Hpb最新文献

{"title":"Obesity and domain-specific postoperative outcomes after liver resection for cancer: a real-world analysis.","authors":"Kizuki Yuza, Selamawit Woldesenbet, Odysseas P Chatzipanagiotou, Qaidar Alizai, Meher Angez, Lorenza Arena, Charalampos M Charalampous, Rida Ejaz, Sebastian O Ekenze, Abdulaziz Elemosho, Areesh Mevawalla, Jethro W Zih-Shuo, Timothy M Pawlik","doi":"10.1016/j.hpb.2026.08.2007","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2007","url":null,"abstract":"<p><strong>Background: </strong>The association between body mass index (BMI) and outcomes after liver resection remains controversial. We examined this association using a large real-world electronic health record cohort.</p><p><strong>Methods: </strong>Patients undergoing liver resection for cancer from 2017 to 2025 were identified from Epic Cosmos. BMI was categorized according to World Health Organization criteria, with normal weight as the reference. Multivariable regression, restricted cubic splines, subgroup analyses, and sensitivity analyses were performed.</p><p><strong>Results: </strong>Among 16,022 patients, class II/III obesity was associated with higher odds of any 30-day complication (aOR 1.22, 95%CI 1.09-1.36), cardiac events (aOR 1.32, 95%CI 1.16-1.51), and renal events (aOR 1.77, 95%CI 1.41-2.22). After additional adjustment for cirrhosis, ALBI grade, and malnutrition, the association with any 30-day complication persisted (aOR 1.39, 95%CI 1.23-1.57). Higher BMI was associated with shorter length of stay in the primary analysis (aIRR 0.89-0.94). Inverse associations with 90-day mortality and hepatobiliary complications were attenuated after additional adjustment.</p><p><strong>Conclusion: </strong>Severe obesity was associated with higher postoperative morbidity, particularly cardiac and renal complications. BMI should be interpreted alongside nutritional status and hepatic reserve in perioperative risk assessment. The attenuated inverse associations should not be interpreted as evidence that higher BMI is protective.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989350","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":"Pancreatic cancer risk in people 60 and over with unexplained acute pancreatitis.","authors":"Hans Scherübl","doi":"10.1016/j.hpb.2026.08.2008","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2008","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148989400","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":"MESODELPHI consensus: omission of the original description of the mesopancreas triangle and total mesopancreas excision (TMpE).","authors":"Mustapha Adham","doi":"10.1016/j.hpb.2026.08.2003","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.08.2003","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":3.3,"publicationDate":"2026-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148982618","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":"Preoperative ALBI and APRI are independently associated with liver-related complications after curative-intent hepatectomy","authors":"Kizuki Yuza,&nbsp;Jun Kawashima,&nbsp;Christian Hobeika,&nbsp;Mickael Lesurtel,&nbsp;Federico Aucejo,&nbsp;Hugo P. Marques,&nbsp;Vincent Lam,&nbsp;Tom Hugh,&nbsp;Irinel Popescu,&nbsp;Sepideh Gholami,&nbsp;Matthew J. Weiss,&nbsp;Guillaume Martel,&nbsp;Francesca Ratti,&nbsp;George A. Poultsides,&nbsp;Andrea Ruzzenente,&nbsp;Itaru Endo,&nbsp;Ana Gleisner,&nbsp;Todd W. Bauer,&nbsp;Feng Shen,&nbsp;Shishir K. Maithel,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2026.05.008","DOIUrl":"10.1016/j.hpb.2026.05.008","url":null,"abstract":"<div><h3>Background</h3><div>Accurate preoperative risk stratification remains essential for patients undergoing curative-intent hepatectomy for intrahepatic cholangiocarcinoma (iCCA) or hepatocellular carcinoma (HCC). Although the albumin-bilirubin (ALBI) score and AST-to-platelet ratio index (APRI) reflect hepatic reserve and fibrosis burden, respectively, their complementary value for predicting liver-related complications across primary liver malignancies remains poorly defined.</div></div><div><h3>Methods</h3><div>A retrospective multi-institutional cohort study included 2668 patients who underwent curative-intent hepatic resection for iCCA or HCC (2000–2023). Multivariable logistic regression evaluated associations of ALBI and APRI with liver-related complications, post-hepatectomy liver failure (PHLF), and major complications. Discrimination was assessed using the area under the receiver operating characteristic curve (AUC) with bootstrap internal validation.</div></div><div><h3>Results</h3><div>Among 2668 patients, 392 (14.7%) developed liver-related complications. Both ALBI (OR 1.65, 95% CI 1.28–2.12) and APRI (OR 1.18, 95% CI 1.05–1.33) were independently associated with liver-related complications. The combined model achieved an AUC of 0.740 (optimism-corrected 0.733). ALBI and APRI also demonstrated differential associations across endpoints, with APRI more strongly associated with PHLF and ALBI more strongly associated with major complications.</div></div><div><h3>Discussion</h3><div>Preoperative ALBI and APRI were independently associated with liver-related complications after hepatectomy for iCCA and HCC, reflecting hepatic reserve and fibrosis-related injury.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1203-1213"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148264316","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":"Practice variation and limited adoption of evidence in POPF prevention after pancreatoduodenectomy: an international E-AHPBA-endorsed survey","authors":"Michael Hoffmann,&nbsp;Lena Anthuber,&nbsp;Sebastian Wolf,&nbsp;Matthias Schrempf,&nbsp;Florian Sommer,&nbsp;Johannes Lauscher,&nbsp;Matthias Anthuber,&nbsp;Katharina Beyer,&nbsp;David Pinto","doi":"10.1016/j.hpb.2026.06.011","DOIUrl":"10.1016/j.hpb.2026.06.011","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative pancreatic fistula (POPF) remains a major source of morbidity after pancreatoduodenectomy. This international survey assessed contemporary preventive strategies and practice variation.</div></div><div><h3>Methods</h3><div>An online survey was distributed to HPB surgeons worldwide. The questionnaire addressed risk assessment, anastomotic technique, pancreatic duct stenting, drain management, antibiotic prophylaxis and somatostatin analogue use. Responses were analysed descriptively.</div></div><div><h3>Results</h3><div>283 surgeons from 48 countries completed the survey. Intraoperative POPF risk assessment was routinely performed by 228/283 respondents (80.6%), yet formal risk tools were used inconsistently. Pancreatic reconstruction was largely uniform, with pancreatojejunostomy performed by 252/283 surgeons (89.0%). Pancreatic duct stenting showed marked variation, with 160/283 respondents (56.5%) reporting routine or frequent use and internal stents preferred by 179/227 surgeons (78.9%). Almost all respondents used intra-abdominal drains (279/283, 98.6%), but the timing of drain removal varied substantially. Ureidopenicillins were used as antibiotic prophylaxis by 120/268 respondents (44.8%), whereas 95/268 (35.4%) used second-generation cephalosporins. Somatostatin analogue use was highly heterogeneous.</div></div><div><h3>Discussion</h3><div>Preventive strategies against POPF vary widely across institutions. Heterogeneity persists even in areas supported by randomized evidence, highlighting important gaps between available data and routine clinical practice and identifying priorities for future interventional studies.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1192-1202"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148445944","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 operative timing on major post-operative complications following liver transplantation: a retrospective cohort study","authors":"Charles W.G. Risbey,&nbsp;Lewis Wood,&nbsp;Susan Virtue,&nbsp;Claire West,&nbsp;Victor Yu,&nbsp;Ken Liu,&nbsp;Simone I. Strasser,&nbsp;Geoffrey W. McCaughan,&nbsp;Michael Crawford,&nbsp;Carlo Pulitano","doi":"10.1016/j.hpb.2026.06.005","DOIUrl":"10.1016/j.hpb.2026.06.005","url":null,"abstract":"<div><h3>Background</h3><div>Liver transplantation (LT) is a technically complex procedure frequently performed out-of-hours. While out-of-hours surgery is associated with higher post-operative morbidity and mortality, contemporary LT-specific data are limited. This paper aimed to characterise the impact of operative timing on major post-operative complications following LT.</div></div><div><h3>Methods</h3><div>All LT from 2019–2024, at Royal Prince Alfred Hospital, Australia, were included. Out-of-hours LT was defined as revascularisation from 7:00pm-7:00am. The primary endpoint was the effect of out-of-hours LT on major postoperative complications. Secondary endpoints included biliary complications, early allograft dysfunction, patient and graft survival.</div></div><div><h3>Results</h3><div>Of 479 consecutive LTs, 160 (33.4%) occurred out-of-hours. Major postoperative complications were more frequent following out-of-hours LT (p = 0.013), with increased rates of delayed abdominal closure (p = 0.003) and renal replacement therapy (p = 0.044). Multivariate analysis demonstrated out-of-hours LT to be an independent risk-factor for major complications (p = 0.041). Anastomotic strictures more commonly occurred after out-of-hours LT (p = 0.009). Long-term graft and patient survival were not significantly different between groups.</div></div><div><h3><em>Conclusion</em></h3><div>Out-of-hours LT is a significant risk factor for major post-operative complications but not reduced long-term patient or graft survival. Strategies to reduce out-of-hours LT, including expanded machine perfusion utilisation, may improve outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1231-1240"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148351667","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":"Data-driven risk stratification and zonal classification of postoperative fluid collections after pancreaticoduodenectomy","authors":"Dimitrios Moris,&nbsp;Jean Namgoong,&nbsp;Piyush Gupta,&nbsp;Grace C. Bloomfield,&nbsp;Aradhya Nigam,&nbsp;Matthew E. Luckman,&nbsp;Thomas M. Fishbein,&nbsp;Pejman Radkani,&nbsp;Emily Winslow","doi":"10.1016/j.hpb.2026.06.001","DOIUrl":"10.1016/j.hpb.2026.06.001","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1284-1287"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148338427","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 anesthesiologists’ hepato-pancreato-biliary volume and outcomes for other surgeries","authors":"Julie Hallet,&nbsp;Naheed Jivraj,&nbsp;Daniel I. McIsaac,&nbsp;François M. Carrier,&nbsp;Alexis F. Turgeon,&nbsp;Alana Flexman,&nbsp;Gianni R. Lorello,&nbsp;Wing C. Chan,&nbsp;Anna Ding,&nbsp;Jessica Armah,&nbsp;Antoine Eskander,&nbsp;Rinku Sutradhar","doi":"10.1016/j.hpb.2026.05.007","DOIUrl":"10.1016/j.hpb.2026.05.007","url":null,"abstract":"<div><h3>Background</h3><div>We examined the association between care by high-volume (HV) HPB anesthesiologists and post-operative outcomes for other non-HPB surgeries.</div></div><div><h3>Method</h3><div>We conducted a population-based retrospective cohort study of adults undergoing non-cardiac, non-orthopedic surgeries. The exposure was care by HV HPB anesthesiologists (≥6 HPB cases/year). The outcome was 90-day major morbidity (MM – Clavien-Dindo grade 3–5).</div></div><div><h3>Results</h3><div>Among 385,944 non-HPB surgeries, 23.1% were performed with HV HPB anesthesiologists and 18.4% had 90-day MM. After adjustment, care by HV HPB anesthesiologist was not associated with 90-day MM (adjusted odds ratio [aOR] 0.99, 95%CI 0.98–1.01). At the hospital level, there was no association between the hospital rate of care by HV HPB anesthesiologists and the hospital rate of 90-day MM (adjusted rate ratio 0.98, 95%CI 0.96–1.01).</div></div><div><h3>Conclusion and relevance</h3><div>HV HPB anesthesiology care was not associated with worse outcomes for most non-HPB surgeries, at the individual surgery or the hospital level. There was procedure-specific heterogeneity.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1182-1191"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148224855","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":"Editorial Board / Aims and Scope","authors":"","doi":"10.1016/S1365-182X(26)00741-0","DOIUrl":"10.1016/S1365-182X(26)00741-0","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Page IFC"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148917334","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":"Pancreatic enzyme replacement therapy use in acute pancreatitis – a systematic review of current practice","authors":"Lewis A. Hall,&nbsp;Joshua S.S. Baxter,&nbsp;Sarah Powell-Brett,&nbsp;Mary E. Phillips,&nbsp;Keith J. Roberts,&nbsp;Sanjay Pandanaboyana,&nbsp;Andrew M. Smith,&nbsp;Matthew Lee,&nbsp;Natalie S. Blencowe,&nbsp;Samir Pathak","doi":"10.1016/j.hpb.2026.06.010","DOIUrl":"10.1016/j.hpb.2026.06.010","url":null,"abstract":"<div><h3>Background</h3><div>Up to two-thirds of inpatients with acute pancreatitis (AP) may develop pancreatic exocrine insufficiency (PEI), persisting long-term in one third. The prevalence, indications, and outcomes of pancreatic enzyme replacement therapy (PERT) following AP remain poorly defined, with limited AP-specific guidance in current international guidelines. This systematic review aimed to determine the prevalence of PERT use after AP and its associated outcomes.</div></div><div><h3>Methods</h3><div>Medline, via Ovid and Pubmed, and Embase were searched for studies reporting PERT prescription rates, indications, timing, or outcomes during or after AP. Randomised and non-randomised primary studies in adult populations were eligible. Single-proportion random-effects meta-analyses estimated pooled prescribing rates; evidence certainty was assessed using GRADE.</div></div><div><h3>Results</h3><div>Twenty-eight studies (14,874 patients) were included. Pooled PERT prescription rates across non-randomised studies, were 17.8% (95% CI 11.4–26.7%) overall, rising to 28.4% (95% CI 15.5–46.0%) in necrotising AP and 42.7% (95% CI 23.8–64.0%) in severe disease, versus 5.0% (95% CI 0.3–45.5%) in mild disease. Outcomes data were inconsistent across biochemical, symptom, and quality-of-life endpoints; heterogeneity precluded meta-analysis of treatment effect. Overall evidence certainty was low.</div></div><div><h3>Conclusions</h3><div>PERT is infrequently prescribed after AP, and evidence for its benefit remains inconsistent. Well-designed trials stratified by severity, including patient-reported outcomes, are needed.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 9","pages":"Pages 1158-1170"},"PeriodicalIF":3.3,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148420902","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}