Hpb最新文献_第9页

The left renal vein: the optimal interposition graft for pancreatic surgery?

IF 2.7 3区医学

Hpb Pub Date : 2025-01-17 DOI: 10.1016/j.hpb.2025.01.004

Ahmer Irfan, Peter Kim, Farah Ladak, David Chan, Sean Cleary, Carol-Anne Moulton, Gonzalo Sapisochin, Trevor Reichman, Chaya Shwaartz, Ian McGilvray

{"title":"The left renal vein: the optimal interposition graft for pancreatic surgery?","authors":"Ahmer Irfan, Peter Kim, Farah Ladak, David Chan, Sean Cleary, Carol-Anne Moulton, Gonzalo Sapisochin, Trevor Reichman, Chaya Shwaartz, Ian McGilvray","doi":"10.1016/j.hpb.2025.01.004","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.004","url":null,"abstract":"<p><strong>Background: </strong>Porto-mesenteric venous resection (PMVR) is employed for advanced pancreatic cancer. When primary anastomosis is not feasible, an interposition graft can be used. At our centre, the left renal vein (LRV) is the preferred choice.</p><p><strong>Methods: </strong>A retrospective analysis of patients undergoing pancreatic resection was performed over a 6-year period. Patients who underwent LRV harvest for a PMVR interposition graft were identified. All patients underwent a contrast-enhanced CT scan on post-operative day 1 to assess for portal vein thrombosis.</p><p><strong>Results: </strong>Pancreatic resection with PMVR was performed in 183 patients. LRV graft was used in 41 patients. Severe complications were observed in 10 patients. There were two deaths within 90 days of the index operation and six readmissions within 30 days of discharge. Post-operative PV thrombus was observed in 4 patients. The serum creatinine increased by 15.7 % on POD1 and peaked at 30.8 %. The majority of patients had returned to a serum creatinine within 10 % or better of their pre-operative creatinine.</p><p><strong>Conclusion: </strong>We present the largest series using the LRV as an interposition graft for PMVR. We propose that the LRV should be used as the first-choice interposition graft. This graft does not cause long-term renal dysfunction and avoids the morbidity of an additional incision.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143079182","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

Visual assessment of liver steatosis at retrieval predicts long term liver transplant outcomes in donation following circulatory death.

IF 2.7 3区医学

Hpb Pub Date : 2025-01-14 DOI: 10.1016/j.hpb.2025.01.007

Ning X Ho, Samuel J Tingle, Georgios Kourounis, Balaji Mahendran, Rebecca Bramley, Emily R Thompson, Aimen Amer, Rodrigo Figueiredo, Stuart McPherson, Steve White, Colin Wilson

{"title":"Visual assessment of liver steatosis at retrieval predicts long term liver transplant outcomes in donation following circulatory death.","authors":"Ning X Ho, Samuel J Tingle, Georgios Kourounis, Balaji Mahendran, Rebecca Bramley, Emily R Thompson, Aimen Amer, Rodrigo Figueiredo, Stuart McPherson, Steve White, Colin Wilson","doi":"10.1016/j.hpb.2025.01.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.007","url":null,"abstract":"<p><strong>Background: </strong>The demand for liver transplantation is rising, as is the prevalence of steatotic liver disease. Steatotic grafts have inferior outcomes post-transplantation, due to increased sensitivity to ischaemia-reperfusion injury. We aimed to formally evaluate the impact of visually assessed liver steatosis in grafts donated following brainstem (DBD) versus circulatory death (DCD).</p><p><strong>Methods: </strong>NHS registry on adult liver transplantation was reviewed retrospectively (2006-2019). We used multiple-imputation for missing data and adjusted regression models with interaction terms to compare the impact of visually assessed donor graft steatosis on transplant outcome.</p><p><strong>Results: </strong>9217 recipients of deceased donor grafts were included (DBD = 7349; DCD = 1868). Multivariable cox regression revealed that the negative impact on graft survival was significantly different in DCD and DBD livers (interaction P = 0.011 and P = 0.043). The largest impact was in DCD livers (moderate steatosis: aHR = 1.851, 1.296-2.645, P = 0.001 and aHR = 5.426; severe steatosis: 1.723-17.090, P = 0.004). Visually assessed steatosis did not predict longer-term graft survival in the DBD cohort.</p><p><strong>Conclusion: </strong>The impact of visually assessed steatosis on post-transplant outcome is far greater in DCD grafts, despite an identical method of steatosis assessment. This highlights novel therapeutics should be considered for steatotic DCD grafts to allow this growing sector of the donor pool to be safely utilised.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143370816","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

Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study.

IF 2.7 3区医学

Hpb Pub Date : 2025-01-07 DOI: 10.1016/j.hpb.2025.01.003

Wan S Cheung, Wong H She, Simon H Y Tsang, Wing C Dai, Albert C Y Chan, Tan T Cheung

{"title":"Comparison of radiofrequency ablation, microwave ablation and high-intensity focused ultrasound for hepatocellular carcinoma: a retrospective study.","authors":"Wan S Cheung, Wong H She, Simon H Y Tsang, Wing C Dai, Albert C Y Chan, Tan T Cheung","doi":"10.1016/j.hpb.2025.01.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.003","url":null,"abstract":"<p><strong>Background: </strong>The recommended first-line treatment for respectable hepatocellular carcinoma (HCC) is surgical resection, but local ablation has gained popularity as a safe alternative. This study aims to compare the effectiveness of radiofrequency ablation (RFA), microwave ablation (MWA) and high-intensity focused ultrasound (HIFU) as first-line treatments for HCC.</p><p><strong>Methods: </strong>In this single-centre retrospective study, 352 patients receiving RFA, MWA, or HIFU as first-line treatment for HCC were included. Pre- and post-treatment tumour sizes and overall and disease-free survival rates were analysed to compare the three local ablation modalities. Propensity-score matching was used to reduce the bias due to differences in pre-treatment liver function.</p><p><strong>Results: </strong>Patients receiving HIFU had significantly higher pre-treatment MELD score and Child-Pugh grade. The complete response rates of HIFU patients were significantly lower than those of RFA and MWA groups (p < 0.001) despite propensity-score matching. However, the three groups had similar disease-free survival (p = 0.216) and comparable one-year survival (p = 0.173).</p><p><strong>Discussion: </strong>HIFU serves as a last resort rescue therapy for patients with poor pre-treatment liver function who are not eligible for other local ablative means. Despite the low complete response rate, the overall survival and disease-free survival rates of patients having HIFU were comparable to those having RFA or MWA.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023280","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

Highlights in this issue

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/S1365-182X(24)02438-9

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}

引用次数: 0

Learning curve in robotic liver surgery: easily achievable, evolving from laparoscopic background and team-based 机器人肝脏手术的学习曲线：容易实现，从腹腔镜背景发展而来，以团队为基础。

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.007

Francesca Ratti , Sara Ingallinella , Marco Catena , Diletta Corallino , Rebecca Marino , Luca Aldrighetti

{"title":"Learning curve in robotic liver surgery: easily achievable, evolving from laparoscopic background and team-based","authors":"Francesca Ratti , Sara Ingallinella , Marco Catena , Diletta Corallino , Rebecca Marino , Luca Aldrighetti","doi":"10.1016/j.hpb.2024.10.007","DOIUrl":"10.1016/j.hpb.2024.10.007","url":null,"abstract":"<div><h3>Background</h3><div>Limited and heterogeneous literature data necessitate a focused examination of the learning curve in robotic liver resections. This study aims to assess the learning curve of two surgeons from the same team with differing laparoscopic backgrounds.</div></div><div><h3>Methods</h3><div>Since February 2021, San Raffaele Hospital in Milan has implemented a robotic liver surgery program, performing 250 resections by three trained console surgeons. Using cumulative sum (CUSUM) analysis, the learning curve was evaluated for a Pioneer Surgeon (PS) with around 1200 laparoscopic cases and a New Generation Surgeon (NGS) with approximately 100 laparoscopic cases. Cases were stratified by complexity (38 low, 74 intermediate, 85 high).</div></div><div><h3>Results</h3><div>Both PS and NGS demonstrated a learning curve for operative time after 15 low-complexity and 10 intermediate-complexity cases, with high-complexity learning curves apparent after 10 cases for PS and 18 cases for NGS. Conversion rates remained unaffected, and neither surgeon experienced increased blood loss or postoperative complications. A “team learning curve” effect in terms of operative time emerged after 12 cases, suggesting the importance of a cohesive surgical team.</div></div><div><h3>Conclusion</h3><div>The robotic platform facilitated a relatively brief learning curve for low and intermediate complexity cases, irrespective of laparoscopic background, underscoring the benefits of team collaboration.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 45-55"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142590681","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

Is robotic liver resection feasible in patients with lesions in close proximity to major vessels? A propensity score matching analysis 病变靠近大血管的患者是否可行机器人肝脏切除术？倾向得分匹配分析

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.010

Edoardo M. Muttillo , Leonardo L. Chiarella , Francesca Ratti , Paolo Magistri , Andrea Belli , Giammauro Berardi , Giuseppe M. Ettorre , Graziano Ceccarelli , Francesco Izzo , Marcello G. Spampinato , Nicola De Angelis , Patrick Pessaux , Tullio Piardi , Fabrizio Di Benedetto , Luca Aldrighetti , Riccardo Memeo

{"title":"Is robotic liver resection feasible in patients with lesions in close proximity to major vessels? A propensity score matching analysis","authors":"Edoardo M. Muttillo , Leonardo L. Chiarella , Francesca Ratti , Paolo Magistri , Andrea Belli , Giammauro Berardi , Giuseppe M. Ettorre , Graziano Ceccarelli , Francesco Izzo , Marcello G. Spampinato , Nicola De Angelis , Patrick Pessaux , Tullio Piardi , Fabrizio Di Benedetto , Luca Aldrighetti , Riccardo Memeo","doi":"10.1016/j.hpb.2024.09.010","DOIUrl":"10.1016/j.hpb.2024.09.010","url":null,"abstract":"<div><h3>Introduction</h3><div>Robotic surgery is widely diffused in the surgical field and is becoming increasingly prevalent, however several aspects need more detailed assessment. One of them concerns the role of robotic liver surgery for lesions in contact with major vascular (CMV) pedicles. The aim of our study is to evaluate and compare intra and post operative outcomes in patients undergoing robotic liver resections between lesions in contact or free from major vessels.</div></div><div><h3>Methods</h3><div>A multicentric retrospective study was performed including 1030 patients who underwent robotic liver resection. Patients were divided into two groups according to vascular contact. Intra and post-operative outcomes were compared between the groups before and after Propensity Score Matching.</div></div><div><h3>Results</h3><div>After propensity score matching 889 patients were included in the study. Among these lesions, 595 were not in contact with major vessels (NCMV) and 294 were in contact with major vessels (CMV). Use of Pringle Manoeuvre was more associated with CMV resections (49.8 % vs 31.2 %, p = 0,0001). No differences in terms of operative time, conversion rate, morbidity and type of complications were observed after PSM.</div></div><div><h3>Conclusion</h3><div>The presents study shows how robotic surgery is a valid and safe technique also for resection of tumors close to vascular pedicles.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 21-28"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142464201","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

Combined division of the splenic vessels and pancreatic parenchyma during laparoscopic distal pancreatectomy is a safe alternative to separate division: a single-institution retrospective study 腹腔镜胰腺远端切除术中合并分割脾血管和胰腺实质是一种安全的替代单独分割的方法：一项单一机构的回顾性研究。

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.002

Kareem Sadek, Andrew Shaker, Mary Tice, John A. Stauffer

{"title":"Combined division of the splenic vessels and pancreatic parenchyma during laparoscopic distal pancreatectomy is a safe alternative to separate division: a single-institution retrospective study","authors":"Kareem Sadek, Andrew Shaker, Mary Tice, John A. Stauffer","doi":"10.1016/j.hpb.2024.10.002","DOIUrl":"10.1016/j.hpb.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Limited data exists regarding the safety and outcomes of combined division of the splenic vessels with the pancreatic parenchyma during laparoscopic distal pancreatectomy (LDP). This study aims to evaluate the combined division technique.</div></div><div><h3>Methods</h3><div>Patients who underwent LDP for pancreatic cancer from April 2011 to December 2022 were retrospectively reviewed and categorized into the following groups: combined (CV) versus separate (SV) division of the splenic vein; combined (CA) versus separate (SA) division of the splenic artery; and combined (CAV) versus separate (SAV) division of the splenic artery and vein, with or without the pancreatic parenchyma.</div></div><div><h3>Results</h3><div>Among the 80 patients included, 44 underwent CV and 36 underwent SV. Operative time and major morbidity were significantly lower in CV compared with SV. Similar findings were observed in CAV versus SAV, as well as lower blood loss in CAV. Operative time was significantly lower in CA versus SA. Pancreatic fistula and postpancreatectomy hemorrhage rates showed no significant differences between groups. No patient developed splenic arteriovenous fistula in follow-up.</div></div><div><h3>Conclusion</h3><div>Combined division of the splenic vessels with the pancreatic parenchyma during LDP is safe and associated with improved outcomes compared with separate division.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 80-86"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142619352","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

Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer 对 17,183 名胰腺癌患者进行胰腺切除术后一年死亡率的全国性分析。

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.011

Ugo Marchese , Xavier Lenne , Gaanan Naveendran , Stylianos Tzedakis , Martin Gaillard , Yasmina Richa , Laurent Boyer , Didier Theis , Amelie Bruandet , Stephanie Truant , David Fuks , Mehdi EL Amrani

{"title":"Nationwide analysis of one-year mortality following pancreatectomy in 17,183 patients with pancreatic cancer","authors":"Ugo Marchese , Xavier Lenne , Gaanan Naveendran , Stylianos Tzedakis , Martin Gaillard , Yasmina Richa , Laurent Boyer , Didier Theis , Amelie Bruandet , Stephanie Truant , David Fuks , Mehdi EL Amrani","doi":"10.1016/j.hpb.2024.10.011","DOIUrl":"10.1016/j.hpb.2024.10.011","url":null,"abstract":"<div><h3>Background</h3><div>The use of 1-year mortality following pancreatectomy for PDAC as a measure of surgical quality has not been evaluated. We aim to i) assess the 1-year mortality rate following pancreatectomy for PDAC, and ii) identify patient and hospital characteristics associated with 1-year mortality.</div></div><div><h3>Methods</h3><div>Data was extracted retrospectively from the French national medico-administrative database. The study included patients who underwent pancreatectomy for PDAC between January 2012 and December 2019. The primary outcome was 1-year postoperative mortality. Hospitals were classified based on volume (high (≥26 resections/year) and low volume (<26)).</div></div><div><h3>Results</h3><div>Overall, 17,183 patients who underwent pancreatectomy for PDAC were included. The overall 90-day and 1-year mortalities were 6.5 % and 21.5 %, respectively. 1-year mortality varied significantly between low and high-volume hospitals (23.6 % vs. 18.6 %, respectively, <em>p</em> < 0.001). Older age, Charlson Comorbidity Index (CCI), readmission, major complications were predictive factors for 1-year mortality. Pancreatectomy in low volume hospitals increased the risk of 1-year mortality by 1.23-fold (OR = 1.23, 95 % CI [1.15–1.32], <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>The overall 1-year mortality after pancreatectomy for PDAC was 21.5 %, and was higher in patients of older age, with higher comorbidities, who experienced major complications, and who did not receive adjuvant therapy. Management in high-volume centers decreased mortality rates, regardless of the patient’s condition.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 123-129"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638824","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

Prognostic value of resection margin and lymph node status in perihilar cholangiocarcinoma 肝周胆管癌切除边缘和淋巴结状态的预后价值

IF 2.7 3区医学

Hpb Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.012

Faruk Koca , Ekaterina Petrova , Hanan El Youzouri, Jan Heil, Michael Heise, Svenja Sliwinski, Wolf O. Bechstein, Andreas A. Schnitzbauer

{"title":"Prognostic value of resection margin and lymph node status in perihilar cholangiocarcinoma","authors":"Faruk Koca , Ekaterina Petrova , Hanan El Youzouri, Jan Heil, Michael Heise, Svenja Sliwinski, Wolf O. Bechstein, Andreas A. Schnitzbauer","doi":"10.1016/j.hpb.2024.09.012","DOIUrl":"10.1016/j.hpb.2024.09.012","url":null,"abstract":"<div><h3>Background</h3><div>The impact of resection margin and lymph node status on survival in patients undergoing resection for perihilar cholangiocarcinoma (pCCA) is controversial. The aim of this study was to investigate the influence of nodal and resection margin status on long-term survival after resection for pCCA.</div></div><div><h3>Methods</h3><div>Retrospective analysis of patients resected for pCCA at the University Hospital Frankfurt, Germany between 1999 and 2022. The patients were categorized in four groups according to resection margin (R) and nodal status (N). Survival was analyzed with univariable and multivariable Cox regression.</div></div><div><h3>Results</h3><div>Out of 123 patients, 100 with long-term survival were included in the survival analysis. In the univariable analysis, negative resection margin (p = 0.02) and lower grade (p = 0.004) were the only significant positive prognostic factors, while the difference between N0 and N+ was not statistically significant (p = 0.062). Median survival in the groups R0N0, R0N+, R + N0 and R+N+ groups was 40.1, 29.9, 18.4 and 18.9 months, respectively (p = 0.03). In the multivariable analysis, after adjusting for grade, nodal and resection margin status, only grade and resection margin had prognostic significance.</div></div><div><h3>Conclusion</h3><div>Patients with negative resection margin after resection for pCCA have a better prognosis, regardless of the presence of lymph node metastases.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 1","pages":"Pages 71-79"},"PeriodicalIF":2.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142499457","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