Infections cause significant morbidity and mortality in patients undergoing hepatopancreatobiliary (HPB) surgery. In the era of more extensive resections in elderly comorbid patients with the greater use of perioperative chemoradiotherapy and biliary instrumentation, surgical-site infection (SSI) rates after HPB procedures…
Introduction The immune system manifests two strategies of host defense termed innate and adaptive immunity ( Fig. 10.1 ). Innate immunity refers to the nonspecific first line of defense against danger signals from pathogens or tumor cells. The repertoire of…
Biliary tract cancers First described by Durand-Fardel in 1840, biliary tract tumors arise from cholangiocytes residing in the biliary tree. The biliary tract cancers include intrahepatic cholangiocarcinoma (IHCC, within the liver; see Chapter 50 ), extrahepatic cholangiocarcinoma (EHCC, within the…
Pancreatic cancer overview Pancreatic ductal adenocarcinoma (PDA), commonly referred to as “pancreatic cancer” is the fourth most common cause of cancer in both men and women. PDA remains a devastating diagnosis, with an overall survival rate of no greater than…
Overview Tumors of the hepatobiliary (HB) system are among the most challenging tumors to effectively manage in the clinic. At time of diagnosis, only approximately 25% of gallbladder carcinoma (GBC) patients, 30% of cholangiocarcinoma (CCA) patients, and 30% of hepatocellular…
Overview of molecular etiology Recent advances in molecular genetics have emphasized the multistep process of tumorigenesis. It is evident that cancer is a genetic disease involving aberrant chromosome rearrangements, genetic mutations, and epigenetic silencing of tumor suppressor genes. Independent of…
Introduction In recent years, there has been an increased understanding of the molecular and cellular processes that govern hepatopancreatobiliary (HPB) diseases. These processes, which include those that are immune-mediated, involve chronic inflammation or processes of neoplastic transformation and are driven…
Overview Bile secretion is one of the major functions of the liver, which serves two major purposes: (1) the excretion of hepatic metabolites—including bilirubin, cholesterol, drugs, and toxins—and (2) the facilitation of intestinal absorption of lipids and fat-soluble vitamins. More…
Liver fibrosis represents a scarring response to either acute or chronic liver injury. After acute liver injury, parenchymal cells regenerate to successfully preserve hepatocellular mass and function. This acute process is associated with an inflammatory and fibrogenic response but with…
Introduction to liver regeneration The ability of the liver to regenerate was recognized by the Greeks in the ancient myth of Prometheus, the Titan god of forethought, who gave fire to the mortals and angered Zeus. Prometheus was chained to…