Heterogeneity of management practices surrounding operable gallbladder cancer - results of the OMEGA-S international HPB surgical survey

BACKGROUND

Gallbladder cancer (GBC) is an aggressive, uncommon malignancy, with variation in operative approaches adopted across centres and few large-scale studies to guide practice. We aimed to identify the extent of heterogeneity in GBC internationally to better inform the need for future multicentre studies.

METHODS

A 34-question online survey was disseminated to members of the European-African Hepatopancreatobiliary Association (EAHPBA), American Hepatopancreatobiliary Association (AHPBA) and Asia-Pacific Hepatopancreatobiliary Association (A-PHPBA) regarding practices around diagnostic workup, operative approach, utilization of neoadjuvant and adjuvant therapies and surveillance strategies.

RESULTS

Two hundred and three surgeons responded from 51 countries. High liver resection volume units (>50 resections/year) organised HPB multidisciplinary team discussion of GBCs more commonly than those with low volumes (p < 0.0001). Management practices exhibited areas of heterogeneity, particularly around operative extent. Contrary to consensus guidelines, anatomical liver resections were favoured over non-anatomical resections for T3 tumours and above, lymphadenectomy extent was lower than recommended, and a minority of respondents still routinely excised the common bile duct or port sites.

CONCLUSION

Our findings suggest some similarities in the management of GBC internationally, but also specific areas of practice which differed from published guidelines. Transcontinental collaborative studies on GBC are necessary to establish evidence-based practice to minimise variation and optimise outcomes.

DVP parametric imaging for characterizing ovarian masses in contrast-enhanced ultrasound

AIM

To evaluate whether parametric imaging with contrast-enhanced ultrasound is an approach capable of for the differential diagnosis of ovarian masses.

MATERIALS AND METHODS

The authors analysed 50 cases of ovarian masses by routine ultrasound and contrast-enhanced ultrasound with a new dedicated parametric image processing software-Sonoliver. The angiogenesis and blood perfusion mode on a digital video recorder were recorded and the morphological characteristics of time-intensity curve (TIC) and dynamic vascular pattern (DVP) curve were subsequently described. The quantity factor, including time to peak (TTP), maximum intensity (IMAX), rise time, (RT), mean transit time (mTT), generated by Sonoliver software were compared in both histological gradings.

RESULTS

There were 24 cases (86%) displaying mainly hypo-enhanced with blue imaging in those with benign masses and 15 cases (68%) displaying mainly hyper-enhanced imaging with red in those with malignant masses. The difference was statistically significant (p < 0.05). DVP curves were unipolar below the baseline in 23 cases (82%) of benign masses and unipolar above the baseline in 15 cases (68%) of malignant masses. IMAX, TTP, and mTT were all significantly higher in those with malignant masses than those with benign ones (all p < 0.05), but, no statistical difference in the RT between the two groups was found (p > 0.05).

CONCLUSIONS

According to the results, DVP parametric imaging is a new approach capable of differential diagnoses of overian masses with contrast-enhanced ultrasound.