BACKGROUND AND OBJECTIVES

Hepatobiliarypancreatic tuberculosis (HBPTB) is a less common form of tuberculosis that often presents as malignancy or lithiasis. Advances in diagnostics and minimally invasive procedures have led to the detection of more patients with milder forms of TB requiring surgical management. Due to the low incidence rates and lack of standardized approaches, additional studies are needed to improve patient outcomes. This study examined the risk factors, diagnostic methods, and treatments for HBPTB patients at the University of the Philippines – Philippine General Hospital (UP-PGH) from January 1, 2014 to December 31, 2021.

METHODS

This retrospective descriptive study utilized our institutional database to identify patients who underwent a surgical procedure for HBPTB and their associated risk factors. Inclusion criteria required biopsy or microbiologic proof of tuberculous involvement of the biliary tract or nearby structures.

RESULTS

Among a total of 45 patients, the most common admitting diagnosis were HBP tuberculosis (37.8%) and malignancy (35.6%). 47.6% of patients had a previous or concurrent TB exposure. Sixty percent had subclinical malnutrition indicated by normal weight and low albumin. The liver (37.8%) and the bile ducts (33.3%) were the most common organs involved. The most common surgical procedures done were ultrasound-guided liver biopsy, biliary enteric anastomosis, percutaneous transhepatic biliary drainage (PTBD), and endoscopic retrograde cholangiopancreatography with or without stenting (ERCP).

CONCLUSIONS

This study provides additional data for clinicians to tailor diagnostic and treatment plans accordingly. Striking a balance between surgical procedures and appropriate anti-tuberculous therapy (ATT) is essential for successful treatment. Local data can be useful to help identify tuberculosis patterns unique to Filipinos and highlight socio-economic factors contributing to this rare presentation of TB.

Human ; Tuberculosis, Extrapulmonary ; Biliary Tract Diseases ; General Surgery ; Acute Care Surgery ; Liver Diseases ; Pancreas

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