Special Session

Symposium

Video symposium

Panel discussion

Workshop

Video session

Requested Session

Free Paper (Oral/Poster)

【SS】

Robot-assisted surgery in HBP field

【SY1】

HBP surgery for elderly patients

Geriatric patients are characterized by a greater number of comorbid conditions and lower physiologic reserve including neurological, musculoskeletal, and organ functions, than their younger counterparts. Generally speaking, hepato-pancreato-biliary (HPB) surgery is more invasive than other general surgeries; therefore, its application in geriatric patients should be carefully considered, regarding the delicate balance among operative invasiveness, physiologic reserve of the patient, expected complications, and prognosis. To achieve this goal, development of reliable and objective indices that can accurately predict the risks in HPB surgery are important. Various scores incorporating factors such as frailty and sarcopenia have been proposed; however, none of these have been routinely used. Furthermore, the advantage of laparoscopic HPB surgery for geriatric patients has not been well established. In this symposium, each institution is expected to present the indications and outcomes of HPB surgery for geriatric patients, to facilitate discussion regarding the best strategy for managing geriatric patients undergoing major HPB surgery.

【SY2】

Indication of laparoscopic surgery for pancreatic cancer

Laparoscopic pancreatectomy is difficult due to its anatomical characteristics, but the magnifying effect of the laparoscope is effective for accurate resection, and laparoscopic pancreatectomy is possible due to the development of energy devices. Technique for laparoscopic pancreatectomy has been improving. Under these circumstances, laparoscopic pancreatectomy for pancreatic cancer is also covered by insurance, and laparoscopic distal pancreatectomy has become widely used as it was covered by insurance in 2016. On the other hand, laparoscopic pancreaticoduodenectomy was just covered by insurance in 2020, and surgical techniques have not been established, so there are many issues for each facility in Japan to safely introduce it. In particular, pancreatojejunostomy and hepaticojejunostomy require highly difficult endoscopic suturing techniques, and it is important to establish a safe reconstruction method to reduce postoperative complications. In this session, we will discuss the current status of indications for laparoscopic pancreatectomy for pancreatic cancer, including in-house standards and standardized surgical techniques, reconstruction workers and treatment results. Furthermore, we would like to discuss the future development of laparoscopic pancreatectomy for pancreatic cancer, and the future prospects by the comparison with laparotomy.

【SY3】

Long-term outcomes after surgical treatment in patients with pancreaticobiliary maljunction / congenital choledochal cyst

Although cholecystectomy with excision of the extrahepatic bile duct is the standard surgical procedure for patients with choledochal cyst, no consensus has been reached on the use of bile duct resection for patients with non-dilated biliary tract. In the long-term follow-up after flow diversion surgery, refractory cholangitis and intrahepatic stone formation as well as the development of bile duct cancer have frequently been reported.
In this session, based on the postoperative long-term follow-up of cases, we would like you to examine and report on the selection of surgical procedure and outcomes at each facility, the actual status of post-operative follow-up, the frequency and treatment of complications (such as cholangitis, anastomotic strictures, intrahepatic stones, and intrapancreatic stones) that occurred after bile duct resection, and the development of bile duct cancer.

【SY4】

Perioperative infection control in HBP surgery

The main purpose of perioperative infection control is the prevention of surgical site infection (SSI) that occurs in the surgical operation site. In hepatic surgery, factors such as background liver, intraoperative liver transection method and thread to be used, selection of device, presence / absence of drain placement, postoperative preventive antibacterial agent administration period, and measures against bile leakage are factors of infection. Preoperative biliary drainage, intraoperative bile contamination, and postoperative pancreatic juice leakage are involved in pancreato-biliary surgery. Appropriate antibacterial drug selection and drain management are required. In the field of hepatobiliary and pancreatic surgery, the surgery itself is highly invasive, and perioperative infection control and nutritional management are important to prevent postoperative complications. It seems that such a wide range of perioperative management reduces the number of premature deaths after surgery and improves the prognosis. For this symposium, we would like to ask specialists in each area of liver, gall bladder, and pancreas to report and describe their ideas for perioperative management in each institution.

【SY5】

Treatment strategies for multiple liver metastases from colorectal cancer

Recent advances in procedural technique now allow numerous patients to have potentially curative hepatectomy for multiple colorectal liver metastases. Several strategies have been reported and published treating this type of metastases, such as hepatectomy following potent chemotherapy, extended hepatectomy including hepatectomy with portal vein embolization, 2-stage hepatectomy and ALPPS, parenchyma-sparing resection, resection with ablation, laparoscopic approach, R1 approach, and liver-first approach. However, these strategies still are debatable, and no standardized approach is yet established. In this symposium, strategy in each individual institution will be disclosed with its supportive data and discuss aiming to establish Japanese standard.

【VSY1】

Tips of laparoscopic S7/8 resection

Liver resection is a procedure in which the liver protected inside the subphrenic “Rib Cage” is resected. In open procedure, the “Cage” is opened with large incision and the liver is picked up with mobilization. On the other, the laparoscopic liver resection is performed with direct intrusions of laparoscope and instruments into the “Cage”.
Since laparoscope and instruments usually intrude into the “Cage” from caudal direction, S7 and S8 of the liver are in the deepest area of the surgical field and difficult to be handled in laparoscopic procedure. However, there should also be a difference between the approaches to S7 and S8. S7 is fixed to the retroperitoneum in bare area and S8 is just beneath the dome of diaphragm. In this video symposium, authors can present their specific procedures to S7 and S8 and its advantages based on their experiences with videos.

【VSY2】

Recovery shot for intraoperative injury/complication in laparoscopic HBP surgery

Laparoscopic hepatobiliary pancreatic surgery has become a standardized and widely performed practice in many surgical procedures. However, in difficult surgical procedures such as anatomical major hepatectomy and pancreaticoduodenectomy, there is a possibility of fatal intraoperative accidents such as massive bleeding due to injury to large blood vessels. In addition, appropriate repair of bile leakage from the Glissonian pedicle and the hepatic dissection surface in liver resection is directly linked to the avoidance of postoperative bile leakage. In this video symposium, we would like you to show us strategies to avoid intraoperative injuries and complications, improving the overall safety of performing laparoscopic hepatobiliary and pancreatic surgery and recovery shots.

【VSY3】

Simulation and navigation in hepatobiliary-pancreatic surgery

In most hepato-biliary-pancreatic surgery we have to manipulate several complicated vessels. To avoid abrupt bleeding or bile duct injury, development of preoperative 3-dimensional simulation imaging and intraoperative attentive navigation system has long been expected. As medical fee revision in FY 2018 government granted additional 2,000 points for perioperative support with navigation system (K939 Additional fee for perioperative support with imaging). In FY 2020, 500 points were furthermore added if we intraoperatively visualize tumors or vessels using ICG or 5-aminolevulinic acid in both open and laparoscopic hepatectomy (K939-2 Additional fee for intraoperative vessel visualization). As above, government expects to promote navigation system in hepatectomy, and many institutions are now struggling to develop and practically apply this technique. In this session we would like to share state of the art of their development and discuss about their future prospect.

【VSY4】

HBP surgery with vascular reconstruction

Although vascular resection for HBP malignancies can improve curability and expand surgical indications, it is important to reduce perioperative risks and stabilize surgical outcomes. In addition, conversion surgery for initially unresectable HBP malignancies after multidisciplinary therapy often requires vascular resection with technical difficulty and high surgical risk. In this Video Symposium, surgical indications, strategy and techniques of vascular resection for HBP malignancies will be discussed. High quality videos which give us new viewpoints and lead to breakthrough for locally advanced HBP malignancies are expected.

【PD1】

Conversion surgery for locally advanced pancreatic cancer

Locally advanced unresectable (UR-LA) pancreas cancer may be rendered resectable after multidisciplinary treatment including chemotherapy or chemoradiotherapy. However, the best regimen of anticancer drugs, and proper indication, timing and resection range of surgery are all still in the middle of discussion. In this Panel Discussion, the treatment policy, strategy, and results are presented by each speaker. Future direction of multidisciplinary surgical treatment for UR-LA pancreas cancer will be discussed.

【PD2】

Surgical treatment for intrahepatic cholangiocarcinoma

Surgical resection of intrahepatic cholangiocarcinoma (ICC) sometimes requires extensive hepatic resection with and without bile duct resection, and/or lymph adenectomy, because ICC often represents invasive extension, multiple tumors and lymph node metastases. However, no apparent oncological evidence has been established for the extent of liver resection, significance of bile duct resection or the impact of lymph node dissection, as well as surgical indications. Even after curative resection, ICC often shows recurrences, and it is known that recurrence pattern differs depending on the macroscopic types of ICC. Although systemic chemotherapy or surgical resection has been performed for such recurrence, the concrete treatment algorithm for the recurrence of ICC has not been clarified. Now, the guideline for the treatment of ICC is going to be published soon. We would like you to present your current strategy for surgical treatment for ICC including multidisciplinary approach at each institution.

【PD3】

Therapeutic strategy for advanced hepatocellular carcinoma

Hepatocellular carcinoma recurs at a high rate due to its tumor nature and background liver, even if the initial treatment is successful, and progresses to advanced liver cancer after repeated local therapy. Furthermore, the form of progression is wide-ranging, such as multiple, giant, vascular invasion, and metastasis, and an appropriate treatment method for each pathological condition should be selected. In this session, we would like you to consider their characteristics and progression types, and describe the indications and limitations of the unique treatments of each institution with high response rates, along with the treatment results. On that basis, we would like to proceed with discussions to clearly show the position of "advanced liver cancer treatment" in the future.

【PD4】

Surgical treatment for advanced gallbladder cancer

【WS1】

Translational research in HBP surgery

WS1-1
Translational research is intended to translate the new discoveries made in basic research into clinical practice. Advances in surgical treatment, radiotherapy, and drug therapy, etc. have improved the outcome of solid tumors in the hepato-biliary-pancreatic field, but it is still poor compared to other gastrointestinal cancers, and further acceleration of translational research in this intractable region is required. In recent years, translational research in cancer genome medicine has been attracting attention due to the insurance inclusion of cancer gene panel tests and technological innovations such as next-generation sequencing. In addition to that in this session, we will focus on other areas such as robotic surgery, gene therapy, immunotherapy, and regenerative medicine for hepato-biliary-pancreatic diseases. We would like to present new research results of translational research aiming seriously at clinical applications in robotic surgery, gene therapy, immunotherapy, regenerative medicine, etc. for hepato-biliary-pancreatic diseases, and have a lively discussion while summarizing the current status and problems in each research field.

WS1-2
The treatment outcomes in the field of HBP surgery are still not satisfied although it has been tried to improve by multidisciplinary treatment that combines surgical treatment with drug and radiation therapy. For its further improvement, translational research, by which the results of basic research is used in clinical practice, is very important, for example characteristics and prognosis of the disease, prediction of therapeutic effect of chemotherapy and radiation therapy based on protein and gene analysis in the sample from the patients. In this workshop, please report a wide variety of translational research in the field of HBP surgery.

【WS2】

Treatment strategy for pancreatic neuroendocrine tumor

The 2nd edition of clinical practice guidelines for neuroendocrine neoplasms (NEN) by JNETS was published in 2019. It organized the clinical questions for localized, regional and metastatic pancreatic NEN (NET and NEC). However, there have been some unsolved issues including (1) surgical indications for poorly differentiated NEC, (2) the pros and cons of observational policy for small, non-functioning NET, (3) indications for postoperative adjuvant therapies, and (4) significance of surgical interventions for metastatic NEN and appropriate timings and procedures of these interventions. In this workshop, the authors are encouraged to present their treatment strategies as well as clinical outcomes regarding many aspects of treatments for pancreatic NEN.

【WS3】

Long-term results outcomes after resection of papillary carcinoma of the papilla of Vater

Ampullary cancer has 95% resection rate and the 5-year survival rate is over 60%, and ampullary cancer is thought to have relatively good prognosis among pancreatic and biliary cancers. However, advanced ampullary cancer with T2 (duodenal invasion), T3 (pancreatic invasion) and/or N1 showed a dismal prognosis. In recent years, survival time has been prolonged in pancreatic and biliary cancers because of the improvement of surgical approach and peri-operative multidisciplinary treatment, but there is now no evidence of adjuvant chemotherapy in ampullary cancer. In this workshop, please show the results of long-term survival of ampullary cancers in each hospital, and announce various approaches for the improvement of survival for ampullary cancers.

【WS4】

Intervention of nutrition and exercise therapy in HBP surgery

The characteristics of hepato-biliary-pancreatic (HBP) surgery, such as hepatic resection and pancreatic resection in patients with HBP cancer, is not only massive surgical invasion but also advanced malignancy itself.  As a result, many patients had serious problems in malnutrition and bad physical condition even before operation.  In addition, surgical outcomes are likely to depend on skills of preoperative administration.  Therefore, it is crucial for better surgical outcomes to intervene preoperative nutrition and exercise therapies and to evaluate its effectiveness appropriately.  Recently, surgical patients associated with sarcopenia mainly because of aging is increasing with the increase of elderly patients.  In this session, we would like to discuss about current topics regarding various perioperative treatments of nutrition and exercise in your institutes and its evaluation and good timing of the intervention of these therapies.  Besides, if possible, introduction of effective intervention of nutrition and exercise therapies against sarcopenia and elderly patients undergoing HBP surgery will be expected.

【WS5】

Optimal Surgery for IPMN

Recent advances in diagnosis lead the increasing detection of asymptomatic IPMN and number of resected cases is also increasing. On the other hand, limiting overtreatment and morbidity from surgery still remain problems in the treatment of IPMN. There are several guidelines which show the recommended indicators for surgical resection, such as IAP, AGA, and European Study Group on Cystic Tumours of the Pancreas. However, these guidelines based on evidences with insufficient levels and there are several discrepancies within them. Recently, several reports show the usefulness of genetic analysis of cystic fluid or pancreatic juice. According to surgical management, there are many debates of the indication of minimally invasive surgery or/and organ sparing resection. In this session, we discuss about these points and aim to establish the base of future guidelines.

【WS6】

Biomarkers in HBP field

Recent advances of studies on various biomarkers for hepato-biliary-pancreatic diseases are expected to apply the biomarkers not only to early detection and prediction of prognosis but also to optimal treatment based precisely on pathological phenotype. For example, α-fetoprotein (AFP), one of the classical tumor markers, is useful for the diagnosis of hepatocellular carcinoma, and recently for the criteria of ramucirumab therapy, and the 5-5-500 rule for liver transplantation. Along with advanced analysis of surgical specimens, there are novel biomarkers such as cfDNA, microRNA and exosomes using blood, bile and pancreatic juice. In this workshop, we would like to make a wide range of presentations from the innovative research of biomarkers to the clinical application of prevention and treatment. We hope that the active discussions will be useful for tomorrow's clinical practice.

【VS1】

New devices in HBP surgery

【VS2】

Technics and devices for liver parenchymal resection (laparotomy, laparotomy)

【VS3】

Laparoscopic surgery for benign biliary diseases

【VS4】

Technics for laparoscopic biliary and pancreatic reconstruction

【VS5】

Tips for re-liver resection

【RS1】

Surgical treatment for cases with biliary tract infection

【RS2】

Improvement of long-term outcomes after liver transplantation

【RS3】

Problems related to the portal vein (thrombosis, hyperactivity, etc.)

【RS4】

Treatment results for benign biliary stricture (including anastomotic stricture)

【RS5】

Current topics pf pancreas transplantation

【RS6】

Management of bile leakage

【RS7】

Management of pancreatic fistula countermeasures

【RS8】

Long-term outcomes sfter total pancreatectomy

【RS9】

Surgical treatment for duodenal cancer

【RS10】

Perioperative management for HBP surgery