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{"title":"Oncological resection and perioperative outcomes of robotic, laparoscopic and open pancreatoduodenectomy for ampullary adenocarcinoma: a propensity score matched international multicenter cohort study","authors":"Bas A. Uijterwijk ,&nbsp;Alma Moekotte ,&nbsp;Ugo Boggi ,&nbsp;Michele Mazzola ,&nbsp;Bas Groot Koerkamp ,&nbsp;Raffaele Dalle Valle ,&nbsp;Sharnice Koek ,&nbsp;Louisa Bolm ,&nbsp;Alessandro Mazzotta ,&nbsp;Misha Luyer ,&nbsp;Brian K.P. Goh ,&nbsp;Miguel A. Suarez Muñoz ,&nbsp;Bergthor Björnsson ,&nbsp;Geert Kazemier ,&nbsp;Benedetto Ielpo ,&nbsp;Patrick Pessaux ,&nbsp;Jorg Kleeff ,&nbsp;Poya Ghorbani ,&nbsp;Vasileios K. Mavroeidis ,&nbsp;Giuseppe K. Fusai ,&nbsp;Brett Ecker","doi":"10.1016/j.hpb.2024.11.013","DOIUrl":"10.1016/j.hpb.2024.11.013","url":null,"abstract":"<div><h3>Background</h3><div>Ampullary adenocarcinoma (AAC) typically presents at an early stage due to biliary obstruction and therefore might be specifically suitable for minimally invasive pancreatoduodenectomy (MIPD). However, studies assessing MIPD specifically for AAC, including the robotic and laparoscopic approach, are limited. The aim of this study is to compare short- and long-term oncological resection and perioperative outcomes of robotic (RPD), laparoscopic (LPD) and open pancreatoduodenectomy (OPD) performed specifically for AAC.</div></div><div><h3>Methods</h3><div>In this multicenter international cohort study, encompassing 35 centers from 11 countries, MIPD versus OPD and subgroup analyses of LPD versus RPD were undertaken. The primary outcomes regarded the oncological resection (R1 resection rate, lymph node yield) and 5-years overall survival. Secondary outcomes were perioperative outcomes (including intra-operative variables, surgical complications and hospital stay).</div></div><div><h3>Results</h3><div>In total, patients with AAC who underwent OPD (1721) or MIPD (141) were included. After propensity-score matching, 134 patients per cohort were included. The MIPD group consisted of 53 RPDs and 71 LPDs (50 per group after PSM). There was no difference in overall survival between MIPD and OPD (61.6 % vs 56.2 %, <em>P</em> = 0.215). In the MIPD group, operative time was longer (439 vs 360 min, <em>P</em> &lt; 0.001). Between RPD and LPD, overall survival was not significantly different (75.8 % vs 47.4 %, <em>P</em> = 0.098) and lymph node yield was higher in RPD (21 vs 18, <em>P</em> = 0.014).</div></div><div><h3>Conclusion</h3><div>In conclusion, patients with AAC seem to have comparable oncological resection and perioperative outcomes from MIPD compared to the traditional OPD. Both RPD as LPD appear to be safe alternatives for patients with AAC, which warrants confirmation by future randomized studies.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 318-329"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143512647","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":"Factors influencing failure of progression to completion hepatectomy following liver venous deprivation procedures (PVE or DVE): a longitudinal observational study","authors":"Swizel A. Cardoso ,&nbsp;George Clarke ,&nbsp;Ananya Nayak ,&nbsp;Kunal Joshi ,&nbsp;Ramanivas Sudereyan ,&nbsp;Salil Karkhanis ,&nbsp;Nikolaos Chatzizacharias ,&nbsp;Keith J. Roberts ,&nbsp;Naveen Condati ,&nbsp;Michail Papamichail ,&nbsp;Ravi Marudanayagam ,&nbsp;David Bartlett ,&nbsp;Syed S. Raza ,&nbsp;Robert P. Sutcliffe ,&nbsp;Homoyoon Mehrzad ,&nbsp;Bobby V.M. Dasari","doi":"10.1016/j.hpb.2024.11.011","DOIUrl":"10.1016/j.hpb.2024.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Two-staged hepatectomy (TSH) with portal (PVE) or dual vein embolization (DVE) gained acceptance in liver surgery. The current study assesses the incidence and causes of failure to progress to completion hepatectomy following PVE/DVE and its influence on overall survival (OS).</div></div><div><h3>Methods</h3><div>This is a longitudinal observational study of patients who underwent PVE or DVE between April 2010–December 2023. Future liver remnant (FLR) volume was measured at least four weeks later. Restaging and resectability was assessed on imaging performed within 6–8 weeks of planned completion surgery.</div></div><div><h3>Results</h3><div>130 patients underwent PVE (90) or DVE (40) during the study period. Of these, 73 (56 %) patients proceeded to definitive resection. Reasons for failure to progress to completion surgery were: disease progression (79 %), declined fitness for surgery (3.5 %) and inadequate FLR volume (14 %). Synchronous disease is a poor prognostic factor for achieving completion hepatectomy CRLM patients (p = 0.009). The median OS with and without completion hepatectomy was 38 months vs. 13 months in CRLM patients (p=&lt;.001) and 31 months vs. 26 months in pCCA groups respectively (p = 0.471).</div></div><div><h3>Conclusion</h3><div>A significant percentage of patients did not progress to completion hepatectomy due to disease progression. Patient selection and efficient pathways are essential to improve resection rates following these resource-intensive procedures.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 299-310"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846582","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":"ChatGPT vs. surgeons on pancreatic cancer queries: correspondence","authors":"Hinpetch Daungsupawong,&nbsp;Viroj Wiwanitkit","doi":"10.1016/j.hpb.2024.12.019","DOIUrl":"10.1016/j.hpb.2024.12.019","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 420-421"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142948086","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":"ChatGPT vs. surgeons on pancreatic cancer queries: accuracy & empathy evaluated by patients and experts","authors":"Rosa Klotz ,&nbsp;Thomas M. Pausch ,&nbsp;Jörg Kaiser ,&nbsp;Maximilian C. Joos ,&nbsp;Rüdiger Hecktor ,&nbsp;Azaz Ahmed ,&nbsp;Colette Dörr-Harim ,&nbsp;Arianeb Mehrabi ,&nbsp;Martin Loos ,&nbsp;Susanne Roth ,&nbsp;Christoph W. Michalski ,&nbsp;Christoph Kahlert","doi":"10.1016/j.hpb.2024.11.012","DOIUrl":"10.1016/j.hpb.2024.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) offers potential support in patient–clinician interactions, but its impact on such communication remains unexplored.</div></div><div><h3>Methods</h3><div>In this study, ChatGPT was compared with two pancreatic surgeons in responding to ten pancreatic cancer surgery-related questions, co-designed with the Patient Advisory Board of the Surgical Society's Study Center. A blind evaluation of these responses, considering content congruency and clarity for non-specialists, was conducted by patients and surgeons.</div></div><div><h3>Results</h3><div>From June 23 to July 21, 2023, 24 patients and 25 surgeons participated, of which eleven patients and ten surgeons completed the survey in full. Utilizing a quantitative scale from 1 (strong-disagreement) to 5 (full-agreement), consensus was observed among patients and specialists concerning the content delivered by ChatGPT. The metrics for comprehensibility to a non-specialist audience consistently showed positive reception. In the evaluation of empathetic resonance, ChatGPT's responses mirrored those of the surgeons in the patient's view. A significant proportion ranked Surgeon 1's contributions foremost, followed closely by ChatGPT.</div></div><div><h3>Discussion</h3><div>This study demonstrates that surgeons and ChatGPT answer common queries from patients regarding pancreatic cancer surgery comparable regarding reliability, lay comprehension and empathy as evaluated by patients and surgical experts. These findings highlight the potential of AI in enhancing patient-provider interactions.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 311-317"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142822031","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":"Utility of endoscopic ultrasound-guided fine needle aspiration for genetic analysis in pancreatic ductal adenocarcinoma","authors":"Irene Ligato,&nbsp;Ana Garcia Garcia de Paredes,&nbsp;Sergio Lopez Duran,&nbsp;Irene Gonzalez Garcia,&nbsp;Amparo Benito Berlinches,&nbsp;Estefania Romio de las Heras,&nbsp;Alejandra Caminoa Lizarralde,&nbsp;Almudena Santon Roldan,&nbsp;Mercedes Rodriguez Garrote,&nbsp;Carmen-Guillen Ponce,&nbsp;Victor Defarges,&nbsp;Jose Ramon Foruny Olcina,&nbsp;Agustin Albillos,&nbsp;Enrique Vazquez Sequeiros","doi":"10.1016/j.hpb.2024.11.009","DOIUrl":"10.1016/j.hpb.2024.11.009","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 414-416"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142824301","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":"Microwave ablation versus radiofrequency ablation for hepatocellular carcinoma in patients with decompensated cirrhosis","authors":"Hongli Yu ,&nbsp;Yao Yang ,&nbsp;Xinran Lin ,&nbsp;Yinling Xu ,&nbsp;Anna Ying ,&nbsp;Boling Lu ,&nbsp;Yuemin Feng ,&nbsp;Xinya Zhao ,&nbsp;Qiang Zhu ,&nbsp;Hang Zheng","doi":"10.1016/j.hpb.2024.12.010","DOIUrl":"10.1016/j.hpb.2024.12.010","url":null,"abstract":"<div><h3>Background</h3><div>The efficacy of microwave ablation (MWA) and radiofrequency ablation (RFA) in hepatocellular carcinoma (HCC) patients with decompensated cirrhosis remains unclear.</div></div><div><h3>Methods</h3><div>A total of 315 patients with decompensated cirrhosis and HCC who underwent MWA or RFA were recruited. Recurrence beyond the Milan criteria (RBM), local tumor progression (LTP), overall survival (OS), and complications were evaluated and compared.</div></div><div><h3>Results</h3><div>After propensity score matching, the overall liver-related complication rates were 12.1 % in the current study. The cumulative RBM rates were lower in patients treated with MWA compared to those treated with RFA (21.9 % vs. 23.4 % at 1 year; 42.3 % vs. 66.8 % at 5 years; <em>p</em> = 0.016). In addition, lower cumulative rates of LTP were found in patients treated with MWA compared to those treated with RFA (6.2 % vs. 19.9 % at 1 year; 14.7 % vs. 27.8 % at 3 years; <em>p</em> = 0.032). The OS rates at 1 and 5 years were 89.9 % and 58.9 % in the MWA group, and 80.7 %, and 38.9 % in the RFA group, respectively (<em>p</em> = 0.105).</div></div><div><h3>Conclusion</h3><div>HCC patients with decompensated cirrhosis can undergo MWA or RFA with acceptable mortality, morbidity and liver-rated complications rates. MWA demonstrates superiority over RFA in tumor control.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 377-384"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909519","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":"Next-generation sequencing demonstrates racial and sex differences in genomic profiling of hepatocellular carcinoma patients: an AACR GENIE project analysis","authors":"Diamantis I. Tsilimigras ,&nbsp;Hunter Stecko ,&nbsp;Dimitrios Moris ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.12.008","DOIUrl":"10.1016/j.hpb.2024.12.008","url":null,"abstract":"<div><h3>Background</h3><div>Genomic variations related to racial and sex differences among patients with hepatocellular carcinoma (HCC) have not been investigated. We sought to characterize the mutational landscape of patients with HCC relative to race and sex.</div></div><div><h3>Methods</h3><div>The American Association for Cancer Research GENIE project (v16.0) was used to assess data on genomic variations among adult patients (&gt;18 years) with HCC who underwent next-generation sequencing. Variations in 787 genes were identified and characterized relative to race and sex.</div></div><div><h3>Results</h3><div>Among 832 patients, 60.8 % of individuals were White, 7.7 % Black, and 12.4 % Asian (other/unknown:19.1 %). Most patients had genetic data from the primary tumor (71.2 %), whereas 17.2 % had metastatic disease sequenced (unknown:11.6 %). <em>TERT</em> mutations occurred more frequently in White (48.0 %) and Black (46.7 %) versus Asian (23.4 %) patients (q = 0.003), while <em>TP53</em> mutations were more common in Asian (48.6 %) versus Black (45.5 %) or White (33.1 %) individuals (q = 0.03). <em>TERT</em> (46.1 % vs. 28.6 %) and <em>CTNNB1</em> mutations (47.7 % vs. 29.3 %) were more likely to occur in males than females (both q &lt; 0.05). Marked variations in prevalence of other common genetic HCC mutations were noted across different races and sexes.</div></div><div><h3>Conclusions</h3><div>Differences in mutational profiles of HCC patients highlight the importance of accruing diverse populations of patients to clinical trials.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 371-376"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927197","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: “Tumor burden score as a prognostic factor in patients with intermediate and locally advanced hepatocellular carcinoma undergoing liver resection”","authors":"You-Fei Wei,&nbsp;Yin-Feng Xu","doi":"10.1016/j.hpb.2024.12.004","DOIUrl":"10.1016/j.hpb.2024.12.004","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 422-423"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142894202","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":"The management of splanchnic vein thrombosis in acute pancreatitis: a global DELPHI consensus study","authors":"Michael Scott ,&nbsp;Mudassar Ghazanfar ,&nbsp;John Windsor ,&nbsp;George Ramsay ,&nbsp;Mohamed Bekheit","doi":"10.1016/j.hpb.2024.12.002","DOIUrl":"10.1016/j.hpb.2024.12.002","url":null,"abstract":"<div><h3>Background</h3><div>Splanchnic vein thrombosis (SpVT) occurs in 17%–23 % of acute pancreatitis cases. Serious sequelae include hepatic and bowel ischaemia. However, management with therapeutic anticoagulation remains controversial due to potential bleeding risk. We aim to determine the level of consensus on prognosis, diagnosis, management, and outcomes of SpVT through a DELPHI process.</div></div><div><h3>Methods</h3><div>Using purposive, non-probability sampling and DELPHI methodology, 173 clinicians with experience of SpVT in acute pancreatitis were approached. From April 2022 to April 2023, a three-round DELPHI process was implemented to completion. A total of 88 statements were posed for ranking via a four-point Likert scale.</div></div><div><h3>Results</h3><div>The mean acute pancreatitis caseload per respondent per year was 68·0, 72·6 and 73·0 for DELPHI rounds 1,2 and 3 respectively. For SpVT anatomical location, there was strong consensus favouring anticoagulation for portal vein (89·1 %) and SMV thrombosis (90·9 %), and no consensus to treat splenic vein thrombosis (47·3 %). 74·1 % rejected radiological resolution as a definitive anticoagulation endpoint. Majority consensus favoured death, bleeding risk, bowel or liver ischaemia, hospital admission length and ITU admission as significant outcomes for experimental research design.</div></div><div><h3>Conclusion</h3><div>There was significant consensus for anticoagulation treatment of SpVT of the portal and superior mesenteric veins, especially with complete occlusion by thrombosis. Randomised controlled trials are required to grade management recommendations.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 343-351"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142909521","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":"Textbook outcome in liver surgery for intrahepatic cholangiocarcinoma: defining predictors of an optimal postoperative course using machine learning","authors":"Abdullah Altaf ,&nbsp;Mujtaba Khalil ,&nbsp;Miho Akabane ,&nbsp;Zayed Rashid ,&nbsp;Jun Kawashima ,&nbsp;Shahzaib Zindani ,&nbsp;Andrea Ruzzenente ,&nbsp;Luca Aldrighetti ,&nbsp;Todd W. Bauer ,&nbsp;Hugo P. Marques ,&nbsp;Guillaume Martel ,&nbsp;Irinel Popescu ,&nbsp;Matthew J. Weiss ,&nbsp;Minoru Kitago ,&nbsp;George Poultsides ,&nbsp;Shishir K. Maithel ,&nbsp;Carlo Pulitano ,&nbsp;Feng Shen ,&nbsp;François Cauchy ,&nbsp;Bas G. Koerkamp ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.12.013","DOIUrl":"10.1016/j.hpb.2024.12.013","url":null,"abstract":"<div><h3>Background</h3><div>We sought to define textbook outcome in liver surgery (TOLS) for intrahepatic cholangiocarcinoma (ICC) by considering the implications of perioperative outcomes on overall survival (OS).</div></div><div><h3>Methods</h3><div>Using a multi-institutional database, TOLS for ICC was defined by employing novel machine learning (ML) models to identify perioperative factors most strongly predictive of OS ≥ 12 months. Subsequently, clinicopathologic factors associated with achieving TOLS were investigated.</div></div><div><h3>Results</h3><div>A total of 1556 patients with ICC were included. The ML classification models demonstrated that the absence of post-hepatectomy liver failure, intraoperative blood loss &lt;750 mL, absence of major infectious complications, and R0 resection were the perioperative outcomes associated with prolonged OS, thereby defining TOLS for ICC. On multivariable analysis, older age, ASA class &gt;2, lymph node metastasis, receipt of neoadjuvant therapy, advanced T status, poor histological grade and microvascular invasion were independently associated with lower odds of achieving TOLS (all <em>p</em>-values&lt;0.05). Overall, 60.2 % (<em>n</em> = 936) of the patients achieved TOLS, demonstrating markedly improved OS and recurrence-free survival (RFS) than individuals who did not (both <em>p</em> &lt; 0.05).</div></div><div><h3>Conclusion</h3><div>A standardized definition of TOLS for ICC was established that may be used to evaluate hospital performance at the patient level and help optimize surgical outcomes for patients with ICC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 3","pages":"Pages 402-413"},"PeriodicalIF":2.7,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927198","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}