Session Category List

Special Session (Open call for abstracts)

“How I do it in HBP surgery” by U-40 surgeons from Asian countries

In this special session, we would request HBP surgeons under the age of 40 from Asian countries to demonstrate their clinical expertise in HBP surgery. Video case presentations and clinical research will be also welcome. With open discussions among young surgeons who will lead the next generation, we would like to reach out to and collaborate with the global community in the field of HBP disease and surgery.

Symposium (Open call for abstracts)

1) Role of biomarkers in liver transplantion as indication criteria for hepatocellular carcinoma

In liver transplantation for hepatocellular carcinoma (HCC), the importance of biological markers and morphological markers, such as size and number, has been highlighted. In Japan, more than 2 years have passed since the introduction of the 5-5-500 criteria, including AFP, to the Milan criteria for liver transplantation for HCC. We would like to discuss the usefulness of different biomarkers included in the indication criteria. We would also like to report on the changes in the number of transplant cases for HCC and results of liver transplantation at each institution since the 5-5-500 criteria were added to the indication criteria in Japan.

2) Preoperative evaluation of liver functional reserve for patients with marginal liver function

Preoperative evaluation of liver functional reserve is a prerequisite, especially for patients with marginal liver function, to prevent post-hepatectomy liver failure. Although several tests, such as ICG clearance, ALBI grade, and evaluation using GSA scintigraphy or EOB-MRI have been used, the modalities to exactly estimate the upper limit of resectable liver volume (or lower limit of remnant liver volume) based on the liver functional reserve are to be established. In this symposium, we would request the speakers to present novel and useful modalities for this purpose and discuss their impact on the clinical outcomes in their institutions.

3) Patient selection criteria and surgical procedure of conversion surgery for initially unresectable pancreatic cancer

The number of patients undergoing conversion surgery for initially unresectable pancreatic cancer are increasing owing to the improvements in perioperative chemotherapy. However, there is no consensus among researchers regarding the appropriate patient selection criteria and surgical procedures. In this symposium, the short- and long-term outcomes of each specialized institution with their own criteria and surgical procedures will be discussed.

4) Enhanced recovery after surgery (ERAS) protocol in hepatobiliary surgery

The ERAS protocol refers to a patient-centered, evidence-based, multidisciplinary team-developed pathways for a surgical specialty and facility culture to reduce the patient’s surgical stress response, optimize their physiologic function, and facilitate recovery. Recently, several ERAS protocols, beneficial for postoperative patient management, have been reported in various fields of surgery. In this symposium, each institution is expected to present an ERAS protocol for managing patients undergoing major hepatobiliary surgery and its effect on the clinical outcomes.

5) Perioperative management of hilar cholangiocarcinoma

A balance between curability and safety is important for the surgical treatment of hilar cholangiocarcinoma. We will discuss the ingenuity of perioperative management (including consideration of surgical margin and liver reserve function), indication of preoperative chemotherapy, perioperative antibiotic management in cases of cholangitis, indication of preoperative portal vein embolization, and methods of preoperative biliary drainage to improve the results of surgery.

Video Symposium (Open call for abstracts)

1) Zero complication laparoscopic cholecystectomy

Preoperative assessment of biliary anatomy and intraoperative creation of a critical view of safety are reportedly useful strategies for safe laparoscopic cholecystectomy. However, the creation of a critical view of safety is not possible in all cases. In this video symposium, we would like to request the specialists to establish a road map for zero-complication laparoscopic cholecystectomy.

2) Recent advances in robotic hepato-biliary and pancreatic (HBP) surgery

In recent years, robotic HBP surgery has been performed in several specialized centers. Robotic surgery offers theoretical advantages to conventional laparoscopic surgery, including improved instrumental dexterity, three-dimensional visualization, and better ergonomics. In this session, we would like to present a video that explains future expansion of robotic HPB surgery.

3) Tips and pitfalls for laparoscopic repeat hepatectomy

Laparoscopic liver resection is widely used for HCC and metastatic liver tumors. Moreover, the rate of laparoscopic repeat hepatectomy is also increasing. Please discuss the ingenuities for safe laparoscopic repeat hepatectomy, such as appropriate devices, surgical techniques, and anti-adhesion agents.

4) Function-preserving pancreatic surgery

Pancreaticoduodenectomy and distal pancreatectomy are the major pancreatic surgeries; however, their procedures are relatively simple. In contrast, duodenal-preserving pancreatic head resection, pancreatic head-preserving duodenal resection, and lower pancreatic head resection are surgical procedures that preserve the function of the pancreas and duodenum; however, the number of studied cases treated with these procedures are small. In this session, we would request the experts to present videos of these complicated function-preserving pancreatic surgeries.

5) Minimal invasive surgery for donor hepatectomy

In weighing the balance between donor safety and benefit for postoperative recovery, minimally invasive donor hepatectomy, such as mini-laparotomy, and laparoscopic and robot-assisted hepatectomy have been developed in some liver transplant centers. In this video symposium, surgical indications, strategies, and techniques of minimally invasive donor hepatectomy will be presented by experienced specialists.

6) Resection and reconstruction of major blood vessels in surgery for hepatobiliary pancreatic cancer: indications based on the difficulty of surgery and long-term prognosis

Hepatobiliary and pancreatic malignancies can easily invade adjacent vessels and often require combined vascular resection.
However, for patients with vascular resection, the frequency of complications is high, and there are many cases of postoperative recurrence. Please present surgical procedure videos of each facility considering safety and curability, along with the treatment results.

Panel Discussion (Open call for abstracts)

1) Current treatment strategy for ampullary tumor

Although ampullary cancer has a favorable prognosis, some patients have poor prognoses because of pancreatic invasion or lymph node metastases. The widely accepted adjuvant therapy for advanced ampullary cancer has not yet been established. However, for early cancer, minimally invasive organ-preserving procedures, such as ampullectomy may be a treatment option. We request the panelists to demonstrate the treatment strategies for ampullary cancer used at their specialized centers.

2) Treatment strategies for advanced gallbladder cancer

Radical resection is the only curative treatment for gallbladder cancer. However, there is no consensus on an optimal surgery. Appropriate perioperative treatment also provides poor evidence. In this session, we will discuss strategies for advanced gallbladder cancer to establish future guidelines.

3) Tradition and ingenuity in HBP surgery for the next generation

Generally, HBP trainees take a long time to acquire HBP surgical skills because of the difficult surgical procedures. In this panel discussion, we would like to discuss about “tradition and ingenuity,” which should be noteworthy for the next generation of attending surgeons.

4) Recent advances in pancreas/islet transplantation

As the number of donors have been gradually increasing, approximately 40 cases of pancreas transplantation are now performed annually in Japan. Pancreatic islet transplantation has also been accepted as a treatment modality for type I diabetes and has been covered by social insurance since 2020. In this section, the current transplant outcomes and future perspectives will be discussed.

5) Strategy to improve short-term survival rates after advanced HBP surgery

Recently, short-term survival outcomes after advanced HBP surgery have gradually improved in Japan. However, the 90-day mortality rate after liver transplantation, hepatic resection with biliary reconstruction, and hepatopancreatoduodenectomy is as high as around 3%–5%. In this session, we request each institution to present the measures that they have been taking to decrease the short-term mortality rate after advanced HBP surgery and discuss strategies for further improvement.

6) Indication and surgical procedure for intraductal papillary mucinous neoplasms

The number of patients diagnosed with intraductal papillary mucinous neoplasms are increasing because of improvements in imaging modalities. However, preoperative diagnosis of the indication for surgical resection is occasionally difficult. Furthermore, the criteria for the indication of minimally invasive organ-preserving procedures have not been determined. In this session, indications for surgical resection, appropriate surgical procedures, and long-term outcomes will be discussed by specialists in detail.

7) Current treatment strategy for pancreatic neuroendocrine neoplasms (PNENs)

Treatment strategies for PNENs are occasionally difficult not only for advanced PNENs, but also for early stage PNENs. We request you to discuss the treatment strategies for PNENs, including surgical indications, appropriate surgical procedures, and perioperative chemotherapy.

8) Role of molecular-targeted agents in treatment of hepatocellular carcinoma

In recent years, the number of molecular-targeted agents for HCC have increased, thus changing the treatment for advanced HCC. Their effectiveness in converting initially unresectable cases to be indicated for surgery (conversion surgery), preoperative treatment for Vp4 and Vv3 cases, and adjuvant chemotherapy in advanced HCC has been observed. Please indicate the role of molecular-targeted agents in multidisciplinary treatment for patients with advanced HCC and how surgical outcomes have changed by using them.

Workshop (Open call for abstracts)

1) Computer-assisted simulation and navigation in HBP surgery

To safely perform surgical procedures, preoperative anatomical understanding is necessary in HBP surgery, especially in liver surgery. To avoid massive bleeding or bile duct injury, preoperative three-dimensional simulation imaging and intraoperative attentive navigation system should be used. Therefore, in this session, we will share novel navigation systems for HBP surgery and discuss their future prospects.

2) Innovative research of biomarkers for HBP cancers

Recent intensive research on cancer biomarkers among HBP malignant diseases has unlimited potential for early detection and prediction of prognosis. In this workshop, we discuss innovative research on biomarkers.

3) Long-term outcomes after ABO-incompatible/DSA-positive liver transplantation

Different outcomes of ABO-incompatible/DSA-positive liver transplants have been reported. We request you to present the strategy and short-/long-term results of ABO-incompatible liver transplantation or liver transplantation with preformed donor-specific antibodies.

4) Neoadjuvant therapy and conversion surgery for hepatobiliary malignancy

Advanced intrahepatic/extrahepatic cholangiocarcinoma has a high recurrence rate, but there is poor evidence for preoperative chemotherapy, and it has not been strongly recommended by the guidelines. Please present the indications and results of neoadjuvant chemotherapy followed by radical surgery. We also request the presenters to show the outcome of conversion surgery for unresectable cases.

5) Indication for and treatment outcomes after HBP surgery for elderly/frail patients

Elderly patients generally have many comorbidities, such as frailty syndrome and sarcopenia. Please discuss the indications, strategies, and results of hepatobiliary and pancreatic surgery for elderly patients at each institution.

6) ALLPS: current status and perspective

Associating liver partition and portal vein ligation for staged hepatectomy (ALLPS) was developed 10 years ago for patients with advanced liver metastasis from colorectal cancer. This procedure has the benefit of rapid and increased regeneration of the remnant liver compared to that with portal vein embolization; however, a higher risk of mortality and morbidity have been reported. In some institutions, modified methods, such as limited liver partitioning have been introduced. In this section, we will discuss the current indications and outcomes of ALLPS procedures and their role in the treatment of liver malignancies.

7) Benefits and disadvantages of neoadjuvant therapy for resectable pancreatic cancer

Neoadjuvant chemotherapy is recommended for resectable pancreatic cancer according to the guidelines. However, neoadjuvant chemotherapy can induce severe adverse events. In contrast, some patients have favorable prognoses, even with the strategy of up-front surgery with adjuvant chemotherapy. In this session, we request the specialists to discuss the benefits and disadvantages of neoadjuvant therapy for resectable pancreatic cancer.

8) Treatment strategies and outcomes for intraductal papillary neoplasm of the bile duct (IPNB)

IPNB is considered a precancerous and/or early cancer lesion. The 2010 edition of the World Health Organization Classification of Tumors of the Digestive System proposed new classification categories as counterparts of IPMN. However, the clinicopathological features of IPNB are unclear. In addition, prognostic factors for IPNB are not well established. In this section, we will discuss the treatment strategies and outcomes for IPNB.

9) Useful anatomical knowledges in HBP surgery

Newly acknowledged anatomies have been visualized owing to the magnified view of laparoscopic surgery, which can even be adopted for open surgery. Expert surgeons perform their own procedures based on their original anatomical knowledge. Please demonstrate the surgical procedure using the original anatomical knowledge for young HBP surgeons.

Mini-Symposium (Open call for abstracts)

1) Strategies to prevent long-term complications after PD

Glucose intolerance, fatty liver, and repetitive cholangitis are well-known long-term complications of pancreatoduodenectomy. Speakers are requested to present strategies to prevent these complications.

2) Treatment results for pT1 pancreatic ductal adenocarcinoma (PDAC)

Although the number is small, early detection of PDAC is increasing because of the developments in diagnostic imaging and screening. The results of pT1 PDAC are relatively good, but there are several unclear points, such as what kind of cases have recurred, whether postoperative adjuvant chemotherapy is necessary for all cases, and whether treatment outcomes vary depending on the site of occurrence. Please present the treatment results for pT1 PDAC.

3) Contribution of radiological/endoscopic intervention for the treatment of postoperative complication

The outcomes of HBP and liver transplant surgery are improving, and currently, a very low mortality rate is observed. Surgical instruments and techniques as well as perioperative radiological/endoscopic interventions contribute to considerable postoperative outcomes. We request the presenters to show the clinical impact of radiological/endoscopic interventions for perioperative management.

4) Role of lymph node (LN) 16b1 sampling and lavage cytology during surgery for HBP cancers

Appropriate LN dissection is required to achieve curability in patients with pancreatic cancer during HBP surgery. In this session, with a focus on LN16b1 sampling/dissection and peritoneal lavage cytology, we request you to present the purpose, needs, and oncological outcomes of LN16b1 dissection and lavage cytology.

5) What is the appropriate neoadjuvant regimen for borderline resectable pancreatic cancer?

Although there is a general consensus among clinicians regarding neoadjuvant therapy for borderline resectable pancreatic cancers, an agreement has not been reached regarding its regimen. Please present the treatment outcomes in patients with borderline resectable pancreatic cancer following various neoadjuvant therapies used in each institution to discuss the appropriate regimen.

6) Role of genetic analysis in the treatment of HBP malignancy

Genetic panel testing has now been adopted in the Japanese insurance system. However, the opportunity to address HBP malignancy using genetic analysis in clinical settings is a rare situation for HBP surgeons. Please show the association and usefulness of genetic analysis and HBP surgery for future expansion.

7) Perioperative management to reduce surgical-site infection (SSI)

SSI is observed in 10%–20% of HBP surgery cases. Several risk factors for SSI have been reported, including nutritional status, operative time, and massive blood loss. Therefore, appropriate perioperative management is required. In this symposium, we request the experts to discuss perioperative management to reduce SSI and demonstrate their results using the protocols applied in each institution.

8) Introduction and educational program for robotic-assisted pancreatic surgery

The indications for robotic-assisted surgery have been expanding for pancreatic surgery in Japan. The rapid increase in the utilization of robotic-assisted surgery has necessitated a standardized educational system. In this session, we would like to present the existing or future programs and provide updates on their respective validation processes.

9) Treatment results for intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma has a high recurrence rate and requires multidisciplinary treatment; however, there is still little evidence. The need for lymph node dissection during surgery and perioperative chemotherapy is controversial. Please present the strategies used at each institution to manage intrahepatic cholangiocarcinoma and the treatment results.

10) Impact of everolimus on outcome after liver transplantation

New immunosuppressive agents, such as everolimus, contribute to the improvement of long-term prognosis after liver transplantation. Everolimus reportedly has a positive impact on graft survival, cancer-specific survival, renal function, and glucose tolerance. We request the presenters to discuss the indications, treatment regimens, and outcomes of patients administered everolimus after liver transplantation.

11) Treatment strategy for multiple colorectal liver metastases

Recent advances in surgical procedures, perioperative management, and chemotherapy have improved the prognosis of multiple colorectal liver metastases. Preoperative chemotherapy, extended hepatectomy (such as two-stage hepatectomy or ALPPS), parenchymal-sparing hepatectomy, and combined ablation therapy are reportedly useful procedures to address multiple tumors. Please show the outcomes of multidisciplinary treatment for multiple liver metastases in each institution.

Requested Video (Open call for abstracts)

1) Ingenuity for enteric reconstruction after pancreatoduodenectomy (PD) to prevent postoperative complications

Postoperative complications are a major concern for advanced cancer because they delay the initiation of adjuvant chemotherapy. However, PD is a highly morbid procedure. Please show us the originality and ingenuity of the enteric reconstruction of PD to avoid postoperative complications.

2) How to perform hepatic segmentectomy

Various procedures for hepatic segmentectomy have been reported. Several methods to determine the hepatic segment, such as the staining method or indocyanine green fluorescence method, have also been reported. It is important to remove the entire ischemic area in the remnant liver even for a procedure smaller than segmentectomy. Please show the useful techniques for segmentectomy using a video presentation.

3) Vascular reconstruction techniques using various grafts during liver transplantation

In recipient operation during liver transplantation, vascular reconstruction using various grafts is required for some patients, such as those whose main portal trunk is obstructed or those who need middle hepatic vein tributary reconstruction. We request the presenters to show their own ingenuities in vascular reconstruction techniques using various vascular grafts.

4) Measures against bile leakage after hepatectomy

Bile leakage is an unavoidable problem in hepatectomies. Please show the video of the measures, such as the device used during liver dissection, stump treatment method, C tube placement, and use of fibrin glue for excision stump, necessity of drain undertaken at each facility to reduce bile leakage.

5) Recovery shot for potentially life-threatening near-miss events during HBP surgery

HBP surgery is one of the most difficult operations in abdominal surgery. Therefore, the perioperative complication rate is higher than that with other gastroenterological surgeries. Occasionally, we experience fatal intraoperative accidents, such as massive bleeding and other organ injuries. To overcome these accidents, we will discuss the respective surgical complications and their management.

6) Laparoscopic or robot-assisted distal pancreatectomy

Laparoscopic/robotic distal pancreatectomy is now a widely accepted procedure for treating left-sided pancreatic tumors. We would request the specialists from experienced institutions to demonstrate videos of laparoscopic or robotic distal pancreatectomy.

Free Paper (Oral/Poster)