Educational Symposium

Evidence from Clinical Study Groups

Clinical research conducted in a multicenter setting can be expected to yield highly reliable results with a large sample size. In this symposium, we would like to discuss the future of multicenter clinical research in Japan by introducing the establishment and management of implementation systems and examples of highly original clinical research conducted by highly mobile regional clinical research groups characterized by close inter-institutional collaboration, among the multicenter collaborations conducted on various scales. We would like to have a deeper discussion on the future of multicenter collaborative research in Japan.

Translational medicine in HBP surgery

We would like to introduce the examples of translational medicine (exploratory medicine) such as genomic and omics medicine, immunotherapy, regenerative medicine, and medical-engineering fusion innovation based on basic research to overcome unmet medical needs in hepatobiliary-pancreatic surgery, and to teach us how to reflect surgeons' unique insights to new medical treatments.

Being a Modern Surgeon-scientist

The Grant-in-Aid for Scientific Research (KAKENHI) from the Japan Society for the Promotion of Science (JSPS) is a "competitive fund" that aims to develop academic research based on researchers' free ideas, from basic to applied research. Japanese researchers conduct their academic activities on the basis of KAKENHI, and Surgeon-scientists are no exception. In this session, former senior researchers of the Research Center for Academic Systems at JSPS, will present details of the KAKENHI system and trends in Japanese academic research.

Symposium

Surgical Treatment Strategies for Intrahepatic Recurrence of Hepatocellular Carcinoma

Hepatocellular carcinoma is a frequently recurring cancer, and surgical treatment for recurrence is known to be highly significant. Although the Hepatocellular Carcinoma Treatment Guidelines recommend "following the treatment algorithm at the time of initial treatment," there are limited research reports with a high level of evidence for recurrent hepatocellular carcinoma. Now that effective drug therapies are available, we would like to discuss the indications and timing of surgical treatment for recurrent cases, including hepatic resection and liver transplantation.

Treatment Strategies for Unresectable Pancreatic Cancer

Surgical treatment of unresectable pancreatic cancer (URLA, URM) by conversion surgery (CS) has been reported to be effective in cases of response to chemotherapy or chemoradiotherapy. However, there are many issues to be addressed, such as preoperative treatment regimens and duration of treatment, indication criteria for CS, establishment of safe surgical techniques such as vascular resection and reconstruction, and postoperative adjuvant therapy. This session will discuss the indications and outcomes for UR pancreatic cancer at each institution, and discuss the evolving multidisciplinary management.

Med- and long-term results of laparoscopic anatomical liver resection

Several years have passed since laparoscopic anatomical liver resection became widespread and was included in the health care list in Japan in 2017. Short-term results have been reported so far, focusing on safety, but curative potential as a surgical treatment for liver cancer is beginning to be discussed. We would like to discuss whether laparoscopic anatomic liver resection is no less or more effective than open anatomic liver resection, with a focus on mid- to long-term results.

Panel Discussion

Biological Borderline Resectable Pancreatic Cancer in the Era of Preoperative Treatment

The resectability of pancreatic cancer has been anatomically defined, with a focus on the tumor’s location in relation to the major vascular structures surrounding the pancreas. In recent years, preoperative treatment has emerged as the standard of care. Consequently, our understanding of pancreatic cancer has evolved from the notion that only surgical resection with negative margins can potentially cure, to the concept that pancreatic cancer should be managed as a systemic disease from the outset. In this session, we invite you to revisit the concept of Biological Borderline Resectable pancreatic cancer, with a focus on biological factors such as serum CA19-9 levels, SUVmax of PET-CT, and circulating tumor DNA.

Definition of the Borderline Resectable for Colorectal Liver Metastases

The concept of borderline resectable (BR) with a high risk of early recurrence after resection has been widely adopted in the practice of pancreatic cancer and other hepatobiliary cancers. Conversion strategies for unresectable colorectal liver metastases (CRLM) of have become widely accepted, but there is a possibility that BR may also exist in CRLM. Preoperative chemotherapy as well as postoperative adjuvant chemotherapy have not yet been established, and we would like to discuss the definition of BR in CRLM.

Challenging the Limits of Resection for Perihilar Cholangiocarcinoma: Combined Vascular Resection and Liver Transplantation

Resection, the only curative treatment for hilar cholangiocarcinoma, has been pursued in terms of expanding the extent of resection with vascular resections and securing residual liver function by altering portal vein blood flow. On the other hand, the promissing results of liver transplantation with total hepatectomy have been demonstrated in Europe and the U.S., and clinical trials have begun in Japan as well. In addition, drug therapy for biliary tract cancer, such as molecular-targeting drugs and immune checkpoint inhibitors, is also advancing. We would like to ask for future discussion on whether liver resection or liver transplantation should be considered.

Debate

Treatment Strategies for Anatomical Resectable Pancreatic Cancer: Upfront surgery vs. Neoadjuvant therapy

For patients with anatomically resectable pancreatic cancer, the Japanese guidelines suggest the use of gemcitabine plus S-1 as preoperative adjuvant therapy. On the other hand, the NCCN guidelines suggest that upfront surgery should be performed and preoperative treatment should be considered for high-risk patients. In this session, we would like to ask the panelists to debate the treatment strategy for anatomically resectable pancreatic cancer from the standpoint of upfront surgery and preoperative treatment.

Workshop

Optimal surgical approach for intrahepatic cholangiocarcinoma

Surgical treatment, the only curative treatment for intrahepatic cholangiocarcinoma, still contains unresolved themes such as the significance of lymph node dissection and anatomical liver resection. Furthermore, with the advent of immune checkpoint inhibitors and molecular targeted drugs, the potential of preoperative treatment for advanced cancer is being discussed. In this workshop, based on the results of a questionnaire from members, we would like to discuss preoperative and intraoperative diagnosis of intrahepatic cholangiocarcinoma, surgical selection, indications and timing of resection, etc.

Defining the borderline resectable for hepatocellular carcinoma from the perspective of both tumor factors and liver function.

Advances in drug therapy for hepatocellular carcinoma hold promise not only for conversion therapy in cases of unresectable advanced cancer, but also for improved outcomes in poor prognosis cases previously considered resectable. Indications for liver resection for hepatocellular carcinoma have traditionally been discussed in terms of liver function, i.e. whether the tumour is resectable or not, whereas the borderline resectable are mainly discussed in terms of tumour factors. Both oncological and hepatic functional aspects are required when discussing indications for resection in liver cancer, and a multifaceted discussion is requested.

Treatment Strategies for Peritoneal Cytology Positive Pancreatic Cancer

In pancreatic cancer, positive cytology (CY+) is defined as distant metastasis by the UICC 8th edition and the General Rules for the Study of Pancreatic Cancer, 8th edition. However, there is still room for debate regarding diagnostic methods such as staging laparoscopy, timing of diagnosis, and treatment strategies for CY+ cases. This session will discuss the diagnosis, treatment strategy, and outcomes of CY+ pancreatic cancer.

Treatment strategies for octogenarian patients with pancreatic cancer

In an aging society, pancreatic cancer patients are getting older. There are many issues to be addressed in the treatment of pancreatic cancer in the elderly, such as the tolerability of highly invasive surgery and the pros and cons of preoperative and postoperative adjuvant therapy. On the other hand, clinical trials of anticancer drugs have not been conducted in patients older than 80 years, and there is a lack of evidence. In this workshop, we would like to discuss optimal treatment strategies for pancreatic cancer in elderly patients over 80 years of age and the innovations in each institution.

Defining borderline resectable (BR) and unresectable (UR) in biliary tract cancer

While the classification of resectability in pancreatic cancer is widely accepted and used to guide treatment strategies, no definition has been established for biliary tract cancer (BTC). In BTC, the degree of horizontal and vertical biliary and vascular invasion, distant metastasis, and residual liver function reserve must be considered. In this session, the criteria for borderline resectable (BR) and unresectable (UR) BTC at individual centers will be presented and data on perioperative treatment strategies, their relevance and outcomes will be discussed.

Innovative and up-to-date approaches to pancreas transplantation surgical techniques

Surgical complications following pancreas transplantation are still common and can contribute to graft loss. As medical treatment for type 1 diabetes continues to evolve, pancreas transplantation as a curative procedure needs to become safer and achieve better long-term outcomes. We would like to present and discuss the innovations in surgical techniques at each institution and share the latest approaches.

Pre-transplant anti-tumour therapy in liver transplantation for hepatocellular carcinoma

Anti-tumor treatment prior to liver transplantation for hepatocellular carcinoma has been undertaken to prevent tumour progression during the waiting period, to prevent recurrence after transplantation, or to downstage to within the indication criteria. Although a certain level of efficacy has been reported in Europe and the USA, there is insufficient evidence in Japan, where living donor liver transplantation is the mainstay of treatment. There are also reports that the number of pre-transplant treatments and the means of treatment affect the prognosis after liver transplantation. In this session, the results and significance of pre-transplant anti-tumour treatment, including downstaging, will be discussed.

Challenging the limits of resection for locally advanced liver cancer: Ex-situ, and Ante-situ liver resection

Several innovations have been made to overcome the limitations of resection for locally advanced liver cancer. Resection of locally advanced liver cancer, such as those invading the hepatic vein root to the inferior vena cava and extensive vascular invasion of the porta hepatis, requires a response to prolonged blood flow interruption and warm ischemic time. In this session we would like to present innovations in surgical techniques for locally advanced liver cancer, including ex-situ liver resection, autotransplantation, and ante-situm liver resection with intracorporeal cooling.

Experience with genome-informed surgical treatment of the HBP cancer

Cancer genomic profiling tests (CGP) are now being introduced in practice for various cancers; PARP inhibitors for hereditary breast and ovarian cancer syndromes with BRCA mutations and FGFR inhibitors for biliary tract cancers with FGFR2 fusion genes or FGFR2 gene reconstructions are widely used as companion diagnostics. Immune checkpoint inhibitors are also indicated for MSI-high cases. However, genomic medicine has not yet been generalised in the treatment of Hepato-biliary-pancreatic cancer, and we would like to present cases where genomic medicine has been effective in the treatment process, including resection, and discuss the generalisation of this treatment.

Diagnostic and therapeutic strategies for Intraductal Papillary Neoplasm with an associated invasive carcinoma of the pancreas

Intraductal papillary mucinous adenocarcinoma of the pancreas is broadly classified into invasive and noninvasive forms. In particular, intraductal papillary neoplasm (IPMN) with associated invasive carcinoma has been reported to show similar biological behavior to invasive pancreatic ductal carcinoma, but effective diagnostic and therapeutic strategies have not been established. In this workshop, we will focus on IPMN with associated invasive carcinoma and discuss optimal treatment strategies based on data from individual institutions.

Strategies for liver transplant marginal donors

The selection of a marginal donor in liver transplantation is important to assess and address, as it has a significant impact on transplant success rates and patient outcomes. In particular, clear definitions of marginal donors, recipient selection, short- and long-term outcomes of liver transplantation and criteria for risk assessment have not been well established. In this session, we would like to discuss the response of each institution to marginal donors and the establishment of evaluation criteria, based on the latest research and clinical cases.

Surgical treatment strategies for hepatocellular carcinoma with extrahepatic lesions.

Hepatocellular carcinoma with extrahepatic metastases is a Stage IV advanced cancer, for which guidelines recommend pharmacological treatment, but conditions with few extrahepatic lesions, such as oligometastasis, may warrant multimodal treatment, including surgery. Suspected lesions that cannot be confirmed preoperatively may also confound the indication for resection. In this workshop, we invite discussion on the preoperative and intraoperative diagnosis of extrahepatic lesions, choice of pharmacological treatment, indications and timing of resection.

Video Workshop

Liver transplantation for polycystic liver disease: techniques and innovations

Polycystic Liver Disease (PCLD) is sometimes enlarged and occupies the abdomen, making it a potential indication for liver transplantation. However, its massive size makes total hepatectomy difficult. In this session, a video presentation of a case of liver transplantation in a giant PCLD will be shown and the techniques and innovations will be discussed.

Techniques for liver parenchymal transection in robot-assisted liver resection

Robotic-assisted hepatectomy was covered by insurance in 2022 and many centres have moved towards its introduction. In this session, we would like to discuss the innovations and results of each institution in robotic hepatic parenchymal transection.

Knack and pitfalls of liver resection requiring biliary reconstruction and vascular resections

Resection of hilar cholangiocarcinoma and intrahepatic cholangiocarcinoma invading the hilar region is highly challenging, especially in locally advanced cases requiring combined resection of the hepatic artery and portal vein. The proximity of the site of arteriovenous invasion and the site of planned bile duct dissection makes it difficult to perform bile duct dissection, combined arteriovenous dissection and reconstruction in an optimal and safe location. In this session, we will present surgical videos and discuss the ingenuity of bile duct dissection and vascular reconstruction in cases of combined vascular resection.

Use and ingenuity of shunts and bypasses in liver transplant

A period of time without a liver is inevitable in liver transplantation, and temporary extracorporeal porto-systemic shunts or bypasses may be used to maintain circulation and counteract intestinal congestion. However, there is no consensus on the indications for and selection of these methods, as they are complicated procedures and have disadvantages such as coagulation abnormalities and hypothermia associated with extracorporeal circulation. The aim of this video workshop is to present the use and innovations of shunts and bypasses in liver transplantation.

Treatment strategies for bile duct injury after cholecystectomy

The incidence of intraoperative bile duct injury (BDI) in cholecystectomy is low, at less than 1%, but once it occurs it is difficult to treat in some cases. In this session, we will discuss recovery shots when BDI is diagnosed intraoperatively and treatment strategies for cases diagnosed with BDI postoperatively, presenting case examples.

Surgical techniques in liver resection for giant hepatic haemangiomas

Hepatic cavernous haemangiomas are common, but when they are indicated for resection, they are not infrequently difficult to operate on due to their massive size. The innovations and results of resection for giant hepatic haemangiomas should be presented.

Standardization of robot-assisted surgery for pancreatic cancer

After insurance coverage in Japan in 2020, robot-assisted pancreatectomy is rapidly increasing and has been applied to pancreatic cancer at advanced institutions. Various reports have been published on the standardization of robot-assisted surgery for pancreatic cancer, including lymph node dissection. In this video workshop, we will discuss surgical indications, surgical outcomes, and surgical techniques for the standardization of robot-assisted pancreatectomy for pancreatic cancer, and discuss future directions and issues.

Surgical approach to pancreatic cancer with arterial contact or invasion

The usefulness of arterial resection to achieve R0 has been reported in the resection of borderline resectable (BR-A) and locally advanced (UR-LA) pancreatic cancer after preoperative treatment. On the other hand, plexus dissection without arterial resection and plexus-preserving strategy with radiation therapy have also been reported. In this workshop, we would like to discuss the optimal treatment approach for the artery in BR-A/UR-LA pancreatic cancer, including preoperative treatment, indication for surgery, and surgical strategy with video.

Standardize minimally invasive surgery for biliary disease

Minimally invasive procedures (MICs) for biliary tract disease are increasing dramatically with the proliferation of robotic surgery. This session will present videos of MICs for biliary tract diseases such as congenital biliary dilatation and gallbladder cancer, and discuss the indications, surgical outcomes, and efforts to standardize the procedure.

Next Generation Program

Pancreatic resection by the surgeons of the next generation

Eligibility: 45 years of age or younger at the time of abstract submission
Pancreatectomy requires advanced skills for young surgeons training to become board-certified expert HBP surgeons and/or board-certified endoscopic pancreatic surgeons. The training environment has changed dramatically in recent years with the proliferation of minimally invasive surgery. In this session, we would like to invite young surgeons who will lead the next generation to present their daily training methods and techniques for pancreatectomy as well as their efforts to achieve board certification.

Liver resection by the surgeons of the next generation

Eligibility: 45 years of age or younger at the time of abstract submission
Liver resection requires advanced skills for young surgeons training to become board-certified expert HBP surgeons and/or board-certified endoscopic pancreatic surgeons. The training environment has changed dramatically in recent years with the proliferation of minimally invasive surgery. In this session, we would like to invite young surgeons who will lead the next generation to present their daily training methods and techniques for liver resection as well as their efforts to achieve board certification.

Empowering Women in HPB Surgery: Expert Perspectives

HPB surgery, with its complex procedures and extensive training period, is a challenging field. Training HPB surgeons is a crucial mission for our society. With the recent rise in the number of female surgeons, we anticipate that women in HPB surgery, though currently few in number, will make significant advancements in the future. The “Empowering Women in HPB Surgery” session will showcase presentations by women leaders in HPB surgery, aiming to inspire the next generation of surgeons.

English presentation skill up session for young HPB surgeons

Student & Resident

Campfire session

Nightmare case session

In the field of hepatobiliary and pancreatic surgery, we sometimes encounter desperate situations both intraoperatively and postoperatively, and it would be very meaningful to share such experiences for the next generation. In this Campfire Session, we would like to share and discuss such experiences by presenting cases of recovery from nightmarish situations, as well as cases that unfortunately did not lead to a successful outcome.

Requested Oral

Perioperative Nutritional Management of HBP Surgery

Surgical Treatment of HBP Cancer in the Elderly

Biomarkers of HBP Cancer

Prevention and Treatment of Bile Leakage after hepatectomy

De novo malignancies after liver transplantation

Prevention of bile duct injury after cholecystectomy

Peritoneal cytology in biliary tract cancer

Perioperative management and outcomes of total pancreatectomy

Surgical Treatment of Chronic Pancreatitis

Surgical treatment of pancreatic neuroendocrine neoplasms

Prevention and Treatment of Postoperative Pancreatic Fistula

Surgical treatment strategies for duodenal cancer

Navigation and image-guided HBP surgery

Tips and Pitfalls of Hepatectomy with Pancreatoduodenectomy

Optimal surgical approach in living donor liver transplantation

Laparoscopic Surgery for early-stage Gallbladder Cancer

Surgical strategies in the treatment of CBD stones

Free Paper (Oral/Poster)