IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.010

Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal

{"title":"Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis","authors":"Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal","doi":"10.1016/j.hpb.2024.10.010","DOIUrl":"10.1016/j.hpb.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.</div></div><div><h3>Methods</h3><div>A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.</div></div><div><h3>Results</h3><div>Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to −51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to −4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to −1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.</div></div><div><h3>Conclusion</h3><div>Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 135-149"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710036","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}

引用次数: 0

Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma 胰腺导管腺癌胰十二指肠切除术后化疗完成率和总生存率与术后并发症的关系。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.002

Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen

{"title":"Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma","authors":"Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen","doi":"10.1016/j.hpb.2024.11.002","DOIUrl":"10.1016/j.hpb.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS.</div></div><div><h3>Results</h3><div>A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25–3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04–3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found.</div></div><div><h3>Conclusion</h3><div>Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 222-231"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739132","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}

引用次数: 0

New criteria for preoperative liver function assessment with safety margins to avoid postoperative mortality during liver resection for hilar cholangiocarcinoma 为避免肝门部胆管癌肝切除术中的术后死亡率，制定了具有安全范围的术前肝功能评估新标准。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.013

Hideaki Kojima , Yuta Abe , Daisuke Udagawa , Koki Hayashi , Naokazu Chiba , Shunichi Imai , Kisyo Mihara , Hisanobu Higashi , Masanori Odaira , Go Oshima , Wataru Koizumi , Minoru Kitago , Hiroshi Yagi , Yasushi Hasegawa , Shutaro Hori , Masayuki Tanaka , Yutaka Nakano , Shigeyuki Kawachi , Yuko Kitagawa

{"title":"New criteria for preoperative liver function assessment with safety margins to avoid postoperative mortality during liver resection for hilar cholangiocarcinoma","authors":"Hideaki Kojima , Yuta Abe , Daisuke Udagawa , Koki Hayashi , Naokazu Chiba , Shunichi Imai , Kisyo Mihara , Hisanobu Higashi , Masanori Odaira , Go Oshima , Wataru Koizumi , Minoru Kitago , Hiroshi Yagi , Yasushi Hasegawa , Shutaro Hori , Masayuki Tanaka , Yutaka Nakano , Shigeyuki Kawachi , Yuko Kitagawa","doi":"10.1016/j.hpb.2024.10.013","DOIUrl":"10.1016/j.hpb.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Despite recent medical advancements, surgery for hilar cholangiocarcinoma is associated with high complication and mortality rates. This may be partly attributed to the absence of established preoperative liver evaluation criteria for safe surgery. This study aimed to propose a reliable indicator for safe and well-planned management of major hepatectomy with extrahepatic bile duct resection.</div></div><div><h3>Methods</h3><div>We included 150 patients who underwent major hepatectomy with extrahepatic bile duct resection between 2013 and 2021 in Japan. The risk factors for post-hepatectomy liver failure (PHLF) were retrospectively analyzed.</div></div><div><h3>Results</h3><div>PHLF was observed in 24 (16.0 %) patients who underwent major hepatectomy with extrahepatic bile duct resection. In the multivariate analysis, the identified risk factors for PHLF were the ratio of future remnant liver volume to total liver volume (FRLV/TLV) ≤ 42 % and indocyanine green clearance fraction of the future remnant liver (ICGK-F) ≤ 0.07. Patients with these two factors were significantly associated with PHLF compared with those with either one or none of the risk factors (60.0 % vs 15.1 % and 8.1 %, respectively).</div></div><div><h3>Conclusion</h3><div>The combinational use of ICGK-F and FRLV/TLV is useful for preoperative liver function assessment with a safety margin to avoid PHLF and postoperative mortality in hepatectomy for hilar cholangiocarcinoma.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 159-166"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142695488","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}

引用次数: 0

Reoperation for pancreatic fistula: a systematic review of completion pancreatectomy vs. pancreas-preserving-procedures and outcomes 胰腺瘘的再手术：对完全胰腺切除术与保留胰腺的程序和结果的系统回顾。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.006

Alessio Marchetti , Gaetano Corvino , Giampaolo Perri , Giovani Marchegiani , Raffaele De Luca

{"title":"Reoperation for pancreatic fistula: a systematic review of completion pancreatectomy vs. pancreas-preserving-procedures and outcomes","authors":"Alessio Marchetti , Gaetano Corvino , Giampaolo Perri , Giovani Marchegiani , Raffaele De Luca","doi":"10.1016/j.hpb.2024.11.006","DOIUrl":"10.1016/j.hpb.2024.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Consensus on the nomenclature and indications for reoperation for post-operative pancreatic fistula (POPF) after pancreatoduodenectomy (PD) is lacking. This study explores the available literature to classify the different types of reoperations and report outcomes.</div></div><div><h3>Methods</h3><div>A systematic literature search was performed, including articles from 2010 to 2024 reporting reoperations for POPF after PD. The primary outcome was 30- or 90-day-mortality. Secondary outcomes included reoperation date, additional relaparotomy, ICU-admission, hospital stay, rate of pancreatic-exocrine-insufficiency, diabetes and long-term survivors.</div></div><div><h3>Results</h3><div>Twenty-five studies were reviewed with 766 patients reoperated for POPF after PD, 283 (37 %) undergoing completion pancreatectomy (CP) and 483 (63 %) pancreas-preserving-procedures (PPPs). Among PPPs, drainage (30 %), wirsungostomy (14 %), pancreatic anastomosis repair (6 %), “sinking” of pancreatic stump (6 %) and re-do pancreatic anastomosis (4 %) were identified. The main indications for reoperation were post-pancreatectomy hemorrhage, necrotizing acute pancreatitis, sepsis and peritonitis. PPPs were preferred with severe hemodynamic instability. Mortality rates after CP and PPPs ranged from 20 to 56 % and 0–67 %, respectively. Early reoperation was associated with reduced ICU-recovery after “sinking” (<em>p</em> = 0.049).</div></div><div><h3>Conclusion</h3><div>Reoperation for POPF after PD is rarely needed. When it is, early timing seems critical for better outcomes, and PPPs seems to be the best bail out option in patients with severe hemodynamic instability.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 240-249"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142806944","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}

引用次数: 0

Adjunct mucin biomarkers MUC2+MUC5AC and MUC5AC+PSCA in a clinical setting identify and may improve correct selection of high-risk pancreatic lesions for surgery 临床环境中的辅助粘蛋白生物标志物MUC2+MUC5AC和MUC5AC+PSCA可识别高风险胰腺病变并提高手术选择的正确性。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.018

Eva Philipson , Karolina Jabbar , Svein-Olav Bratlie , Gunnar Hansson , Jan Persson , Caroline Vilhav , Johanna Wennerblom , Riadh Sadik , Peter Naredi , Johan Bourghardt Fagman , Cecilia Engström

{"title":"Adjunct mucin biomarkers MUC2+MUC5AC and MUC5AC+PSCA in a clinical setting identify and may improve correct selection of high-risk pancreatic lesions for surgery","authors":"Eva Philipson , Karolina Jabbar , Svein-Olav Bratlie , Gunnar Hansson , Jan Persson , Caroline Vilhav , Johanna Wennerblom , Riadh Sadik , Peter Naredi , Johan Bourghardt Fagman , Cecilia Engström","doi":"10.1016/j.hpb.2024.10.018","DOIUrl":"10.1016/j.hpb.2024.10.018","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer has dismal prognosis with a 5-year survival of 12 %. Cystic lesions have been identified as premalignant lesions. The challenge is to identify lesions with high risk of malignant progression, to offer patients prophylactic curative pancreatic surgery. Previous studies have identified mucin biomarker panels (MUCPs) as potential discriminators of pre- and malignant pancreatic cystic lesions. The present study assessed whether MUCPs contribute to more accurate identification of patients with high-risk pancreatic lesions and improve selection for surgery.</div></div><div><h3>Methods</h3><div>This retrospective crossover study included 88 patients referred to endoscopic ultrasound because of unclear pancreatic cystic lesions. Clinical management and surgical decision-making with and without MUCP values were assessed by two expert teams with access to patient medical history, radiology, fine-needle aspirates, cytology, and cystic fluid carcinoembryonic antigen.</div></div><div><h3>Results</h3><div>The adjunct of MUCPs improved decision-making in 2 of 21 cases with surgical pathology, identifying one cancer that otherwise would have been missed and sparing one patient from unnecessary surgery.</div></div><div><h3>Conclusion</h3><div>Access to MUCPs in a clinical setting improved correct selection of high-risk pancreatic lesions for surgery in single cases. A higher number of incorrect recommendations for surgery with the adjunct of MUCPs was also noted, which calls for caution.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 214-221"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675055","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}

引用次数: 0

Transfusion of irradiated autologous blood for hepatobiliary and pancreatic cancer resections: a feasibility study 输注辐照自体血用于肝胆胰癌切除术的可行性研究。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.003

Leyo Ruo, Pablo E. Serrano, Jennifer Ramsay, James J. Hankinson

引用次数: 0

Outcome of a ‘step-up approach’ for recurrent cholangitis in patients with a non-stenotic hepaticojejunostomy after hepato-pancreato-biliary surgery: single center series 肝-胰-胆手术后非狭窄性肝空肠吻合术患者复发性胆管炎的 "升级方法 "疗效：单中心系列研究。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.016

Alessandro M. Bonomi , Anouk G. Overdevest , Jeska A. Fritzsche , Olivier R. Busch , Freek Daams , Geert Kazemier , Rutger-Jan Swijnenburg , Ulrich Beuers , Babs M. Zonderhuis , Roy L.J. van Wanrooij , Joris I. Erdmann , Rogier P. Voermans , Marc G. Besselink

{"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 , Anouk G. Overdevest , Jeska A. Fritzsche , Olivier R. Busch , Freek Daams , Geert Kazemier , Rutger-Jan Swijnenburg , Ulrich Beuers , Babs M. Zonderhuis , Roy L.J. van Wanrooij , Joris I. Erdmann , Rogier P. Voermans , 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}

引用次数: 0

Original articles: step-by-step decision-making for achieving oncologically acceptable but avoiding over-invasive surgery for gallbladder cancer 原文章：一步一步的决策实现肿瘤可接受，但避免过度侵入胆囊癌手术。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.10.014

Kyoji Ito, Yoshikuni Kawaguchi, Yujiro Nishioka, Akinori Miyata, Akihiko Ichida, Nobuhisa Akamatsu, Norihiro Kokudo, Kiyoshi Hasegawa

{"title":"Original articles: step-by-step decision-making for achieving oncologically acceptable but avoiding over-invasive surgery for gallbladder cancer","authors":"Kyoji Ito, Yoshikuni Kawaguchi, Yujiro Nishioka, Akinori Miyata, Akihiko Ichida, Nobuhisa Akamatsu, Norihiro Kokudo, 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}

引用次数: 0

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 术前门静脉和肝静脉栓塞增强肝功能容量的设置是预防胆道癌肝切除胆管切除术后严重并发症的关键。

IF 2.7 3区医学

Hpb Pub Date : 2025-02-01 DOI: 10.1016/j.hpb.2024.11.005

Kenichiro Araki, Akira Watanabe, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Shunsuke Kawai, Kei Hagiwara, Kouki Hoshino, Takaomi Seki, Norifumi Harimoto, Ken Shirabe

{"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, Akira Watanabe, Takamichi Igarashi, Mariko Tsukagoshi, Norihiro Ishii, Shunsuke Kawai, Kei Hagiwara, Kouki Hoshino, Takaomi Seki, Norifumi Harimoto, 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 < 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}

引用次数: 0

Artificial intelligence in the detection of choledocholithiasis: a systematic review 人工智能在胆总管结石检测中的应用：系统综述。

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.009

Joshua Blum , Lewis Wood , Richard Turner

{"title":"Artificial intelligence in the detection of choledocholithiasis: a systematic review","authors":"Joshua Blum , Lewis Wood , Richard Turner","doi":"10.1016/j.hpb.2024.09.009","DOIUrl":"10.1016/j.hpb.2024.09.009","url":null,"abstract":"<div><h3>Importance</h3><div>Choledocholithiasis is a potentially life-threatening manifestation of acute biliary dysfunction (ABD) often requiring magnetic resonance cholangiopancreatography (MRCP) for diagnosis when standard investigation findings are inconclusive. Machine learning models (MLMs) may offer alternatives to diagnose choledocholithiasis.</div></div><div><h3>Objective</h3><div>This systematic review seeks to evaluate the performance of MLMs in predicting choledocholithiasis and to compare this performance with the American Society of Gastrointestinal Endoscopy (ASGE) guidelines.</div></div><div><h3>Review</h3><div>This review adhered to PRISMA guidelines. Four databases were searched for relevant records published between January 2000 and April 2024. Two researchers appraised records. MLM performance and ASGE guideline efficacy were compared, and the clinical utility of MLMs was assessed.</div></div><div><h3>Findings</h3><div>408 records were screened; eight were eligible. Model accuracy ranged from 19 % to 97 %. Several records demonstrated a moderate-to-high risk of bias; of those featuring low risk of bias, peak accuracies ranged from 70 % to 85 %. Most MLMs outperformed ASGE guidelines. Important predictor variables included age, total bilirubin, and common bile duct diameter.</div></div><div><h3>Conclusions</h3><div>MLMs outperform ASGE guidelines in predicting choledocholithiasis. Nonetheless, biases in study design and reporting limit their prospective applicability. Current MLMs do not yet rival MRCP in detecting choledocholithiasis. Future guideline development should consider MLM-driven insights for better risk prediction.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 1-9"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464199","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}

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