Training and practice of the next generation HPB surgeon: analysis of the 2014 AHPBA residents' and fellows' symposium survey

Seshadri, Ramanathan; Ali, Noaman; Warner, Susanne G.; Cochran, Allyson; Vrochides, Dionisios; Iannitti, David A.; Jeyarajah, D. Rohan

doi:10.1111/hpb.12498

Cited by 22 publications

(12 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To our knowledge, this was the first study to provide quantitative evidence that LT skills and knowledge do have a positive impact on the postoperative outcome of complex liver resection. The clinical implication of such finding would be for training of future liver surgeons that should entail a LT training component for 1–2 years in a well-established HBP fellowship program 46 . Currently, this may only be possible for trainees working in tertiary-referral centers with both LT and HBP service, but for those working in less resourceful centers without transplant service, 47 they most often need to arrange a LT rotation in another center on a voluntary basis 48,49 .…”

Section: Discussionmentioning

confidence: 99%

Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience

et al. 2020

View full text Add to dashboard Cite

Objective:To study the impact of LT experience on the outcome of CLR for locally advanced hepatobiliary malignancySummary of Background data:Despite evolution in LT knowledge and surgical techniques in the past decades, there is yet data to evaluate the significance of LT experience in performing CLR.Methods:Postoperative outcome after CLR between 1995 and 2019 were reviewed and correlated with LT experience in a single center with both LT and CLR service. CLR was defined as hepatectomy with vasculobiliary reconstruction, or multivisceral resection, central bisectionectomy (S4/5/8), or associating liver partition and portal vein ligation for staged hepatectomy. Spearman rank correlation and receiver operating characteristic analysis were used to define the association between CLR-related outcomes and LT experience.Results:With cumulative single-center experience of 1452 LT, 222 CLR were performed during the study period [hepatectomy with biliary (27.0%), or vascular (21.2%) reconstruction, with multivisceral resections (9.9%), with associating liver partition and portal vein ligation for staged hepatectomy (18.5%)] mainly for hepatocellular carcinoma (53.2%), and hilar cholangiocarcinoma (14%). Median tumor size was 7.0 cm. Other features include macrovascular invasion (23.4%), and juxta-visceral invasion (14%). Major postoperative complication rate was 25.2% and mortality rate was 6.3%. CLR-complication rate was inversely associated with LT experience (R = −0.88, P < 0.005). Receiver operator characteristic analysis revealed the cutoff for LT experience to have the greatest influence on CLR was 95 with a sensitivity of 100% and Youden index of 1. Multivariable analysis showed that blood transfusion, prolonged operating time, LT experience < /=95 were associated with major postoperative complications.Conclusion:LT experience was complimentary to CLR for locally advanced hepatobiliary malignancy with improved postoperative outcome.

show abstract

Section: Discussionmentioning

confidence: 99%

Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Firstly, it is improved intraoperative urgent pathological examination to standardize it more between different pathology centers. Secondly, seeking for R0 resection margin by improving surgical technique-surgeon must perform at least 10 PDR annually [28]. Finally, it is personal medicine-targeted neoadjuvant or adjuvant chemotherapy according to gene mutations [29]- [31].…”

Section: Discussionmentioning

confidence: 99%

Stage II Pancreatic Cancer: Radical, Palliative Surgery or Stenting?

Šileikis¹,

Kurlinkus²,

Kryžauskas³

et al. 2015

View full text Add to dashboard Cite

Background: Pancreatic ductal adenocarcinoma is the fourth most common reason of death among oncological diseases with ever increasing mortality. At the time of diagnosis, patients are usually suitable for three ways of treatment: radical, palliative surgery or stenting. Deciding the best option depends on clinical situation, but is still a matter of debate. Methods: We performed a retrospective research of patients with stage II pancreatic head cancer treated in our clinic between years 2002-2014. Four groups were formed according to the used treatment method: group A: radical surgery with R0 (microscopic tumour clearance) margin; group B: radical surgery with R1 (presence of tumour cells within 1 mm of the resection margin) margin; group C: biliary tract stenting; group D: biliodigestive anastomosis. Clinical data and most importantly the survival of these patients were compared. Results: 200 patients were involved in the final analysis, 82 (41%) of them were IIA and 118 (59%) were IIB. Group A consisted of 113 patients; group B consisted of 28 patients; group C consisted of 33 patients; group D consisted of 26 patients. In patients with IIA stage, group A had the highest survival rate compared with other groups, mean survival was 3.242 versus 1.600; 0.454; 0.652 years. Patients with IIB stage of cancer similarly had longer survival in group A versus other groups, 1.720 versus 0.931; 0.713; 0.957 years. Conclusions: Patients with IIA and IIB stage of pancreatic cancer benefit the most from radical surgery with R0 margin. However, for patients with lymph node involvement (stage IIB) and when achieving R0 margin is hardly possible, neoadjuvant treatment seems promising, but we need further randomized controlled trials to fully confirm its effectiveness.

show abstract

“…Survey content was based on feedback from previous HPB fellows and their overall training experience. 9 A preliminary survey consisting of 44 multiple-choice questions related to HPB fellowship training was developed by a group of program directors, faculty surgeons, and current fellows. Questions were divided into five sections: education, operative training (decision-making and autonomy), research opportunities, mentorship, and program quality or weaknesses.…”

Section: Methodsmentioning

confidence: 99%

“…7,8 Fellows who chose to specialize in HPB surgery should have reasonable exposure and practice with these advanced therapies to competently care for their patients and stay competitive in their careers. 9 A consensus conference between the Society of Surgical Oncology, the American Society of Transplant Surgeons, and the AHPBA agreed that program accreditation should be more stringent. Programs should be required to demonstrate an appropriate educational environment, minimum caseload volumes should be specified, and programs must balance training and clinical care.…”

Section: Introductionmentioning

confidence: 99%

Fellows' perspective of HPB training programs in North America: results of a survey

Siddiqui

Sastry

Martinie

et al. 2018

HPB

Self Cite

View full text Add to dashboard Cite

show abstract

Training and practice of the next generation HPB surgeon: analysis of the 2014 AHPBA residents' and fellows' symposium survey

Cited by 22 publications

References 14 publications

Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience

Transferability of Liver Transplantation Experience to Complex Liver Resection for Locally Advanced Hepatobiliary Malignancy-Lessons Learnt From 3 Decades of Single Center Experience

Stage II Pancreatic Cancer: Radical, Palliative Surgery or Stenting?

Fellows' perspective of HPB training programs in North America: results of a survey

Contact Info

Product

Resources

About