Hpb最新文献

{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(26)02757-7","DOIUrl":"10.1016/S1365-182X(26)02757-7","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 10","pages":"Page iii"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149125373","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":"Failure to rescue after pancreatoduodenectomy and the advent of robotic surgery: outcomes across 20 years practice","authors":"Alessia Vallorani,&nbsp;Lavisha Singh,&nbsp;Sangrag Ganguli,&nbsp;Colin M. Johnson,&nbsp;Sarah B. Hays,&nbsp;Aram Rojas,&nbsp;Syed A. Mehdi,&nbsp;Miral S. Grandhi,&nbsp;Melissa E. Hogg","doi":"10.1016/j.hpb.2026.06.017","DOIUrl":"10.1016/j.hpb.2026.06.017","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatoduodenectomy (PD) remains associated with substantial morbidity, but mortality has dropped in specialized centers. Failure to rescue (FTR), defined as mortality following major postoperative complications, has emerged as a key indicator of surgical quality. The influence of surgical approach on FTR remains uncertain.</div></div><div><h3>Methods</h3><div>A retrospective review of elective open and robotic PDs performed between 2007 and 2024 at a single high-volume center was conducted. Demographics, comorbidities, operative details, and major complications were analyzed. Rescue interventions included reoperation, interventional radiology, or intensive care unit (ICU) escalation. The primary outcome was ninety-day FTR.</div></div><div><h3>Results</h3><div>Among 572 open and 140 robotic PDs, median age was 68 years and 50.1% were female. Major complications occurred in 28%. Thirty- and ninety-day mortality were 1.5% and 3%, respectively; FTR was 8.4% (n = 17/202). Compared with open PD, robotic procedures showed fewer major complications (21% vs 30%, p = 0.042) and shorter median hospital stay (7 vs 9 days, p &lt; 0.001). FTR was not influenced by surgical approach, but was associated with higher comorbidity, organ failure and lack of timely ICU escalation.</div></div><div><h3>Conclusion</h3><div>Over nearly two decades, low FTR rates were achieved. Rescue success reflected patient risk, complication severity, and institutional response.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 10","pages":"Pages 1342-1353"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561924","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 consensus on mesopancreas and total mesopancreas excision (MESODELPHI)","authors":"Luís Felipe Leite,&nbsp;Marcos Belotto,&nbsp;Marcelo Sá de Araújo,&nbsp;Samuel Menezes,&nbsp;Luiz F. de Almeida,&nbsp;Mohammad A. Hilal,&nbsp;Cándido F. Alcázar López,&nbsp;Juan S. Azagra,&nbsp;Anita Balakrishnan,&nbsp;Frederik Berrevoet,&nbsp;Marc G. Besselink,&nbsp;Gerardo Blanco-Fernández,&nbsp;Ugo Boggi,&nbsp;Oscar Chapa-Azuela,&nbsp;F.J.F. Coimbra,&nbsp;Bobby V.M. Dasari,&nbsp;Safi Dokmak,&nbsp;Álvaro A. Duarte,&nbsp;Massimo Falconi,&nbsp;Alexandre F. Oliveira,&nbsp;José M. Ramia","doi":"10.1016/j.hpb.2026.06.012","DOIUrl":"10.1016/j.hpb.2026.06.012","url":null,"abstract":"<div><h3>Background</h3><div>The absence of a standardized anatomical definition of the mesopancreas has precluded meaningful comparison across studies on total mesopancreas excision (TMpE). The MESODELPHI consensus aimed to establish international agreement on its definition, surgical boundaries, and clinical role in pancreatic cancer management.</div></div><div><h3>Methods</h3><div>An international modified Delphi process, informed by a prior systematic review, included 43 pancreatic surgery experts from 20 countries across two rounds. Statements were rated on a 5-point Likert scale, with consensus predefined as ≥80% agreement.</div></div><div><h3>Results</h3><div>Consensus was achieved for 19 of 27 statements in Round 1. All participants (100%) agreed the mesopancreas is a retropancreatic compartment of lymphatic, neurovascular, and adipose tissue, with 97.7% agreeing on its anatomical boundaries. Both artery-first and mesenteric-first approaches were considered feasible surgical strategies (97.7%). Most experts (81.4%) favored TMpE over conventional pancreatoduodenectomy for curative-intent surgery. There was strong agreement that further investigation into the impact of TMpE on survival outcomes is necessary (97.7%), and that education on mesopancreas anatomy should be integrated into surgical training programs (93.0%).</div></div><div><h3>Conclusions</h3><div>This consensus provides the first standardized definition of the mesopancreas, recommends \"mesopancreas\" as the unifying term over alternative nomenclature, and offers an international framework to guide future research and surgical practice.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 10","pages":"Pages 1311-1317"},"PeriodicalIF":3.3,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420946","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 2026 global guideline for the management of hepatocellular carcinoma in resource-constrained healthcare settings.","authors":"Ajith K Siriwardena, Eduard Jonas, Glenn Bonney, Shridhar Iyer, John Primrose, Rafik Filobbos, Paleswan Lakhey, T P Kingham, Mehan Siriwardhane, Elijah Dixon, Mariano E Gimenez, Rohan Jeyarajah, Jose M Ramia, Javier Lendoire, Tian Q Song, Francesco Lancellotti, Deirdre Kruger, Ewen M Harrison, Gabriel Abellay, Oscar Imventarza, Martin I Prince, Shailesh V Shrikhande, Ramesh Bhandari, Arinda Dharmapala, Rohan Siriwardana, Ivan C Martinez, Sharon Barker, Louise M Finch, Stefan Stattner, Aiste K Gulla, Mustafa Kerem, Carlijn I Buis, Anita Balakrishnan, Steven J Wigmore, David Leggett, Felipe Comibra, Roeland de Wilde, Alejandro Serrablo, Avinash Supe, Nuru Bayramov, Anya Adair, Frederik Berrevoet, Manuel Maglione, William Jarnagin, Norihiro Kokudo, Krishnakumar Madhavan, Martin Smith, Rene Adam","doi":"10.1016/j.hpb.2026.08.2009","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2009","url":null,"abstract":"<p><strong>Background: </strong>Current guidelines for the management of patients with HCC are predominantly focused on well-resourced healthcare systems. In 2024, the IHPBA Legacy committee initiated a process to develop global resource-sensitive guidelines for the management of HCC.</p><p><strong>Methods: </strong>An IHPBA global guideline group produced and circulated statements on the management of HCC from diagnosis to treatment, discussed these in online webinars and generated guidelines. This document focuses on the diagnosis and management of patients with HCC in resource-constrained healthcare settings.</p><p><strong>Results: </strong>Initial diagnosis by ultrasound is supported by cross-sectional imaging. Alfa-feto protein and assessment of liver synthetic function are recommended at diagnosis. Lesion biopsy is not mandated. Liver resection is the recommended treatment of choice for single HCC in patients with preserved liver function and up to 3 lesions ≤3 cm. Radiofrequency and microwave are regarded as equivalent and can be used if resection is not available. Ethanol injection can be used if thermal ablation is not available but should be restricted to small lesions. TACE and TAE can be used for intermediate stage disease. Atezolizumab/bevacizumab combination is recommended as first line systemic therapy with sorafenib and Lenvatinib being recommended if first line is not an option. Advice for the care of the patient with advanced or terminal disease is provided.</p><p><strong>Conclusions: </strong>This document provides resource-sensitive HCC guidelines that prioritise feasibility, maximise benefit, and reduce default reliance on best supportive care alone and are produced for the IHPBA by discussion with the global community of IHPBA.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181514","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":"Survival benefit of laparoscopic anatomical resection in patients with hepatocellular carcinoma.","authors":"Takashi Kokudo, Yuichiro Mihara, Mai Nakamura, Norihiro Kokudo","doi":"10.1016/j.hpb.2026.09.012","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.012","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149181522","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":"Treatment of anastomotic biliary strictures after liver transplantation: long-term outcomes and risk factors for failure.","authors":"James M Halle-Smith, Angus Hann, Debashis Haldar, Andrew Holt, Max Almond, Robert P Sutcliffe, Keith J Roberts, Rebeca Sanabria-Mateos","doi":"10.1016/j.hpb.2026.09.011","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.011","url":null,"abstract":"<p><strong>Background: </strong>Anastomotic biliary strictures (AS) remain a common problem after liver transplantation. To guide treatment decisions and accurately counsel patients, it is important to compare the long-term success and morbidity rates of endoscopic and surgical treatment.</p><p><strong>Methods: </strong>Adult recipients of a whole liver graft with duct-to-duct biliary anastomosis between 2013 and 2019 were reviewed. Those who developed AS requiring intervention were identified and the outcomes and morbidity associated with endoscopic and surgical treatment were collected.</p><p><strong>Results: </strong>Of 1360 total transplants, 90 patients (7%) developed an AS requiring intervention, with a median follow-up of 104 months. Most patients (87, 97%) had endoscopic therapy as first-line. This was successful in 34 (39%) patients with the remainder (53, 61%) requiring further non-endoscopic biliary interventions. Of these, 42 underwent biliary reconstruction, which was successful in the majority of cases (30/42, 91%). A delay from stricture diagnosis to first endoscopic treatment was a risk factor for endoscopic failure (24 days vs 7 days; p = 0.04). The likelihood of success from a surgical repair was significantly greater if it was performed within 2 years of transplantation (100% vs. 72%; p = 0.007).</p><p><strong>Conclusions: </strong>Delays to treatment significantly reduce the chance of success for both endoscopic and surgical management of AS.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149215982","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":"Postoperative complications following hepatectomy for hepatocellular carcinoma in patients with Child-Pugh B liver function: a systematic review and meta-analysis.","authors":"Jiahui Yang, Wenjie Li, Kai Deng, Qingyan Kong, Wei Peng, Zheyu Chen","doi":"10.1016/j.hpb.2026.09.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.007","url":null,"abstract":"<p><strong>Background: </strong>Liver resection is a curative option for hepatocellular carcinoma (HCC), but its safety in patients with Child-Pugh B cirrhosis remains incompletely defined, and quantitative complication benchmarks are lacking.</p><p><strong>Methods: </strong>This systematic review and single-proportion meta-analysis followed PRISMA Harms guidelines. PubMed, Web of Science, Embase, and Cochrane Library were searched for studies reporting outcomes after curative-intent hepatectomy in Child-Pugh B HCC patients. Pooled proportions were calculated using generalized linear mixed models with logit transformation and random-effects models.</p><p><strong>Results: </strong>14 studies comprising 1238 patients were included. The pooled overall complication rate (Clavien-Dindo grade I-V) was 38.22% (95% CI, 30.05%-47.12%), and the trim-and-fill adjusted major complication rate (Clavien-Dindo ≥ III) was 14.87% (95% CI, 10.48%-20.67%). The 30-day and 90-day mortality rates were 1.09% (95% CI, 0.20%-5.59%) and 2.56% (95% CI, 1.43%-4.53%), respectively. Surgical approach was a significant moderator of major complications (open 18.18% vs. minimally invasive 7.83%; P = 0.01).</p><p><strong>Conclusion: </strong>These findings provide preliminary quantitative safety estimates that offer a useful reference for clinicians and patients and may help frame shared decision-making at the patient level.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127399","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":"Survival after resection compared to no resection among octogenarians with pancreatic and periampullary malignancies: a nationwide study.","authors":"Karin Johansen, Jacob Freedman, Dennis Björk, Per Sandström, Bergthor Björnsson","doi":"10.1016/j.hpb.2026.09.010","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.010","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to compare survival after surgery among elderly patients with pancreatic and periampullary tumours with patients who were offered resection but declined.</p><p><strong>Methods: </strong>Data were obtained from the Swedish national registry for tumours in the pancreatic and periampullary region 2010-2022 for patients ≥80 years. Patients were excluded who were not eligible for upfront resection or who had missing data regarding treatment decision. Remaining patients were compared between one group that underwent surgery and one group that was offered surgery but declined.</p><p><strong>Results: </strong>Out of 3991 patients, 467 remained after the selection, of whom 360 underwent surgery and 107 declined. Patients who declined surgery were a median two years older and had higher rates of pulmonary disease, peptic ulcer disease and heart failure. Charlson Comorbidity Index was comparable between groups. The median overall survival was 2.2 years after surgery and 0.8 years without surgery. Significant factors in the multivariable analysis for overall survival were surgery, age and diagnosis.</p><p><strong>Discussion: </strong>The group undergoing surgery had significantly longer overall survival, although this must be interpreted in the light of baseline differences between groups and possible selection bias. This study may serve as an aid for preoperative counseling.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127350","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":"Post percutaneous transhepatic biliary intervention pancreatitis: rate and risk factors.","authors":"Matthew J McGuinness, Christopher Khoory, Matthew Marshall-Webb, William Fleischl, Universe Leung, Howe Mao, Michael Rodgers, Sanket Srinivasa, Jonathan Koea, Snehal Patel, Rahul Bera","doi":"10.1016/j.hpb.2026.09.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.008","url":null,"abstract":"<p><strong>Background: </strong>Percutaneous transhepatic biliary intervention (PTBI) is an established technique for managing biliary pathology. The incidence and predictors of post-PTBI pancreatitis remain poorly defined. This study evaluated the rate and risk factors for pancreatitis following PTBI.</p><p><strong>Methods: </strong>A single-centre retrospective cohort study was performed of adults undergoing PTBI between June 2020-June 2025. Pancreatitis was defined using the revised Atlanta criteria. Associations between procedural factors and post-PTBI pancreatitis were assessed using logistic regression.</p><p><strong>Results: </strong>A total of 503 PTBI procedures were performed in 201 patients. The mean age was 68.7 years (SD 13.6); 43% were female. Malignant obstruction accounted for 76% of procedures. Post-PTBI pancreatitis occurred after 35 procedures (7.0%). On multivariable analysis, first-time PTBI (aOR 6.2, 95% CI 2.8-15.2; p < 0.001) and stent placement (aOR 2.4, 95% CI 1.1-5.1; p = 0.023) were independently associated with pancreatitis. Pancreatitis occurred exclusively following procedures involving trans-ampullary instrumentation.</p><p><strong>Discussion: </strong>Pancreatitis is a clinically important complication following PTBI. First-time procedures and biliary stenting significantly increase risk, of pancreatitis. Procedural strategies that minimise ampullary manipulation should be considered to reduce pancreatitis risk.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127432","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":"A four-week dichotomy cannot answer a non-monotonic question: comment on \"timing of revision surgery for incidental gallbladder cancer: a systematic review and individual patient data meta-analysis\".","authors":"Lei Feng","doi":"10.1016/j.hpb.2026.09.006","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.006","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149127378","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}