Updates in Molecular Profiling of Pancreatic Ductal Adenocarcinoma
Outcomes from pancreatic ductal adenocarcinoma (PDAC) remain poor and better methods of prognostication and therapeutic approaches are needed. Recent advances in cancer genomics have led to the development of molecular subtypes of PDAC associated with clinical outcomes. Current evidence also suggests that the subtypes have differential response to first-line chemotherapy regimens. PDAC is also characterized by different stroma and immune environments. Further work is needed to confirm the utility of these subtypes to predicting response to different systemic therapies. (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: Jaewon James Lee, Jen Jen Yeh Source Type: research

Neoadjuvant and Adjuvant Therapy in Resectable Pancreatic Adenocarcinoma
While pancreatic adenocarcinoma requires surgical resection definitive cure, treatment paradigms are shifting toward a neoadjuvant approach to systemic therapy. Rationale is twofold: micro-metastatic disease is likely present in a majority of patients, reinforcing the importance of systemic therapy regardless of resectability; moreover, systemic therapy is well-tolerated and improves surgical outcomes when delivered preoperatively. Second, a neoadjuvant approach allows for selection of biology and patients most likely to benefit from potentially morbid surgery. This review examines the increasing body of evidence in suppor...
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: Ryan Johnson, Paul H. McClelland, Syed A. Ahmad Source Type: research

Biliary Dyskinesia and Hyperkinesis
Biliary dyskinesia refers to a group of functional and motility disorders of the biliary system in patients presenting with typical biliary pain, but without any visible structural abnormalities on standard imaging. The Rome IV Criteria establishes diagnostic criteria for functional gallbladder disorder (gallbladder dyskinesia and biliary hyperkinesia), functional biliary sphincter of Oddi disorder (biliary dyskinesia), and pancreatic sphincter of Oddi disorder. Many diagnostic adjuncts such as hepatobiliary scintigraphy and sphincter of Oddi manometry exist, although these results are supportive and not necessarily diagno...
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: Joshua Tseng, Yufei Chen, Catherine McDonald Source Type: research

Surgical Palliation for Advanced Pancreas Cancer
To provide optimal care in pancreatic ductal adenocarcinoma, involvement of palliative medicine and nutritional support is recommended. Advances in endoscopy have resulted in robust options for biliary and gastrointestinal stenting for relief of obstruction. Notwithstanding, surgical hepaticojejunostomy and gastrojejunostomy remain incontrovertible considerations for biliary obstruction and gastric outlet obstruction, respectively. For PDAC-associated pain, opioid therapy continues to be the mainstay. However, refractory pain may be treated with interventional procedures such as celiac or splanchnic nerve blocks or neuroly...
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: Caitlin S. Jacobs, Dominic J. Vitello, Akhil Chawla Source Type: research

The Role of Surgery in “Oligometastatic” Pancreas Cancer
The majority of patients diagnosed with pancreatic cancer already have metastatic disease at the time of presentation, which results in a 5-year survival rate of only 13%. However, multiagent chemotherapy regimens can stabilize the disease in select patients with limited metastatic disease. For such patients, a combination of curative-intent therapy and systemic therapy may potentially enhance outcomes compared to using systemic therapy alone. Of note, the evidence supporting this approach is primarily derived from retrospective studies and may carry a significant selection bias. Looking ahead, ongoing prospective trials a...
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: D. Brock Hewitt, Christopher L. Wolfgang Source Type: research

Biliary Diseases
This issue of the Surgical Clinics addresses Biliary disease, which represents one of the mainstays of current general surgical practice. Biliary disease can range from the common to the obscure, with a multitude of anatomic variations to further complicate the management of biliary disease. More than 600,000 cholecystectomies are performed in the United States each year, and while being a common operation, it is fraught with hazard. For the less common and more obscure biliary diseases, there are often questions regarding the efficient workup and management of these problems that often require expert consultation. (Source...
Source: Surgical Clinics of North America - May 16, 2024 Category: Surgery Authors: Nicholas Manguso, Randall Zuckerman Tags: Preface Source Type: research

Cholangiocarcinoma
Management of intrahepatic cholangiocarcinoma relies on a thorough understanding of the tumor ’s location and proximity to critical vasculobiliary structures. Mid-common bile duct tumors may require hemihepatectomy or pancreatoduodenectomy based on the status of the intraoperative frozen section. Distal common bile tumors are treated with pancreatoduodenectomy. When appropriate, volumetric assessment of the remnant liver should be performed to identify cases requiring preoperative liver augmentation strategies. A similar strategy should be employed for perihilar tumors, which require a right trisegmentectomy with bilioen...
Source: Surgical Clinics of North America - May 9, 2024 Category: Surgery Authors: Jon M. Harrison, Brendan C. Visser Source Type: research

The Role of Interventional Radiology in the Management of Biliary Disease
Interventional radiologists are an important part of a multidisciplinary team for the management of patients with biliary disease. Minimally invasive image-guided procedures can diagnose, temporize, and treat patients presenting with a broad spectrum of disease, including acute, chronic, benign, and malignant etiologies. In certain cases, interventional radiologists may provide definitive therapy for this often-difficult patient population. Effective treatment of patients with biliary disease is predicated on cooperation and collaboration of a multidisciplinary team working together providing optimal treatment to achieve p...
Source: Surgical Clinics of North America - May 9, 2024 Category: Surgery Authors: Benjamin J. Pomerantz Source Type: research

Identification and Management of Bile Duct Injuries
Injury to the biliary system can be a major problem leading to significant morbidity for the patient. This most commonly occurs due to iatrogenic causes and identification as early as possible is critical to maximizing the patient outcome. The timing of identification will dictate the optimal time for repair, and this should be undertaken at a facility with hepatobiliary surgery expertise as well as advanced gastroenterology and interventional radiology services. Many biliary injuries can be managed through external drainage and/or endoscopic approaches, but significant injuries to major biliary structures will require ope...
Source: Surgical Clinics of North America - May 9, 2024 Category: Surgery Authors: Nicholas Manguso, Randal Zuckerman Source Type: research

Biliary Anatomy and Variations
The unique capacity, robust vascular supply, and drainage of the liver allow for surgeons to perform formal, nonanatomic, and parenchymal sparing resections for primary and metastatic hepatic lesions. Knowledge of hepatobiliary anatomy is crucial to allow for safe dissection and adequate preservation of the future liver remnant. The functional anatomy of the liver is based on Couinaud classification. Vascular, portal and biliary anatomic variations are necessary to identify on preoperative imaging to avoid unintentional injuries. Conventional common hepatic artery, hepatic arterial branches, portal, and biliary anatomy acc...
Source: Surgical Clinics of North America - May 9, 2024 Category: Surgery Authors: Brent T. Xia Source Type: research

Management of Acute Cholangitis and Choledocholithiasis
Acute cholangitis is a life-threatening emergency, caused by blockage of bile, most commonly by a gallstone (choledocholithiasis). Stasis of bile leads to an infection in the biliary tree known as cholangitis. Cholangitis is graded into 3 categories according to severity of symptoms. The infections are polymicrobial and are predominantly gram-negative rods. Management consists of early initiation of antibiotics and prompt biliary decompression. The biliary tree can be drained by endoscopic retrograde cholangiopancreatography, percutaneous transhepatic cholangiography, rendezvous, or surgical means. Future directions will f...
Source: Surgical Clinics of North America - April 27, 2024 Category: Surgery Authors: Sarah E. Smith Source Type: research

Colorectal Surgery
SURGICAL CLINICS OF NORTH AMERICA (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 26, 2024 Category: Surgery Authors: Quinton M. Hatch Source Type: research

Copyright
ELSEVIER (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 26, 2024 Category: Surgery Source Type: research

Contributors
RONALD F. MARTIN, MD, FACS (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 26, 2024 Category: Surgery Source Type: research

Contents
Ronald F. Martin (Source: Surgical Clinics of North America)
Source: Surgical Clinics of North America - April 26, 2024 Category: Surgery Source Type: research