The professionals of the Hepato-Bilio-Pancreatic Surgery and Liver Transplantation group of the Vall d'Hebron Research Institute (VHIR) have seized the opportunity of the 15th congress of the European-African association of their speciality to present the results of their research. This meeting is held every two years and is one of the most important in the sector, bringing together more than 1,000 experts from Europe, Africa and the Middle East. In total, Vall d'Hebron researchers presented four posters and two oral presentations, one on pancreas and the other on liver. In addition, two surgeons from the Department of Hepatobiliopancreatic Surgery and Transplants of Vall d'Hebron University Hospital and main researchers of the group, Dr. Gómez-Gavara and Dr. Dopazo, were speakers of two lectures.

Dr Cristina Dopazo, who is also a researcher at the CIBER of Liver and Digestive Diseases (CIBEREHD), explained the key aspects of performing a liver transplant in patients with polycystic liver disease. Dr Concepción Goméz-Gavara participated in a symposium on the use of fluorescence imaging techniques to operate. In particular, she explained why and when green indocyanine can be used during biliary surgery.

Improving the information at the time of diagnosis

Two of the papers presented are focused on improving the information received by the patient at the time of diagnosis, the two studies led by Dr. Elizabeth Pando, and are part of the doctoral theses of Dr. Sara Villasante and Dr. Rodrigo José Mata.

In the first, presented by Dr. Villasante, artificial intelligence techniques were used to predict the severity of acute pancreatitis. The prognosis can be obtained using data from the patient's medical history and a physical examination, without the need for additional tests.

In the second, explained by Dr. Mata and performed jointly with the Digestive Endoscopy Unit (Dr. Monder and Dr. Masachs), it has been proven the reliability of performing ultrasound-guided core-needle endoscopy at the time of diagnosis to obtain tumour samples on which a state-of-the-art molecular analysis can be performed. The procedure is key to identifying therapeutic targets from minute 0, which allows for personalised and more effective treatment.

Optimising existing surgical techniques

Dr. Claudia Cabau, from the General and Digestive Surgery Department of the Vall de Hebron University Hospital, presented a case of a completely robotic Modified Puestow procedure in a patient with chronic pancreatitis. This intervention, which consists of performing anastomosis or surgical union between the pancreas and the jejunum, (a part of the small intestine) is one of the standard treatments for this pathology in manual format. Dr. Cabau's results show the feasibility of using robotics for this type of operation, which eases the recovery process.

The presentation by Dr. Martin Huerta, a 2nd year resident in the same department, takes advantage of the popularisation of fluorescence-assisted liver surgery using indocyanine green to obtain more information about the tumours treated. The study shows that the fluorescence produced by this dye differs according to the tumoural structure it illuminates. The research team has divided the results into total, partial or contour-only fluorescence and categorised the type of tumour according to the results. For example, an adenoma fluoresces fully, while a metastasis of colorectal cancer only its outline gets illuminated. More studies are needed, but the researchers hope that this study will improve the planning of liver surgeries by providing extra information to the medical team.

The work led by Dr. Nair Fernandes, from the Department of Hepatobiliopancreatic Surgery and Transplantation at Vall d'Hebron Hospital and researcher at VHIR, determined the optimal position for drainage after pancreatoduodenectomy. To avoid complications, such as fistulas, the use of an intra-abdominal drain has long been established, but the specific place where it should be placed had not been determined. The new study has determined that placing the drain within a one-centimetre circular area around the pancreatojejunal anastomosis reduces the risk of complications.

Finally, the work of Dr. Laura Vidal, from the Department of Hepatobiliopancreatic Surgery and Transplantation at Vall d'Hebron Hospital and researcher at VHIR, served to test whether the hypothesis that tumour manipulation during surgery releases tumour elements into the bloodstream and whether this influences patient survival is true. The team performed a meta-analysis of studies that had liquid biopsy data before and after an operation to remove an adenoma. They found that many more patients went from a positive to a negative tumour index after the operation than the other way around. Therefore, the operation positively affected the tumour index. However, the minority who went from negative to positive had a lower long-term survival rate. There was no discernible difference between operations, nor was it possible to establish a specific cause for the change, and the team postulates that further studies will be able to resolve these questions.