The best of HPB surgery in BJS Open in 2022

The year 2022 has been a very busy one for hepato-pancreato-biliary (HPB) surgery. Considered as a whole, the evidence in the field has been expanded by the publication of a paper on its ‘textbook outcome’¹. Defined as a multidimensional measure reflecting the ideal outcome after surgery, it can predict the overall survival after HPB cancer surgery. The landmark systematic review published in BJS Open has set its standards by defining it as including ‘no prolonged length of stay’, ‘no complications’, ‘no readmission’, and ‘no deaths’, paving the way for further systematic studies in the field.

Once we dig deeper into the subspecialties of HPB, from the liver surgery standpoint, BJS Open has recently published a meta-analysis on the impact of perioperative steroid administration². While the liver surgery community still strives for novel tools capable of improving outcomes, the paper provides strong evidence about the capability of steroids in reducing complications after elective cases (OR 0.6) by analysing ten RCTs on almost 1000 patients. In contrast with an historical skepticism in their regards, steroids have also shown a similar rate of adverse events. Indeed, this is a practice-changing message and will likely serve as a key reference for future guidelines assessing standard of care for elective liver surgery.

Finally, the pancreas field has also seen some major publications in BJS Open in 2022. Of great interest, for a non-surgical readership also, is a paper focusing on the risk of type 3c diabetes mellitus after more than 2000 cases of acute pancreatitis followed for a minimum of 5 years after the index episode has been published³. The analysis underlines the current burden of long-term comorbidity after acute pancreatitis, particularly once this has required critical care, and calls for a personalized and multidisciplinary approach, including diabetes screening. Despite the topic of pancreatitis being covered by other relevant publications, pancreas cancer has been by far the most recurring topic in BJS Open in 2022. As pancreas cancer surgery is now invariably combined with chemotherapy with the aim of achieving better survival results, it has been of great value to read the publication of a 15-year national cohort of more than 10 000 cases in Norway⁴. The paper highlights how the improvement in surgical skills, including vascular resections, to achieve a radical dissection, postoperative outcomes, and the expansion of either pre- or postoperative chemotherapy have contributed to significantly improve survival. Particularly striking was the increase in the proportion of patients receiving neoadjuvant chemotherapy, as the 1 per cent of 2010 became 27 per cent 8 years after. Still, the overall poor prognosis and the vast proportion of individuals not benefiting from a surgical resection point out how early detection and more effective therapies are of utmost need. We hope this will be one of the main topics of further publications for 2023, all of them being very welcome in BJS Open.