Dr. Jonathan Navarro Hepatobiliary, Pancreas, and Liver Transplant Clinic

Dr. Jonathan Navarro Hepatobiliary, Pancreas, and Liver Transplant Clinic Liver, Gallbladder, Pancreas diseases and Liver Transplantation Specialty Clinic

Laparoscopic Left Hepatectomy.. less blood loss, less pain, less scar, and early return to work.
29/05/2026

Laparoscopic Left Hepatectomy.. less blood loss, less pain, less scar, and early return to work.

The optimal treatment for intrahepatic cholangiocarcinoma remains liver resection plus lymph node dissection. However, d...
13/03/2021

The optimal treatment for intrahepatic cholangiocarcinoma remains liver resection plus lymph node dissection. However, despite this strong recommendation, lymphadenectomy is not routinely performed even in centers with expert surgeons. It is noteworthy that even the performance of lymphadenectomy for ICC may not affect the long term outcome. Nonetheless, lymphadenectomy may provide appropriate staging and will provide better adjuvant treatment thereafter.
Recently, we published our paper about who might not and might benefit from lymphadenectomy among patients with intrahepatic cholangiocarcinoma. We were able to categorize this patient into low risk and high risk for lymph node metastasis. Low risk patient may not benefit on lymphadenectomy while high risk patient may benefit on it.
Nowadays, I apply this to my patient and carefully categorize them into low risk and high. Recently, I performed liver resection plus lymph node dissection in a patient with ICC and high risk for lymph node metastasis. Tumor invaded/adherent to the vena cava thus primary repair of the vena cava was performed.

What prognostic parameters can easily and inexpensively obtain during preoperative work-up for gallbladder cancer?Recent...
11/01/2021

What prognostic parameters can easily and inexpensively obtain during preoperative work-up for gallbladder cancer?
Recently, we published a clinical application of the preoperative BLOOD GLUCOSE level (FBS) and one of the cellular components of the systemic inflammatory response, the LYMPHOCYTE count, particularly as a new prognostic marker in T2 gallbladder cancer. We hypothesized that the glucose to lymphocyte ratio (GLR) might be a sensitive parameter to determine the glucose metabolism and behavior of the cancer (i.e., its aggressiveness), and the immunologic status of a patient with cancer.
INTERESTINGLY, our finding had been duplicated in various studies from China. they found that it was indeed a strong prognostic factors for overall survival among patients with pancreatic cancer.
https://doi.org/10.1016/j.jss.2019.02.043

With improvements of neoadjuvant treatment, preoperative evaluation is crucial for the optimal treatment of pancreatic c...
01/01/2021

With improvements of neoadjuvant treatment, preoperative evaluation is crucial for the optimal treatment of pancreatic cancer. Evidences nowadays already shade light to the important role of neoaduvant chemotherapy with or without RT for pancreatic cancer particulary for borderline resectable.
Nonetheles, such strategy warrants sophisticated modalities to properly determine the resectability and biology of a tumor.
In our current set-up, it seems like “so near yet so far”; although we are always striving for best treatment for our patient. Recently, I encountered one patient with borderline resectable PDAC. I decided to do surgery with possible portal-smv resection and reconstruction. Through careful dissection along the PV, we’re able to free the tumor.

One of the interesting topics in HPB surgery is the optimal management of T2 Gallbladder Cancer. Recently, we published ...
18/12/2020

One of the interesting topics in HPB surgery is the optimal management of T2 Gallbladder Cancer. Recently, we published an article about T2 GB cancer with a very exciting results. We found that liver resection was not associated with survival advantage compared to no liver resection. Likewise, extended LND was not associated with improved survival outcome compared to regional LND.
Nonetheless, this article should be carefully interpreted because proper preoperative work-up and sophisticated imaging modilities is required to achieve these interesting results. As such, Radical cholecystectomy is still the best option for countries or institutions with limited resources.
A week ago, we performed extended lymph node dissection with segment 4b/5 liver resection for T2 GB cancer.

Please see our publish article. https://doi.org/10.1097/md.0000000000020039

The ramification of the anterior pedicle has been previously demonstrated in various study. During my fellowship, I was ...
16/12/2020

The ramification of the anterior pedicle has been previously demonstrated in various study. During my fellowship, I was frequently exposed to the beauty of the anterior pedicle anatomy.
Today, I was able to apply its value to one of my patient who had multiple and huge tumor on segment 2-4 . Doing an extended left hepatectomy would compromised the remnant liver volume - the posterior section. As such, a DORSAL SEGMENT PRESERVING EXTENDED LEFT HEPATECTOMY was the most appropriate approach for optimal patient safety. Patient was discharged after 5th post-operative stay.

Standardizing a technique is very crucial for the implementation of laparoscopic approach for liver resection. Through a...
15/12/2020

Standardizing a technique is very crucial for the implementation of laparoscopic approach for liver resection. Through accumulated experiences, an improvement of skill proficiency may improve surgical outcome..
Our article below may sheds light on how to implement a laparoscopic program.

https://doi.org/10.1016/j.hpb.2019.11.001

Proud to be trained by a world-renowned liver surgeon.
13/12/2020

Proud to be trained by a world-renowned liver surgeon.

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