{"title":"Diagnostic yields and clinical impact of endoscopic ultrasound-guided tissue acquisition for biliary lesions.","authors":"Daiki Agarie, Susumu Hijioka, Yoshikuni Nagashio, Daiki Yamashige, Kohei Okamoto, Shin Yagi, Soma Fukuda, Shota Harai, Kazuko Yamamoto, Takuji Okusaka","doi":"10.1002/jhbp.12143","DOIUrl":"https://doi.org/10.1002/jhbp.12143","url":null,"abstract":"<p><strong>Background/purpose: </strong>Diagnostic yields of endoscopic ultrasound-guided tissue acquisition (EUS-TA) for biliary lesions have not been fully established due to limited evidence. We aimed to clarify the efficacy of EUS-TA for biliary lesions.</p><p><strong>Methods: </strong>Diagnostic yields and adverse event rates of EUS-TA for biliary lesions were evaluated. The subject cases were only limited to cases in which the biliary lesions itself was punctured. Diagnostic yields of endoscopic retrograde cholangiography (ERC)-guided biopsy/cytology performed within the same period were also evaluated to assess the additional effect of EUS-TA.</p><p><strong>Results: </strong>EUS-TA was attempted in 71 cases (28 hilar bile duct, 19 distal bile duct, 4 ampulla of Vater, and 20 gallbladder), and the final diagnosis was malignant in 54 cases (76.1%). The sensitivity, specificity, and accuracy of EUS-TA were 96.3% (52/54), 100% (17/17), and 97.2% (69/71), respectively. Adverse events were observed in one case (1.4%, peritonitis). The accuracy of ERC biopsy/cytology was 82.5% (212/257 cases); additional EUS-TA diagnosed 30 cases as malignant additionally and improved the accuracy (94.2%; 242/257 cases; p < .01).</p><p><strong>Conclusions: </strong>EUS-TA is an accurate and safe diagnostic test for biliary lesions. The addition of EUS-TA may be considered when there is a suspicion of a false-negative ERC result.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764046","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}
Dharmenaan Palamuthusingam, Carmel M Hawley, Elaine M Pascoe, David Wayne Johnson, Palvannan Sivalingam, Simon T Wood, Pranavan Palamuthusingam, Matthew D Jose, Magid Fahim
{"title":"Operative and nonoperative management of acute cholecystitis in patients on chronic kidney replacement therapy.","authors":"Dharmenaan Palamuthusingam, Carmel M Hawley, Elaine M Pascoe, David Wayne Johnson, Palvannan Sivalingam, Simon T Wood, Pranavan Palamuthusingam, Matthew D Jose, Magid Fahim","doi":"10.1002/jhbp.12133","DOIUrl":"https://doi.org/10.1002/jhbp.12133","url":null,"abstract":"<p><strong>Background: </strong>Patients with kidney failure receiving chronic kidney replacement therapy (KRT: dialysis or kidney transplantation) have increased risks of postoperative mortality and morbidity. This study assesses the outcomes of acute cholecystitis in patients on chronic KRT who undergo cholecystectomy compared to nonoperative management.</p><p><strong>Methods: </strong>This bi-national population cohort study evaluated all incident and prevalent patients receiving chronic KRT using linked data between Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry and jurisdictional hospital admission datasets between 2000 and 2015. Patients with a primary diagnosis of acute cholecystitis were identified using the International Classification of Diseases (ICD) and were divided into two groups: patients who underwent cholecystectomy and those who received nonoperative management. Comorbidity-adjusted Cox models were used to determine the associations of cholecystectomy with 30-day and 12-month mortality.</p><p><strong>Results: </strong>From the 46 779 patients on chronic KRT, there were 1520 patients with an initial emergency presentation of acute cholecystitis, of whom 87% received nonoperative management. Thirty-day mortality risk was no different between the two groups (5.4 vs. 5.1%, p = .83). Despite higher odds for nonfatal outcomes including composite cardiovascular complications (MI, CVA, cardiac arrest: OR 2.08, 95% CI (1.13-3.81)), ICU admission (OR 3.51, 95% CI (2.41-5.10)), and blood transfusions (OR 2.29, 95% CI (1.60-3.27)), surgery was associated with improved survival at 12 months compared with nonoperative management (HR 0.61, 95% CI (0.43-0.87)). Patients who received nonoperative management had a higher 30-day readmission rate (17.6 vs. 12.5%, p = .44).</p><p><strong>Conclusions: </strong>In patients with acute cholecystitis, compared with nonoperative management, surgery was associated with better survival at 12 months but higher rates of early morbidity.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143700541","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":"Comparable impact of lymph node metastases in T2 gallbladder cancer on postoperative prognosis irrespective of the extent of the metastases: A retrospective analysis.","authors":"Yoji Kishi, Teiichi Sugiura, Takashi Mizuno, Hiromichi Ito, Yu Takahashi, Takehiro Noji, Yuta Abe, Shimpei Otsuka, Shoji Kawakatsu, Asayo Kato, Masayuki Tanaka, Tomoki Ebata, Satoshi Hirano","doi":"10.1002/jhbp.12140","DOIUrl":"https://doi.org/10.1002/jhbp.12140","url":null,"abstract":"<p><strong>Background: </strong>Lymph node metastases beyond the hepatoduodenal ligament are sometimes encountered in locally limited T2 gallbladder cancer (GBCA). However, the incidence and impact on prognosis remain unclear.</p><p><strong>Methods: </strong>This was a retrospective multi-institutional study of patients who underwent surgical resection for GBCA from 2002 to 2022. The eighth edition of the Union for International Cancer Control staging was used for tumor-node-metastasis categorization. The lymph node location was classified as follows: (A) along the hepatoduodenal ligament and common hepatic artery; (B) posterior side of the pancreatic head; and (C) others. Metastasis to regions A, B, and C nodes was denoted as Na, Nb, and Nc, respectively.</p><p><strong>Results: </strong>Data for 379 patients (pT1, 29; pT2, 162: pT3, 141; and pT4, 47) were evaluated; none with pT1 GBCA had node metastasis. For N1/2 GBCA, the proportion of patients with N2 disease increased with increasing T grade (p = .001), while the proportions of patients with Na, Nb, and Nc disease were comparable between pT2 (61%, 26%, and 13%), pT3 (63%, 26%, and 12%), and pT4 (50%, 38%, and 12%) disease (p = .681), respectively. Overall survival for pT2N1/2 disease (5 years, 43.8%) was comparable to that for pT3/4N0 disease (5 years, 37.2%; p = .192). Among patients with node-positive pT2 disease, overall survival was comparable for Na, Nb, and Nc disease, with 5-year survivals of 46%, 43%, and 31%, respectively (p = .346).</p><p><strong>Conclusion: </strong>Region B or C node metastasis was not rare even in pT2 GBCA. Regarding survival outcomes, pT2 node-positive GBCA should be considered advanced disease irrespective of the extent of node metastasis.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692343","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":"Impact of the COVID-19 pandemic on the short-term outcomes after advanced liver resections performed in institutions certificated by Japanese Society of Hepato-Biliary-Pancreatic Surgery: Results from the Japanese National Clinical Database, 2018-2022.","authors":"Yusuke Takemura, Hideki Endo, Taizo Hibi, Ryo Seishima, Masashi Takeuchi, Hiroyuki Yamamoto, Hiromichi Maeda, Kazuhiro Hanazaki, Akinobu Taketomi, Yoshihiro Kakeji, Yasuyuki Seto, Hideki Ueno, Itaru Endo, Masayuki Ohtsuka, Masaki Mori, Ken Shirabe, Yuko Kitagawa","doi":"10.1002/jhbp.12141","DOIUrl":"https://doi.org/10.1002/jhbp.12141","url":null,"abstract":"<p><strong>Purpose: </strong>This study aimed to investigate the effects of the coronavirus disease 2019 pandemic on morbidity and mortality after advanced hepatectomy by surgical volume in Japan.</p><p><strong>Methods: </strong>Data from patients who underwent advanced hepatectomy between 2018 and 2022 from the Japanese National Clinical Database were collected. The transition of the number of hepatectomies and changes in risk-adjusted mortality and major complication rates based on the type of institutions certified by the Japan Society of Hepato-Biliary-Pancreatic Surgery were investigated.</p><p><strong>Results: </strong>A total of 33 454 cases were included. The number of advanced hepatectomies gradually decreased, whereas the proportion of hepatectomies performed in certified institutions increased (from 63.4% in 2018 to 71.3% in 2022). Although the major complication rate in institution A was higher than that in institution B or noncertified institutions (16.3% vs. 14.5% vs. 13.5%), the in-hospital mortality rate was consistently favorable in the order of institution A, institution B, and noncertified institutions (1.4% vs. 2.0% vs. 2.8%). The monthly standardized mortality and major complication ratios did not significantly increase mostly throughout the pandemic, regardless of the institution type.</p><p><strong>Conclusions: </strong>The centralization to certified institutions progressed even during the pandemic. Surgical safety after advanced hepatectomy was satisfactorily maintained in any institution.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143692435","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":"Prognostic factors and clinical significance of preoperative systemic therapy in patients with borderline resectable hepatocellular carcinoma: A JSHBPS project study 2023, Part 2.","authors":"Junichi Shindoh, Masaru Matsumura, Shohei Komatsu, Takumi Fukumoto, Akihiko Ichida, Kiyoshi Hasegawa, Takamichi Ishii, Etsuro Hatano, Masafumi Nakamura, Masayuki Ohtsuka","doi":"10.1002/jhbp.12138","DOIUrl":"https://doi.org/10.1002/jhbp.12138","url":null,"abstract":"<p><strong>Purpose: </strong>To explore factors influencing the prognosis in patients with borderline-resectable hepatocellular carcinoma (BR-HCC) undergoing surgery.</p><p><strong>Methods: </strong>The clinical data of patients with BR-HCC according to the definition in the Expert Consensus Statement 2023 were collected from board-certified HPB training centers and analyzed in detail.</p><p><strong>Results: </strong>Data of a total of 1509 patients with BR-HCC (BR1, n = 718 and BR2, n = 791) who underwent surgery were collected. The 5-year disease-specific survival rate (DSS) and 3-year recurrence-free survival rate (RFS) were determined as 40.8% and 19.7%, respectively. Multivariate analysis identified the oncological resectability category (i.e., BR2 vs. BR1) as a significant prognostic factor, and also the number of criteria fulfilled for classification into BR2 disease as being predictive of the DSS (hazard ratio (HR) [95% CI]: one factor: 1.32 [1.13-1.54]; two to three factors: 1.51 [1.15-1.96]). Preceding systemic therapy was significantly correlated with a longer DSS (HR, 0.41: 95% CI, 0.18-0.91) and RFS (HR, 0.80: 95% CI, 0.66-0.97) in the patients with BR1 disease, while its clinical significance was unclear in the patients with BR2 disease.</p><p><strong>Conclusion: </strong>Multicenter data confirm the clinical relevance of the oncological resectability category and the potential advantage of preceding systemic therapy in a specific group of BR-HCC.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143657360","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":"Reply to the Letter to the Editor.","authors":"Shota Ebinuma, Yuichi Imanaka","doi":"10.1002/jhbp.12130","DOIUrl":"https://doi.org/10.1002/jhbp.12130","url":null,"abstract":"","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649168","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":"A questionnaire survey to explore the current treatment policies adopted for patients with advanced hepatocellular carcinoma at board-certified HPB training institutions in Japan: A JSHBPS project study 2023, Part 1.","authors":"Junichi Shindoh, Masaru Matsumura, Satoshi Okubo, Takuma Okada, Masaji Hashimoto, Masafumi Nakamura, Masayuki Ohtsuka","doi":"10.1002/jhbp.12139","DOIUrl":"https://doi.org/10.1002/jhbp.12139","url":null,"abstract":"<p><strong>Purpose: </strong>To clarify the views of expert hepatobiliary surgeons on the management of advanced hepatocellular carcinoma (HCC) in real-world clinical practice.</p><p><strong>Methods: </strong>A questionnaire survey was conducted of Japanese board-certified HPB training centers.</p><p><strong>Results: </strong>A total of 100 centers responded to the survey. For solitary large (>10 cm) lesions, 77% of the respondents selected upfront surgery, while an increasing number of respondents selected combined therapy with atezolizumab + bevacizumab as the treatment of first choice as the number of lesions increased. In regard to the treatment of patients with vascular invasion, the proportion of respondents who selected systemic therapy with the intent to \"potential conversion\" surgery increased according to the extent of tumor thrombosis, while only a limited number of respondents excluded these groups of patients from potential surgical indications. As for the initial treatment for extrahepatic spread, consideration of systemic conversion therapy was the most commonly selected option, while upfront surgery was frequently selected for right adrenal metastasis (50%) and solitary hilar node involvement (35%).</p><p><strong>Conclusions: </strong>The present survey clarified the current clinical approaches for the treatment of advanced HCC at HPB training centers. Future analysis, including survival outcomes, would offer important insights into the optimal management of advanced HCC.</p>","PeriodicalId":16056,"journal":{"name":"Journal of Hepato‐Biliary‐Pancreatic Sciences","volume":" ","pages":""},"PeriodicalIF":3.2,"publicationDate":"2025-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143649138","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}