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{"title":"Root-cause analysis of mortality after pancreatic resection in a nationwide cohort","authors":"Anne Claire Henry ,&nbsp;F. Jasmijn Smits ,&nbsp;Lois A. Daamen ,&nbsp;Olivier R. Busch ,&nbsp;Koop Bosscha ,&nbsp;Ronald M. van Dam ,&nbsp;Coen J.L. van Dam ,&nbsp;Casper H. van Eijck ,&nbsp;Sebastiaan Festen ,&nbsp;Erwin van der Harst ,&nbsp;Ignace H.J.T. de Hingh ,&nbsp;Geert Kazemier ,&nbsp;Mike S. Liem ,&nbsp;Vincent E. de Meijer ,&nbsp;Peter Noordzij ,&nbsp;Gijs A. Patijn ,&nbsp;Jennifer M.J. Schreinemakers ,&nbsp;Martijn W.J. Stommel ,&nbsp;Bert A. Bonsing ,&nbsp;Bas G. Koerkamp ,&nbsp;I. Quintus Molenaar","doi":"10.1016/j.hpb.2024.11.014","DOIUrl":"10.1016/j.hpb.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement.</div></div><div><h3>Methods</h3><div>This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures.</div></div><div><h3>Results</h3><div>Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %).</div></div><div><h3>Conclusion</h3><div>Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 461-469"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028661","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":"Systematic review of peritoneal lavage and dialysis for patients with severe acute pancreatitis","authors":"Mikolaj R. Kowal ,&nbsp;Varuni Bhatnagar ,&nbsp;James Pine ,&nbsp;Samir Pathak ,&nbsp;Andrew Smith ,&nbsp;Iestyn Shapey","doi":"10.1016/j.hpb.2025.01.011","DOIUrl":"10.1016/j.hpb.2025.01.011","url":null,"abstract":"<div><h3>Aims</h3><div>Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.</div></div><div><h3>Methods</h3><div>Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.</div></div><div><h3>Results</h3><div>210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.</div></div><div><h3>Conclusions</h3><div>PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 425-433"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407343","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":"Transcription enhanced associate domain factor 1 (TEAD1) predicts liver regeneration outcome of ALPPS-treated patients","authors":"Mirco Küchler ,&nbsp;Mareike Ehmke ,&nbsp;Kai Jaquet ,&nbsp;Peter Wohlmuth ,&nbsp;Johannes M. Feldhege ,&nbsp;Tim Reese ,&nbsp;Thilo Hartmann ,&nbsp;Richard Drexler ,&nbsp;Tessa Huber ,&nbsp;Thorsten Burmester ,&nbsp;Karl J. Oldhafer","doi":"10.1016/j.hpb.2024.12.007","DOIUrl":"10.1016/j.hpb.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>The two-stage surgical technique of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) enables extensive liver resection and promotes future liver remnant regeneration (FLR), in part by inhibiting the Hippo signalling pathway. Its main effector, Yes-associated protein (YAP), has low intrinsic transcriptional activity and requires the transcription enhanced associated domain factor (TEAD) family members as cofactors for target gene transcription. We evaluated the intracellular localization and expression of TEAD1-4, hypothesized to regulate the activity of YAP and, consequently, liver regeneration.</div></div><div><h3>Methods</h3><div>The intracellular localization of TEAD1-4 was characterized in tumor-free liver (TFL) tissue samples from 44 ALPPS patients obtained during the two stages of ALPPS surgery. Expression levels were correlated with clinical and pathological data as well as liver regeneration metrics.</div></div><div><h3>Results</h3><div>TEAD family members are simultaneously expressed in individual hepatocytes and show relations with liver regeneration, clinical outcome and outcome parameters when comparing TFL tissue obtained at different stages of ALPPS surgery. Furthermore, differences in TEAD expression and localization within hepatocytes appeared to be independent of global factors.</div></div><div><h3>Conclusion</h3><div>TEAD1-4 expression correlates with liver regeneration outcomes. Specifically, cytoplasmic and nuclear expression scores of TEAD1 serve as predictive markers for clinical outcomes following ALPPS.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 470-479"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052370","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 spectrum and outcome of metastatic hepatocellular carcinoma in a South African patient cohort","authors":"Muhammad Emmamally ,&nbsp;Urda Kotze ,&nbsp;Marc Bernon ,&nbsp;Barbara Robertson ,&nbsp;Rufaida Khan ,&nbsp;Sanju Sobnach ,&nbsp;Mark Sonderup ,&nbsp;C Wendy Spearman ,&nbsp;Eduard Jonas","doi":"10.1016/j.hpb.2025.01.001","DOIUrl":"10.1016/j.hpb.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally, particularly in developing countries in Southeast Asia and sub-Saharan Africa (SSA), where chronic hepatitis B virus (HBV) dominates as a major aetiological factor.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study to quantify the metastatic profile of HCC in a South African patient population managed at a tertiary centre. Demographic, clinical and treatment data were extracted from an institutional registry. Patients with and without metastases were compared to identify factors associated with an increased risk of developing metastases.</div></div><div><h3>Results</h3><div>Of 676 patients, 194 (28.7 %) had metastases. Patients with metastases were younger (46.37 vs. 52.23 years; <em>p</em> &lt; 0.00001) and more frequently had chronic HBV, HIV co-infection and schistosomiasis compared to non-metastatic patients. The most common metastatic sites were lungs, skeletal, and peritoneum. For non-treated patients, skeletal metastases had the poorest survival.</div></div><div><h3>Conclusion</h3><div>This study confirms a typical SSA disease profile of aggressive HCC in a young population. We reported on the metastatic profile of HCC and the impact of different metastases on survival. Future research should focus on defining the concept of oligometastatic disease in HCC to identify patients where intervention targeting metastatic disease may be of benefit.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 572-581"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059017","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":"Ethics and trustworthiness of artificial intelligence in Hepato-Pancreato-Biliary surgery: a snapshot of insights from the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) survey","authors":"Niki Rashidian ,&nbsp;Mohammed Abu Hilal ,&nbsp;Isabella Frigerio ,&nbsp;Martina Guerra ,&nbsp;Sigrid Sterckx ,&nbsp;Francesca Tozzi ,&nbsp;Giulia Capelli ,&nbsp;Daunia Verdi ,&nbsp;Gaya Spolverato ,&nbsp;Aiste Gulla ,&nbsp;Francesca Ratti ,&nbsp;Andrew J. Healey ,&nbsp;Alessandro Esposito ,&nbsp;Matteo De Pastena ,&nbsp;Andrea Belli ,&nbsp;Stefan A. Bouwense ,&nbsp;Angelakoudis Apostolos ,&nbsp;Sven A. Lang ,&nbsp;Victor López-López ,&nbsp;Gregor A. Stavrou ,&nbsp;Andrew A. Gumbs","doi":"10.1016/j.hpb.2024.12.016","DOIUrl":"10.1016/j.hpb.2024.12.016","url":null,"abstract":"<div><h3>Background</h3><div>Hepato-Pancreato-Biliary (HPB) surgery is a complex specialty and Artificial Intelligence (AI) applications have the potential to improve pre- intra- and postoperative outcomes of HPB surgery. While ethics guidelines have been developed for the use of AI in clinical surgery, the ethical implications and reliability of AI in HPB surgery remain specifically unexplored.</div></div><div><h3>Methods</h3><div>An online survey was developed by the Innovation Committee of the E-AHPBA to investigate the current perspectives on the ethical principles and trustworthiness of AI in HPB Surgery among E-AHPBA membership. The survey consisted of 22 questions, based on guidelines outlined by the Artificial Intelligence Surgery Journal Task Force on AI Ethics in clinical surgery and was disseminated via email to all E-AHPBA members.</div></div><div><h3>Results</h3><div>A total of 84 members of the E-AHPBA participated in the survey. Seventeen out of 22 questions achieved more than 80 % agreement, with nine of those exceeding 90 %. Five questions had agreement levels between 70 % and 80 %.</div></div><div><h3>Conclusion</h3><div>While HPB surgeons are aware of the need to regulate the use of AI devices, robots, and to protect patient data, consensus appears to be heterogeneous regarding AI's role in mitigating gender-related and minority biases, as well as ensuring fairness and equity.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 502-510"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004774","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":"Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: an international multicentre retrospective cohort study","authors":"Peter L.Z. Labib ,&nbsp;Thomas B. Russell ,&nbsp;Jemimah L. Denson ,&nbsp;Mark A. Puckett ,&nbsp;Fabio Ausania ,&nbsp;Elizabeth Pando ,&nbsp;Keith J. Roberts ,&nbsp;Ambareen Kausar ,&nbsp;Vasileios K. Mavroeidis ,&nbsp;Ricky H. Bhogal ,&nbsp;Gabriele Marangoni ,&nbsp;Sarah C. Thomasset ,&nbsp;Adam E. Frampton ,&nbsp;Duncan R. Spalding ,&nbsp;Pavlos Lykoudis ,&nbsp;Manuel Maglione ,&nbsp;Nassir Alhaboob ,&nbsp;Parthi Srinivasan ,&nbsp;Hassaan Bari ,&nbsp;Andrew Smith ,&nbsp;Sandra Paterna-López","doi":"10.1016/j.hpb.2024.11.015","DOIUrl":"10.1016/j.hpb.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.</div></div><div><h3>Methods</h3><div>Patients who underwent PD for PDAC between June 2012 and May 2015 (29 centres, eight countries) were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on demographics, comorbidities, investigations, operation details, complications, histology, adjuvant therapies, recurrence and survival. Univariable tests and regression analysis investigated factors associated with any-site and local-only recurrence.</div></div><div><h3>Results</h3><div>Of 866 patients, 573 (66 %) developed recurrence: 170 (20 %) developed local-only recurrence, 164 (19 %) developed mixed local/distant recurrence, and 239 (28 %) developed distant-only recurrence. Local-only or lung-only recurrence had a more favourable prognosis than other recurrence patterns. Predictors of any-site recurrence were preoperative biliary stenting, venous resection and poorly-differentiated, node-positive tumours. Predictors of local-only recurrence were preoperative radiological lymphadenopathy, well-differentiated tumours, fewer than 15 resected lymph nodes and intraoperative blood transfusion.</div></div><div><h3>Discussion</h3><div>Ensuring radical resection and avoiding intraoperative blood transfusion may reduce the risk of local-only recurrence following PD for PDAC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 445-460"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052369","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 impact of vascular injuries on the management of bile duct injury following laparoscopic cholecystectomy- insights from a prospective study","authors":"Rohith Kodali ,&nbsp;Utpal Anand ,&nbsp;Kunal Parasar ,&nbsp;Rajeev N. Priyadarshi ,&nbsp;Ramesh Kumar ,&nbsp;Basant N. Singh ,&nbsp;Kislay Kant","doi":"10.1016/j.hpb.2024.12.022","DOIUrl":"10.1016/j.hpb.2024.12.022","url":null,"abstract":"<div><h3>Background</h3><div>Our study aimed to compare the clinical presentation and outcomes of post-cholecystectomy bile duct injuries (BDI) with and without arterial injuries.</div></div><div><h3>Methods</h3><div>A prospective analysis of 123 patients with post-cholecystectomy BDI between July 2018 and January 2022 was performed. Multivariate logistic regression analysis was used to assess the impact of vascular injuries on perioperative complications and long-term outcomes after delayed repair.</div></div><div><h3>Results</h3><div>Of 123 patients, 42 (34%) had associated vascular injuries, predominantly right hepatic artery disruptions. These patients experienced significantly higher perioperative complications after the index surgery (Cholangiolar abscess- 83.3% vs 32.1% ( p&lt;0.001), recurrent cholangitis- 66.67 % vs 14.81 % ( p&lt;0.001), blood transfusions ³2 - 89.74 % vs 28.57 % ( p&lt;0.001), hospital admissions ³3 – 3.88 ± 1.99 vs 2.49 ± 0.74 ( p&lt;0.001). Delayed Hepp-Couinaud biliary repair was performed in 112 patients. After a median follow-up, of 2 years, 85 (51.43 % vs. 88.16 % ), 12 (25.71 % vs. 3.89 %), 6 (11.43 % vs. 2.59 %), and 9 (11.43 % vs. 6.49 %) patients had excellent, good, fair, and poor outcomes.</div></div><div><h3>Conclusion</h3><div>Concomitant vasculobiliary injuries were associated with increased morbidity after index surgery; however, the long-term outcomes following definitive biliary repair remained comparable.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 544-552"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004813","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":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)00529-5","DOIUrl":"10.1016/S1365-182X(25)00529-5","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143740035","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":"Revisiting the place of surgical portal decompression for adults with noncirrhotic portal hypertension due to chronic extrahepatic portal vein obstruction: a scoping review","authors":"Chetana Lim ,&nbsp;Faouzi Saliba ,&nbsp;Chady Salloum ,&nbsp;Daniel Azoulay","doi":"10.1016/j.hpb.2025.01.005","DOIUrl":"10.1016/j.hpb.2025.01.005","url":null,"abstract":"<div><h3>Background</h3><div>Liver cirrhosis accounts for more than 90 % of portal hypertension cases, and the other cases are due to noncirrhotic portal hypertension (NCPH). Variceal bleeding is the most life-threatening complication of portal hypertension and its primary treatment is medical according to the Baveno VII guidelines. This review discusses the evidence on surgical portal decompression for adult patients with NCPH secondary to chronic extrahepatic portal vein obstruction (EHPVO).</div></div><div><h3>Methods</h3><div>This is a scoping review of the evidence for the feasibility and effectiveness of surgical portal decompression in adults with NCPH secondary to EHPVO.</div></div><div><h3>Results</h3><div>This scoping review yielded 17 studies, including a total of 110 patients. Patient age(s) ranged from 19 to 68 years, with the majority undergoing nonphysiological (i.e., portosystemic shunts) shunts (N = 84, 76.4 %), mostly for variceal bleeding refractory to medical and endoscopic treatments. Physiological shunts (i.e., Rex shunts) had a potential advantage over nonphysiological shunts in postoperative rebleeding (5 % vs. 10 %) and hepatic encephalopathy rates (0 % vs. 13 %). Conversely, nonphysiological shunts had a potential advantage over physiological shunts in postoperative shunt thrombosis (8 % vs. 22 %).</div></div><div><h3>Discussion</h3><div>This scoping review reported that surgical portal decompression is feasible in adults with NCPH due to EHPVO with favorable outcomes and long-term patency.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 434-444"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143038187","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":"Laparoscopic versus open resection for hepatocellular carcinoma according to the procedure’s complexity: real-world weighted data from a national register","authors":"Simone Famularo ,&nbsp;Flavio Milana ,&nbsp;Francesco Ardito ,&nbsp;Federica Cipriani ,&nbsp;Alessandro Vitale ,&nbsp;Andrea Lauterio ,&nbsp;Matteo Serenari ,&nbsp;Andrea Fontana ,&nbsp;Daniele Nicolini ,&nbsp;Mario Giuffrida ,&nbsp;Mattia Garancini ,&nbsp;Tommaso Dominioni ,&nbsp;Matteo Zanello ,&nbsp;Pasquale Perri ,&nbsp;Quirino Lai ,&nbsp;Simone Conci ,&nbsp;Sarah Molfino ,&nbsp;Mariano Giglio ,&nbsp;Giuliano LaBarba ,&nbsp;Cecilia Ferrari ,&nbsp;Guido Mantovani","doi":"10.1016/j.hpb.2024.12.017","DOIUrl":"10.1016/j.hpb.2024.12.017","url":null,"abstract":"<div><h3>Background</h3><div>Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.</div></div><div><h3>Methods</h3><div>Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.</div></div><div><h3>Results</h3><div>From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29–0.43, <em>p</em> &lt; 0.001), and MC (OR 0.738, 95%CI:0.59–0.91, <em>p</em>: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37–0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10–1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.</div></div><div><h3>Conclusion</h3><div>In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 511-522"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970671","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}