Background and Objective: Understanding the normal anatomy and size of the extrahepatic biliary tree is vital for surgeons to make informed decisions regarding the necessity of additional procedures beyond cholecystectomy. The extrahepatic bile duct (EHBD) comprises the common hepatic duct (CHD) and the common bile duct (CBD), with the former formed by the convergence of the right and left hepatic ducts and the latter extending from the CHD to the duodenum. A normal diameter is indicative of the absence of any signs of obstruction in the EHBD, and the determination of the average range for these ducts are essential for identifying pathologies that may require further surgical intervention. Cholecystolithiasis is a common condition managed at the Philippine General Hospital (PGH). Trans-abdominal ultrasonography is frequently utilized to diagnose cholecystolithiasis, and it can also be used to determine the size of the common bile duct. Knowledge of the normal CBD diameter aids clinicians in distinguishing obstructed bile ducts from normal ones, prompting further diagnostic tests for improved patient management. However, there is limited data on the average diameter of the CBD among Filipino patients with this condition. The study aimed to determine the mean diameter of the common bile duct and common hepatic duct among patients diagnosed with cholecystolithiasis with no signs of obstruction in the EHBD managed at the Philippine General Hospital. Methods: This prospective cross-sectional study included 80 patients who underwent cholecystectomy with intraoperative cholangiography. The CBD and CHD diameters were measured using intraoperative ultrasonography, and the data were analyzed using descriptive statistics and independent t-test. Results: The mean diameter of the CBD was 5.17 mm, with a range of 2.7-10 mm (1.41) mm. The mean diameter of the CHD was 4.71 mm, with a range of 2.3- 10 mm (1.59) mm. There was no significant difference in the CBD and CHD diameters between male and female patients, and across different age groups. Conclusion In patients with cholecystolithiasis managed at the PGH, the mean diameter of the CBD and the CHD was 5.17 mm and 4.71 mm, respectively, with no significant difference between genders and age groups. The mean diameter of the CBD among Filipino patients with cholecystolithiasis is similar to those reported in other countries. These findings may have clinical implications for the management of patients with cholecystolithiasis, particularly in the planning of endoscopic retrograde cholangiopancreatography (ERCP) and laparoscopic cholecystectomy. Further studies with larger sample sizes and different populations are recommended to validate these results. These findings can aid clinicians in determining the need for pre-operative Magnetic Resonance Cholangiopancreatography (MRCP) or selective intraoperative cholangiography to detect extrahepatic bile duct obstruction.
Common Bile Duct ; Cholecystolithiasis

Background: Metastatic pancreatic and periampullary adenocarcinoma is associated with a poor prognosis, with a life expectancy of less than one year at diagnosis, a 5-year survival rate of only 1-2%, and a median survival of 3 to 6 months. In the Philippines, pancreatic cancer is the 14th most common cancer and the 8th leading cause of cancer-related death, with over 153,000 cases and 92,600 deaths reported in 2020. Current literature suggests that in carefully selected patients, synchronous resection of primary pancreatic and periampullary adenocarcinoma with liver metastases can yield favorable surgical outcomes with low morbidity and mortality. However, survival outcome data for such cases within the Philippine population remain limited. Objective: To evaluate survival rates in patients with pancreatic and periampullary adenocarcinoma with oligometastasis who underwent pancreatic resection and metastasectomy at the Philippine General Hospital from 2011 to 2021. Methods: A retrospective cohort study was conducted using data collected from the Department of Surgery’s electronic medical records, cross-referenced with the Philippine Statistics Authority’s death registry. Inclusion criteria included patients aged 19 and above with histologically confirmed pancreatic and periampullary adenocarcinoma with three or fewer metastases. Descriptive statistics were calculated, and Kaplan-Meier survival analysis was used to determine overall survival rates. Results: Of the patients reviewed, 75% were female, with a median age of diagnosis of 60 years. Tumor locations included the pancreatic head (50% of cases), ampullary region (37.5%), and pancreatic body/tail (12.5%). The 1-year survival rate was 62.5%, the 2-year survival rate was 25%, and the median overall survival was 17.3 months, with a range from 7 to 28.8 months. Conclusion The findings suggest that synchronous resection of primary tumors and metastases may offer survival benefits for selected patients with metastatic pancreatic and periampullary cancers. However, further prospective clinical trials are necessary to confirm the potential survival advantage of this approach in a broader population.
metastasectomy

RATIONALE/OBJECTIVE

Hepatic Resection (HR) has emerged as a potentially curative treatment for HCC, particularly in Barcelona Clinic Liver Cancer – B (BCLC-B) patients, even though Transarterial Chemoembolization (TACE) is the standard of care according to the BCLC staging system. This study aimed to investigate the characteristics, survival rates and outcomes of patients who underwent HR for HCC BCLC-B at a single center over a 10-year period.

METHODS

Patients who were diagnosed HCC BCLC-B and had undergone HR from January 2011 to December 2021 were analyzed. Only complete records with long-term follow-up were included in the study. The authors described patient characteristics, calculated overall survival rates, and assessed associations between patient, disease factors, and survival.

RESULTS

Of 344 patients who underwent HR, 20 of them had complete records with long-term follow-up. This cohort had a median age of 57, predominantly male (70%), exhibiting a median alpha-fetoprotein (AFP) level of 230.5 ng/mL and an average of 4 nodules. Lymphovascular invasion was evident in 65%, with 85% displaying negative primary tumor margins. Major hepatectomy was the primary procedure (50%), followed by bisegmentectomy (40%) and trisegmentectomy (10%). The 1, 2 and 3-year survival rates post-hepatic resection (HR) for HCC BCLC-B stood at 65%, 35% and 25% respectively.

CONCLUSION

The study shows that the institution’s treatment approach for BCLC-B HCC patients achieved acceptable 3-year survival rates, and the median overall survival rate observed are comparable with global data. This study highlights hepatic resection as a potential curative option for BCLC-B HCC patients.

Human ; Carcinoma, Hepatocellular ; Survival Rate ; Hepatectomy