Session Category List
Special Program: International Panel Discussion
Therapeutic strategies for advanced hepatocellular carcinoma: how has the advent of new systemic treatments changed the landscape of liver surgery?
Special Program: International Panel Discussion
Chemotherapy for the treatment of hepatocellular carcinoma (HCC) is entering a new era with the approval of novel effective drugs for advanced HCC in 2018. A variety of treatment strategies are being tried, including pre- and post-operative adjuvant therapies for cases with vascular invasion or multiple tumors, with the aim of employing conversion therapy to treat initially unresectable cases. This session will discuss how the advent of new drugs has changed multidisciplinary strategies for the treatment of advanced HCC and the position of surgery within that process as a joint program with oversea experts.
＜Credit＞Special Program
"Current status and future outlook for liver and pancreas transplants: Where are we headed?"
＜Credit＞Special Program
Laparoscopic left lateral segmentectomy to obtain a graft for use in living donor liver transplantation was approved for Japanese National Health Insurance coverage in 2022, and overseas, robot-assisted surgery is now also used in recipient surgery in addition to laparoscopic surgery. The concept of transplant oncology has also gained attention in recent years, underlying advances in multidisciplinary approaches to liver transplantation for the treatment of unresectable hepatobiliary cancLaparoscopic left lateral segmentectomy to obtain a graft for use in living donor liver transplantation was approved for Japanese National Health Insurance coverage in 2022, and overseas, robot-assisted surgery is now also used in recipient surgery in addition to laparoscopic surgery. The concept of transplant oncology has also gained attention in recent years, underlying advances in multidisciplinary approaches to liver transplantation for the treatment of unresectable hepatobiliary cancer and prompting efforts to extend the boundaries of conventional cancer surgery, such as extracorporeal resection and autotransplantation, in the form of “super” extended resection. Islet transplantation, which received insurance coverage in 2020, has been a boon to patients with Type I diabetes and those who have undergone pancreatectomy as an addition to conventional pancreas transplantation. In this session, we look forward to a wide-ranging discussion on a new therapeutic framework, starting with surgical techniques, by asking what the future holds for organ transplantation in terms of how to treat incurable diseases and how to improve the current treatment strategies.er and prompting efforts to extend the boundaries of conventional cancer surgery, such as extracorporeal resection and autotransplantation, in the form of “super” extended resection. Islet transplantation, which received insurance coverage in 2020, has been a boon to patients with Type I diabetes and those who have undergone pancreatectomy as an addition to conventional pancreas transplantation.
＜Credit＞ Panel Discussion
Pancreatic ductal adenocarcinoma: Novel criteria for resectability
＜Credit＞ Panel Discussion
Resectability of pancreatic cancer has been classified based on the technical difficulty of resection. However, with the development of effective chemotherapy and improvements in surgical techniques, a greater emphasis should be placed on the biology of pancreatic cancer, focusing on long-term treatment outcomes such as recurrence and survival rates. We plan to discuss the establishment of novel resectability criteria that go beyond contrast-enhanced CT evaluations, including a definition of biological BR using diagnostic imaging, such as MRI and PET-CT, tumor markers, peritoneal washing cytology, as well as targeted genomic sequencing.
＜Credit＞ Educational Session
Updates on diagnosis and treatment of cystic tumors of the liver
＜Credit＞ Educational Session
Hepatic cystic tumors widely range from benign adenomas to adenocarcinomas, and some cases are difficult to diagnose and treat. Disease concepts such as MCN and IPNB as hepatic cystic neoplasms have long been proposed. In the WHO classification, they are described as precancerous or early cancerous lesions of cholangiocarcinoma. Nevertheless, there are few opportunities to encounter these rare diseases. In this session, each institution is invited to bring a detailed case report of a hepatic cystic tumor, from diagnosis to treatment course, and to deepen the knowledge of hepatic cystic disease through pathological discussion. Preoperative CT or MRI images and pathological results are mandatory for abstracts.
Next Generation Program
Pancreatic resection by the surgeons of the next generation
Next Generation Program
Eligibility for abstract submission： Under 45 years old at the time of presentation. It is common for young surgeons to train as board-certified expert HBP surgeons or as board-certified endoscopic surgeons. Pancreatic surgery requires a high level of skill, but recent advances in the treatment of pancreatic cancer, as well as the growing use of laparoscopic surgery and robotic surgery, are changing the nature of training for young HBP surgeons. In this session, we would like to invite young surgeons who will lead the next generation to present their daily learning methods and techniques for pancreatic resection, as well as their efforts to obtain board certification.
Hepatic resection by the surgeons of the next generation
Next Generation Program
Eligibility for abstract submission： Under 45 years old at the time of presentation. Young surgeons typically train with the goal of advancing their careers as board-certified expert HBP surgeons or as board-certified endoscopic surgeons. Recently, due to the widespread use of laparoscopic hepatectomy, training methods of hepatic resection for young HBP surgeons have been changing. But it is important to learn as many surgical techniques as possible with the limited number of cases available in order to become proficient. In this session, we would like to invite young surgeons who will lead the next generation to present their daily learning methods and techniques for hepatic resection, as well as their efforts to obtain board certification.
Women in HBP surgery: Role of female expert surgeons
HBP surgery involves many difficult procedures and requires a long training period. Preparing new surgeons is a critical mission in the HBP field. The ratio of female surgeons is now growing, but because of the very low absolute number of females traditionally entering the HBP surgery profession, there is still plenty of room for growth. “Women in HBP surgery” is a special program designed to communicate the appeals of HBP surgery to female surgeons with the aim of fostering the next generation of surgeons.
Panel Discussion
Management of long-term complications following pancreatectomy
Panel Discussion
There are different types of surgical excision in pancreatectomy, including pancreaticoduodenectomy, distal pancreatectomy, total pancreatectomy, and middle pancreatectomy. Long-term complications after a pancreatectomy, such as postoperative cholangitis and nutritional disorders, including glucose intolerance and fatty liver, sometimes exacerbate quality of life and have a negative impact on life expectancy. In this session, we will discuss the perioperative predictive factors and the treatment of these long-term complications after pancreatectomy.
Introduction of robotic hepatectomy and standardization of techniques
Panel Discussion
In April 2022, robotic hepatectomy was approved for insurance coverage. Surgical robots are useful surgery-assistance devices with the potential to address maneuverability issues imposed by the limited degree of freedom of laparoscopic forceps and overcome other challenges relating to suture techniques and exposure of vessels in the hepatoduodenal ligament. However, there are also challenges specific to robotic surgery, including prolongation of surgery time and difficulties expanding the surgical field and performing liver transection. In this session, we will discuss the process of introducing robotic hepatectomy in each institution and the standardization of surgical techniques.
Therapeutic strategies for resectable/borderline resectable pancreatic cancer in the era of preoperative treatment
Panel Discussion
Even if pancreatic cancer is resectable (R) or borderline resectable (BR), the prognosis after surgical resection is not satisfactory. Recently, clinical trials have shown the benefit of preoperative treatment for R- and BR-pancreatic cancer. This session will be focused on R- and BR-pancreatic cancer, and optimal treatment regimens and indications/timing of surgery will be discussed. We look forward to discussing treatment outcomes and current best practices.
Bile duct cancer: How to determine the rational surgical procedure
Panel Discussion
Choosing an appropriate surgical procedure for bile duct cancer is often challenging because the disease's oncological behavior varies considerably by location and extent of tumor spread. Preoperative diagnosis of tumor progression both vertically and horizontally is important for choosing the right surgical procedure to achieve R0, but diagnostic modalities and criteria differ by the hospital. Treatment strategies also vary by institution, such as the minimum remnant liver volume, the upper limit of bile duts resection, the optimum range of lymph node dissection, as well as indications for vascular resection and for hepatopancreatoduodenectomy. We look forward to a presentation of strategies for choosing appropriate surgical procedures for bile duct cancer from the perspective of short- and long-term outcomes.
Discussion on borderline resectable bile duct cancer
Panel Discussion
Long-term outcomes for bile duct cancer have yet to be satisfactory, but the emergence of evidence for adjuvant chemotherapy for bile duct cancer in 2022 represents a great advance in management and provides promising prospects for future outcomes. Meanwhile, a proposal to define the resectability of bile duct cancer similar to pancreatic cancer is under consideration, and the definition of borderline resectable (BR) bile duct cancer should be approached from the surgical and oncological aspects. In this session, we will present the criteria used by various institutions to classify BR bile duct cancer, data on perioperative treatment strategies, and their validity.
Symposium
Metastatic liver cancer: Treatment strategies focusing on surgical resection
Symposium
In recent years, the role of resection in the treatment of metastatic liver cancer has been increasing due to the favorable results of multidisciplinary treatment, especially chemotherapy, and the improved safety of liver resection. Favorable results have been obtained even for cancers with high biological grades, including metastatic breast cancer and gastric cancer. However, clinical factors such as surgical indications and timing of surgery also vary between institutions. In this symposium, institutions with extensive experience in treating liver metastases from colorectal and non-colorectal cancers will describe their treatment strategies and the outcomes that support them. In particular, the questions that many HBP surgeons often ask are: (1) Which should be prioritized, surgery or chemotherapy? (2) when to perform primary site versus hepatic resection, and (3) attributes of non-colorectal cancer cases for which hepatic resection is indicated. We hope that the evidence from this symposium will be of immediate clinical relevance.
Indications and perioperative management of HBP surgery in elderly/frail patients
Symposium
Elderly patients typically have numerous comorbidities and exhibit various forms of frailty—physical, mental, and social. These factors, rather than age alone, are crucial to determining surgery eligibility. Many diseases require multidisciplinary treatment and postoperative maintenance of ADL and QOL. The question is how to objectively assess the operative tolerance of such cases and whether there is room for preoperative intervention in anticipation of the postoperative period. In this session, we will look at key considerations relating to HBP surgery and perioperative management of elderly or frail patients from a variety of viewpoints, including the impact of adopting minimally invasive surgery.
Update on therapeutic strategies for Pancreatic neuroendocrine neoplasms
Symposium
In June 2021, PRRT therapy was approved in Japan as a new treatment for pancreatic neuroendocrine tumors (Pan-NENs). While various treatment methods are available for Pan-NENs, there have still been many unclear issues, such as the treatment strategy for NET-G3/NEC, the usefulness of surgical debulking for advanced settings, the treatment for hormone-symptomatic lesions with distant metastases, and the indication for surgery in non-functioning Pan-NENs with small tumor size. We would like to discuss the treatment strategies for various lesions of Pan-NENs at each institution, including surgical signs, surgical selection, and multidisciplinary treatment based on the latest findings.
Video Symposium
Challenges in highly difficult laparoscopic liver resection
Video Symposium
Laparoscopic liver resection (LLR) has been performed not only for partial resection but also for major hepatectomy. Some institutions may be challenging difficult cases such as large tumors, repeat hepatectomy cases, and cirrhotic cases, which were once hesitant to be performed by LLR. Although no new knowledge can be gained without challenge, it is also necessary to appropriately expand indications while ensuring safety. This session will look at how to overcome obstacles to treating highly difficult cases as well as current indication thresholds.
Pushing the limits of surgery: Liver resection and transplantation
Video Symposium
Although various novel agents have been introduced in the treatment of hepatocellular carcinoma and metastatic liver cancer, surgical resection remains the only curative treatment. Recently, highly advanced cases have been treated with challenging extended liver resection involving major vessels and two-stage hepatectomy. On the other hand, there have been innovations in procedures of organ transplantation, such as multiple organ transplantation, split liver transplantation, and complex vascular reconstruction. This video session will focus on open liver surgery for extremely difficult cases.
Pancreatectomy based on precise anatomy
Video Symposium
A precise understanding of anatomy is essential to pancreatectomy's safe and highly reproducible performance. However, the peri-pancreatic region has a complex structure of membrane with dense nervous plexus. There are many variations in the surrounding vasculature, and the anatomy remains controversial. In recent years, new anatomical insights have been obtained due to the high-resolution images in minimally invasive surgery and advances in imaging equipment. In this session, we would like to have reports of useful anatomical findings for pancreatectomy and video presentations of innovations and approaches to surgical techniques based on this understanding of precise anatomy.
Pushing the limits of surgery: Advanced biliary/pancreatic cancer
Video Symposium
Because of advances in multidisciplinary treatment, a growing number of advanced biliary-pancreatic cancer cases can be treated with resection. However, operations for these advanced cases inevitably involve significant risks. The question is how to safely perform extended surgeries such as pancreatectomy with major vessel resection and major hetatopancreatoduodenectomy. In addition, the extended indication of minimally invasive surgery for advanced cancers would not be possible without challenges. In this video session, we would like to discuss the extremely difficult procedures for both open and minimally invasive biliary/pancreatic surgery.
Workshop
Gallbladder cancer: What is the optimal surgery?
Workshop
In 2022, laparoscopic surgery with gallbladder bed resection for gallbladder cancer became covered by Japan's National Health Insurance system. The indications and techniques for laparoscopic surgery for gallbladder cancer are issues for discussion. On the other hand, a very wide range of techniques are indicated for gallbladder cancer, from cholecystectomy to simultaneous hepatopancreatic resection, depending on the invasion of adjacent organs, hilar extension, lymph node metastasis, and horizontal extension of the bile duct. In this session, each center's policy for determining the surgical procedure and its outcome will be presented, and the optimal procedure for gallbladder cancer will be discussed.
Role of genomic medicine in the field of HBP surgery
Workshop
Cancer treatment based on genomic testing in Japan has been dramatically transformed with the extension of the Japanese National Health Insurance coverage to targetted gene panel sequences. This has elevated the importance of drug therapy selection based on genetic mutation. How genomic medicine in hepatobiliary-pancreatic cancers, which are known to be intractable, will affect surgical practice is an issue for the future. This session is intended to be a broad examination of the role of genomic medicine in the field of HBP surgery in terms of its current state and future prospects.
Updates on diagnosis & treatment of pancreatic cystic neoplasms
Workshop
Opportunities for pancreatic cyst detection have been rapidly increasing in recent years because of the wider implementation of various health screenings and advances in imaging exams. The proper response following detection requires staged testing with consideration to differential diagnosis and an algorithm for determining where surgery is indicated and where further observation is warranted. It is also necessary to establish criteria for selecting the technique to be used against pancreatic cysts when resection is indicated and for deciding where minimally invasive or organ-preserving surgery is indicated. This session will focus on the findings that contribute to the development of diagnostic algorithms for pancreatic cysts, as well as reports on prognosis and treatment outcomes, and will be followed by a lively discussion.
Management of postoperative biliary complications
Workshop
In the field of HBP surgery, including organ transplants, biliary reconstruction is performed using multiple approaches, including open, laparoscopic, and robot-assisted. As long-term prognoses can be expected not only for low-grade malignancies and organ-transplant cases but also for malignant diseases, management of postoperative biliary stenosis and postoperative cholangitis has become a major issue. Advances in endoscopic procedures have made it possible to approach hepaticojejunostomy and have expanded treatment options. In this session, we will discuss the ingenious methods of biliary reconstruction to prevent postoperative biliary stricture, as well as the pathogenesis and treatment of refractory postoperative cholangitis.
DP-CAR: Indication, technique & perioperative management
Workshop
Distal pancreatectomy with celiac axis resection (DP-CAR) can contribute to the treatment of locally advanced pancreatic body cancer with invasion of the celiac artery or common hepatic artery. However, a high incidence of postoperative complications associated with celiac axis resection has been reported. There are many unanswered questions with regard to topics such as optimal preoperative adjuvant therapy, appropriate patient selection, handling of the left gastric artery (including preservation/reconstruction), and ingenuity in pancreatic fistula countermeasures. In this session, we would request the speakers to present their efforts and surgical outcomes regarding the optimal indication of DP-CAR and safety-improving ideas for surgical techniques and perioperative management.
The latest translational research for HBP surgery
Workshop
Translational research is conducted to bridge the gap between basic research and clinical application by using the insights gained from basic research to resolve clinical challenges. HBP surgeons must contend with many difficult-to-treat conditions and diverse issues in the current state of therapy and thus have a strong need for contributions from translational research. In this session, we would request the speakers to present the findings from research aimed at producing clinical applications and will discuss potential solutions for the challenges faced in HBP surgery.
Laparoscopic cholecystectomy: Strategies and troubleshooting for difficult cases
Workshop
Patients who are difficult to treat with laparoscopic cholecystectomy are often encountered in our daily practice. Especially, patients with conditions such as acute or chronic cholecystitis, gallstone impacted in the gallbladder neck, Mirizzi syndrome, or bile duct branch abnormalities are not only hard to treat with dissection but also have a high risk of unexpected bleeding or bile duct injury during surgery, and thus are typically challenging to the use of conventional techniques alone. We will share each facility's creative approaches for treating such cases and their troubleshooting experiences and engage in an in-depth discussion of challenging cases.
Novel surgical challenges for unresectable pancreatic cancer
Workshop
Although systemic chemotherapy is the first choice for initially unresectable pancreatic cancer (UR-LA/UR-M), radical conversion surgery (CS) may be possible in highly responding cases. However, there are still many points to be discussed, including the indications, timing, and prognostic effects of CS. For example, in the case of UR-LA, how is residual tumor tissue around the superior mesentery after chemotherapy considered resectable? If complete resection is not possible, should the artery be resected concomitantly? For UR-M, how is the indication for resection established based on information such as the number and size of tumors, the number of metastatic organs, and their response to chemotherapy? In this session, we will discuss the novel challenges and limitations for surgeons in the evolving multidisciplinary treatment for initially unresectable pancreatic cancer.
Simulation & navigation in HBP surgery
Workshop
Safe HBP surgery requires a deep understanding of the complex local anatomy and varied anatomical variations. A single misinterpretation can lead to potentially fatal complications. Therefore, preoperative simulation for a detailed understanding of the local anatomy and intraoperative navigation technology to support highly accurate surgery play a significant role. Their development and practical application have made remarkable progress in recent years. In this session, various new approaches and future prospects for simulation and navigation in HBP surgery will be discussed.
Pancreatic function-preserving surgery
Workshop
Reliable surgical techniques and postoperative management strategies have been established for pancreaticoduodenectomy and distal pancreatectomy. However, due to the small number of cases, in pancreatic function-preserving surgery—such as central or partial pancreatectomy or pancreas-preserving duodenectomy for duodenal neoplasms—a solid consensus has yet to be formed. In this session, experts will present their efforts in pancreatic function-preserving surgery.
Video Workshop
Robotic & laparoscopic surgery for Choledochal cyst
Video Workshop
Choledochal cysts potentially complicate biliary tract cancer during the natural course of the disease, and prophylactic bile duct and gallbladder resection is recommended. Recently, laparoscopic and robotic surgery for choledochal cysts has been covered by insurance in Japan. Due to the benign nature of the disease, most patients are expected to survive long-term after surgery. Therefore, there are concerns not only in the early postoperative period but also about long-term complications such as anastomotic stenosis and carcinogenesis in the remaining bile duct. In this session, we would like to request video presentations on procedural innovations and standardization in laparoscopic/robotic surgery for choledochal cysts, including the pursuit of hepaticojejunostomy and intrapancreatic bile duct resection.
Troubleshooting for laparoscopic /robotic liver resection
Video Workshop
Critical events such as hemorrhage from major blood vessels must be assumed in liver resection, and the ability to respond to such events as an emergency is required. If such difficulties occur during laparoscopic or robot-assisted liver resection, different handling is required compared to open surgery. In addition to hemorrhage, a number of other difficult situations can also be anticipated, such as bile leaks and carbon dioxide emboli. In this session, we would like to request a video presentation on troubleshooting laparoscopic/robotic liver resection.
Safe technique for laparoscopic cholecystectomy
Video Workshop
Laparoscopic cholecystectomy is one of the oldest forms of endoscopic surgery. Tokyo Guideline 2018 confirms the critical view of safety (CVS) and presents basic surgical techniques for improving safety, such as dissection along the SS-Inner layer. Nevertheless, from the results of questionnaires on endoscopic surgery, it still remains difficult to completely eliminate collateral injury. This session will bring together presentations on clinical experiences with a focus on collateral injury and on the creative solutions that surgeons have employed so that we can engage in a fuller discussion of how to make laparoscopic cholecystectomy safer.
Knack and pitfalls for laparoscopic extended cholecystectomy
Video Workshop
For gallbladder cancer above pT2 and higher, an extended cholecystectomy with hepatectomy, lymph node dissection, and, if necessary, bile duct resection is required. In 2022, laparoscopic cholecystectomy with liver bed resection for gall bladder cancer was covered by insurance in Japan. In this session, the technical innovations and tips on laparoscopic extended cholecystectomy for gallbladder cancer will be presented in a video.
Laparoscopic pancreatectomy: Creative use of surgical devices and technical tips
Video Workshop
Recently, due to the development of various techniques and instruments, pancreaticoduodenectomy (PD) and distal pancreatectomy (DP) are increasingly being performed laparoscopically. However, in order for this technique to become more common, it is necessary to consolidate the innovations performed at each institution and promote the standardization of the procedure. In this session, we will request a video presentation regarding the innovations and tips of laparoscopic PD/DP performed at each institution, focusing on the use of various devices and peripheral equipment.
Standardization of robotic pancreatectomy
Video Workshop
Recently, Japanese National Health Insurance coverage was extended to robotic pancreatectomy. Although the number of this procedure in Japan is increasing, it is still a work in progress. The approaches used—including trocar position, the devices used, and the role of assistants—vary greatly from one institution to another. This session will broadly explore robotic DP/PD, particularly with regard to creative approaches in procedures and techniques, standardization efforts, and troubleshooting. Our discussion will be aimed at helping to spread safe approaches to robotic pancreatectomy.