Hpb最新文献

{"title":"Textbook outcome in liver surgery after staged versus simultaneous resection for synchronous colorectal liver metastases.","authors":"Zayed Rashid, Abdullah Altaf, Mujtaba Khalil, Giovanni Catalano, Shahzaib Zindani, Andrea Ruzzenente, Irinel Popescu, Minoru Kitago, George A Poultsides, Kazunari Sasaki, Nazim Bhimani, Tom Hugh, Mathew Weiss, Luca Aldrighetti, Federico Aucejo, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.04.014","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.014","url":null,"abstract":"<p><strong>Background: </strong>We sought to define the likelihood of textbook outcome in liver surgery (TOLS) among patients undergoing simultaneous versus staged resection for sCRLM.</p><p><strong>Methods: </strong>Patients with sCRLM who underwent curative-intent resection between 2000-2022 were identified from an international multi-institutional database. TOLS was defined by the absence of intraoperative grade ≥2 events, R1 resection margin, post-hepatectomy liver failure, bile leakage, major postoperative complications, in-hospital/90-day mortality, and 90-day readmission. Multivariable regression was utilized to study associations between surgical approach and TOLS.</p><p><strong>Results: </strong>Among 897 patients with median age of 62 (IQR 55-69) years, 376 (41.9 %) patients underwent synchronous resection whereas 521 (58.1 %) patients had staged resection of sCRLM. 62.8 % of patients had TOLS following sCRLM resection and patients who underwent staged resection were more likely to have TOLS (staged: 65.8 % vs. simultaneous: 58.5 %, p = 0.025). Staged resection was associated with 37 % higher odds of TOLS (OR 1.37, 95 % CI 1.04-1.80) than simultaneous resection. Incidence of TOLS decreased with extensive resection (low-risk colectomy and minor hepatectomy: 69.6 % vs. high-risk colectomy and major hepatectomy: 2.8 %; p < 0.001).</p><p><strong>Conclusion: </strong>62.8 % of patients had TOLS following sCRLM resection. Staged versus simultaneous resection was associated with 37 % higher odds of TOLS. Extent of resection should be considered when determining the optimal operative approach.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143965095","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":"Long-term survival and recurrence after pancreatoduodenectomy for pancreas cancer.","authors":"Chris Varghese, Elizabeth B Habermann, Patrick Starlinger, Susanne G Warner, Rory L Smoot, Michael L Kendrick, Mark J Truty, Cornelius A Thiels","doi":"10.1016/j.hpb.2025.04.013","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.013","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143981809","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":"First results from the international registry on liver venous deprivation (EuroLVD).","authors":"Gaëtan-Romain Joliat, Patrick Chevallier, Stephen Wigmore, David Martin, Ismail Labgaa, Emilie Uldry, Nermin Halkic, Timothy Newhook, Antony Haddad, Jean-Nicolas Vauthey, Riccardo Memeo, Bobby V M Dasari, Eva Braunwarth, Raffaele Brustia, Daniele Sommacale, Giorgia A Rodda, Hicham Kobeiter, Rafael Duran, Alban Denys, Nicolas Demartines, Emmanuel Melloul","doi":"10.1016/j.hpb.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.02.017","url":null,"abstract":"<p><strong>Background: </strong>An international registry on liver venous deprivation (LVD, simultaneous portal and hepatic vein embolization) was created in 2020. This study assessed the outcomes after LVD in patients included in the registry.</p><p><strong>Methods: </strong>Eight international centers participated. Future liver remnant (FLR) and standardized FLR ratios were defined as FLR/total functional liver volume and FLR/total estimated liver volume.</p><p><strong>Results: </strong>216 patients were included (80 women, median age 63). Main surgical indication was colorectal metastases (n=124). Median and standardized FLR ratios before LVD were 33% (IQR27-47) and 32% (IQR24-39). In one patient, right hepatic vein embolization failed. Complications after LVD occurred in 14 patients (6.5%). After LVD, median and standardized FLR ratios significantly increased to 46% (IQR38-60, p<0.001) and 44% (IQR35-51, p<0.001), corresponding to a median kinetic growth rate of 3.4%/week (IQR1.5-6.0). Hepatectomy was performed in 160 patients (72 extended hepatectomies), while 56 dropped out (4% insufficient hypertrophy, 13% tumor progression). Seventy-seven patients had postoperative complications (48%; 5 postoperative liver failures, 3%). Median Comprehensive Complication Index was 20.9 (IQR0-30.8).</p><p><strong>Conclusion: </strong>Preliminary data of this international registry showed that LVD had a high technical success rate with few post-procedural complications and significant kinetic growth. Major hepatectomy after LVD appeared to be safe.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144003528","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":"Stratifying the risk in liver surgery: performance in an Italian cohort of 3.280 liver resection for HCC.","authors":"Guido Costa, Matteo Donadon, Federica Cipriani, Matteo Serenari, Francesco Ardito, Andrea Fontana, Daniele Nicolini, Pasquale Perri, Maurizio Iaria, Mattia Garancini, Ottavia Cicerone, Matteo Zanello, Quirino Lai, Simone Conci, Sarah Molfino, Cecilia Ferrari, Paola Germani, Mauro Zago, Giuseppe Zimmitti, Giuliano La Barba, Maurizio Romano, Ivano Sciannamea, Luca Fumagalli, Albert Troci, Valentina Ferraro, Riccardo Memeo, Michele Crespi, Marco Chiarelli, Adelmo Antonucci, Giacomo Zanus, Giorgio Ercolani, Moh'd Abu Hilal, Enrico Pinotti, Paola Tarchi, Guido Griseri, Gian L Baiocchi, Andrea Ruzzenente, Massimo Rossi, Elio Jovine, Marcello Maestri, Fabrizio Romano, Raffaele D Valle, Gian L Grazi, Marco Vivarelli, Alessandro Ferrero, Felice Giuliante, Matteo Cescon, Luca Aldrighetti, Guido Torzilli","doi":"10.1016/j.hpb.2025.04.005","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.005","url":null,"abstract":"<p><strong>Background: </strong>Liver resection classifications have traditionally been based on the number of segments resected. However, with advancements in techniques and the diffusion of minimally invasive surgery (MiLS), these classifications may no longer adequately represent the complexities of modern liver surgery. This study evaluates five liver resection classifications using a multicenter Italian database of hepatocellular carcinoma resections with the main focus of catching surgical outcomes, rather than technical complexity.</p><p><strong>Methods: </strong>The study included 3280 resections (2436 open, 844 MiLS) from 25 Italian centers. Five classifications were assessed: Minor-Major, Segment-based, GK-LLR, S-L OLR, and CLISCO. Outcomes included morbidity, liver failure, and 90-day mortality. Chi-square or Fisher's exact tests were used for comparisons.</p><p><strong>Results: </strong>All classifications showed increased morbidity and mortality with higher complexity. For open resections, Minor-Major and Segment-based classifications successfully stratified patients for all outcomes, outperforming other systems. However, all classifications performed poorly for MiLS patients.</p><p><strong>Discussion: </strong>Minor-Major and Segment-based classifications remain the most accurate for predicting risks in open liver resections. The poor performance for MiLS patients highlights the need for a separate risk stratification tool for this approach. Current classifications do not always accurately represent the technical complexity and technological evolution in liver resection, particularly for MiLS procedures.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144119368","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":"Applicability of current nodal staging system for resected pancreatic cancer after neoadjuvant therapy: a retrospective study.","authors":"Woohyung Lee, Jeein Park, Aram Shin, Mirang Lee, Min Kyu Sung, Kwangpyo Hong, Yejong Park, Ki Byung Song, Jae Hoon Lee, Dae Wook Hwang, Song Cheol Kim","doi":"10.1016/j.hpb.2025.04.011","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.011","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of nodal staging in patients undergoing surgery for borderline resectable (BRPC) and locally advanced pancreatic cancer (LAPC) remains unclear. This study evaluated a novel system based on metastatic lymph nodes (nMLN).</p><p><strong>Methods: </strong>Patients who underwent surgery were categorized into upfront surgery (UP) and neoadjuvant chemotherapy (NAT) groups. In the NAT group, the nMLN system was developed using K-adaptive partitioning, classifying patients by the number of metastatic lymph nodes (nMLN0: 0; nMLN1: 1-4; nMLN2: ≥5). Prognostic performance was compared between the nMLN and AJCC 8th edition systems using time-dependent area under the curve (AUC) analyses.</p><p><strong>Results: </strong>A total of 730 UP and 347 NAT patients were included. Compared to the UP group, the NAT group had fewer N1 cases (P = 0.032) and less lymphovascular invasion (P < 0.001). The nMLN system significantly stratified overall survival (OS) and recurrence-free survival (RFS) in NAT (P < 0.001) and UP groups (P < 0.001). Prognostic performance was comparable between the nMLN and AJCC 8th systems for OS (AUC: 0.628 vs. 0.629) and RFS (AUC: 0.643 vs. 0.649).</p><p><strong>Conclusion: </strong>Both the nMLN and AJCC 8th staging systems provide effective prognostic stratification and are applicable in NAT and UP settings.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144019362","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":"Diagnostic value of pancreatic cystic fluid Elastase-1 in detecting and differentiating malignancy: a prospective cohort study.","authors":"Chien-Ming Chiang, Pei-Tseng Chao, Kun-Ru Chou, Meng-Ying Lin, Wei-Lun Chang","doi":"10.1016/j.hpb.2025.04.012","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.012","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143978089","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":"Distal pancreatectomy with celiac axis resection (DP-CAR) for pancreatic ductal adenocarcinoma in a retrospective monocentric cohort: neoadjuvant treatment and three-axis embolization of the celiac axis are key factors of success.","authors":"Thibaud Bertrand, Safi Dokmak, Béatrice Aussilhou, Louis de Mestier, Olivia Hentic, Jérome Cros, Vinciane Rebours, Maxime Ronot, Mickael Lesurtel, Alain Sauvanet","doi":"10.1016/j.hpb.2025.04.009","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.009","url":null,"abstract":"<p><strong>Background: </strong>Distal pancreatectomy with celiac axis resection (DP-CAR) carries severe morbidity and risk of gastric and liver ischemia. We present the results of three axis embolization of celiac axis (CA) before DP-CAR.</p><p><strong>Methods: </strong>A prospectively maintained single-institution database was queried for patients operated on for potentially resectable locally advanced pancreatic cancer (LAPC) invading the CA.</p><p><strong>Results: </strong>From 2008 to 2023, DP-CAR was considered in 27 patients with distal LAPC. All 27 patients had received neoadjuvant treatment (NAT), including 7 who had no resection because of tumor progression and 20 patients who had DP-CAR; 19 had pre-operative three-axis embolization after laparoscopic exploration (LE), and one patient needed arterial reconstruction. There was one death from hepatic ischemia, but no patients had gastric ischemia, with 7 of patients suffering from 90-day severe morbidity. R0 resection was achieved in 16 patients and 13 patients received adjuvant chemotherapy. With 74 months of median follow-up, median disease-free survival was 36 months. Median overall survival was 52 for patients who underwent DP-CAR.</p><p><strong>Conclusions: </strong>DP-CAR for LAPC is associated with high morbidity. However, NAT and LE may prevent unnecessary surgery for patients with progressive disease. Three-axis embolization of CA may prevent ischemic complications.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144183628","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":"Assessment of two different criteria for post-pancreatectomy acute pancreatitis: a single-center retrospective analysis and literature review.","authors":"Asahi Sato, Akie Tani, Yusuke Mishima, Takahito Ohmine, Jun Ichikawa, Masaki Tani, Kosuke Toda, Takefumi Yazawa, Ben Sasaki, Hidenori Ohe, Masahiro Yamada, Kenya Yamanaka","doi":"10.1016/j.hpb.2025.04.010","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.010","url":null,"abstract":"<p><strong>Background: </strong>The significance of postoperative acute pancreatitis (postoperative pancreatitis [POP] as defined by Connor and post-pancreatectomy acute pancreatitis [PPAP] as defined by the International Study Group for Pancreatic Surgery [ISGPS]) has not been determined because of the transition of definitions, a lack of prospective studies and ignorance regarding appropriate management.</p><p><strong>Methods: </strong>The incidence of POP/PPAP were retrospectively analyzed. Additionally, the clinicopathological parameters and outcomes were compared between patients with and without POP/PPAP.</p><p><strong>Results: </strong>Using Connor's criteria, 46% of patients (70/151) showed Grade A POP and 17% (26/151) displayed clinically relevant (CR)-POP. Using ISGPS criteria, the prevalences of postoperative hyperamylasemia and CR-PPAP were 12% (18/151) and 10% (15/151), respectively. The duration of antibiotics and carbapenem were longer in CR-POP (p < 0.001). Total health care cost was significantly higher in CR-POP compared with other grades in Connor's criteria (p = 0.010), whereas no difference was seen in the ISGPS criteria (p = 0.677). The frequencies of complications including pancreatic fistula (Non-POP vs. Grade A POP vs. CR-POP, 22% vs. 36% vs. 81%, p < 0.001), reoperation and length of hospital stay tended to be greater as Connor's grade of POP increased.</p><p><strong>Discussion: </strong>Connor's definition appeared more closely associated with postoperative worse outcomes than the ISGPS definition.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143963267","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":"Enhancing outcome prediction in patients with colorectal liver metastases undergoing hepatectomy: the synergistic impact of FIB-4 index and tumor burden score across KRAS profiles.","authors":"Miho Akabane, Jun Kawashima, Selamawit Woldesenbetm, Amanda B Macedo, Abdullah Altaf, Federico Aucejo, Irinel Popescu, Minoru Kitago, George A Poultsides, Kazunari Sasaki, Yuki Imaoka, Andrea Ruzzenente, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.04.002","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.002","url":null,"abstract":"<p><strong>Background: </strong>The prognostic value of Fibrosis-4 (FIB-4) index, concerning KRAS status (wild-type [wtKRAS] vs. mutated [mutKRAS]) remains unclear in post-hepatectomy colorectal liver metastases (CRLM). We evaluated the combined impact of FIB-4 and Tumor Burden Score (TBS) on overall survival (OS)/recurrence-free survival (RFS), stratified by KRAS status.</p><p><strong>Methods: </strong>CRLM patients undergoing hepatectomy (2000-2020) were analyzed, grouped by TBS/FIB-4.</p><p><strong>Results: </strong>Among 828 patients, 196 had high FIB-4. High TBS had worse 5-year OS (P < 0.001). In wtKRAS, high TBS correlated with worse OS (P < 0.001), but not in mutKRAS. High FIB-4 correlated with worse OS (P = 0.01). Sub-stratification showed no OS difference by FIB-4 in wtKRAS, but a difference in mutKRAS (P = 0.03). Multivariable analysis identified mutKRAS (HR: 1.90), high TBS (HR: 1.62), and FIB-4 (HR: 1.15) as mortality risk factors. The TBS-FIB-4-KRAS index had highest predictive accuracy. For RFS, TBS and FIB-4 independently stratified outcomes. High TBS was associated with worse RFS in wtKRAS (P < 0.001) but not in mutKRAS. High FIB-4 decreased RFS in mutKRAS (P = 0.001) but not in wtKRAS. FIB-4 was associated with a 10% increased recurrence risk.</p><p><strong>Conclusion: </strong>TBS and FIB-4, alongside KRAS status, should be considered to improve outcome predictions.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144002663","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":"Natural history and management of IPMN in solid organ transplant patients: is it any different?","authors":"Melissa E Chen, Chirag S Desai","doi":"10.1016/j.hpb.2025.04.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.04.004","url":null,"abstract":"<p><strong>Background: </strong>Intraductal papillary mucinous neoplasms (IPMNs) are premalignant lesions with established surveillance and surgical resection guidelines. This systematic review aims to provide evidence-based guidance for managing IPMNs in transplant patients.</p><p><strong>Methods: </strong>A search of MEDLINE, Embase, and Scopus identified studies published between January 1, 2004, and July 31, 2024, describing transplant candidates or recipients with IPMNs. Covidence software was used to screen and synthesize articles. Data were reviewed to determine whether IPMNs should preclude transplant, delay listing, require different surveillance, necessitate adjusted immunosuppression, or affect surgical complexity or cancer conversion rates.</p><p><strong>Results: </strong>Seventeen studies involving 7023 transplant patients, including 339 with suspected or confirmed IPMNs (4.82 %), were analyzed. No evidence suggested IPMNs should preclude transplant candidacy or delay listing. IPMN surveillance guidelines for transplant patients should align with those for non-transplant patients. Transplant recipients did not experience higher rates of IPMN conversion to pancreatic cancer, indicating no need to modify immunosuppression.</p><p><strong>Conclusion: </strong>This qualitative systematic review found no evidence that the natural history or management of IPMNs differs between transplant and non-transplant patients, suggesting no need for special management in transplant populations.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998259","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}