Hpb最新文献

{"title":"Not all early recurrences define futility: relapse patterns shape outcomes after colorectal liver metastases resection.","authors":"Rebecca Marino, Buonanno Silvia, Catena Marco, Remo Alessandris, Emanuele Mini, Federica Cipriani, Luca Ruotolo, Chiara Bonini, Francesca Ratti","doi":"10.1016/j.hpb.2026.09.005","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.005","url":null,"abstract":"<p><strong>Background: </strong>Recurrence after curative resection of colorectal liver metastases (CRLM) is heterogeneous. Early recurrence not always implies futile surgery. This study distinguishes predictors of early recurrence versus futile surgery and examines recurrence patterns.</p><p><strong>Methods: </strong>This study analyzed the prospective LiMeT cohort of patients undergoing curative-intent resection for CRLM at IRCCS San Raffaele. Early recurrence was defined as <12 months and futile surgery as Time-to-Surgical-Failure (TSF) < 12 months (unresectable recurrence, progression, or death). Logistic regression identified predictors, and Sankey analysis mapped recurrence characteristics.</p><p><strong>Results: </strong>Two hundred twenty-eight patients were included: 74 without recurrence, 115 early recurrences, and 39 late recurrences. Early recurrence was independently associated with synchronous CRLM (OR1.56, p = 0.02), primary tumor N1-N2 stage (OR2.23, p < 0.01), KRAS mutation (OR2.40, p = 0.024), ≥5 CRLM (OR2.15, p < 0.01), and metastatic diameter ≥3 cm (OR2.19, p < 0.01). Futility was associated with age>65, T4 stage, KRAS mutation, and no adjuvant chemotherapy. Sankey analysis showed that early recurrence not always leads to futility, often remaining liver-limited or oligometastatic.</p><p><strong>Conclusion: </strong>Early recurrence and futile surgery represent distinct forms of postoperative failure. Early recurrence reflects tumor burden and biology, whereas futility identifies relapse that becomes unresectable or fatal, negating benefit. TSF provides complementary information on the durability of surgical benefit.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108463","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 layered risk framework for non-benchmark intrahepatic cholangiocarcinoma after curative-intent resection: an international multi-institutional analysis.","authors":"Kizuki Yuza, Odysseas P Chatzipanagiotou, Christian Hobeika, Federico Aucejo, Hugo P Marques, Tom Hugh, Feng Shen, Shishir K Maithel, Bas Groot Koerkamp, Irinel Popescu, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, George Poultsides, Andrea Ruzzenente, Todd W Bauer, Ana Gleisner, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2026.09.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.003","url":null,"abstract":"<p><strong>Background: </strong>Surgical benchmark (BM) values define attainable perioperative outcomes after curative-intent resection for intrahepatic cholangiocarcinoma (iCCA), yet non-benchmark (non-BM) patients remain poorly characterized. Whether tumor biology refines prognosis beyond BM status remains unclear.</p><p><strong>Methods: </strong>Patients undergoing curative-intent resection for iCCA at international centers (2000-2023) were classified using published BM criteria. Non-BM patients were stratified as surgical-axis only, medical-axis only, or dual-axis. A five-component biology risk score, tumor burden score (TBS), and BM status were evaluated for overall survival (OS).</p><p><strong>Results: </strong>Among 1794 patients, 1128 (62.9%) were non-BM. Non-BM iCCA met 6 of 11 benchmark cutoffs, although readmission, severe complications, and 90-day mortality exceeded thresholds. Five-year OS differed between BM and non-BM patients (45.4% vs 37.1%; p < 0.001), but not across non-BM axes. Within non-BM, ≥2 biology risk factors were associated with worse OS (aHR 2.29, 95%CI 1.53-3.44). Five-year OS ranged from 52.8% in BM/low-TBS to 29.1% in non-BM/high-TBS. Biology score remained associated with OS across BM status (aHR 1.34 per factor, 95%CI 1.17-1.54).</p><p><strong>Conclusion: </strong>Non-BM iCCA comprised most resected patients and met several benchmark cutoffs. Surgical and medical axes captured perioperative complexity without refining long-term prognosis, whereas TBS and pathologic biology provided additional oncologic stratification.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108451","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":"Infectious complications after liver resection in patients with prior biliary-enteric anastomosis: a multicenter retrospective cohort study.","authors":"Hayata Sano, Takeshi Urade, Atsushi Takebe, Motofumi Tanaka, Shohei Komatsu, Hidetoshi Gon, Kenji Fukushima, Shinichi So, Toshihiko Yoshida, Keisuke Arai, Kosuke Iguchi, Kentaro Tai, Hisoka Yamane, Kentaro Oji, Masahiro Kido, Ippei Matsumoto, Takumi Fukumoto","doi":"10.1016/j.hpb.2026.09.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.004","url":null,"abstract":"<p><strong>Background: </strong>Liver resection in patients with prior biliary-enteric anastomosis (BEA) is associated with high rates of infectious complications. We evaluated the incidence, patterns, and risk factors.</p><p><strong>Methods: </strong>This multicenter retrospective study included patients with prior BEA who underwent liver resection at three Japanese institutions between 2008 and 2025. The primary endpoint was organ/space surgical site infection (SSI) within 30 days postoperatively. Univariable analyses were performed to identify factors associated with organ/space SSI, comparing patients with and without this complication.</p><p><strong>Results: </strong>Among the 26 patients, pancreatoduodenectomy was the most common preceding BEA procedure. Organ/space SSI occurred in 10 patients, and overall infectious complications occurred in 13 patients, including 3 with other infections. Cultures were positive in 6 of 10 organ/space SSI cases, and all isolates were enteric organisms. Organ/space SSI occurred more frequently with concave-type than flat-type transection surface morphology (8 of 13 vs. 2 of 13; P = 0.041). Organ/space SSI was associated with significantly prolonged postoperative hospital stay (median [range], 28.5 [13-94] vs. 13 [6-105] days; P = 0.003).</p><p><strong>Conclusion: </strong>Liver resection after BEA carries a substantial risk of postoperative organ/space SSI. Concave transection surface morphology may represent a clinically relevant risk factor in this high-risk population.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108431","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":"Association of metabolic dysfunction-associated steatotic liver disease with colorectal cancer incidence and surgical outcomes.","authors":"Abdulaziz Elemosho, Selamawit Woldesenbet, Arshum Mirzaeifard, Kizuki Yuza, Meher Angez, Odysseas P Chatzipanagiotou, Charalampos M Charalampous, Areesh Mevawalla, Qaidar Alizai, Rida Ejaz, Lorenza Arena, Timothy M Pawlik","doi":"10.1016/j.hpb.2026.09.002","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.002","url":null,"abstract":"<p><strong>Background: </strong>The incidence as well as how metabolic dysfunction-associated steatotic liver disease (MASLD) impacts colorectal cancer (CRC) remains unclear. We sought to define CRC incidence among patients with MASLD and assess the association of MASLD with postoperative outcomes.</p><p><strong>Methods: </strong>Adults with incident MASLD/MASH were identified using Epic Cosmos to estimate CRC incidence. CRC patients with versus without pre-existing MASLD were evaluated using propensity score matching and multivariable regression.</p><p><strong>Results: </strong>Among 2,995,488 patients with MASLD (MASH n = 400,935), 10,588 developed incident CRC (incidence: 109.13 per 100,000 persons per year). CRC incidence was similar in MASH and MASLD without MASH. Patients with MASLD were younger (median age, 67 vs 73 years) and more often had severe obesity (37.7% vs 15.7%), type-2 diabetes (39.9% vs 31.0%), and cirrhosis (10.3% vs 1.6%). After matching, MASLD was independently associated with longer length-of-stay (IRR 1.12, 95% CI 1.09-1.16), 30-day readmission (OR 1.29, 95% CI 1.16-1.44), ICU stay (OR 1.20, 95% CI 1.07-1.34), any 30-day complication (OR 1.24, 95% CI 1.15-1.33), hepatobiliary (OR 1.19, 95% CI 1.06-1.33) and renal complications (OR 1.25, 95% CI 1.05-1.47), yet no difference in mortality.</p><p><strong>Conclusions: </strong>CRC arising in the setting of MASLD was associated with greater metabolic and liver-related comorbidity and greater postoperative morbidity, yet long-term survival was similar.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108426","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":"What are the subsegments of the right hemiliver and when are they surgically relevant? A systematic review.","authors":"Kah Heng Alexander Lim, Clare O'Sullivan, Minghao Zheng, Gary Jeffrey, Jaswinder Samra, Lingjun Mou","doi":"10.1016/j.hpb.2026.09.001","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.09.001","url":null,"abstract":"<p><strong>Background: </strong>Since publication of the Tokyo 2020 consensus that formalised definitions of hepatic subsegments and cone units based on inflow, information on these smaller-than-Couinaud entities and their surgical relevance remains sparse.</p><p><strong>Methods: </strong>A systematic review was performed to identify right hemiliver subsegments; focusing on resections, intraoperative visualisation, and anatomical studies.</p><p><strong>Results: </strong>74 articles were included (80% from East Asia), describing a wide range of techniques to isolate subsegmental inflow. Resections of 8 dorsal and 8 ventral are consistently described, with authors favouring transfissural approaches to access subsegment glissonean pedicles. Subsegments bordering the right hepatic vein are potential sources of nomenclature confusion. Of these, the entity '6 ventral' - supplied by inflow from the right posterior trunk but residing medial to the right hepatic vein - is a target for preservation during major resections of the right anterior section. Subsegments uniformly supplied by side-branches from a trunk can be classified in hilum-distal order; others formed by terminal branching of right anterior/posterior trunks are poorly described using heterogeneous nomenclature.</p><p><strong>Conclusions: </strong>Reproducibility of subsegment-level reporting remains limited. International expert collaboration is required to standardise nomenclature and assess inter-observer reliability. This would improve external validity and facilitate comparison of increasingly complex inflow-based liver resections.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108492","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":"External validation of surgical complexity classification for intrahepatic cholangiocarcinoma.","authors":"Jose Manuel Ramia, Celia Villodre, Cándido Alcázar, Mariano Franco","doi":"10.1016/j.hpb.2026.08.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.003","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982637","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":"Defining borderline resectability in pancreatic neuroendocrine tumors and the role of neoadjuvant therapy.","authors":"Wilson M Alobuia, Susan Tsai, Mary Dillhoff, Timothy M Pawlik, Alex B Blair, Vineeth Sukrithan, Bhavana Konda, Jordan M Cloyd","doi":"10.1016/j.hpb.2026.08.2006","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2006","url":null,"abstract":"<p><strong>Background: </strong>Although surgical resection offers the best outcomes for patients with localized/oligometastatic pancreatic neuroendocrine tumors (pNET), definitions for borderline resectable (BR) disease to guide patient selection and neoadjuvant therapy (NT) have not been established. This study sought to validate a proposed definition of BR-pNET and evaluate the impact of NT and surgical resection on overall survival (OS).</p><p><strong>Methods: </strong>Using the National Cancer Database, patients with invasive, well-differentiated pNETs were classified as BR [T4 stage and/or liver-only metastases] or resectable (<T4, without distant metastases). Kaplan-Meier and multivariable Cox regression models were used to evaluate OS.</p><p><strong>Results: </strong>Among 15,473 patients, BR-pNET [2,945 (19%)], was independently associated with worse OS (HR 3.24, 95% CI 2.95-3.55; p<0.001). Among BR-pNET patients, resection was associated with longer median OS (128.6 vs 46.4 months; p<0.001). This benefit persisted in a 6-month landmark analysis (HR 0.36, 95% CI 0.30-0.44). NT use was uncommon (1.8%) and was not independently associated with survival (HR 1.14, 95% CI 0.66-1.97; p = 0.625).</p><p><strong>Conclusion: </strong>Among patients with well-differentiated pNET, borderline resectability was associated with worse OS, although surgical resection conferred meaningful survival benefit. The use of NT was uncommon and not associated with improved OS in this retrospective cohort.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108513","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":"Comment on \"Robotic versus Laparoscopic Liver Resection for Intrahepatic Cholangiocarcinoma: a Head-to-Head Multicenter Propensity Score-Matched Analysis\".","authors":"Syeda B Rizvi, Muhammad Saqib, Muhammad Yousaf, Shahnila Javed, Salman K Alotaibi, Muhammad Z Yusuf","doi":"10.1016/j.hpb.2026.08.2002","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2002","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149038421","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":"Does reperfusion time affect chances of HCC recurrence after liver transplantation?","authors":"Pranay Gangaram, Antony M Attia, Daniel Ahn, Toshihiro Nakayama, Kazunari Sasaki","doi":"10.1016/j.hpb.2026.08.2004","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2004","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149016795","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":"ERAS protocols and 'step-up' complication management are associated with improved short-term outcomes following elective total pancreatectomy: a multicenter cohort study.","authors":"Matthäus Felsenstein, Dou Ma, Cao Zhong Jing Jin, Alexandra Zuehlke, Clarissa Schweizer, Karl-Herbert Hillebrandt, Lea Timmermann, Felix Krenzien, Jens Neudecker, Phillip Pfeffer, Frauke V Oberwittler, Rahel Kuhlmann, Kim C Honselmann, Maximillian Coerper, Alexander Semaan, Ramez Wahib, Freya Brodersen, Felix Nickel, Anja K Bardenhorst, Andreas Andreou, Benjamin Struecker, Andreas Pascher, Tobias Keck, Jörg C Kalff, Thilo Hackert, Igor M Sauer, Johann Pratschke, Thomas Malinka","doi":"10.1016/j.hpb.2026.08.2005","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2005","url":null,"abstract":"<p><strong>Background: </strong>Total pancreatectomy remains associated with substantial morbidity and mortality, largely driven by postoperative complications and failure-to-rescue. ERAS and 'step-up' strategies are each associated with improved outcomes after pancreatic surgery, yet their combined effect following total pancreatectomy remains poorly defined.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study analyzed 429 patients undergoing elective PPTP. The reference cohort from Charité University Hospital (n=236, 2014-2023) was stratified into pre-ERAS and ERAS trial periods, the latter coinciding with 'step-up' complication management procedures (2019-2023). Institutional data were prospectively recorded via the EIAS and benchmarked against national ERAS (n=80) and non-ERAS centers (n=113). Adjusted multivariable Cox regression and Kaplan-Meier analyses assessed survival and recovery.</p><p><strong>Results: </strong>The combined ERAS care era was associated with significantly shorter length of stay (17.9d|25.6d; p<0.001), fewer major complications (19.7%|41.4%; p<0.001) and a non-significant 30d mortality reduction (2.2%|7.1%; p=0.09), confirmed also via adjusted regression analyses. Mean interventions per patient decreased by 52.9% (p=0.01) with a shift from surgical to interventional treatments (p=0.005). High ERAS adherence (≥80%) correlated with earlier ICU and hospital discharge.</p><p><strong>Conclusions: </strong>Combined ERAS and 'step-up' management was associated with improved safety and recovery after PPTP supporting broader implementation of standardized multidisciplinary perioperative care after total pancreatectomy.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149024699","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}