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X
- •Foreword
- •Preface
- •Introduction
- •Contents
- •Contributors
- •1.5 Venous Anatomy
- •1.6 Conclusion
- •References
- •2.1 Introduction
- •2.1.1.1 IPDA
- •1.1 Introduction
- •1.2 Arterial Anatomy
- •1.3 Portal Venous Anatomy
- •1.4 Biliary Anatomy
- •2.1.1.4 Dorsal Pancreatic Artery (DPA)
- •2.3 Surgical Techniques
- •2.4 Discussion
- •2.5 Conclusion
- •References
- •3.1 Introduction
- •3.2 Intrahepatic Biliary Tract
- •3.2.4 Accessory Biliary Ducts
- •3.3 Extrahepatic Biliary Tract
- •3.3.2 Retroduodenopancreatic Portion
- •3.3.3 Intramural Portion
- •3.5 Accessory Biliary Tract
- •3.5.2 Vascularization
- •References
- •4.1 Introduction
- •4.2 Posthepatectomy Liver Failure (PHLF)
- •4.3.1 Portal Hypertension
- •4.3.3 Blood Chemistry Tests
- •4.3.4 Indocyanine Green (ICG) Clearance Test
- •4.4 M2BPGi
- •4.5 Scintigraphy
- •4.7 Measuring FLR Function
- •4.8 Conclusions
- •References
- •5.1.1 Hemangioma
- •5.1.2 Focal Nodular Hyperplasia
- •5.1.3 Simple Hepatic Cyst
- •5.1.4 Hepatic Adenoma
- •5.2.1 Hepatocellular Carcinoma
- •5.2.2 Metastatic Disease
- •5.2.3 Intrahepatic Cholangiocarcinoma
- •5.2.4 Hepatic Angiosarcoma
- •5.3.1 Acute Calculous Cholecystitis
- •5.3.2 Chronic Cholecystitis
- •5.3.3 Acalculous Cholecystitis
- •5.3.4 Biliary Dyskinesia
- •5.3.5 Choledocolithiasis
- •5.3.7 Choledochal Cysts
- •5.3.8 Primary Sclerosing Cholangitis
- •5.3.9 Benign Biliary Stricture
- •5.4.1 Extrahepatic Cholangiocarcinoma
- •5.4.2 Gall Bladder Cancer
- •5.5.1 Acute Pancreatitis
- •5.5.2 Chronic Pancreatitis
- •5.5.3 Pancreas Neuroendocrine Tumors
- •5.5.4 Pancreas Cystic Neoplasms
- •5.5.4.1 Intraductal Papillary Mucinous Neoplasm
- •5.5.4.2 Mucinous Cystic Neoplasm
- •5.5.4.3 Solid Pseudopapillary Neoplasm
- •5.6.1 Pancreas Adenocarcinoma
- •References
- •6.2.1 Gallbladder
- •6.3.1 Gallbladder Dysfunction
- •6.3.3 Pancreaticobiliary Maljunction
- •6.4.2 Enterohepatic Circulation
- •6.4.3 Bile Acids
- •References
- •7.1 Introduction
- •BilINs
- •IPNBs
- •7.1.1.2 Imaging Findings
- •BilINs
- •IPNB
- •7.1.2.1 Gross
- •BilIN
- •IPNB
- •Controversial Cases: BilIN or IPNB
- •7.1.2.2 Histologies
- •BilINs
- •IPNB.
- •8.4 Gallbladder Carcinoma
- •8.4.1 Gross Features
- •8.4.2 Microscopic Features
- •8.4.3 Molecular Features
- •References
- •BilIN
- •IPNB
- •7.1.4.1 BilIN
- •7.1.4.2 IPNB
- •7.2 Conclusion
- •References
- •8.1 Introduction
- •8.2 Intrahepatic Cholangiocarcinoma
- •8.2.1 Gross Features
- •8.2.2 Microscopic Features
- •8.2.3 Molecular Features
- •8.3 Extrahepatic Cholangiocarcinoma
- •8.3.1 Gross Features
- •8.3.2 Microscopic Features
- •8.3.3 Molecular Features
- •References
- •10.1.2 Epidemiology
- •10.1.3 Etiology
- •10.1.4 Clinical Features
- •10.1.5 Radiology
- •10.1.6 Pathology
- •10.1.6.1 Macroscopic Appearance
- •10.1.6.3 Immunohistochemistry
- •10.1.6.4 Grading
- •10.1.6.6 Molecular Pathology
- •10.2.2 Epidemiology
- •10.2.3 Etiology
- •10.2.4 Clinical Features
- •10.2.5 Radiology
- •10.2.6 Pathology
- •10.2.6.1 Macroscopic Appearance
- •10.2.6.2 Microscopic Appearance
- •10.2.6.3 Immunohistochemistry
- •10.2.6.5 Molecular Pathology
- •10.3.2 Epidemiology
- •10.3.3 Etiology
- •10.3.4 Clinical Features
- •10.3.5 Radiology
- •10.3.6 Pathology
- •10.3.6.1 Macroscopic Appearance
- •10.3.6.3 Immunohistochemistry
- •10.3.6.5 Molecular Pathology
- •References
- •11: Mucinous Cystic Neoplasms
- •11.1 Introduction
- •11.2 Clinical Aspects
- •11.3 Pathological Findings
- •11.3.1 Macroscopical Features
- •11.3.2 Histological Features
- •11.4 Molecular Abnormalities
- •References
- •12.1 Introduction
- •12.1.1 General Features
- •12.1.2 Diagnostic Features
- •12.1.3 Clinical Implications
- •12.1.4 Desmoplastic Stroma
- •12.1.5 Venous Invasion
- •12.1.6 Variants
- •12.2 Conclusions
- •References
- •13.2.1 Benign Liver Tumors
- •13.2.2 Malignant Liver Tumors
- •13.2.3.1 Liver Abscess
- •13.4.1 Biliary Tree Tumors
- •13.5.1 Pancreatic Tumors
- •References
- •14.1 MRE Technique
- •14.2 MRE Performance
- •14.4 Technical Limitations
- •14.5 Summary
- •References
- •15.1 Introduction
- •15.6 Conclusion
- •References
- •17.1 Intraoperative Cholangiography
- •17.2 Intraoperative Ultrasound
- •17.2.1 Anatomy
- •17.2.2 Diagnosis
- •17.2.3 Resection Guidance
- •17.2.3.2 Resection Guidance
- •17.3 Intraoperative Fluorescence Imaging
- •17.4 Navigation Assisted Liver Resection
- •References
- •18.1 Introduction
- •18.2 Photon Therapy
- •18.3 Charged Particles Therapy
- •18.4 MRI Guided Therapy
- •18.5 Combination Strategies Using Cytotoxics
- •18.6 Radioimmunotherapy
- •18.8 Summary
- •References
- •19.1 Introduction
- •19.2 Systemic Chemotherapy
- •19.2.1 Adjuvant Therapy
- •19.2.2 First-Line Therapy
- •19.2.3 Second-Line Therapy
- •19.3 Targeted Therapy
- •19.4 Immunotherapy
- •19.5 Precision Medicine
- •References
- •20.1 Introduction
- •20.2.1 Neoadjuvant Chemotherapy
- •20.2.2 Adjuvant Chemotherapy
- •20.2.3 Palliative Chemotherapy
- •20.3 Immunotherapy
- •20.4 Tumor Microenvironment
- •20.5 Summary
- •References
- •21.1 Background
- •21.5 Combination Strategies
- •21.7 Future Perspectives
- •References
- •22.1 FGFR Alterations
- •22.2 IDH Mutations
- •22.3 BRAF Alterations
- •22.7 Conclusions
- •References
- •23.1 Introduction
- •23.2 Adjuvant Systemic Therapy
- •23.3 Neoadjuvant Systemic Therapy
- •23.4.3 Second-Line Therapy
- •23.4.4 Targeted Therapy
- •References
- •24.1 Introduction
- •24.4 The Various Stents Available
- •24.8 Hilar Strictures (Resectable Cases)
- •24.9 Hilar Stricture: Palliative Cases
- •24.11 Endoscopic Ultrasound-Guided Biliary Drainage
- •24.12 Conclusions
- •References
- •25.1 Introduction
- •25.3 EUS-TD Technique
- •25.4 EN Technique
- •25.6 Conclusion
- •References
- •26.1 Background
- •26.2 Short History
- •26.4.6 Personalized Cancer Treatment
- •References
- •27.1 Introduction
- •27.3.1 Pre-Admission Optimization
- •27.3.3 Carbohydrate Loading
- •27.3.6 Early Feeding
- •27.6 Conclusion
- •References
- •28.1 Introduction
- •28.5 Conclusion
- •References
- •29.6 Conclusion
- •References
- •30.1 Introduction
- •30.3 Surgical Indication
- •30.4 Surgical Technique
- •30.4.1 Exposure
- •30.4.4 Parenchymal Transection
- •30.5 Clinical Advantages
- •30.5.1 Technical Advantages
- •30.5.2 Prognostic Advantages
- •30.6 Conclusions
- •References
- •31.1 Introduction
- •31.2 Multiple Bilobar CLM
- •31.2.1 Intraoperative Ultrasound
- •31.2.2 Tumor-vessel Detachment
- •31.2.3 Communicating Veins
- •31.3 New Procedures
- •31.3.1.1 Eligibility Criteria
- •31.3.2 Upper Trasversal Hepatectomy (UTH))
- •31.3.2.1 Mini-Upper Transversal Hepatectomy
- •31.3.2.2 Right Upper Transversal Hepatectomy [33]
- •31.3.2.3 Left Upper Transversal Hepatectomy [24]
- •31.3.2.4 Total Upper Transversal Hepatectomy [24, 34]
- •Eligibility Criteria
- •31.3.3 Mini-mesohepatectomy (MMH) [35, 36]
- •31.3.3.1 Eligibility Criteria
- •31.3.4 Liver Tunnel [37, 38]
- •Eligibility Criteria
- •31.4 Discussion
- •31.5 Concerns & Future Directions
- •31.6 Conclusions
- •References
- •32.1 Introduction
- •References
- •33.1 Introduction
- •33.6 Segmentectomy, Cone Unit Resection
- •33.7 Surgical Outcomes
- •References
- •34.1 Introduction
- •34.6 Laparoscopic Parenchymal Sparing Anatomical Hepatectomy (Lap-PSAH)
- •34.7 Surgical Procedures at Ageo Central General Hospital (ACGH)
- •34.8 Conclusion
- •References
- •35.5 Laparoscopic Segmentectomy V (S5)
- •35.6 Laparoscopic Segmentectomy VI (S6)
- •35.7 Laparoscopic Segmentectomy VII (S7)
- •References
- •36: Modified ALPPS Procedure
- •36.1 Introduction
- •36.2 Discussion
- •36.2.1 Parenchymal Transection
- •36.2.2 Hepatoduodenal Ligament Dissection
- •36.2.4.1 Partial ALPPS
- •36.2.4.2 Hybrid ALPPS
- •36.2.4.3 Mini-ALPPS/ALPTIPS
- •36.2.4.5 Tourniquet ALPPS
- •36.3 Conclusion
- •References
- •37.1 Introduction
- •37.3 Right-Posterior Approach
- •37.4 Right-Uncinate Approach
- •37.5 Mesenteric Approach
- •37.6 Left-Posterior Approach
- •37.7 Anterior Approach
- •37.8 Mesopancreatic Resection
- •37.10 Summary
- •References
- •38: Organ- and Parenchyma-sparing Pancreatic Surgery
- •38.1 Introduction
- •38.2 Organ-Sparing Techniques
- •38.2.1 Spleen-Preserving Distal Pancreatectomy
- •38.3 Parenchyma-Sparing Techniques
- •38.3.2 Dorsal Pancreatectomy
- •38.3.4 Middle-Preserving Pancreatectomy
- •38.4 Conclusion
- •References
- •39.1 Introduction
- •39.2.1 Laparotomy
- •39.2.2 Supramesocolic Approach
- •39.2.3 Inframesocolic Approach
- •39.3 Mesenteric Incision
- •39.9 Antithrombogenic PV Catheter Bypass
- •39.13 Discussion
- •References
- •40.1 Introduction
- •40.4 HA Reconstruction
- •40.4.1 Simple Reconstruction Case
- •40.4.2 Complicated Reconstruction Case
- •40.4.3 Concomitant Vein Resection
- •40.4.4 Management after HA Reconstruction
- •40.5 Conclusions
- •References
- •41.1 Introduction
- •41.3.1 Patients
- •41.3.2 Preoperative Treatments
- •41.3.5 Statistical Analyses
- •41.4 Results
- •41.5 Discussion
- •References
- •42.1 Introduction
- •42.1.1 Preoperative Planning
- •42.2 Surgical Technique
- •42.2.1 Basic Preliminary Maneuvers
- •42.3 Postoperative Management
- •42.4 Conclusions
- •References
- •43: Robotic Pancreaticoduodenectomy
- •43.1 Background
- •43.2 Robotic PD
- •43.3 Conclusion
- •References
- •44: Duodenum-Preserving Pancreatic Head Resection
- •References
- •45.1 Introduction
- •45.2 Surgical Technique
- •45.3 Discussion
- •References
- •46: Spleen-Preserving Distal Pancreatectomy
- •46.1 Introduction
- •46.2 Indications
- •46.4 Technique
- •46.4.1 Warshaw’s Technique
- •46.5 Postoperative Follow-Up
- •References
- •References
- •48.1 Introduction
- •48.10 Surgical Technique Preserving Left Gastric Artery
- •48.12 Conclusions
- •References
- •49: Robotic Distal Pancreatectomy
- •49.1 Surgical Technique
- •49.1.3 Distal Splenopancreatectomy
- •49.1.4 Spleen-Preserving Distal Pancreatectomy
- •49.2 Results
- •49.3 Discussion
- •References
- •50: Total Pancreatectomy
- •50.1 Introduction
- •50.2 Indications
- •50.3 Surgical Procedure
- •50.4 Vascular Resection
- •50.5 Comment
- •References
- •References
- •52.1 Introduction
- •52.2.1 Non-Functional PNEN (NF-PNEN)
- •52.2.2 Functional PNEN
- •52.2.4 High-grade PNEN
- •52.4 Conclusions
- •References
- •53.1 Introduction
- •53.1.1 Fukuoka Guidelines 2012 (Revised 2017)
- •53.1.2 European Guidelines 2018 (EG18)
- •53.2 Discussion
- •References
- •54.1 Introduction
- •54.1.1 Developmental Mechanism
- •54.1.2 Designations
- •54.1.3 Incidence
- •54.1.4 Predictive Factors
- •54.1.5 Treatment
- •54.2 Conclusion
- •References
- •55: Benign Biliary Diseases
- •55.1 Introduction
- •55.2 Congenital Anomalies
- •55.2.1 Biliary Atresia
- •55.2.2 Choledochal Cyst
- •55.3 Diagnosis
- •55.4 Complications
- •55.5 Management
- •55.5.1 Gallstones
- •55.6 Pathogenesis
- •55.8 Complications
- •55.9 Bile Duct Stones
- •55.10 Management
- •55.11 Intrahepatic Stones
- •55.13.1 Benign Biliary Strictures (BBS)
- •55.14 Iatrogenic Biliary Injury
- •55.15 Mirizzi Syndrome (MS)
- •55.16 Liver Transplantation Related BBS
- •55.17 Primary Sclerosing Cholangitis (PSC)
- •55.17.1 Biliary Dyskinesia
- •References
- •56.1 Introduction
- •56.2 Preoperative Evaluation
- •56.2.1 Preoperative Biliary Drainage
- •56.2.2 Portal Vein Embolization
- •56.3.2 Hilar No Touch “En-bloc” Technique
- •56.3.3 Vascular Resection
- •56.3.4 Margin Status
- •56.3.5 Lymph Node Dissection
- •56.3.6 Minimally Invasive Surgery
- •56.4 Short-term Results
- •56.5 Long-term Results
- •56.6 Conclusions
- •Bibliography
- •57.1 Introduction
- •57.2 Clinical Presentation
- •57.3 Serum Tumor Markers
- •57.4 Imaging
- •57.5 Treatment
- •57.6 Surgical Management
- •57.6.1 Liver Resection
- •57.11 Surgical Resection Procedure
- •57.13.2 Long-Term Outcomes
- •57.14 Recurrence
- •57.14.1 Liver Transplantation
- •References
- •58.1 Introduction
- •58.1.2 Surgical Techniques
- •58.1.4 Outcomes After HPD
- •58.1.5 Practical Management During Surgery
- •References
- •59: Hepato-biliary Injuries
- •59.1 Etiology
- •59.4 Diagnosis
- •59.4.1 Clinical Presentation
- •59.4.2 Imaging
- •References
- •60.1 Background
- •60.2 Diagnostics
- •60.3 Treatment
- •60.3.1 Nonoperative Management
- •60.3.2 Interventional Treatment
- •60.3.3 Surgery
- •References
- •61.1 Historical Overview
- •61.2.1.1 Acute Liver Failure (ALF)
- •61.2.1.2 Chronic Liver Failure
- •61.2.3 MELD Exceptions
- •61.2.4 Other Standardized MELD Exceptions
- •61.2.4.1 Non-Standardized MELD Exceptions
- •References
- •62.3 Patient Assessment
- •62.4 Prognostic Factors
- •62.6 Extracorporeal Liver Support Systems
- •62.8 Conclusion
- •References
- •63.1 Introduction
- •63.2 Donation After Brain Death
- •63.3 Donors after Circulatory Death
- •63.4.1 Surgical Technique
- •63.4.1.1 Cross-clamping
- •63.4.2 Technical Variants
- •63.4.2.1 Split Liver Retrieval
- •63.4.2.2 En-bloc Liver-pancreas Retrieval
- •63.4.2.3 En-bloc Liver-bowel Retrieval
- •63.4.3 Back-table
- •63.4.3.1 Incidents: Accidents
- •References
- •64.1 Introduction
- •64.11 Conclusions
- •References
- •65: Living Donor Liver Transplantation
- •65.1 Introduction
- •65.2.1 Graft Size
- •65.2.2 Left Liver Graft
- •65.2.3 Right Liver Graft
- •65.2.4 Right Lateral Sector Graft
- •65.2.5 Dual Graft
- •65.2.6 ABO Blood Type Incompatible Graft
- •References

Masatoshi Makuuchi · Norihiro Kokudo
Irinel Popescu · Jacques Belghiti
Ho-Seong Han · Kyoichi Takaori
Dan G. Duda Editors
The IASGO Textbook of
Multi-Disciplinary
Management of HepatoPancreato-Biliary Diseases
123

The IASGO Textbook of Multi-Disciplinary
Management of Hepato-Pancreato-Biliary
Diseases

Masatoshi Makuuchi • Norihiro Kokudo
Irinel Popescu • Jacques Belghiti
Ho-Seong Han • Kyoichi Takaori • Dan G. Duda
Editors
The IASGO Textbook
of Multi-Disciplinary
Management of
Hepato-Pancreato-Biliary
Diseases

Editors
Masatoshi Makuuchi
Emeritus Professor
The University of Tokyo
Tokyo, Japan
Norihiro Kokudo
National Center for Global Health and Medicine
The University of Tokyo
Tokyo, Japan
Irinel Popescu
“Dan Setlacec” Center of General Surgery
and Liver Transplantation
Fundeni Clinical Institute
Bucharest, Romania
Ho-Seong Han
Department of Surgery
Seoul National University College of Medicine
Seoul National University Bundang Hospital
Seoul, Korea
Dan G. Duda
Massachusetts General Hospital
Harvard Medical School
Boston, USA
Jacques Belghiti
Emeritus Professor University Paris Cité
Paris, France
Kyoichi Takaori
Nagahama City Hospital Network
Shiga, Japan
Asahi University
Gifu, Japan
ISBN 978-981-19-0062-4 ISBN 978-981-19-0063-1 (eBook)
https://doi.org/10.1007/978-981-19-0063-1
© International Association of Surgeons, Gastroenterologists and Oncologists 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether the whole or
part of the material is concerned, specically the rights of translation, reprinting, reuse of illustrations, recitation,
broadcasting, reproduction on microlms or in any other physical way, and transmission or information storage and
retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter
developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not
imply, even in the absence of a specic statement, that such names are exempt from the relevant protective laws and
regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed
to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty,
expressed or implied, with respect to the material contained herein or for any errors or omissions that may have been
made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional afliations.
This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd.
The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore

Foreword
It is with great emotion and satisfaction that I write this foreword to the International Association
of Surgeons, Gastroenterologists, and Oncologists (IASGO) Textbook of Multi-Disciplinary
Management of Hepato-Pancreato-Biliary Diseases.
When Professor Nikolaos Lygidakis founded the Association in 1988, he had a vision: to
put together in the same meeting doctors from all over the world, experts and non-experts, the
ones who teach and the ones who learn, exchanging knowledge in all elds of GI diseases, and
in all specialties: surgeons, gastroenterologists and then oncologists. When I participated for
the rst time at the meeting, I was surprised to meet people coming from countries that are not
represented in usual meetings, keen to learn and bringing their own experience.
When later on I was asked to be President after Professors Thomas Starzl, Meinhard
Classen, and Enrique Moreno-Gonzalez, it was a great pleasure and honor to accept. The
young small society called at that time Gastro Surgical Club had grown to a large association
of thousands of surgeons, gastroenterologists, and oncologists and it was time to transform the
visionary project of Professor Nick Lygidakis into the unique worldwide organization that the
present IASGO has become.
This rst edition of the IASGO Textbook reects well the history of IASGO and the breadth
and depth of our organization, as well as its worldwide outreach. Edited by Professor Masatoshi
Makuuchi, the IASGO President, and by Professor Kyoichi Takaori, the General Secretary,
and other expert surgeons and oncologists, the IASGO Textbook offers an outstanding overview of current approaches and future directions in the multi-disciplinary treatment of challenging hepato-biliary-pancreatic diseases.
I am sure that, beyond its historical signicance, this Textbook will certainly inspire a new
generation of medical professionals in the spirit and vision of our organization.
Paris, France
HenriBismuth
Honorary President, IASGO
v

Preface
The International Association of Surgeons, Gastroenterologists, and Oncologists (IASGO)
was founded in Amsterdam in 1988. Today, we are privileged to have strong IASGO sections
in more than 70 countries, which greatly assists in assessing educational needs. The main goal
of this organization has been and remains globalization of medical knowledge and expertise
through a well-structured and precisely organized system of continued medical education. This
visionary approach has impacted medical communities and the career of young specialists
from all continents.
It is my pleasure to introduce you to our new landmark project, the rst edition of the
IASGO Textbook of Multi-Disciplinary Management of Hepato-Pancreato-Biliary Diseases.
Along with Drs. Norihiro Kokudo, Irinel Popescu, Jacques Belghiti, Ho-Seong Han, Kyoichi
Takaori, and Dan G.Duda, I hereby thank all contributors for their excellent chapters on behalf
of the editors. The diverse display of multi-disciplinary, innovative, and creative approaches to
treatment of these complex diseases is a perfect representation of our organization’s mission
and vision. I take this opportunity to express my sincere thanks to my former President of
IASGO, Professor Henri Bismuth for his continuous support. I would like to dedicate this
textbook to the loving memory of IASGO founder, the late Professor Nikolaos Lygidakis.
MasatoshiMakuuchiTokyo, Japan
President, IASGO
vii

Introduction
To address the complexity and aggressiveness of hepato-pancreato-biliary diseases, surgeons,
gastroenterologists, and oncologists have made great efforts to improve their treatment for
many decades. Despite these efforts, management of these diseases has remained a challenge
for medical professionals and largely an unmet need in medicine. What’s worse, the incidence
of these cancers is increasing worldwide at alarming rates. Treating the diseases in hepatopancreato- biliary regions is particularly difcult due to the complex anatomy, aggressive biological behavior, and poor prognosis.
We think that the key to success in this ongoing crusade is a multi-disciplinary approach to
the treatment. IASGO was founded on this principle by late Professor Nikolaos Lygidakis
more than 30 years ago. In keeping with this unique vision, we have been organizing, apart
from Annual World Congresses, a number of Advanced Post-Graduate Training Courses all
over the world. The main characteristics of this program have been the multi-disciplinary
structure and global reach. These courses are always organized in close cooperation with
national Academic Centers or local Governmental authorities, aiming to update the participants in the eld of Surgery, Gastroenterology, Oncology, Radiology, Pathology, and Tumor
Biology as well as in the newest developments in Radiological and Endoscopic Interventions.
Here, we are expanding our efforts with this rst edition of the IASGO Textbook of MultiDisciplinary Management of Hepato-Pancreato-Biliary Diseases. Edited by Drs. Masatoshi
Makuuchi, Norihiro Kokudo, Irinel Popescu, Jacques Belghiti, Ho-Seong Han, Kyoichi
Takaori, and Dan G.Duda, the textbook includes 70 chapters from an exceptional group of
experts in all areas of hepato-pancreato-biliary diseases. We are so fortunate to have these leading experts as our IASGO colleagues and friends.
We would like to extend our gratitude to Professor Irinel Popescu and Doctor Florin Botea,
whose efforts have been essential for the development of this project and the publication of this
textbook. Last but not least, we would like to dedicate this textbook to all of our colleagues and
patients around the globe.
KyoichiTakaori Kyoto, Japan
Secretary General, IASGO
DanG.Duda
Boston, USA
Secretary General, IASGO
ix

Contents
1 Surgical Anatomy of the Liver . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Kenji Yoshino, Kojiro Taura, Kyoichi Takaori, Yosuke Kasai, and
Etsuro Hatano
2 Surgical Anatomy of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Akihiko Horiguchi, Masahiro Ito, Yukio Asano, Satoshi Arakawa, Hiroyuki
Kato, and Masahiro Shimura
3 Surgical Anatomy of the Biliary Tract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Eduardo Olivera Pertusso, Joaquin Garcia, and Luis Ruso Martinez
4 Liver Function and Posthepatectomy Liver Failure . . . . . . . . . . . . . . . . . . . . . . . . 23
Takanobu Hara and Susumu Eguchi
5 Surgical Approach to Pancreas, Liver, Biliary Physiologic Impairment . . . . . . . . 31
Alexandra W. Acher, Amir A. Rahnemai-Azar, Sharon M. Weber, and
Timothy M. Pawlik
6 Biliary Tract Functions and Impairment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51
Hideo Ohtsuka and Michiaki Unno
7 Preinvasive Intraductal Biliary Neoplasm: Biliary Intraepithelial Neoplasm
and Intraductal Papillary Neoplasm of Bile Duct . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Yasuni Nakanuma, Katsuhiko Uesaka, and Takuro Terada
8 Pathology of Biliary Tract Cancers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65
Claudio Luchini, Michele Simbolo, and Aldo Scarpa
9 Multifocal Hepatocellular Carcinoma: Genomic and Transcriptional
Heterogeneity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Ming Kuang, Lixia Xu, Sui Peng, Manling Huang, Xin Liu, and Guanrui Liao
10 Intraductal Neoplasms of the Pancreas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77
Toru Furukawa
11 Mucinous Cystic Neoplasms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85
Noriyoshi Fukushima
12 Pathology of Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91
Ralph H. Hruban and Elizabeth Thompson
13 CT in Hepato-Bilio-Pancreatic Surgical Pathology . . . . . . . . . . . . . . . . . . . . . . . . . 99
Ioana G. Lupescu and Mugur C. Grasu
14 Magnetic Resonance Elastography (MRE) to Assess Hepatic Fibrosis . . . . . . . . . 113
Aliya Qayyum
15 FDG-PET for Management on Hepato- Pancreato- Biliary Disease . . . . . . . . . . . . 123
Koji Murakami
xi

xii
16 Endoscopic Ultrasound for Hepato- Pancreato- Biliary Diseases . . . . . . . . . . . . . . 135
Yasunobu Yamashita and Masayuki Kitano
17 Intraoperative Imaging Techniques in Liver Surgery . . . . . . . . . . . . . . . . . . . . . . . 145
Florin Botea, Alexandru Barcu, and Irinel Popescu
18 Use of Radiotherapy Alone and in Combination with Other Therapies for
Hepatocellular Carcinoma: Rationale and Future Directions . . . . . . . . . . . . . . . . 153
Dan G. Duda and Franziska D. Hauth
19 Recent Update in Chemotherapy of Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . 165
Jung Hyun Jo, Seungmin Bang, and Si Young Song
20 Chemotherapy in Pancreatic Ductal Adenocarcinoma . . . . . . . . . . . . . . . . . . . . . . 171
Hee Seung Lee, Seung Woo Park, and Si Young Song
21 Immune-Checkpoint Inhibitors in Hepatocellular Carcinoma . . . . . . . . . . . . . . . 177
Rubens Copia Sperandio, Roberto Carmagnani Pestana, and Ahmed O. Kaseb
22 Molecularly Targeted Therapy in Cholangiocarcinoma . . . . . . . . . . . . . . . . . . . . . 185
Aakash Desai and Mitesh J. Borad
23 Systemic Therapies for Pancreatic Cancer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193
Faysal Dane and Nazim Can Demircan
24 Endoscopic Biliary Drainage and Associated Procedures Required
for Patients with Malignant Biliary Strictures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201
Hiroyuki Isayama, Toshio Fujisawa, Shigeto Ishii, Ko Tomishima,
Muneo Ikemura, Hiroto Ota, Daishi Kabemura, Mako Ushio, Sho Takahashi,
Yusuke Takasaki, Akinori Suzuki, Koichi Ito, Kazushige Ochiai, and
Hiroaki Saito
Contents
25 Endoscopic Management of Peripancreatic Fluid Collection . . . . . . . . . . . . . . . . . 209
Yukitoshi Matsunami, Shuntaro Mukai, and Takao Itoi
26 Endoscopic Ultrasound and Fine Needle Tissue Acquisition for Pancreatic
Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215
Razvan Iacob and Cristian Gheorghe
27 Enhanced Recovery After Surgery (ERAS): Concept and Purpose . . . . . . . . . . . . 225
Gregg Nelson and Olle Ljungqvist
28 Multidisciplinary Enhanced Recovery After Surgery (ERAS) Pathway for
Hepatobiliary and Pancreatic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .229
Didier Roulin and Nicolas Demartines
29 ERAS in Pancreatic Surgery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235
Julie Perinel and Mustapha Adham
30 Ultrasound-Guided Anatomic Resection of the Liver . . . . . . . . . . . . . . . . . . . . . . . 241
Junichi Shindoh, Kiyoshi Hasegawa, and Masatoshi Makuuchi
31 Parenchyma-sparing Hepatic Resection for Multiple Metastatic Tumors . . . . . . 247
Bruno Branciforte, Flavio Milana, and Guido Torzilli
32 Open and Laparoscopic Liver Hanging Maneuver . . . . . . . . . . . . . . . . . . . . . . . . . 257
Jacques Belghiti and Sa Dokmak
33 The Glissonean Pedicle Approach: The Takasaki Technique . . . . . . . . . . . . . . . . . 265
Shun-ichi Ariizumi and Masakazu Yamamoto

Contents
xiii
34 Laparoscopic Major Hepatectomy and Parenchymal-Sparing Anatomical
Hepatectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271
Kohei Mishima, Go Wakabayashi, Kazuharu Igarashi, and Takahiro Ozaki
35 Laparoscopic Anatomical Resection oftheLiver: Segmentectomy
andSub-segmentectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279
Boram Lee and Ho-Seong Han
36 Modified ALPPS Procedure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285
Nobuyuki Takemura, Kyouji Ito, and Norihiro Kokudo
37 Artery-First Approach in Pancreaticoduodenectomy . . . . . . . . . . . . . . . . . . . . . . . 289
Daisuke Ban and Minoru Tanabe
38 Organ- and Parenchyma-sparing Pancreatic Surgery . . . . . . . . . . . . . . . . . . . . . . 297
Calogero Iacono, Mario De Bellis, Andrea Ruzzenente, and Alfredo Guglielmi
39 Isolated Pancreatoduodenectomy with Portal Vein Resection Using the
Nakao Mesenteric Approach . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307
Akimasa Nakao
40 Pancreaticoduodenectomy with Hepatic Artery Resection . . . . . . . . . . . . . . . . . . . 313
Atsushi Oba, Tomotaka Kato, Marco Del Chiaro, Y. H. Andrew Wu,
Yosuke Inoue, and Yu Takahashi
41 Pancreaticoduodenectomy with Splenic Artery Resection for Tumors of the
Pancreatic Head and/or Body Invading the Splenic Artery . . . . . . . . . . . . . . . . . . 319
Shugo Mizuno, Kazuyuki Gyoten, and Motonori Nagata
42 Pancreaticoduodenectomy with Superior Mesenteric Resection and
Reconstruction for Locally Advanced Tumors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327
Philippe Bachellier and Pietro Addeo
43 Robotic Pancreaticoduodenectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335
Thilo Hackert
44 Duodenum-Preserving Pancreatic Head Resection . . . . . . . . . . . . . . . . . . . . . . . . . 341
Elena Usova
45 Artery-First Approaches to Distal Pancreatectomy . . . . . . . . . . . . . . . . . . . . . . . . . 347
Kyoichi Takaori, Yosuke Kasai, and Kenji Yoshino
46 Spleen-Preserving Distal Pancreatectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353
Kohei Nakata and Masafumi Nakamura
47 Distal Pancreatectomy with En Bloc Celiac Axis Resection . . . . . . . . . . . . . . . . . . 361
Satoshi Hirano, Toru Nakamura, and Toshimichi Asano
48 Modified Distal Pancreatectomy with Celiac Axis En-bloc Resection . . . . . . . . 365
Ken-ichi Okada and Hiroki Yamaue
49 Robotic Distal Pancreatectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373
Marco Vito Marino, Marco Ramera, and Alessandro Esposito
50 Total Pancreatectomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .377
Aleksandar Karamarkovic, Jovan Juloski, and Vladica Cuk
51 Pancreatic Resection for Solid Pseudopapillary Neoplasms . . . . . . . . . . . . . . . . . . 385
Wenming Wu, Qiang Xu, and Rui Jiang
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