent risk factors for early type I recurrence; perioperative transfusion and a higher grade of hepatitis activity were the independent risk factors for late type I recurrence. Conclusions: The recurrent types and the time to recurrence may help us to predict the cellular origin of intrahepatic recurrent HCC and the prognosis of the patients who suffer with intrahepatic recurrent HCC. -
Kim, Tae-Hwan;Lee, Sung-Gyu;Song, Gi-Won;Hwang, Shin;Kim, Ki-Hun;Ahn, Chul-Soo;Moon, Deok-Bog;Ha, Tae-Yong;Jung, Dong-Hwan 232
Purpose: This study was conducted to evaluate the technical feasibility and the impact on survival of the anterior approach technique for resecting a huge hepatocelluar carcinoma (HCC) as compared with the conventional approach technique. Methods: We performed a retrospective observational study on 57 patients who underwent right hemihepatectomy for a huge HCC over than 10cm in diameter. A total of 57 patients were divided into two groups; the anterior approach technique group (AA group, n=23) and the conventional approach group (CA group, n=34). The overall perioperative data was collected and analyzed. The post-hepatectomy liver function, the operative mortality and morbidity and the survival outcome were compared between the two groups. Results: The post-hepatectomy liver function profile was not significantly different between the two groups. The operative mortality and morbidity were comparable in both groups. The transfusion requirement was not significantly different in both groups (p=0.470), but the cases without transfusion were more common in the AA group (p=0.046). The tumor with an advanced stage (UICC stage III/IV) was significantly more frequent in the AA group (p=0.014). The overall patient survival and disease-free survival was not significantly different between the two groups despite of the difference of the disease stage between the 2 groups (p=0.050, p=0.822). Pulmonary metastasis was more common in the CA group (p=0.035). Conclusions: Despite of the advanced disease state, the anterior approach technique resulted in comparable operative and survival outcomes as compared with the outcomes of the conventional approach technique. In terms of the technical feasibility, the anterior approach technique may reduce the required amount of transfusion when performing hepatectomy for a huge HCC. -
Hee, Kim-Chang;Choi, Gi-Hong;Han, Dai-Hoon;Kim, Dong-Hyun;Choi, Sae-Byeol;Kang, Chang-Moo;Kim, Kyung-Sik;Choi, Jin-Sub;Park, Young-Nyun;Park, Jun-Yong;Kim, Do-Yong;Han, Kwang-Hyub;Chon, Chae-Yoon;Lee, Woo-Jung 238
Purpose: Recent studies have reported improved perioperative and long-term outcomes for the 이우정1,4 initial postoperative results for patients with a huge HCC. The purpose of this study was to investigate the surgical outcomes of patients with a huge HCC and we wanted to identify any subgroup that would likely benefit from hepatic resection. Methods: From January 1996 to August 2006, 55 patients were diagnosed with a huge HCC (${\geq}$ 10cm in diameter). All the tumors were classified as either the expanding nodular type or the non- expanding nodular type. Results: The mean age of the patients was 50.6 years and 39 patients were male. The most common cause of liver disease was hepatitis B virus. The mean size of tumor was 11.9 cm. Microscopic liver cirrhosis was present in 17 patients. Twenty-three patients had tumors of the expanding nodular type. Curative resection was performed in 50 patients. The 5-year diseasefree and overall survival rates after resection were 35.8% and 41.0%, respectively. Univariate analysis revealed that surgical margins of${\leq}$ 1.0, a non-curative resection, the non-expanding nodular type and microscopic vascular invasion were adverse prognostic factors for survival. Multivariate analysis indicated that the gross tumor classification (expanding nodular vs. nonexpanding nodular) was the only independent prognostic factor. Conclusions: Huge HCC is not a homogenous group and the gross tumor pattern may represent the biologic behavior of huge HCC. Because the outcome of surgical treatment is far better than that of non-surgical treatment, resection should be actively considered for patients with a huge HCC. An expanding nodular type tumor is the best candidate for surgical resection. -
Han, Dai-Hoon;Choi, Gi-Hong;Kim, Dong-Hyun;Choi, Sae-Byeol;Kang, Chang-Moo;Kim, Kyung-Sik;Choi, Jin-Sub;Park, Young-Nyun;Park, Jun-Yong;Kim, Do-Yong;Han, Kwang-Hyub;Chon, Chae-Yoon;Lee, Woo-Jung 245
Purpose: Although surgical resection is the most effective treatment for hepatocellular carcinoma (HCC), high recurrence after resection is a major challenging problem. We attempted to determine the optimal strategies for improving the long-term surgical outcome through the review of our 10 years' experience with surgically treating HCC. Methods: We retrospectively reviewed 497 patients who received curative resection at the Yonsei University Health System from January 1996 to August 2006. Results: The 5 year disease-free rate and the overall survival rate after curative resection were 45.0% and 63.9%, respectively. Of the 497 patients, 491 (98.8%) were Child-Pugh A and 107 (56.3%) were diagnosed with liver cirrhosis. The postoperative complication and mortality rates were 28.6% and 1.8%, respectively. Of the 243 recurrent patients, 184 (75.7%) were diagnosed with intrahepatic recurrence alone. Of these intrahepatic recurrent patients, 169 (91.9%) received active treatment, including transplantation (n=7), re-resection (n=12), local ablation therapy (n=18) and transarterial chemoembolization (n=132). Multivariate analysis revealed that perioperative transfusion, a satellite nodule, the pathologic TNM stage, the Edmondsons-Steiner grade, the serum alkaline phosphatase (ALP) and aspartate aminotransferase levels and cirrhosis were associated with disease free survival, and perioperative transfusion, a satellite nodule, macroscopic vascular invasion, the Edmondsons-Steiner grade, the ALP and serum albumin levels and the platelet count were related with overall survival after resection. Conclusions: The long-term surgical outcome of HCC can be further improved by proper patient selection, delicately performed surgery and administering postoperative adjuvant therapy for patients with a high risk of recurrence. Early diagnosis and aggressive treatment are needed to treat the recurrence. -
Ryu, Haeng-Rang;Park, Joon-Seong;Hwang, Ho-Kyung;Kim, Jae-Keun;Kim, Kyung- Sik;Choi, Jin-Sub;Yoon, Dong-Sup;Lee, Woo-Jung;Chi, Hoon-Sang 254
Purpose: Although laparoscopic surgery has become more popular, its technical difficulties have limited the applications of this technique to liver surgery. We report here on our experience with liver resection with perfoming laparoscopic assisted and DaVinci robot assisted hepatectomy. Methods: We retrospectively evaluated 40 patients who underwent laparoscopic assisted and DaVinci robotic assisted hepatectomy at the Yonsei University Health System from January 2002 to January 2008. Results: Thirty patients (75%) had malignancy and ten patients (15%) had benign disease. We performed Lt. hepatectomy (7.5%), wedge resection (17.5%), segmentectomy (30%) and Lt. lateral segmentectomy (45%). The rate of conversion to laparotomy was due to intraoperative bleeding was 10%. The complication and mortality rates were 7.5% and 0%, respectively Conclusion: Laparoscopic and DaVinci robot hepatectomy showed a reduced time to oral intake, a shortened hospital stay and a smaller incisional scar compared to open surgery. So, laparoscopic and DaVinci robot hepatectomy should be performed in selected patients as the postoperative status of the patients is better than that with performing open hepatectomy. -
Lee, Ji-Hoon;Lee, Dong-Shik;Yoon, Sung-Su;Kim, Hong-Jin 258
Purpose: Hepatic resection has been proven to be an effective therapy for metastatic colorectal carcinoma and it is a beneficial therapy for metastatic neuroendocrine tumors. Yet the role and efficacy of hepatic resection for metastatic noncolorectal nonneuroendocrine (NCNN) carcinoma have not yet been well defined. We evaluated the outcome and the prognostic factors of patients who are undergoing hepatic resection for metastases from NCNN carcinoma. Materials and Methods: The records of 46 patients who underwent liver resection for NCNN metastasis from Oct. 1992 to May 2006 were analyzed. Among the 46 patients, 26 patients were excluded due to direct hepatic invasion from stomach cancer. The patient demographics, tumor characteristics, the treatment and the postoperative survival rate were analyzed. Results: The median patient age was 54.9 years (range: 36-69 years) and there were 13 men (85.7%) and 7 women (15.3%). The mean survival time from the date of liver resection was$48{\pm}7.85$ months, and the 5-year survival rate was 33.7%. The primary tumor sites were identified as gastrointestinal in 60% of the patients and non-gastrointestinal in 40% of the patients. Patients with a gastrointestinal primary tumor had a median survival time that was similar to that of patients with non-gastrointestinal primary tumor (48 months versus 42 months, respectively, p=0.847). The number of liver metastases was an independent prognostic factor (p=0.030). Conclusions: In selected patients with NCNN liver metastasis, hepatic resection is an effective management and it can also prolong survival. Hepatic resection should be considered if lymphatic invasion and metastasis of the other organ are excluded. -
Han, Yoon-Gu;Kim, Ick-Hee;Mun, Gi-Myoung;Kim, Jun-Hyun;Hwang, Guk-Seong 263
Purpose: We wanted to clinically evaluate the antibiotic therapy used from pre- to post- laparoscopic cholecystectomy along with the improved surgical techniques and instruments and the patient nutrition. Methods: We prospective studied 105 patients who were treated with laparoscopic cholecystectomy for acute and chronic cholecystitis at Busan St. Mary Hospital from March 2007 to January 2008. The two groups were divided as follows: (A) the group was not injected with antibiotics, and the other group (B) was injected with antibiotics. We did not used antibiotics when the patient had no acute aggravating symptoms, and we exclude the patients with old age (>70 years), a past history of diabetes mellitus (DM) or hypertension (HTN), and a past operation history. Results: Between the two group, there was no difference when they were compared for age, BMI (Body Mass Index), the operation time (minute) and the length of the hospital stay: (A) Group 49.3${\pm}$ 13.0 years, 24.4${\pm}$ 3.2 kg/$m^2$ , 37.9${\pm}$ 10.0 minute and 4.6${\pm}$ 1.3 days, respectively, and (B) Group 55.9${\pm}$ 15.6 years, 23.5${\pm}$ 3.5 kg/$m^2$ , 43.2${\pm}$ 23.8 minute and 5.5${\pm}$ 2.5 days, respectively. There was a significant different in the leukocyte count and the % of neutrophils: (A) Group 6396$\mu\ell^{-1}$ and 53.4%, respectively and (B) Group 9354$\mu\ell^{-1}$ and 66.6%, respectively. In (B) group, there were 2 cases of atrial fibrillation, 1 case of diarrhea and 1 case of wound seroma. There were no surgical related complications in group (A). Conclusion: For the well nourished chronic cholecystitis patients, the use of the prophylatic antibiotics may be less effective because of the many drug-induced side effects. More studies about the use of prophylactic antibiotics are needed. -
Byeun, Chul-Su;Lee, Jae-Myeong;Kim, Bong-Wan;Kim, Wook-Whan;Wang, Hee-Jung;Kim, Myung-Wook 268
Purpose: The objective of this study was to compare the clinicopathologic characteristics of the patients with extrahepatic bile duct cancer between the patients who are younger than 54 years and those who are older than 75 years. Methods: Between 1994 and 2008, 63 patients underwent resectional surgery or palliative treatment for extrahepatic bile duct cancer. The medical records of these patients, including the clinicopathologic characteristics and the other relevant data, were retrospectively reviewed. Results: There were some differences between the patient groups for the tumor location, distant metastasis and preoperative co-morbidity. The frequency of tumor locations were 58% proximal, 13% middle, 22% distal and 5% diffuse in the young patients and these were 33%, 18%, 48% and 0%, respectively, in the older patient group (p=0.049). The frequency of distant metastasis was 13% in the young patient group and none in the older patient group (p=0.026). The elderly patient group showed more preoperative co-morbidities (68% vs 29%, respectively) (p=0.009), but there was no statistical difference between the two groups for postoperative complications (p=0.301). There was no correlation between the preoperative co-morbidity and the operative complications for both groups. There were no differences in the other clinicopathologic characteristics and the survival rate for both groups. Conclusion: Young and elderly patients with extrahepatic bile duct cancer had different clinicopathologic characteristics. Especially, in the young patients, there were more proximally located-tumors and distant metastases. Although there were more preoperative co-morbidities in the elderly patient group over the age of 75, this did not affect the operative complication rate when the co-morbidities were well controlled preoperatively. -
Kang, Sung-Hwa;Park, Kwan-Tae;Kim, Young-Hoon;Seo, Hye-Ryun;Han, Duck- Jong;Kim, Song-Chul 276
Purpose: The purpose of this study is to compare the clinical results of spleen preserving laparoscopic distal pancreatectomy (SPLDP) with en bloc laparoscopic distal pancreatectomy (LDP). Methods: From March 2005 to August 2008, 52 cases of SPLDP and 84 LDPs were performed at our institution and we retrospectively compared these cases. The enrollment period were chronologically divided to four eras of 10.5 months each. Results: The demographics, including the patients' age, gender and BMI, were not different between the two groups. The final pathologic diagnosis was diverse, and it included cystic tumor, SPT, IPMT, cancer, endocrine tumor, etc and there was no difference between the two groups. The tumor location, operative time, tumor size, perioperative transfusion requirement, the length of the hospital stay and the postoperative complications were not different between the two groups. The mean operative time was gradually shortened by eras (Era 1: 236.3 min, Era 2: 223.6 min, Era 3: 188.8 min, Era 4: 187.9 min) and the proportion of SPLDP was increased by eras from 1.9% to 9.6%, 42.3% and 46.2%, respectively. Conclusion: SPLDP might be technically more difficult than LDP, and especially in the initial learning stage of performing laparoscopic pancreatic surgery. After overcoming the learning curve, SPLDP can be performed safely and possibly within a shorter time. SPLDP should be tried whenever possible so that the patients get the maximal benefits of minimal invasive surgery and especially for resecting the more distal pancreatic lesions. -
Lee, Seung-Eun;Hwang, Dae-Wook;Lim, Chang-Sup;Jang, Jin-Young;Kim, Sang-Kyun;Jung, Hyun-Chae;Song, In-Sung;Kim, Sun-Whe 284
Purpose: The aim of this study was to characterize the clinical presentation and outcome of a series of patients with Brunner's gland adenoma. Methods: Between 1996 and 2007, 15 patients who underwent surgical resection and 9 patients who underwent endoscopic polypectomy for pathologically confirmed Brunner's gland adenoma were identified. We reviewed the clinico-pathological features of these patients. Results: The mean age of the total patients was 56 years and the male to female ratio was 1.4 to 1. There were no significant differences in age, gender and the polyp size between the surgical resection group and the endoscopic polypectomy group. Among the 15 patients of the surgery group, all 15 patients (100%) were symptomatic (p=0.031). The hospital stay in the endoscopic polypectomy group was significantly shorter than that in the surgery group (p=0.001). Conclusion: Brunner's gland adenoma is a rare duodenal tumor that occurs in middle age people and the patients with this tumor present with either gastrointestinal hemorrhage, obstructive symptoms or other incidental findings. Surgical or endoscopic excision for treating this tumor is uncomplicated, and the long-term outcome is favorable. -
Jeon, Sang-Hoon;Park, Kwan-Tae;Jang, Hyuk-Jai;Kim, Young-Hoon;Han, Duck-Jong;Kim, Song-Chul 287
Purpose: Pancreaticoduodenectomy (PD) is known to have high morbidity and mortality rates among the various abdominal operations, but there have been few reported current series of pancreaticoduodenectomy from large volume medical centers. The purpose of this study is to analyze the postoperative complications of PD and to assess the risk factors for postoperative morbidity. Methods: A total of 398 cases of PD were performed by two surgeons from January 2003 to December 2007 at our institution and we retrospectively reviewed the medical records of these cases. Results: 186 (46.7%) of 398 patients underwent pylorus preserving pancreaticoduodenectomy (PPPD) and 212 patients (53.3%) underwent a classic Whipple procedure. The most common indication for this procedure was pancreatic cancer (151 cases, 37.9%) and the second most common was intraductal papillary mucinous tumor (78 cases, 19.6%). The mean age was 57.2 years, ranging from 12 to 81. The mean postoperative hospital stay was 24.7 days. The most common complication was delayed gastric emptying (11.8%) and next was pancreatic fistula (10.3%), bleeding (6.5%) and new onset diabetes mellitus (DM) (4%). Four patients (1%) died of hospital mortality. The patients' age, gender, DM history, hypertension history and serum bilirubin level had no significant influences on the postoperative morbidity rate. Conclusions: Pancreaticoduodenectomy can be performed safely with an acceptable complication rate and minimal mortality if the surgeon has sufficient surgical experiences and with the advance in anesthesia and postoperative care. -
Lee, Jae-Myeong;Kim, Bong-Wan;Wang, Hee-Jung;Kim, Myung-Wook 294
We report here on a case of synchronous triple primary cancers that occurred in the liver, gall bladder and pancreas. A 69-year-old man who presented with symptoms of diarrhea, poor oral intake and dyspepsia was referred to our hospital. The diagnostic images showed a gall bladder mass (about 2cm in size), a pancreas head mass (2.7cm in size) and a liver mass (about 4cm in size) in segment 7. On positron emission tomography, the liver mass did not show a hypermetabolic uptake. We could not confirm a liver mass between the metastatic lesion and the hepatocellular carcinoma, and so we performed liver biopsy, which revealed hepatocellular carcinoma. Pylorus-preserving pancreaticoduodenectomy, extended cholecystectomy and liver wedge resection of segment 7 were performed. The biopsy showed gall bladder adenocarcinoma, pancreas ductal adenocarcinoma and hepatocellular carcinoma. Many multiple primary malignant neoplasms have previously been reported on, however, reports in the medical literature on synchronous multiple primary cancers occurring in the hepatobiliary and pancreas systems are very rare. -
Lee, Hyung-Soon;Choi, Sae-Byeol;Kim, Kyung-Sik 298
Adrenal myelolipoma is a rare benign, non-functioning tumor that is frequently discovered incidentally. We report here on a case of a 47-year-old woman with an incidentally found adrenal tumor. She was slightly obese and had been diagnosed with diabetes. Her blood sugar level was well-controlled with oral hypoglycemic agents. All the laboratory test results were within normal limits. The abdomen CT scan revealed a well-demarcated homogenous solid mass that was 9cm in diameter, and it consisted of fat tissues. The differential diagnosis for malignant tumors was necessary, so we performed complete surgical excision. The patient recovered well without any major complications. If the diagnosis of adrenal myelolipoma is definite, then regular follow-up of this type of patient is sufficient. However, as the differential diagnosis with malignant tumors is rather difficult and as spontaneous hemorrhage can persist in the giant myelolipomas that are greater than 10cm in diameter, performing complete surgical excision is inevitable. -
Kang, Bong-Su;Kang, Sung-Il;Koo, Hye-Young;Lee, Sung-Bae;Kang, Hye-Yun;Park, Seok-Won;Chung, Chul-Woon 302
Nesidioblastosis is a rare disorder, and it usually considered as a cause of neonatal hyperinsulinemic hypoglycemia. A 35 year-old-woman with hyperinsulinemic hypoglycemia was admitted in an unconscious condition. Abdominal CT, pancreas MRI and celiac angiography with an intra-arterial calcium stimulation test revealed a suspicious insulin-producing tumorous lesion in the head of pancreas. The patient underwent enucleation of the pancreas head tumor under the initial diagnosis of insulinoma. However, the tumor was confirmed histologically as nesidioblastosis that showed ductoendocrine proliferations and numerous small endocrine cell groups. Nesidioblastosis is classified into a focal type and a diffuse type, which are characterized by different clinical outcomes. The patient in our case showed a normal blood glucose level after operation, which is often the case for the focal type. Herein, we report this very rare case of adult nesiodioblastosis that was successfully treated by surgical resection. -
Kwon, Yu-Jin;Lee, Seung-Eun;Hwang, Dae-Wook;Lim, Chang-Sup;Jang, Jin-Young;Kim, Sun-Whe 307
Malignant peripheral nerve sheath tumor (MPNST) is rare, soft tissue, spindle cell sarcoma of an ectomesenchymal origin. MPNSTs frequently occur in the extremities and trunk, whereas there has been only one previous report of MPNST originated from the pancreas. A 55-yr-old previously healthy man was admitted for a pancreas head mass, which was detected during a routine health inspection. Fine needle aspiration biopsy showed atypical cells that were suspicious for malignancy. On open exploration, a 2.6cm sized hypervascular well capsulated mass was seen between the duodenal first portion and the pancreas head, and so enucleation was performed. The tumor was composed with spindle cells without a typical storiform pattern and the cells were positive for mesenchymal antigen, S-100 and vimentin, whereas they were negative for epithelial membrane antigen and cytokeratin. It was concluded that the tumor was a MPNST with perineural cell differentiation. Primary MPNST of the pancreas is extremely rare and performing immunohistochemical staining is necessary for making its diagnosis.