Hpb最新文献

{"title":"ALPPS VS PVE VS LVD: selecting the optimal liver hypertrophy method for patients with liver malignancies, before undergoing large scale hepatectomy; A systematic review and meta-analysis","authors":"Afroditi Fotiadou,&nbsp;Kyriacos Evangelou,&nbsp;Nikolaos Arkadopoulos,&nbsp;Ioannis Hatzaras","doi":"10.1016/j.hpb.2026.04.464","DOIUrl":"10.1016/j.hpb.2026.04.464","url":null,"abstract":"<div><h3>Background</h3><div>Large scale hepatectomy for primary or metastatic liver tumors may be limited by insufficient Future Liver Remnant (FLR). Strategies to enhance FLR hypertrophy include associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), portal vein embolization (PVE), and Liver Venous Deprivation (LVD). Their comparative efficacy in the context of open hepatectomy remains unclear.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of pairwise comparative studies was conducted (PubMed, Embase, Scopus, Cochrane). Risk of bias was assessed using ROBINS-I. Random-effects models were applied, with p &lt; 0.05 considered significant.</div></div><div><h3>Results</h3><div>24 retrospective cohort studies with a total of 1263 patients were included, with 1/3 judged as moderate and the rest as severe overall risk of bias. ALPPS induced higher mean Kinetic Growth Rate (KGR) than PVE (SMD = 1.61; 95%CI = 1.23,1.99; p &lt; 0.01) and LVD (ROM = 3.15; 95%CI = 2.66,3.71, p &lt; 0.01), and LVD than PVE (ROM = 1.96; 95%CI = 1.75,2.22; p &lt; 0.01). ALPPS was associated with superior hepatectomy completion rates compared to PVE (OR = 13.75; 95%CI = 3.24,58.57; p &lt; 0.01), and worse 1-year DFS (OR = 0.45; 95%CI = 0.21,0.93; p = 0.03). The rest of the comparisons failed to reach statistical significance.</div></div><div><h3>Conclusion</h3><div>ALPPS seems to induce the most rapid FLR hypertrophy, but no substantial differences regarding postoperative outcomes were observed. Further, ideally randomised, studies are necessary to draw clear and clinically relevant conclusions.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1034-1051"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015144","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":"Optimizing graft weight prediction in living donor liver transplantation: a machine learning approach integrating pathologic, radiological and biological factors","authors":"Shih-Min Yin,&nbsp;Po-Chun Chuang,&nbsp;Yu-Hung Lin,&nbsp;Itsuko Chih-Yi Chen,&nbsp;Yu-Fan Cheng,&nbsp;Shu-Mei Guo,&nbsp;Ting-Ting Liu,&nbsp;Chao-Long Chen,&nbsp;Jenn-Jier James Lien,&nbsp;Hsin-You Ou","doi":"10.1016/j.hpb.2026.04.457","DOIUrl":"10.1016/j.hpb.2026.04.457","url":null,"abstract":"<div><h3>Background</h3><div>Graft weight (GW) prediction is essential in living donor liver transplantation (LDLT) to mitigate the risks associated with small-for-size grafts. This study aimed to develop and validate a machine learning (ML)-based model integrating clinical, biochemical, radiological, and histopathological features to enhance GW prediction accuracy.</div></div><div><h3>Materials and methods</h3><div>This study included 1001 LDLT donors between 2014 and 2023. Preoperative clinical data, graft volume (GV), radiological and histological steatosis grading were analysed. Multiple models were developed using an 80% training and 20% test split. Model performance was assessed using mean absolute error (MAE), root mean square error (RMSE), and mean absolute percentage error (MAPE) and compared with conventional GW prediction methods.</div></div><div><h3>Results</h3><div>The ML model demonstrated superior performance, with an MAE of 48.51 g, an RMSE of 65.12 g, and a MAPE of 8.49%. Compared with traditional methods, the ML approach significantly reduced prediction errors ≥15% (10.94% vs. 37.31% for conventional models, p &lt; 0.001). Feature analysis highlighted GV, donor anthropometrics, lipid profiles, and CT attenuation values as key predictors, while hepatic steatosis had minimal impact.</div></div><div><h3>Conclusions</h3><div>ML-based GW prediction outperformed conventional methods by incorporating radiological and biochemical parameters, achieving greater accuracy and reducing clinically significant errors.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1076-1085"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015277","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":"Safety and effectiveness of ETHIZIA versus TachoSil for hemostasis during open liver surgery: a randomized controlled multicenter trial","authors":"James V. Guarrera,&nbsp;Navpreet Kaur,&nbsp;Cornelis Verhoef,&nbsp;Ivan Zendejas,&nbsp;Jean Botha,&nbsp;Suomi M.G. Fouraschen,&nbsp;Flavio Paterno,&nbsp;Frank Pianka,&nbsp;Robert J. Porte,&nbsp;Benjamin Samstein,&nbsp;Linda Sher,&nbsp;Jason R. Wellen,&nbsp;Johan C.M.E. Bender,&nbsp;Ingrid Fossan,&nbsp;Stuart J. Head,&nbsp;Johannes H.W. de Wilt","doi":"10.1016/j.hpb.2026.04.466","DOIUrl":"10.1016/j.hpb.2026.04.466","url":null,"abstract":"<div><h3>Background</h3><div>Liver surgery carries a significant risk of perioperative bleeding. This randomized clinical trial compared the safety and efficacy of ETHIZIA, a novel, highly adaptable hemostatic patch, to the current standard of care during open liver surgery.</div></div><div><h3>Methods</h3><div>Adult subjects (<em>N</em> = 132) were randomized 2:1 to ETHIZIA or TachoSil to treat one or more target bleeding sites (TBS) on the liver transection plane. The objective was to demonstrate non-inferiority (margin 10%) and subsequently, superiority, of ETHIZIA to TachoSil in hemostatic success at 3 min post-application.</div></div><div><h3>Results</h3><div>For the first-treated TBS (Per protocol set, ETHIZIA <em>N</em> = 87, TachoSil <em>N</em> = 43), 3-min hemostatic success was both non-inferior (<em>p</em> &lt; 0.0001) and superior (<em>p</em> = 0.0038) for ETHIZIA (93.1%) compared to TachoSil (76.7%); the median time to hemostasis was significantly shorter (0.5 versus 3.0 min, respectively (<em>p</em> &lt; 0.0001)). Failure and rescue rates were lower for ETHIZIA (1.1% and 3.4%) than for TachoSil (7.0% and 11.6%). Efficacy results including additionally treated TBS were similar (ETHIZIA <em>N</em> = 139 TBS, TachoSil <em>N</em> = 59 TBS). Bile/non-bile fluid collections were more frequent in ETHIZIA-treated subjects, but multivariable regression indicated a multifactorial surgical basis and no association with hemostatic device.</div></div><div><h3>Conclusion</h3><div>Fast and robust hemostasis supports ETHIZIA as a valuable and safe new hemostatic agent during open liver surgery.</div></div><div><h3>Clinical trial registration</h3><div>The trial was registered at <span><span>ClinicalTrials.gov</span><svg><path></path></svg></span> as NCT05385952.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1064-1075"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148005194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of tumor location on oncologic outcomes in laparoscopic parenchymal sparing resection of colorectal liver metastases","authors":"Samer Diab,&nbsp;Alessandro D. Mazzotta,&nbsp;Ecoline Tribillon,&nbsp;Brice Gayet,&nbsp;Olivier Soubrane","doi":"10.1016/j.hpb.2026.04.463","DOIUrl":"10.1016/j.hpb.2026.04.463","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic liver resection (LLR) of colorectal liver metastases (CRLM) was shown to be feasible with reduced morbidity, shorter length of stay, and similar oncologic results when compared to open liver resection (OLR). However, no study to date looked at the rate of R₁ resection according to tumor location.</div></div><div><h3>Methods</h3><div>Patients who underwent parenchymal-sparing LLR of CRLM at our institution between January 2015 and December 2022 were included. The respective data was collected with a focused interest on tumor location. Resections were classified in two groups according to whether margins were negative (R₀) or positive (R₁). Data was compared and the rate of positive margins was evaluated according to tumor location.</div></div><div><h3>Results</h3><div>A total of 502 resections were performed of which 119 (23.7%) were R₁. The highest rate was found in segment I (48.3%), followed by segments II (37.3%), VII (26.5%), and IVa (25.7%). The lowest rate was identified in segment IVb (14%), followed by segments III (14.1%), VI (18.4%), V (20%), and VIII (20.8%).</div></div><div><h3>Conclusion</h3><div>LLR from segments I and II carry the highest risk of R₁ resection. An in-depth investigation is required to determine if OLR provides an advantage over LLR for CRLM in specific locations.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1094-1103"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147959916","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":"Optimal intraoperative management in pancreatic surgery: a systematic review of randomized controlled trials","authors":"Belkacem Acidi,&nbsp;Alain Sauvanet,&nbsp;Giovanni Marchegianni,&nbsp;Hop S. Tran Cao,&nbsp;Sébastien Gaujoux","doi":"10.1016/j.hpb.2026.05.003","DOIUrl":"10.1016/j.hpb.2026.05.003","url":null,"abstract":"<div><h3>Background</h3><div>Despite major advances in pancreatic surgery and reduced mortality, intraoperative management remains poorly standardized and largely dependent on surgeon expertise. This systematic review aimed to synthesise randomized controlled trials evaluating intraoperative surgical techniques in pancreatic surgery and their impact on predefined postoperative outcomes (POPF, DGE, SSI, and length of stay).</div></div><div><h3>Methods</h3><div>Following PRISMA guidelines, a comprehensive search of PubMed, EMBASE, and the Cochrane Database (2013–2024) identified RCTs assessing intraoperative management in pancreatic surgery. Studies focusing on oncologic outcomes or including fewer than 60 patients were excluded. Quality and risk of bias were assessed using the Jadad Scale and the Cochrane RoB-2 tool.</div></div><div><h3>Results</h3><div>Of 818 articles screened, 47 RCTs met inclusion criteria (Jadad ≥3). Postoperative pancreatic fistula (POPF) was the primary endpoint in 19 studies. Significant POPF reductions were associated with specific techniques such as end-to-side anastomosis, pancreaticogastrostomy, and polyethylene glycol–coated patches. Minimally invasive distal pancreatectomy showed reduced blood loss, hospital stay, and faster recovery. Selective or no-drain policies in distal pancreatectomy were supported by RCTs to reduce clinically relevant POPF.</div></div><div><h3>Conclusion</h3><div>Intraoperative management in pancreatic surgery remains heterogeneous. Standardized, evidence-based protocols and additional high-quality RCTs are required to optimize surgical techniques and outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1116-1124"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148210705","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 neoadjuvant chemotherapy on the rate of clinically significant postoperative pancreatic fistula","authors":"Sara Saeidishahri,&nbsp;Amir Ebadinejad,&nbsp;Oscar K. Serrano","doi":"10.1016/j.hpb.2026.05.006","DOIUrl":"10.1016/j.hpb.2026.05.006","url":null,"abstract":"<div><h3>Background</h3><div>While numerous studies have evaluated predictors of postoperative pancreatic fistula (POPF) after pancreatectomy, limited data exist regarding the impact of neoadjuvant chemotherapy (NAC) on POPF among patients undergoing surgery for pancreatic ductal adenocarcinoma (PDAC). This study aimed to assess the association between NAC and POPF using a contemporary national cohort.</div></div><div><h3>Methods</h3><div>We queried the American College of Surgeons National Surgical Quality Improvement Program pancreatectomy-targeted datasets for 2022 and 2023. NAC was defined as chemotherapy within 90 days before surgery. Univariate and multivariable logistic regression analyses were performed, adjusting for demographic, clinical, and operative covariates.</div></div><div><h3>Results</h3><div>A total of 7,260 patients with PDAC were included; 48.2% received NAC and 10.3% received neoadjuvant radiation. 79.7% of patients underwent pancreaticoduodenectomy. Compared with non-NAC patients, those receiving NAC were younger and had higher rates of hard gland texture and intraoperative vascular resection. The incidence of POPF was significantly lower in the NAC group (7.2% vs. 12.6%, p &lt; 0.001). On multivariable analysis, NAC remained independently associated with lower odds of POPF (adjusted OR 0.63, 95% CI 0.53–0.76, p &lt; 0.001).</div></div><div><h3>Conclusion</h3><div>NAC is significantly associated with lower POPF incidence after resection for PDAC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1136-1142"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148194662","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":"IHPBA news 2","authors":"","doi":"10.1016/S1365-182X(26)00709-4","DOIUrl":"10.1016/S1365-182X(26)00709-4","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Page OBC"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666833","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":"Multicenter machine learning model to predict very early recurrence after curative-intent resection of hilar cholangiocarcinoma","authors":"Tong Yuan,&nbsp;Ran Tao,&nbsp;Qiuyi Nie,&nbsp;Deyu Li,&nbsp;Qiumeng Liu,&nbsp;Chuang Peng,&nbsp;Yongjun Chen,&nbsp;Zhiyong Huang,&nbsp;Xiaoping Chen,&nbsp;Shuai Xiang","doi":"10.1016/j.hpb.2026.05.001","DOIUrl":"10.1016/j.hpb.2026.05.001","url":null,"abstract":"<div><h3>Background</h3><div>Surgical resection remains the main curative option for hilar cholangiocarcinoma (HCCA), but long-term survival is often limited by very early recurrence (VER, ≤6 months postoperatively). We aimed to develop a model to predict VER after curative-intent resection.</div></div><div><h3>Methods</h3><div>In this retrospective multicenter cohort study, we included patients who underwent curative-intent resection for HCCA at three Chinese centers between April 1, 2010, and March 1, 2023. Patients were randomly assigned to training and validation cohorts. Logistic regression, random forest, support vector machine, and extreme gradient boosting (XGBoost) models were constructed to predict VER. Performance was evaluated using receiver operating characteristic, Brier score, calibration plots, and decision curve analyses. SHapley Additive exPlanations were used to assess feature importance.</div></div><div><h3>Results</h3><div>Among 474 patients, 106 (22.4%) developed VER. The training and validation cohorts comprised 331 and 143 patients, respectively. VER was associated with hepatic artery invasion, portal vein invasion, positive margins, lymph node metastasis, elevated CA19-9, and poor differentiation. XGBoost achieved the highest AUC (0.85, 95% CI 0.78–0.92) and was selected for online deployment.</div></div><div><h3>Conclusion</h3><div>The XGBoost model predicts VER after HCCA resection and may facilitate postoperative risk stratification and management.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1104-1115"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148137590","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":"How much pancreas is too much?: optimal pancreas resection volume to prevent diabetes mellitus after left-sided pancreatectomy","authors":"Inhyuck Lee,&nbsp;Young J. Cho,&nbsp;Go-Won Choi,&nbsp;Younsoo Seo,&nbsp;Yoon S. Chae,&nbsp;Youngmin Han,&nbsp;Hye-Sol Jung,&nbsp;Wooil Kwon,&nbsp;Joon S. Park,&nbsp;Jin-Young Jang","doi":"10.1016/j.hpb.2026.04.461","DOIUrl":"10.1016/j.hpb.2026.04.461","url":null,"abstract":"<div><h3>Background</h3><div>Post-pancreatectomy diabetes is clinically important, but quantitative measurement has not been systematically applied. We identified predictors of new-onset diabetes after left-sided pancreatectomy using CT volumetry and perioperative glycemic assessment.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed 243 adults undergoing left-sided pancreatectomy (2008–2023). Glycemic parameters were measured preoperatively and at 3 months and 1 year. CT volumetry quantified pancreatic volume and resection ratio. In patients without preoperative diabetes (defined by medical records and laboratory criteria), predictors of diabetes at 1 year were assessed using logistic regression after dichotomizing continuous variables at ROC/Youden cut-offs.</div></div><div><h3>Results</h3><div>Of 162 patients without preoperative diabetes, 52 (32.1%) developed diabetes at 1 year. Independent predictors were ASA score ≥ II (OR 3.88, 95% CI 1.32–11.43), age≥48 years (OR 4.26, 1.35–13.43), HbA1c ≥ 6.0% (OR 11.62, 2.92–46.14), fasting glucose≥100 mg/dL (OR 2.75, 1.05–7.22), and resection ratio≥32.0% (OR 10.01, 3.10–32.36). The model AUC was 0.851 (sensitivity 0.827; specificity 0.782).</div></div><div><h3>Conclusion</h3><div>Integration of quantitative volumetric analysis with glycemic markers and operative factors yielded a robust predictive model for postoperative diabetes, facilitating meaningful preoperative risk stratification and individualized surgical planning for left-sided pancreatectomy.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Pages 1086-1093"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148156417","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":"Cover","authors":"","doi":"10.1016/S1365-182X(26)00703-3","DOIUrl":"10.1016/S1365-182X(26)00703-3","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 8","pages":"Page OFC"},"PeriodicalIF":3.3,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148666072","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}