Hpb最新文献

{"title":"Outcome of a ‘step-up approach’ for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series","authors":"Alessandro M. Bonomi ,&nbsp;Anouk G. Overdevest ,&nbsp;Jeska A. Fritzsche ,&nbsp;Olivier R. Busch ,&nbsp;Freek Daams ,&nbsp;Geert Kazemier ,&nbsp;Rutger-Jan Swijnenburg ,&nbsp;Ulrich Beuers ,&nbsp;Babs M. Zonderhuis ,&nbsp;Roy L.J. van Wanrooij ,&nbsp;Joris I. Erdmann ,&nbsp;Rogier P. Voermans ,&nbsp;Marc G. Besselink","doi":"10.1016/j.hpb.2024.10.016","DOIUrl":"10.1016/j.hpb.2024.10.016","url":null,"abstract":"<div><h3>Background</h3><div>Recurrent non-stenotic cholangitis (NSC) is a challenging and poorly understood complication of a surgical hepaticojejunostomy (HJ). Optimal treatment remains unclear.</div></div><div><h3>Methods</h3><div>A retrospective single center series including patients with recurrent cholangitis with a non-stenotic HJ after hepato-pancreato-biliary surgery was conducted (2015–2022). Primary outcome was resolution of NSC (i.e. free of NSC during six months). Secondary outcomes included reduction of NSC monthly episode frequency and secondary sclerosing cholangitis.</div></div><div><h3>Results</h3><div>Overall, 50 of 1179 (4.2%) patients with HJ developed NSC. Treatment included a ‘step-up approach’ with short-course antibiotics (n = 50, 100 %), prolonged antibiotics (n = 26, 52%), and revisional surgery (n = 7, 14 %). Resolution of NSC was achieved in 15 patients (30%) and reduction of NSC frequency in an additional 21 patients (42%). Concomitant ursodeoxycholic acid use and discontinuation of proton pump inhibitors was the only predictor for resolution (OR 4.229, p = 0.035). Secondary sclerosing cholangitis occurred in 12 patients (24%) and was associated with the number of NSC episodes (OR 1.2, p = 0.050).</div></div><div><h3>Conclusion</h3><div>A ‘step-up approach’ to recurrent NSC after HJ resulted in 30 % resolution and further 42 % reduced frequency of NSC although still a quarter of patients developed secondary sclerosing cholangitis. Future prospective studies should assess whether a protocolized approach could improve outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 177-185"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681784","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":"Original articles: step-by-step decision-making for achieving oncologically acceptable but avoiding over-invasive surgery for gallbladder cancer","authors":"Kyoji Ito,&nbsp;Yoshikuni Kawaguchi,&nbsp;Yujiro Nishioka,&nbsp;Akinori Miyata,&nbsp;Akihiko Ichida,&nbsp;Nobuhisa Akamatsu,&nbsp;Norihiro Kokudo,&nbsp;Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2024.10.014","DOIUrl":"10.1016/j.hpb.2024.10.014","url":null,"abstract":"<div><h3>Background</h3><div>Gallbladder cancer is a malignancy with a highly dismal prognosis, requiring optimal surgical strategies to achieve effective outcomes. We aimed to evaluate the outcomes of our algorithm-based decision-making approach based on image T-factors and intraoperative pathology of regional lymph node metastases and the bile duct stumps in patients undergoing gallbladder cancer resection.</div></div><div><h3>Methods</h3><div>A prospectively maintained database of patients who underwent gallbladder cancer resection between April 2001 and June 2022 was reviewed. Our approach included the decision on the extent of local lymph node dissection based on image T-factors and intraoperative rapid pathological diagnosis. The need for extra bile duct resection was decided according to the intraoperative rapid pathological diagnosis of the cystic or bile duct stump.</div></div><div><h3>Results</h3><div>Overall, 148 patients underwent gallbladder cancer resection and were assessed to evaluate the efficacy of an institutional algorithm-based surgical strategy. Oncologically acceptable surgery rate was 98.6 and 96.9 % in terms of decision-making on the extents of lymph node dissection and bile duct resection, respectively.</div></div><div><h3>Conclusion</h3><div>Our step-by-step decision-making approach based on image T-factors and intraoperative pathology for gallbladder cancer resection was effective in achieving oncologically acceptable surgeries.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 186-194"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750562","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 setting of functional liver volume enhanced by portal and hepatic vein embolization is key in preventing serious morbidity after hepatectomy with bile duct resection for biliary tract cancer","authors":"Kenichiro Araki,&nbsp;Akira Watanabe,&nbsp;Takamichi Igarashi,&nbsp;Mariko Tsukagoshi,&nbsp;Norihiro Ishii,&nbsp;Shunsuke Kawai,&nbsp;Kei Hagiwara,&nbsp;Kouki Hoshino,&nbsp;Takaomi Seki,&nbsp;Norifumi Harimoto,&nbsp;Ken Shirabe","doi":"10.1016/j.hpb.2024.11.005","DOIUrl":"10.1016/j.hpb.2024.11.005","url":null,"abstract":"<div><h3>Background</h3><div>The risk of mortality due to serious complications associated with hepatectomy for biliary tract cancer remains high. We aimed to investigate the significance of preoperative functional liver volume in predicting and preventing serious morbidity following hepatectomy with bile duct resection (BDR).</div></div><div><h3>Methods</h3><div>Seventy-one patients who underwent hepatectomy with BDR for biliary tract cancer were included. Functional future remnant liver volume (fFRLV) was calculated using future liver remnant (FLR) volume and functional score measured using EOB-MRI. Patients with unsatisfactory fFRLV values underwent portal or sequential portal/hepatic vein embolization (PVE/HVE). We assessed relationship between variables for liver-related morbidity (LRM), including posthepatectomy liver failure, bile leakage, and persistent ascites. Additionally, we assessed Clavien-Dindo grade IV complications (CD ≥ IV) as indicators of serious morbidity.</div></div><div><h3>Results</h3><div>LRM and CD ≥ IV occurred in 20 (28.2 %) and 6 (8.5 %) cases, respectively. Preoperative FLR volume (p = 0.021), FLR ratio (p = 0.004), fFRLV (p = 0.008), and ICGK-F (p = 0.023) were associated with LRM. fFRLV (p = 0.017) was predictive for LRM but not independent (AUC:0.704). Preoperative FLR volume (p = 0.005), FLR ratio (p = 0.008), and fFRLV (p &lt; 0.001) were associated with CD ≥ IV. fFRLV (p = 0.017) was an independent predictive factor for CD ≥ IV(AUC:0.914), showing greater predictive power compared to other factors.</div></div><div><h3>Conclusion</h3><div>fFRLV predicts CD ≥ IV in patients undergoing hepatectomy with BDR. A sufficient fFRLV, enhanced by PVE/HVE if necessary, may prevent serious morbidity and mortality.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 167-176"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791608","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 pancreaticoduodenectomy outcomes in patients ≥ 75 years old: an NSQIP analysis of 4343 patients.","authors":"Nazgol K Shahbaz, Kevin Verhoeff, Tyrell Wees, Sukhdeep Jatana, Douglas Quan, Juan Glinka, Anton Skaro, Ephraim S Tang","doi":"10.1016/j.hpb.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.015","url":null,"abstract":"<p><strong>Background: </strong>The benefits of MIS in older adults are conflicting. This study evaluates demographics and early outcomes, for older patients (≥75) undergoing minimally invasive (MIS) versus open pancreaticoduodenectomy (PD).</p><p><strong>Method: </strong>We categorized elderly patients who underwent PD from 2017 to 2021 NSQIP databases by surgical approach (open vs MIS). Baseline characteristics were examined with bivariate analysis, and multivariate logistic regression assessed the independent effect of minimally invasive surgery on 30-day serious complications and mortality.</p><p><strong>Results: </strong>Amongst 4137 patients, 150 (3.63 %) underwent MIS PD. Patients demographics were similar. Open cohorts were older (79.1 vs 78.4 years; p = 0.011) with greater tumor invasion (36.6 % vs. 27.0 %; p = 0.018). MIS had longer operations (133.1 vs 119.6 min; p < 0.001). Multivariate analysis demonstrated that MIS approach was associated with increased serious complications (OR 2.21; p < 0.001), but not mortality (OR 2.11; p = 0.173). Post hoc analysis excluding cases converted to open demonstrated no difference in serious complications (OR 1.94; p = 0.070) or mortality (OR 3.58; p = 0.094). PSM analysis estimated a 14.7 % higher rate of serious complications in MIS but similar mortality (p = 0.291).</p><p><strong>Conclusions: </strong>MIS PD uptake in elderly patients remains limited, with early findings indicating longer operations and higher complications. Further research on patient selection differences, technique modifications, and center expertise is required.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448796","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":"Residency robotic biotissue curriculum: the next frontier in robotic surgical training.","authors":"Sarah B Hays, Kristine Kuchta, Aram E Rojas, Syed A Mehdi, Jason L Schwarz, Mark S Talamonti, Melissa E Hogg","doi":"10.1016/j.hpb.2025.01.014","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.014","url":null,"abstract":"<p><strong>Introduction: </strong>Virtual reality has been shown to be a strong introduction to the robot. However, we hypothesized that a biotissue curriculum including common surgical anastomoses can further enhance robotic technical skills in surgical residents.</p><p><strong>Methods: </strong>Post-graduate-year three (PGY-3) general surgery residents completed a two-week robotic simulation rotation. The inanimate exercises used biotissue to simulate common robotic anastomoses, including the running hepaticojejunostomy (RHJ), gastrojejunostomy (GJ), interrupted hepaticojejunostomy (IHJ), and pancreaticojejunostomy (PJ). Drills were timed and graded according to modified Objective Structured Assessment of Technical Skills (OSATS; range 6-30).</p><p><strong>Results: </strong>32 residents completed the curriculum. 81.3% of residents reported prior experience at the surgeon console (median=5 operations). Across all drills the average time to completion decreased from first to fourth attempt (RHJ: 33.7±8.9 vs. 26.3±8.1 min, p<0.001; GJ: 57.2±15.1 vs. 44.6±9.5 min, p<0.001; IHJ: 32.6±7.2 vs. 27.1±7.7 min, p<0.001; PJ: 44.2±9.3 vs. 35.6±10.5 min, p<0.001). Average OSATS score increased across all drills as well (RHJ: 16.0±3.8 vs. 23.3±3.4, p<0.001; GJ: 19.4±2.1 vs. 26.0±2.5, p<0.001; IHJ: 16.9±2.7 vs. 23.2±3.6, p<0.001, PJ: 17.9±2.6 vs. 23.6±3.6, p<0.001).</p><p><strong>Conclusion: </strong>The robotic biotissue curriculum improves resident performance on robotic anastomoses. With the rise of the robotic platform, training in robotic procedures should be incorporated during surgical residency.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382355","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":"Preferred content, construct, and duration of a fellowship structure in HPB surgery: a cross-sectional, pan-European survey among trainees and trainers.","authors":"Tim Reese, Stefan Gilg, Marc G Besselink, Kjetil Soreide","doi":"10.1016/j.hpb.2025.01.012","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.012","url":null,"abstract":"<p><strong>Background: </strong>Fellowships in HPB surgery are lacking across Europe. The aim of this survey was to investigate preferences towards an HPB-fellowship structure among trainees and trainers.</p><p><strong>Methods: </strong>A cross-sectional pan-European survey of trainees and consultants in HPB across Europe. Preferred content, duration and construct of a fellowship program was explored.</p><p><strong>Results: </strong>Responses from 221 eligible participants were analysed, covering all European regions (40 % trainees, of which 31 % women). Preferred duration was 2 years (53 %), international availability (71 %) and in English language (by two-thirds overall; 74 % among trainees). A majority About two-thirds (63 %) preferred an official fellowship teaching curriculum provided by the E-AHPBA. Most The vast majority of participants (n = 211; 95 %) supported accreditation of HPB-fellowships by the E-AHPBA. Trainees reported higher priorities towards technical training (i.e. time in operating room; first surgeon opportunity; minimal-invasive technique training) than consultants, while time for non-operative activities (i.e. ward rounds; responsibility for multidisciplinary team meetings etc) was valued higher by consultants.</p><p><strong>Conclusions: </strong>We identified preferences and needs towards construct and competence in HPB fellowships with strong support for involvement of E-AHPBA in providing a involvement teaching curriculum and accreditation. A unified HPB fellowship construct and registry across Europe guided by E-AHPBA may take this into consideration.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143382349","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":"Central hepatectomy for perihilar cholangiocarcinoma: an alternative technique for parenchymal-sparing hepatectomy to prevent post-hepatectomy liver failure.","authors":"Masahiro Fujisawa, Ryuji Yoshioka, Atsushi Takahashi, Shoichi Irie, Yoshinori Takeda, Hirofumi Ichida, Hiroshi Imamura, Yoshihito Kotera, Yoshihiro Mise, Akio Saiura","doi":"10.1016/j.hpb.2025.01.002","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.002","url":null,"abstract":"<p><strong>Background: </strong>Perihilar cholangiocarcinoma (PHC) often requires major hepatectomy with extrahepatic bile duct resection, carrying the risk of post-hepatectomy liver failure (PHLF). Central hepatectomy (CH), an alternative technique, aims to preserve functional liver reserve. This study evaluated the feasibility of CH and outcomes for patients with PHC within the paradigm of parenchymal-sparing hepatectomy.</p><p><strong>Methods: </strong>A retrospective analysis included PHC patients who underwent CH between March 2019 and January 2023. Preoperative evaluations involved multimodality imaging and assessment of future remnant liver volume.</p><p><strong>Results: </strong>Fourteen patients underwent CH for PHC. Tumor locations were perihilar bile duct (10 patients), and entire extrahepatic bile duct involvement (four patients). Median operative time and intraoperative blood loss were 679.5 min and 450 mL, respectively. Clinically-relevant PHLF occurred in two patients, with one sepsis-related death. Nine patients achieved R0 resection. Functional liver reserve parameters exceeded the standard procedure (p < 0.01).</p><p><strong>Conclusion: </strong>CH for PHC preserves functional liver reserve, potentially reducing PHLF risk. Adequate preoperative evaluation is crucial, and oncological outcomes require further investigation.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143448865","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":"Minimally invasive versus open liver resection for nonmetastatic hepatocellular carcinoma staged BCLC - B and - C: an Italian multicentric analysis.","authors":"Gianluca Cassese, Mariano C Giglio, Alessandro Vitale, Andrea Lauterio, Matteo Serenari, Federica Cipriani, Francesco Ardito, Pasquale Perri, Daniele Nicolini, Giulio Di Gioia, Andrea Pierluigi Fontana, Quirino Lai, Simone Conci, Luca Fumagalli, Maurizio Iaria, Mattia Garancini, Sarah Molfino, Matteo Zanello, Giuliano La Barba, Maria Conticchio, Paola Germani, Simone Famularo, Maurizio Romano, Giuseppe Zimmitti, Michela De Angelis, Albert Troci, Andrea Belli, Francesco Izzo, Michele Crespi, Luigi Boccia, Mohamed Abu Hilal, Giacomo Zanus, Guido Torzilli, Paola Tarchi, Riccardo Memeo, Giorgio Ercolani, Elio Jovine, Gianluca Baiocchi, Fabrizio Romano, Raffaele Della Valle, Marco Chiarelli, Andrea Ruzzenente, Massimo Rossi, Alessandro Ferrero, Marcello Maestri, Marco Vivarelli, Gian Luca Grazi, Felice Giuliante, Luca Aldrighetti, Matteo Cescon, Luciano De Carlis, Umberto Cillo, Roberto I Troisi","doi":"10.1016/j.hpb.2025.01.009","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.009","url":null,"abstract":"<p><strong>Background: </strong>Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far.</p><p><strong>Methods: </strong>Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database. An inverse probability of treatment weighting (IPTW) method was adopted to balance the confounders. The primary outcome was a composite endpoint including post-hepatectomy liver failure, severe postoperative complications and in-hospital mortality.</p><p><strong>Results: </strong>627 patients were included (459 undergoing OLR and 168 receiving MILS). After IPTW, no difference was found in the composite endpoint between MILS and OLR (OR 0.86 [95%CI 0.46-1-60]; p = 0.62). MILS reduced the risk of receiving intra-operative transfusions (OR 0.28 [95%CI 0.13-0.58]; p < 0.001) and of developing postoperative ascites (OR 0.56 [95%CI 0,32-0,98]; p = 0.039), with reduced length of stay (OR 0.82 [95%CI 0.66-1.01]; p = 0.045). The survival analysis showed no differences between MILS and OLR for both OS (p = 0.13) and DFS (p = 0.491).</p><p><strong>Conclusion: </strong>MILS was shown to be safe and feasible for selected non-metastatic HCC patients staged BCLC B and C, reducing the risk of perioperative transfusions and postoperative ascites, and shortening the length of stay.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433179","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":"\"Biological R2\" resection for intrahepatic cholangiocarcinoma: identification of patients at risk for poor oncologic outcomes after curative-intent resection.","authors":"Jun Kawashima, Yutaka Endo, Selamawit Woldesenbet, Mujtaba Khalil, Miho Akabane, François Cauchy, Feng Shen, Shishir Maithel, Irinel Popescu, Minoru Kitago, Matthew J Weiss, Guillaume Martel, Carlo Pulitano, Luca Aldrighetti, George Poultsides, Andrea Ruzzente, Todd W Bauer, Ana Gleisner, Hugo Marques, Bas Groot Koerkamp, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.01.006","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.006","url":null,"abstract":"<p><strong>Introduction: </strong>We sought to define a cohort of patients with \"biological R2\" (bR2) resection, defined as recurrence within 12 weeks, following curative-intent resection for intrahepatic cholangiocarcinoma (ICC). In addition, we sought to identify factors associated with bR2 risk.</p><p><strong>Methods: </strong>Patients who underwent upfront curative-intent surgery for ICC were identified from an international, multi-institutional database. The weighted beta-coefficients of preoperative risk factors were used to construct an online tool to predict bR2.</p><p><strong>Results: </strong>Among 1138 patients, 106 (9.3 %) patients had a bR2 resection. Patients with bR2 were more likely to be younger (OR 0.97) and non-White (OR 2.19), as well as more often had cirrhosis (OR 2.11), a higher neutrophil-to-lymphocyte ratio (OR 1.07), a higher tumor burden score (OR 1.16), and metastatic nodal disease on preoperative imaging (OR 1.92). Patients categorized as low-risk had a 3.2 % risk of bR2, intermediate-risk patients had an 11.1 % risk of bR2, whereas patients in the high-risk category had a 27.6 % risk of bR2 (p < 0.001). An online tool was made available at https://junkawashima.shinyapps.io/bR2_ICC/, https://junkawashima.shinyapps.io/CRLMfollwingchemotherapy/.</p><p><strong>Conclusions: </strong>Approximately one in ten patients with resectable ICC had a bR2 resection. An online calculator can may help clinicians identify patients with ICC at highest risk of a bR2 resection.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364485","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":"Retrospective comparative analyses of liver transplantation for intrahepatic cholangiocarcinoma and combined hepatocellular cholangiocarcinoma versus hepatocellular carcinoma in Brazil.","authors":"Iron P De Abreu Neto, Vincenzo Pugliese, Paulo C B Massarollo, Bárbara B Benini, Mirella M M Marta, Vanessa S Takenaka, Francisco Monteiro, João Luis E Pessoa, Raymundo S De Azevedo Neto, Adriano M Gonzalez","doi":"10.1016/j.hpb.2025.01.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.008","url":null,"abstract":"<p><strong>Background: </strong>Despite the growing interest in liver transplantation for cholangiocarcinomas (CCA), conclusive evidence is lacking. We sought to evaluate the outcomes of liver transplantation for intrahepatic cholangiocarcinoma in Brazil.</p><p><strong>Methods: </strong>Retrospective database analysis of patients undergoing liver transplantation for hepatocellular carcinoma (HCC) within Milan criteria in São Paulo, Brazil. Anatomopathological examination of the explanted liver with the presence of intrahepatic cholangiocarcinoma (iCCA) or combined hepatocellular-cholangiocarcinoma (cHCC-CCA) comprised the study group (50 patients). They were compared to a 1:3 HCC-matched cohort.</p><p><strong>Results: </strong>Study group had lower survival rates than HCC controls (survival at 1, 3, and 5 years, 70.0 %, 57.5 %, and 57.5 % versus 78.7 %, 71.4 %, and 66.6 %, p = 0.019). 5-year survival rates of the control group, cHCC-CCA, and iCCA group were 66.6 %, 59.6 %, and 50.0 % (p = 0.017). There was no statistically significant difference in survival for study group patients with tumors up to 3 cm compared to their controls (p = 0.086).</p><p><strong>Discussion: </strong>Patients with CCA had worse outcomes after liver transplantation than those with HCC. Interesting results were found in the more individualized analyses, but because of the limited number of patients, caution should be taken when analyzing them.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074211","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}