Management of hepatobiliary and pancreatic disorders at the Academic Medical Center Amsterdam, Netherlands

Abstract

Academic Medical Center opened in 1980 and replaced the old pavilion hospitals with separated departments inside Amsterdam. Since that time the concept of a multidisciplinary approach for patients with gastrointestinal disorders, and in particular hepatobiliary and pancreatic diseases, has been developed. This approach started with a strong interest in the non-surgical treatment of HPB diseases by the endoscopic route and stenting developed by Drs Kee S Huibregtse and Guido Tytgat 1,2. The former chairman of the Department of Surgery, Dr Niels van der Heyde, added the expertise of the surgical approach. His main interest was the surgical treatment and effect of radiotherapy for proximal bile duct tumours (Klatskin tumours) 3,4. Drs Huug Obertop (chairman of the Department of Surgery) and Dirk Gouma were appointed in 1993. Together with Dr Thomas van Gulik (head of Experimental Surgery), and Dr Olivier Busch, they lead the ‘surgical’ programme of HPB disorders. The AMC is a tertiary referral center for HPB diseases in the Netherlands as well as providing a general service for the local community. An important binding factor in the clinical programme as a referral centre is the twice-weekly multidisciplinary HPB meeting. The referral and multidisciplinary management of 250 patients with bile duct injuries after laparoscopic cholecystectomy during the past years emphasises this function 5,6. Gallstone formation and the surgical and non-surgical management of symptomatic gallstone disease have also been studied extensively by the departments of Surgery and Gastroenterology 7,8,9. During the past decade several aspects of the management of HPB malignancies have been studied, again by cooperation of different departments. The value of diagnostic laparoscopy and other diagnostic modalities such as endosonography, ultrasound and spiral CT-scan, preoperative biliary drainage and perioperative feeding are analysed in different studies 10,11,12,13,14. The role of systemic inflammation and cytokine release in obstructive jaundice and biliary drainage have been analysed in detail 15,16. The non-operative approach of (benign and malignant) HPB diseases is strongly stimulated by the gastroenterologists and the new team of radiologists (Dr Han Lameris, chairman) 2,5,8,17. The results of the pylorus-preserving pancreatoduodenectomy and aspects of centralisation are studied in data from the AMC and the whole of the Netherlands 18. Together with the Department of Pathology (Drs Fiebo ten Kate and Johan Offerhaus) the prognostic role of diagnostic markers in bile duct and pancreatic carcinoma has been investigated 19,20. Effects of chemoradiotherapy in pancreatic carcinoma and radiotherapy in proximal bile duct tumours are studied in collaboration with the Department of Medical Oncology and Radiotherapy (Drs Gonzalez and Van Tienhoven). Finally within the liver programme, the current studies include the ischaemia-reperfusion phenomenon after liver resection, the effect of extrahepatic cholestasis on liver regeneration, continuous or intermittent vascular inflow occlusion during resection and a new bioartificial liver (BAL) 23,24,25,26. The development of adenoviral gene therapy was initiated recently in a new multidisciplinary research programme. The multidisciplinary approach to patient care has improved the quality of care, as has the combination of clinical and fundamental research by the different members of our HPB team (Figure 1). Figure 1. Standing (from left, to right): Dr Erik AJ Rauws (gastroenterologist), Dr Olivier RC Busch (surgeon), Dr Otto M van Delden (radiologist), Dr Daniel C Aronson (pediatric surgeon), Prof G Johan A Offerhaus (pathologist), Prof Thomas M van Gulik (surgeon), ...