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As we face a worldwide shortage of general surgeon candidates, restrictive working hours and less surgical exposure, de Santibanes and colleagues review the past, present and future of training in hepato-pancreato-biliary surgery during residency. They propose five specific measures to be implemented independently of any paradigm change in surgical training.

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The ‘mesopancreas’ is not a true mesentery because it lacks a fascial envelope attaching the pancreas to the posterior abdominal wall and does not contain all of its blood vessels and primary draining lymphatics. Sharma and colleagues recommend replacing the misnomer with the anatomically correct nomenclature ‘pancreatic head plexus II’.

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Staging laparoscopy revealed latent distant organ metastasis in 62 of 110 patients with radiographically defined locally advanced pancreatic ductal adenocarcinoma. On multivariate analysis, risk factors for latent distant organ metastasis were tumor size >55 mm and CA19-9 level >60 IU/mL. Karabicak and colleagues recommend routine staging laparoscopy in such patients.

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Aiming to clarify the association between infectious complications and corticosteroid use in acute liver failure, Yasui and colleagues showed that corticosteroid use did not significantly increase the incidence of infection and that two weeks after corticosteroid initiation was a critical point for evaluating treatment response and switching to liver transplantation.

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Furuyama and colleagues devised the direct bilirubin to prothrombin time ratio index (DBPTRI) as a simple non-invasive preoperative index for safe hepatectomy, and demonstrated that DBPTRI was the best predictor of remnant liver function and recurrence-free liver failure after hepatectomy, compared with conventional indices such as ICG-R15 and Child-Pugh score.

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Hamaguchi and colleagues investigated the impact of the duration of hepatic pedicle clamping on tumor growth after major hepatectomy in a rat model. Longer hepatic pedicle clamping followed by reperfusion accelerated hepatocellular carcinoma growth in the remnant liver through the induction of HIF-1a and activation of the IL-6-JAK-STAT3 signaling pathway.