Hpb最新文献

{"title":"Ideal outcome after pancreatic resection for neuroendocrine tumors: a nationwide study","authors":"Jeffrey W. Chen ,&nbsp;Simone A. Augustinus ,&nbsp;Bert A. Bonsing ,&nbsp;Stefan A.W. Bouwense ,&nbsp;Ignace H.J.T. De Hingh ,&nbsp;Casper H. Van Eijck ,&nbsp;Bas Groot Koerkamp ,&nbsp;Tessa E. Hendriks ,&nbsp;Anton F. Engelsman ,&nbsp;Marc G. Besselink ,&nbsp;Els J.M. Nieveen van Dijkum ,&nbsp;Dutch Pancreatic Cancer Group","doi":"10.1016/j.hpb.2024.12.024","DOIUrl":"10.1016/j.hpb.2024.12.024","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic resections for pancreatic neuroendocrine tumors (pNET) may experience a higher complication rate than for pancreatic ductal adenocarcinoma (PDAC). This study aimed to determine the rate of the novel composite “Ideal Outcome” measure after resection for pNET, using PDAC as reference.</div></div><div><h3>Methods</h3><div>This observational cohort study included all consecutive patients after pancreatic resection for pNET and PDAC using the nationwide Dutch Pancreatic Cancer Audit (2014–2021). The primary outcome was Ideal Outcome; absence of postoperative mortality, postoperative pancreatic fistulas (POPF) grade B/C, other major complications, prolonged length of stay, reoperations and readmissions.</div></div><div><h3>Results</h3><div>In total, 524 pNET and 2851 PDAC resections were included. The rate of Ideal Outcome was lower after resection for pNET (47.7% <em>versus</em> 55.7%; <em>P</em>&lt;0.001) as compared to PDAC. This difference was driven by a lower rate of Ideal Outcome after pancreatoduodenectomy for pNET (37.7% <em>versus</em> 56.3%; <em>P</em>&lt;0.001), with no difference after left pancreatectomy (54.5% <em>versus</em> 52.5%; <em>P</em>=0.598). Among the individual components of Ideal Outcome after pancreatoduodenectomy, the largest difference was a four times higher rate of POPF (32.1% <em>versus</em> 7.9%; <em>P</em>&lt;0.001) after resection of pNET.</div></div><div><h3>Conclusion</h3><div>Patients undergoing pancreatoduodenectomy for pNET have a reduced Ideal Outcome rate compared to patients with PDAC, related to a fourfold increased risk of POPF. This highlights the value of pNET-specific patient counseling and the need for effective POPF mitigation strategies.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 562-571"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004795","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":"Machine learning based prediction model for bile leak following hepatectomy for liver cancer","authors":"Abdullah Altaf ,&nbsp;Muhammad M. Munir ,&nbsp;Muhammad Muntazir M. Khan ,&nbsp;Zayed Rashid ,&nbsp;Mujtaba Khalil ,&nbsp;Alfredo Guglielmi ,&nbsp;Francesca Ratti ,&nbsp;Luca Aldrighetti ,&nbsp;Todd W. Bauer ,&nbsp;Hugo P. Marques ,&nbsp;Guillaume Martel ,&nbsp;Sorin Alexandrescu ,&nbsp;Matthew J. Weiss ,&nbsp;Minoru Kitago ,&nbsp;George Poultsides ,&nbsp;Shishir K. Maithel ,&nbsp;Carlo Pulitano ,&nbsp;Vincent Lam ,&nbsp;Irinel Popescu ,&nbsp;Ana Gleisner ,&nbsp;Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.12.015","DOIUrl":"10.1016/j.hpb.2024.12.015","url":null,"abstract":"<div><h3>Objective</h3><div>We sought to develop a machine learning (ML) preoperative model to predict bile leak following hepatectomy for primary and secondary liver cancer.</div></div><div><h3>Methods</h3><div>An eXtreme Gradient Boosting (XGBoost) model was developed to predict post-hepatectomy bile leak using data from the ACS-NSQIP database. The model was externally validated using data from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) multi-institutional databases.</div></div><div><h3>Results</h3><div>Overall, 20,570 and 2253 patients were identified from the ACS-NSQIP and multi-institutional databases, respectively. The incidence rates of bile leak were 7.0 %, 6.3 % and 10.2 % in the ACS-NSQIP, HCC and ICC databases, respectively. The XGBoost model achieved areas under receiver operating characteristic curves (AUROC) of 0.748, 0.719 and 0.711 in the training, testing and external validation cohorts, respectively. The SHAP algorithm demonstrated that the factors most strongly predictive of postoperative bile leak were serum alkaline phosphatase, surgical approach and cancer diagnosis. An online tool was developed for ease-of-use and clinical applicability (<span><span>https://altaf-pawlik-bileleak-calculator.streamlit.app/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusion</h3><div>A novel ML model demonstrated strong discrimination power to preoperatively identify patients at high risk of developing bile leak post-hepatectomy. The online calculator may be used as a clinical tool to inform preoperative surgical planning, intraoperative decision-making, and postoperative recovery protocols for patients undergoing hepatectomy.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 489-501"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927241","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":"Risk factors associated with venous thromboembolism after hepatectomy in oncology patients","authors":"Brianna Greenberg ,&nbsp;Alexandra W. Acher ,&nbsp;Alejandro Branes ,&nbsp;Rachel Roke ,&nbsp;Grace Xu ,&nbsp;Myriam Lafreniere-Roula ,&nbsp;Kevin Thorpe ,&nbsp;Keying Xu ,&nbsp;Paul J. Karanicolas ,&nbsp;HPB CONCEPT Team","doi":"10.1016/j.hpb.2024.12.021","DOIUrl":"10.1016/j.hpb.2024.12.021","url":null,"abstract":"<div><h3>Background</h3><div>Liver resection increases venous thromboembolism (VTE) risk due to malignancy-related hyper-coagulopathy and surgical inflammation. Current guidelines recommend early post-operative and extended pharmacologic prophylaxis for all patients but lack stratification by patient or surgical factors. Despite these guidelines, surgeon preferences influence prophylaxis practices. This study aimed to identify clinical factors associated with VTE following liver resection.</div></div><div><h3>Methods</h3><div>Using data from the Hemorrhage During Liver Resection (HeLiX) trial, a randomized clinical trial of patients undergoing liver resection for cancer, univariate comparisons and logistic regression were performed.</div></div><div><h3>Results</h3><div>Study cohort VTE incidence was 4.1 %. Multivariable analysis identified major liver resection (odds ratio (OR) 2.59, 95 % confidence interval (CI) 1.38–5.03) and higher estimated blood loss (EBL) (OR 1.14 per 500 mL increase, 95 % CI 1.03–1.26) as associated with increased risk. Surgical duration (OR 1.14 per hour increase, 95 % CI 0.95–1.34) and use of tranexamic acid (OR 1.77, 95 % CI 0.98–3.27) did not reach statistical significance. VTE rate was highly dependent on extent of resection (1–2 segments, 1.7 %; 3–4 segments, 5.4 %; &gt;4 segments, 6.7 %).</div></div><div><h3>Conclusion</h3><div>Major resection and increased EBL are associated with higher risk of VTE. These patients may warrant more intensive prophylax compared to those having minor resections with minimal blood loss.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 538-543"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143074216","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":"Long-term clinical outcomes of pancreatic cystic lesions in liver transplant patients","authors":"Emma Bradley ,&nbsp;Sobia Siddiqui ,&nbsp;Martin Montenovo ,&nbsp;Mark Radlinski ,&nbsp;Anthony Gamboa ,&nbsp;Patrick Yachimski ,&nbsp;Chandrasekhar Padmanabhan ,&nbsp;Marcus Tan ,&nbsp;Kamran Idrees","doi":"10.1016/j.hpb.2025.03.454","DOIUrl":"10.1016/j.hpb.2025.03.454","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cystic lesions (PCL) are often incidentally diagnosed in transplant patients, although long-term impact in this chronically immunosuppressed population remains unclear. This study examines long-term malignant potential and outcomes of PCL in orthotopic liver transplant (OLT) patients.</div></div><div><h3>Methods</h3><div>A retrospective study of 1110 patients who underwent OLT from 2011 to 2017 at a tertiary referral center was performed. Demographic, imaging, and outcomes data were examined.</div></div><div><h3>Results</h3><div>86 OLT patients with 148 PCL were identified. Median follow up after PCL identification was 7.6 years (IQR 5.7–9.7). Most cysts decreased in size (45%) or remained stable (30.2%). Only 24% of PCL increased in size, with average growth of 2.7 mm/year. Based on American College of Gastroenterology (ACG) 2018 guidelines, 20 patients (23%) developed high-risk imaging characteristics. Of 16 endoscopic ultrasounds (EUS) performed, 1 patient was diagnosed with pancreatic adenocarcinoma. There were no pancreas-specific causes of death and no survival differences in OLT patients with and without PCL on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>There is a low incidence of malignant transformation of PCL in OLT patients and no survival disadvantage at long-term follow up despite immunosuppression. PCL in OLT patients should be managed under similar guidelines as immunocompetent patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 946-951"},"PeriodicalIF":2.7,"publicationDate":"2025-03-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143998271","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":"Risk of recurrence does not decrease in patients undergoing the second and third resection of colorectal liver metastases","authors":"Yuhi Yoshizaki ,&nbsp;Yoshikuni Kawaguchi ,&nbsp;Yusuke Seki ,&nbsp;Shu Sasaki ,&nbsp;Akinori Miyata ,&nbsp;Yujiro Nishioka ,&nbsp;Akihiko Ichida ,&nbsp;Nobuhisa Akamatsu ,&nbsp;Junichi Kaneko ,&nbsp;Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2025.03.453","DOIUrl":"10.1016/j.hpb.2025.03.453","url":null,"abstract":"<div><h3>Background</h3><div>Repeat liver resection is a well-established treatment option for patients with recurrent colorectal liver metastases (CLM). However, the risk of recurrence following the second and third CLM resections was not assessed.</div></div><div><h3>Methods</h3><div>Data of patients undergoing first, second, and third CLM resection between 2005 and 2018 were obtained from a prospectively maintained database.</div></div><div><h3>Results</h3><div>Of the 695 patients, 486, 159, and 50 underwent first, second, and third CLM resections, respectively. The changing risks of recurrence in patients undergoing first, second, and third CLM resection, and the cumulative recurrence curve after a given interval without recurrence in patients undergoing first and second CLM resection were relatively similar. Time to recurrence after the first CLM resection ≤12 months (HR 2.09, 95% CI 1.35–3.23, <em>P</em> = 0.001) and number of CLM (HR 1.07, 95% CI 1.02–1.12, <em>P</em> = 0.003) were significant risk factors for recurrence in patients undergoing second CLM resection.</div></div><div><h3>Conclusion</h3><div>Patients undergoing second and third CLM resection did not have a lower risk of recurrence than those undergoing first CLM resection. The surveillance strategy after the second and third CLM resections should be similar to that after the first CLM resection.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 937-945"},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008785","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":"Towards determining clinical factors influencing critical structure identification using Artificial Intelligence.","authors":"Isaac Tranter-Entwistle, Lucy Culshaw, Roma Vichhi, Yiu Luke, Carole Addis, Imanol Luengo, Maria Grammatikopoulou, Karen Kerr, Danail Stoyanov, Tim Eglinton, Saxon Connor","doi":"10.1016/j.hpb.2025.03.452","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.03.452","url":null,"abstract":"<p><strong>Background: </strong>Studys into factors influencing critical view of safety achievement depends on large volumes of video data and granular anatomical annotations, which are limited by the burden of inefficient manual work. Artificial intelligence (AI) has the potential to radically scale the size of clinical studies by automating operative video analysis.</p><p><strong>Methods: </strong>481 videos of laparoscopic cholecystectomy were recorded at Christchurch Hospital, New Zealand over three years. AI algorithms analysed the videos, marking time points where the cystic duct and cystic artery were visible and operative phases. Metrics were stratified by surgeon experience (trainee or consultant) and case complexity (North Shore Grading scale). Nine timing metrics were derived based on the outputs of the AI algorithms and compared against the clinical variables.</p><p><strong>Results: </strong>Operative time increased with increasing operative difficulty. Significantly consultants demonstrated a higher proportional duration of anatomy visualisation than trainees in complex patients The cystic duct was commonly identified prior to the cystic artery independent of complexity grade.</p><p><strong>Conclusion: </strong>Surgical video review offers the potential of significant new insights with substantive benefits to patients but is often limited by the costly effort of manual analysis. This paper correlates AI-derived analytics with clinical factors demonstrating real-world utility of AI video analysis.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144293575","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":"Surface microdialysis to monitor hepatic metabolism in liver surgery","authors":"Niklas Löfgren ,&nbsp;Per-Jonas Blind ,&nbsp;Hanna Nyström ,&nbsp;Bijar Ghafouri ,&nbsp;Mikael Öman ,&nbsp;Oskar Hemmingsson","doi":"10.1016/j.hpb.2025.03.451","DOIUrl":"10.1016/j.hpb.2025.03.451","url":null,"abstract":"<div><h3>Background</h3><div>Microdialysis (μD) monitors local metabolism in tissues. Traditional μD requires intraparenchymal catheters, risking tissue damage, interfering with the analysis. This study evaluated the safety and feasibility of monitoring liver metabolism with a novel surface μD probe after liver resection.</div></div><div><h3>Methods</h3><div>Two μD catheters were attached to the liver surface intraoperatively. Concentrations of glucose, lactate, and pyruvate were determined and related to venous blood samples. Complications were registered 30 days postoperatively and graded according to Clavien–Dindo Classification and CTCAE guidelines.</div></div><div><h3>Results</h3><div>Samples were collected for a median of 4.7 days in 17 patients. No major complications related to μD were observed. The coefficients of variation for glucose, lactate, pyruvate, and the lactate/pyruvate ratio (L/P) were 18 %, 22 %, 28 %, and 21 %. Lactate in liver μD was significantly higher than in plasma and further increased in an ischemic area. Postoperative μD L/P was significantly correlated to a later increase in alanine aminotransferase. μD sampling from a hepatocellular carcinoma indicated elevated lactate compared with healthy liver.</div></div><div><h3>Conclusions</h3><div>Surface μD is a safe and feasible method to monitor liver metabolism postoperatively and may survey tumour metabolism <em>in vivo</em>. Biomarker trends can be monitored <em>in vivo</em> and may precede changes in systemic venous samples.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 930-936"},"PeriodicalIF":2.7,"publicationDate":"2025-03-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144012035","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":"“Obesity Paradox” as a new insight from long-term survivors in pancreatic cancer patients","authors":"Boram Lee,&nbsp;Ho-Seong Han,&nbsp;Yoo-Seok Yoon,&nbsp;Yeshong Park,&nbsp;MeeYoung Kang,&nbsp;Jinju Kim","doi":"10.1016/j.hpb.2025.03.450","DOIUrl":"10.1016/j.hpb.2025.03.450","url":null,"abstract":"<div><h3>Background</h3><div>Obesity is traditionally associated with poor outcomes. However, the recently emerging concept of the “obesity paradox” suggests that obese cancer patients have better survival rates than non-obese patients. While this phenomenon has been confirmed in several cancers, its relevance to pancreatic cancer remains unclear. This retrospective study explores whether the obesity paradox applies to pancreatic cancer (PC) after pancreatectomy.</div></div><div><h3>Methods</h3><div>A total of 404 PC patients who underwent surgery between 2004 and 2022 were studied. Patients were classified into the non-obese (BMI &lt;25.0) (n = 313) and obese (BMI ≥25.0) (n = 91) groups. A subgroup analysis examined the impact of the visceral fat to subcutaneous fat ratio (VSR) on survival within the obese cohort.</div></div><div><h3>Results</h3><div>Obese patients had a significantly better 5-year overall survival (p = 0.040) and cancer-specific survival (p = 0.047) than non-obese patients. Within the obese cohort, a lower VSR was associated with improved survival (p = 0.012), indicating the importance of fat distribution in outcomes.</div></div><div><h3>Conclusion</h3><div>Obesity is associated with improved survival in patients with PC, highlighting the potential benefits of a nuanced approach to manageing obese patients. Distribution of adipose tissue, particularly subcutaneous fat relative to visceral fat, further influences survival, suggesting that tailored treatment strategies may improve outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 922-929"},"PeriodicalIF":2.7,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143795281","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":"Global survey on surgeon preference and current practice for pancreatic neck and body cancer with portomesenteric venous involvement","authors":"Hiroyuki Ishida ,&nbsp;Thomas F. Stoop ,&nbsp;Atsushi Oba ,&nbsp;Philippe Bachellier ,&nbsp;Daisuke Ban ,&nbsp;Itaru Endo ,&nbsp;Oskar Franklin ,&nbsp;Tsutomu Fujii ,&nbsp;Aiste Gulla ,&nbsp;Thilo Hackert ,&nbsp;Asif Halimi ,&nbsp;Satoshi Hirano ,&nbsp;Jin-Young Jang ,&nbsp;Matthew H.G. Katz ,&nbsp;Aya Maekawa ,&nbsp;William H. Nealon ,&nbsp;Giampaolo Perri ,&nbsp;Jose M. Ramia ,&nbsp;Ingmar F. Rompen ,&nbsp;Sohei Satoi ,&nbsp;Nicholas J. Zyromski","doi":"10.1016/j.hpb.2025.03.005","DOIUrl":"10.1016/j.hpb.2025.03.005","url":null,"abstract":"<div><h3>Background</h3><div>Evidence regarding the optimal surgical approach for pancreatic neck/body cancer with portomesenteric vein (PV) involvement is scarce. We aimed to clarify the current practice using an international survey.</div></div><div><h3>Methods</h3><div>An online survey was distributed to members of nine international associations and study groups. Surgeons who performed pancreatectomy with PV resection (PVR) in the last 12 months were asked about three clinical scenarios with different PV involvement: scenarios A (&lt;90°; length 1 cm), B (&lt;90°; length 3 cm), and C (90–180°; length 3 cm), with or without common hepatic artery (CHA) involvement. PVR was defined according to the ISGPS definition.</div></div><div><h3>Results</h3><div>Overall, 222 surgeons from 49 countries in 6 continents completed the survey. The most selected procedures were left pancreatectomy with PVR ISGPS-type 1 for scenario A (52.3 %), PVR ISGPS-type 2 for B (28.8 %), and pancreatoduodenectomy with PVR ISGPS-type 3 for C (28.4 %). In patients with CHA involvement, the most selected procedures were left pancreatectomy without arterial reconstruction for A (57.7 %) and B (50.0 %), and total pancreatectomy for C (29.7 %).</div></div><div><h3>Conclusions</h3><div>The survey illustrates the heterogeneity in surgical management of pancreatic neck/body cancer with PV involvement, indicating the need for prospective studies and guidelines.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 910-921"},"PeriodicalIF":2.7,"publicationDate":"2025-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143989883","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":"Implementation of robotic and laparoscopic hepatopancreatobiliary surgery in low- and middle-income settings: a systematic review and meta-analysis","authors":"Adebayo Falola ,&nbsp;Chioma Ezebialu ,&nbsp;Sophia Okeke ,&nbsp;Rhoda T. Fadairo ,&nbsp;Oluwasina S. Dada ,&nbsp;Ademola Adeyeye","doi":"10.1016/j.hpb.2025.03.006","DOIUrl":"10.1016/j.hpb.2025.03.006","url":null,"abstract":"<div><h3>Background</h3><div>Despite numerous barriers, the application of minimally invasive surgery (MIS) for hepatopancreatobiliary (HPB) conditions has been increasing globally. This study aims to review the current status of HPB MIS in LMICs.</div></div><div><h3>Methods</h3><div>Relevant databases were searched, identifying 3452 publications, 38 of which met the inclusion criteria. Meta-analysis of outcomes was carried out using “R” statistical software.</div></div><div><h3>Results</h3><div>This study reviewed reports of application of MIS for HPB conditions in LMICs, analyzing a total of 3272 procedures. India (66.87 %) and Egypt (20.11 %) contributed majorly to the procedures reviewed. Others were from Indonesia (8.68 %), Colombia (3.06 %), Pakistan (0.67 %), Sri Lanka (0.34 %), Trinidad and Tobago (0.18 %), and Nigeria (0.09 %). India was the only LMIC with robotic HPB MIS. The majority of the procedures were biliary (74.88 %). Basic procedures accounted for 55.63 %, while 44.37 % were advanced. The overall conversion rate and prevalence of morbidity were 8 % [95 % CI: 5; 13], and 15 % [95 % CI: 9; 22], respectively. Robotics was associated with higher conversion (14 % vs 6 %, <em>p</em> &lt; 0.01) but lower morbidity (10 % vs 16 %, <em>p</em> = 0.91), compared to laparoscopic surgery. There were 5 cases of mortality from laparoscopy.</div></div><div><h3>Conclusion</h3><div>The outcomes in this systematic review, compared to findings in other settings indicate successful implementation of HPB MIS in LMICs.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 7","pages":"Pages 869-883"},"PeriodicalIF":2.7,"publicationDate":"2025-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143811397","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}