Hpb最新文献

{"title":"Liver transplantation for hepatocellular adenomas: UK NHSBT-liver advisory group guidelines for patient selection","authors":"Bobby V.M. Dasari ,&nbsp;Anya Adair ,&nbsp;Alberto Quaglia ,&nbsp;Chris Bellamy ,&nbsp;Raneem Albazaz ,&nbsp;Praveen Peddu ,&nbsp;Jessica Dyson ,&nbsp;Mike Allison ,&nbsp;Varuna Aluvihare","doi":"10.1016/j.hpb.2025.07.001","DOIUrl":"10.1016/j.hpb.2025.07.001","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation (LT) for hepatic adenomas has been described, but there are no set criteria for patient selection. A Fixed Term Working Group (FTWG), set up by the NHS Blood and Transplant (NHSBT) Liver Advisory Group (LAG), advised systematic work-up and using strict selection criteria as a national guideline.</div></div><div><h3>Methods</h3><div>Opinions were sought from patient representatives, expert hepatologists, histopathologists, liver transplant and hepatobiliary surgeons, and radiologists, all with expertise in adenoma management and familiarity with UK transplant pathways. The group discussed the wide range of radiological, histological, and clinical characteristics of HAs and formulated a set of core questions that address the clinical scenarios requiring consideration of liver transplantation, and thus developing appropriate patient selection criteria, referral and transplant listing pathways were identified.</div></div><div><h3>Results</h3><div>This paper summarises the selection criteria for LT in United Kingdom for HAs, and highlights the investigation framework, the work-up needed prior to transplant assessment and the referral pathway for LT.</div></div><div><h3>Conclusion</h3><div>This manuscript details the protocol for the work-up, referral, streamlined and standardised selection of patients with HAs for LT and represents a significant development in the management of HA patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1243-1247"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of post-hepatectomy liver failure on recurrence following major hepatectomy for colorectal cancer liver metastases","authors":"Johanna Sterner ,&nbsp;Martin Andersson ,&nbsp;Anna Olofsson ,&nbsp;Hannes Jansson ,&nbsp;Cecilia Strömberg ,&nbsp;Melroy D'Souza ,&nbsp;Christian Sturesson ,&nbsp;Ernesto Sparrelid ,&nbsp;Marco Gerling ,&nbsp;Stefan Gilg ,&nbsp;Jennie Engstrand","doi":"10.1016/j.hpb.2025.07.006","DOIUrl":"10.1016/j.hpb.2025.07.006","url":null,"abstract":"<div><h3>Background</h3><div>Limited research exists on whether post-hepatectomy liver failure (PHLF) impacts recurrence following major hepatectomy for colorectal cancer liver metastases (CRLM). This retrospective study aims to explore this further.</div></div><div><h3>Methods</h3><div>Data from patients who underwent major hepatectomy for CRLM at Karolinska University Hospital, Sweden, between 2012 and 2020 was analyzed. PHLF definition followed the International Study Group of Liver Surgery criteria. Recurrence risks were estimated with cumulative incidence functions, and Gray's test compared groups. Liver-specific and overall recurrence-free survival (RFS) were assessed using the Fine &amp; Gray subdistribution hazards model, considering competing risks.</div></div><div><h3>Results</h3><div>Of 327 patients, 11 % developed PHLF grade A and 8 % developed PHLF grade B/C. Liver metastasis recurred in 57 % after a median follow-up of 40 months. Three-year cumulative incidences of liver recurrence was not significantly different: no PHLF (56 %), PHLF grade A (50 %), and PHLF grade B/C (48 %). Respectively for overall recurrence: no PHLF (75 %), PHLF grade A (63 %), and PHLF grade B/C (76 %). PHLF did not significantly impact either liver-specific RFS or overall RFS in multivariable analyses.</div></div><div><h3>Conclusion</h3><div>Despite its substantial effect on short-term outcomes, PHLF does not appear to be a critical factor for disease recurrence after major hepatectomy for CRLM.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1309-1317"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144775312","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"International validation of a natural-killer-cell–based model to predict recurrence-free survival in hepatocellular carcinoma","authors":"Miho Akabane ,&nbsp;Jun Kawashima ,&nbsp;Selamawit Woldesenbet ,&nbsp;François Cauchy ,&nbsp;Federico Aucejo ,&nbsp;Irinel Popescu ,&nbsp;Minoru Kitago ,&nbsp;Guillaume Martel ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;George A. Poultsides ,&nbsp;Yuki Imaoka ,&nbsp;Andrea Ruzzenente ,&nbsp;Itaru Endo ,&nbsp;Ana Gleisner ,&nbsp;Hugo P. Marques ,&nbsp;Vincent Lam ,&nbsp;Tom Hugh ,&nbsp;Nazim Bhimani ,&nbsp;Feng Shen ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2025.06.011","DOIUrl":"10.1016/j.hpb.2025.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Models estimating recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on clinical variables and often overlook tumor immunobiology. The Liver Immune Status Index (LISI), derived from BMI, albumin, and Fibrosis-4 (FIB-4), reflects liver-resident natural killer (NK) cell activity. We validated the HISCO-HCC score, combining LISI, tumor burden score (TBS), and alpha-fetoprotein (AFP), using an international cohort.</div></div><div><h3>Methods</h3><div>Patients undergoing curative-intent hepatectomy for HCC (2000–2023) were identified from an international database (median follow-up: 38.9 [14.9–67.5] months). RFS was the primary endpoint. LISI’s predictive performance was compared with other liver-related indices. The original HISCO-HCC (oHISCO-HCC) was recalibrated via multivariable Cox regression in a training cohort (80 %) stratified by region, yielding a modified score (mHISCO-HCC). Validation was conducted in the testing cohort (20 %).</div></div><div><h3>Results</h3><div>Among 1213 patients, LISI had the highest AUCs among liver-related indices for 1-/2-year RFS (0.60/0.60) and 1-/5-year OS (0.64/0.60). The formula: mHISCO-HCC = 0.49 × TBS + 0.41 × log(AFP) + 0.13 × LISI. In testing, mHISCO-HCC outperformed oHISCO-HCC and mHALT-HCC for 12-/36-/60-month RFS (AUCs: 0.73/0.71/0.66) with the lowest AIC. It also had the highest OS AUCs and stratified RFS and OS (p &lt; 0.001).</div></div><div><h3>Conclusions</h3><div>The mHISCO-HCC score, integrating tumor morphology, biology, and NK cell-based immunity, improves prediction of recurrence and survival. It may aid postoperative stratification.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1259-1269"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144667578","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes and recurrence patterns following resection of T1 ampullary carcinomas: single centre experience of 92 cases","authors":"Gurudutt P. Varty ,&nbsp;Arindam Mondal ,&nbsp;Siva Sumanth Dukkipati ,&nbsp;Akash Pawar ,&nbsp;Vikram Chaudhari ,&nbsp;Shailesh V. Shrikhande ,&nbsp;Manish S. Bhandare","doi":"10.1016/j.hpb.2025.07.005","DOIUrl":"10.1016/j.hpb.2025.07.005","url":null,"abstract":"<div><h3>Background</h3><div>Resected early-stage (T1) ampullary carcinomas (ACs) have the best overall survival (OS) but can have higher postoperative morbidity compared to higher-stage ACs and other periampullary cancers.</div></div><div><h3>Method</h3><div>A retrospective analysis of resected T1-ACs at Tata Memorial Centre, Mumbai, from January 2012 to December 2022 was performed. Perioperative and long-term outcomes were assessed.</div></div><div><h3>Results</h3><div>A total of 92 patients underwent resection for T1-ACs, with a significant morbidity rate (Clavien-Dindo ≥3) of 38%, and a clinically relevant postoperative pancreatic fistula rate of 22.5%. The node positivity rate in resected T1-ACs was 25%. The 3- and 5-year OS rates were 77.9% and 74.5%, while recurrence-free survival (RFS) rates were 81.8% and 78.4%, respectively. There were 18 (19.6%) recurrences (2 local, 16 distant) during a median follow-up of 66.7 months. The 3- and 5-year OS after recurrence was 29.6% and 14.8% respectively. Lymph node metastasis was the sole significant factor affecting OS (HR 2.815, 95% CI: 1.114–7.112, <em>p</em> = 0.029) and RFS (HR 2.54, 95% CI: 0.978–6.595, <em>p</em> = 0.056).</div></div><div><h3>Conclusion</h3><div>T1-ACs have excellent survival after resection; however, about 20% of patients develop recurrence. Lymph node metastasis remains the most important factor affecting long-term survival.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1328-1339"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pancreatectomy with venous resection and peritoneal patch reconstruction: bridging transplantation and pancreatic surgery to combine the advantages of tangential and segmental resections","authors":"Umberto Cillo ,&nbsp;Giampaolo Perri ,&nbsp;Domenico Bassi,&nbsp;Riccardo Pellegrini,&nbsp;Nicola Canitano,&nbsp;Simone Serafini,&nbsp;Enrico Gringeri ,&nbsp;Giovanni Marchegiani","doi":"10.1016/j.hpb.2025.07.010","DOIUrl":"10.1016/j.hpb.2025.07.010","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatectomy with venous resection (PVR) is considered standard practice and accomplished with different techniques.</div></div><div><h3>Methods</h3><div>Patients undergoing PVR with portal (PV) and/or superior mesenteric (SMV) vein resection for PDAC between 2015 and 2024 at a high-volume HPB and Liver Transplant Unit were retrospectively analyzed according to ISGPS types.</div></div><div><h3>Results</h3><div>A total of 104 patients underwent PVR: tangential w/primary closure (Type 1 = 30; 29 %) or peritoneal patch (Type 2 = 30; 29 %), segmental w/primary anastomosis (Type 3 = 31; 30 %) or interposition graft (Type 4 = 13; 12 %). Type 2 was mostly used for low (SMV-to-SMV = 37 %) or extended (PV-to-SMV = 50 %) resections (p &lt; 0.001), with lowest rate of splenic vein sacrifice (7 %; p = 0.001). Major morbidity and hemorrhage (PPH) were similar among different ISGPS types (Type 2 = 27 % and 30 %, respectively), as well as mortality (Type 2 = 3 % at 90 days). Prophylactic dose anticoagulation was used in 73 % of Type 2 patients, with 3 % early (≤30 days) and no late (≤1 year) thrombosis.</div></div><div><h3>Discussion</h3><div>The peritoneal patch offers the advantages of both tangential and segmental resections. It can be used for low or extended infiltrations, preserving venous collaterals without sacrificing radicality, with acceptable morbidity and mortality, and near-zero thrombotic events using prophylactic anticoagulation only.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1318-1327"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of social deprivation upon the preoperative pathway and early surgical outcomes after pancreatoduodenectomy for PDAC and non-PDAC periampullary cancer in England: the Surg-Panc-UK study","authors":"Thomas W. Thorne ,&nbsp;Siobhan C. McKay ,&nbsp;Samir Pathak ,&nbsp;Richard Wilkin ,&nbsp;Jenifer Barrie ,&nbsp;John Moir ,&nbsp;Keith J. Roberts","doi":"10.1016/j.hpb.2025.07.007","DOIUrl":"10.1016/j.hpb.2025.07.007","url":null,"abstract":"<div><h3>Background</h3><div>Socioeconomic deprivation is linked to poorer outcomes in many cancers, however the impact of social deprivation on survival in resectable pancreatic and other peri-ampullary cancers appears mixed. Moreover, no studies consider the impact of social deprivation on diagnostic pathway length.</div></div><div><h3>Methods</h3><div>A retrospective observational cohort study of adults with suspected periampullary cancer undergoing pancreaticoduodenectomy in England. Following surgery, patients were stratified by cancer type (PDAC, duodenal cancer, cholangiocarcinoma and ampullary cancer) and the impact of social deprivation (IMD deprivation quintiles) upon short-term survival and diagnostic pathway length analysed.</div></div><div><h3>Results</h3><div>648 patients from England with social deprivation data were identified, including PDAC (n = 386) and non-PDAC periampullary malignancies (n = 262). For PDAC and non-PDAC patients, there was no association between resection rate and IMD quintile (p = 0.172 and p = 0.084). For PDAC patients, no difference in neoadjuvant chemotherapy rates (p = 0.462) or 1-year survival (p = 0.052) existed across IMD quintiles.</div></div><div><h3>Discussion</h3><div>Across England socioeconomic deprivation does not appear to relate to survival outcomes after PD for periampullary cancer, regardless of histological subtype. This suggests that pancreatic resectional centres are managing health inequality well.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1340-1347"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical complexity and long-term outcomes after liver resection for intrahepatic cholangiocarcinoma: a multicenter study","authors":"Tomoaki Yoh ,&nbsp;Shinichi Nakanuma ,&nbsp;Makoto Kurimoto ,&nbsp;Hiroaki Sugita ,&nbsp;Hideaki Sueoka ,&nbsp;Takamichi Ishii ,&nbsp;Ikuo Nakamura ,&nbsp;Seiko Hirono ,&nbsp;Shintaro Yagi ,&nbsp;Etsuro Hatano","doi":"10.1016/j.hpb.2025.06.010","DOIUrl":"10.1016/j.hpb.2025.06.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Intrahepatic cholangiocarcinoma (ICC) can invade surrounding structures such as inferior vena cava or hepatic hilum, leading to the surgical complexity; however, its effect on long-term outcomes remains poorly understood.</div></div><div><h3>Methods</h3><div>Data from consecutive patients with ICC who underwent liver resection (LR) between 2000 and 2020 at three tertiary hepatobiliary centers were retrospectively analyzed. Surgical complexity was defined as follows: Class I; LR, Class II; LR with biliary resection and reconstruction only, and Class III; LR with major vascular resection and reconstruction.</div></div><div><h3>Results</h3><div>A total of 303 patients were enrolled in this study, with 206 (68.0 %), 64 (21.1 %), and 33 (10.9 %) classified as Class I, Class II, and Class III, respectively. The median overall survival (OS) for Class I, Class II, and Class III was 57.6 months, 31.0 months, and 17.5 months, respectively (<em>P</em> &lt; 0.001). On multivariate analysis, Class III was identified as an independent predictor of poorer OS together with lymph node metastasis and tumor multiplicity; Class I and Class II were not independent.</div></div><div><h3>Conclusion</h3><div>Surgical complexity may help stratify survival outcomes in patients with ICC after LR. Moreover, the poor prognosis associated with Class III highlights the requirement of a refined strategy for these patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1250-1258"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144764860","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)01602-8","DOIUrl":"10.1016/S1365-182X(25)01602-8","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Page iii"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145183676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reappraisal of the impact of resection margin on outcomes after hepatectomy and perioperative treatment for Alveolar echinococcosis a single center experience","authors":"Antoine Notte ,&nbsp;Alexandre Doussot ,&nbsp;Paul Calame ,&nbsp;Carine Richou ,&nbsp;Frédéric Grenouillet ,&nbsp;Damien Montange ,&nbsp;Florent Demonmerot ,&nbsp;Laurence Millon ,&nbsp;Delphine Weil-Verhoeven ,&nbsp;Solange Bresson-Hadni ,&nbsp;Bruno Heyd ,&nbsp;Célia Turco","doi":"10.1016/j.hpb.2025.07.002","DOIUrl":"10.1016/j.hpb.2025.07.002","url":null,"abstract":"<div><h3>Background</h3><div>Alveolar echinococcosis (AE) is a rare benign but potentially life-threatening condition. Albeit benign, recurrence after surgical resection remains frequent. Systematic perioperative benzimidazoles (BZM) treatment along with complete and large resection margin have been advocated to prevent recurrence, although data on long-term outcomes are lacking.</div></div><div><h3>Methods</h3><div>Consecutive patients who underwent hepatectomy for AE between 2005 and 2023 were included. Perioperative management and long-term outcomes were analyzed.</div></div><div><h3>Results</h3><div>Over the study period, 76 patients underwent hepatectomy for AE, of which 71 (93 %) received preoperative antiparasitic treatment. R0 rate was 58 % and R1 resection rate was 41 %, including 21 planned R1 resections. Severe morbidity occurred in 7 patients (9 %) including one postoperative death. Overall, 70 patients (92 %) received postoperative treatment for a median duration of 24 months (range, 10–108). After a median follow-up of 48 months (range, 10–226), 2 patients developed recurrence. No recurrence was observed in patients who underwent planned R1 resections. Overall survival at 5 and 10 years were 99 % and 86 % respectively.</div></div><div><h3>Conclusion</h3><div>Hepatectomycombined with perioperative parasitostatic treatment allowed prolonged overall survival similar to the general population. R1 resection does not seem to influence survival.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1284-1289"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144717889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-technical skills for HPB surgeons – A necessary evolution in surgical training","authors":"Isabella Frigerio ,&nbsp;Federico Gheza ,&nbsp;Paola Dora ,&nbsp;Riccardo Memeo","doi":"10.1016/j.hpb.2025.07.011","DOIUrl":"10.1016/j.hpb.2025.07.011","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 10","pages":"Pages 1348-1350"},"PeriodicalIF":2.4,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144730112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}