Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"Extended versus simple cholecystectomy for pathologic T1b gallbladder cancer: A systematic review and meta-analysis.","authors":"In Soo Cho, Keun Soo Ahn, So Hyeon Gwon, Nak-Hoon Son, Tae-Seok Kim, Min Jae Kim, Yong Hoon Kim","doi":"10.14701/ahbps.26-091","DOIUrl":"https://doi.org/10.14701/ahbps.26-091","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The optimal surgical approach for pathologic T1b gallbladder cancer (GBC) is debated, with conflicting data on whether extended cholecystectomy (EC) offers a survival advantage over simple cholecystectomy (SC). To address this, we performed a systematic review and meta-analysis comparing oncologic outcomes between EC and SC specifically in patients with pathologically confirmed T1b GBC.</p><p><strong>Methods: </strong>We searched MEDLINE, Embase, and the Cochrane database from their inception to July 2025. We included studies that compared EC to SC in pT1b GBC and reported overall survival (OS), disease-specific survival (DSS), or recurrence rate. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pool7ed using fixed- or random-effects models, depending on heterogeneity. The ROBINS-I tool was used to assess the risk of bias. This study is registered with PROSPERO (CRD42024498316).</p><p><strong>Results: </strong>Our analysis included 26 non-randomized comparative cohorts, comprising 1,316 patients. No study was deemed to have a low risk of bias (11 were moderate, 16 serious). EC was linked to significantly better 5-year OS compared to SC (HR 0.48; 95% CI 0.33-0.70; <i>p</i> = 0.0001; I² = 53%), with consistent results across institutional and registry-based subgroups, as well as geographic regions. However, no statistically significant differences were found in 5-year DSS (HR 0.73; 95% CI 0.41-1.28; <i>p</i> = 0.27) or recurrence-free survival (RFS) (RR 0.75; 95% CI 0.57-1.00; <i>p</i> = 0.0504).</p><p><strong>Conclusions: </strong>While EC was associated with improved OS in pT1b GBC, it did not demonstrate a benefit for DSS or recurrence rate. Given the inherent limitations of the retrospective evidence, these findings advocate for a risk-adapted surgical strategy and highlight the critical need for prospective studies with standardized operative and pathologic definitions.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148868132","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of dual hepatic and portal vein embolization on future liver remnant function and volume prior to major hepatectomy.","authors":"Ananya Nayak, Anitha Muthusami, Michael Wilson, Salil Karkhanis, Homoyon Mehrzad, Khalid Hussain, Ramanivas Sundareyan, Robert Peter Sutcliffe, Ravi Marudanayagam, Keith John Roberts, Nikolaos Chatzizacharias, David Christopher Bartlett, Alicja Psica, Syed Soulat Raza, Bobby V M Dasari","doi":"10.14701/ahbps.26-092","DOIUrl":"10.14701/ahbps.26-092","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Dual hepatic and portal vein embolization, also known as dual venous embolization (DVE), is a potentially superior alternative to portal vein embolization for enhancing liver regeneration prior to major hepatectomy. This study evaluates the impact of DVE on the kinetic growth rate (KGR), volume increase (VI), functional increase (FI), and the correlation between volume and functional changes in the future liver remnant (FLR).</p><p><strong>Methods: </strong>Patients who underwent DVE with pre- and post-procedure volume and functional assessments were included. Growth rates of FLR volume and function were assessed using Tc99-mebrofenate single-photon emission computed tomography-computed tomography (Tc99-m SPECT-CT) scans. Correlation coefficients (R) were calculated to evaluate the relationship between VI and FI.</p><p><strong>Results: </strong>Among the 37 patients included, 27 proceeded to definitive surgery. The median time between DVE and the functional scan was 33 days (interquartile range [IQR], 13-69). The median increase in FLR volume was 30% (IQR, 14-50), and FLR function increased by 75% (IQR, 25-122) (<i>p</i> = 0.004). Median KGR (volume) was 6% (IQR, 3%-12%), and KGR (function) was 15% (IQR, 7%-23%) (<i>p</i> = 0.001). Pearson's correlation coefficient between VI and FI was 0.179 (confidence interval, 0.15-0.48). Functional resectability was achieved in 35 patients.</p><p><strong>Conclusions: </strong>The increase in FLR function following DVE is significantly greater than the increase in volume. Earlier SPECT-CT scans may reduce delays to surgery and warrant further investigation.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"317-322"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical significance and outcomes of left-sided gallbladder for cholecystectomy: A retrospective cohort study based on 12-year single-center experience.","authors":"Hong Seok Han, Seung Hwan Lee, Geun Hyeok Yang, Sun-Hyung Joo, Hyun Cheol Kim","doi":"10.14701/ahbps.26-125","DOIUrl":"10.14701/ahbps.26-125","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Left-sided gallbladder (LSG) is a rare biliary anomaly where the gallbladder (GB) is situated to the left of the ligamentum teres, without situs inversus. Most cases are not preoperatively identified during routine evaluations, which tend to focus more on surgical pathology than detailed anatomical variations. This study investigated the clinical implications of LSG in patients undergoing cholecystectomy.</p><p><strong>Methods: </strong>We retrospectively reviewed 7,487 consecutive cholecystectomies performed at a single center between June 2014 and October 2025. LSG was confirmed by intraoperative findings and operative photographs/videos. The indication for surgery, operative time, GB perforation, drain insertion, and postoperative complications were assessed and compared with non-LSG cases.</p><p><strong>Results: </strong>LSG was identified in 23 patients (0.3%). Mean operative time was comparable between LSG and non-LSG groups (43.5 vs. 42.4 min, <i>p</i> = 0.845). GB perforation rates were similar (17.4% vs. 17.8%, <i>p</i> = 0.964). Drain insertion was less frequent in LSG patients, although this did not reach statistical significance (8.7% vs. 27.3%, <i>p</i> = 0.046; continuity-corrected <i>p</i> = 0.078). No intraoperative or postoperative complications, including bile duct injury, occurred in the LSG group. Preoperative imaging failed to diagnose any case of LSG.</p><p><strong>Conclusions: </strong>The incidence of LSG (0.3%) in our series was consistent with previous reports. Standard laparoscopic cholecystectomy can be performed in most LSG cases. Nonetheless, surgeons should remain alert to the possibility of associated biliary or vascular anomalies to ensure safe dissection.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"352-359"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148665295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left hepatectomy for chronic biopsy-induced intrahepatic arterioportal fistula with aneurysmal degeneration.","authors":"Evangelia Florou, Michail Pizanias, Pauline Kane, Parthi Srinivasan, Andreas Prachalias","doi":"10.14701/ahbps.26-061","DOIUrl":"10.14701/ahbps.26-061","url":null,"abstract":"<p><p>Arterioportal fistula (APF) is a rare complication of percutaneous liver biopsy. While most biopsy-induced shunts are asymptomatic and resolve on their own, persistent high-flow lesions can lead to progressive vascular remodeling, creating significant management challenges. A 49-year-old woman presented 17 years after undergoing a percutaneous liver biopsy, complaining of a pulsatile epigastric mass. Computed tomography revealed a large aneurysmal intrahepatic APF involving the middle hepatic artery and left portal vein. Due to the complexity of the anatomy and concerns about portal perfusion, endovascular embolization was not pursued. Instead, the patient underwent a formal left hepatectomy, which effectively controlled the fistulous area. Histopathological examination confirmed chronic arterialization of portal venous structures, accompanied by fibromyxoid intimal thickening, consistent with long-standing high-flow shunting. This case illustrates the delayed progression of biopsy-induced APF and emphasizes that hepatic resection is a definitive and safe option for anatomically complex lesions when embolization is not feasible. Careful preoperative mapping of arterial inflow and portal venous outflow is essential for effective operative planning and safe resection in complex APFs.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"393-398"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147790647","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pre-operative neutrophil-to-lymphocyte ratio significantly predicts local recurrence in pancreatic ductal adenocarcinoma.","authors":"Alwin Puthiyakunnel Saji, Bhamini Vadhwana, Manaal Bharadia, Madhava Pai, Duncan Spalding","doi":"10.14701/ahbps.26-101","DOIUrl":"10.14701/ahbps.26-101","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Recurrence rates in patients with resected pancreatic ductal adenocarcinoma (PDAC) remain high, posing a significant clinical challenge. Pre-operative neutrophil-to-lymphocyte ratio (NLR) has shown promise as a prognostic marker in various cancers. NLR's role in PDAC recurrence has not been widely explored. This study aims to investigate the effect of pre-operative NLR on post-operative PDAC recurrence.</p><p><strong>Methods: </strong>A retrospective analysis was performed on patients who underwent surgery with curative intent for PDAC between 2015 and 2024. Patients were divided into two groups (high and low) using an NLR threshold of 3. Primary outcome was disease recurrence. The predictive value of NLR was compared using receiver operating characteristic curves and univariable and multivariable Cox regression models.</p><p><strong>Results: </strong>125 Patients were included; high NLR group n = 53 and low NLR group n = 72. Both groups were well balanced across all baseline characteristics. NLR is a strong predictor of recurrence compared to platelet-to-lymphocyte ratio (PLR) (AUC: NLR 0.716 vs. PLR 0.593, <i>p</i> = 0.022). The high NLR group had a significantly greater recurrence rate compared to the low NLR group (62.3% vs. 31.9%, <i>p</i> = 0.002) and a significantly greater local recurrence rate (43.4% vs. 19.4%, <i>p</i> = 0.004). A high NLR remains a significant negative prognosticator for recurrence in univariable (hazard ratio [HR] 2.540, <i>p</i> < 0.001) and multivariable analysis (HR 2.817, <i>p</i> < 0.001).</p><p><strong>Conclusions: </strong>A high pre-operative NLR (> 3) was associated with significantly greater risk of recurrence, especially local recurrence. NLR may be used within risk stratification models to identify patients at risk of PDAC recurrence.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"374-384"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490740/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148563879","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bile duct segmental resection versus pancreaticoduodenectomy for middle-third extrahepatic cholangiocarcinoma: A propensity-matched, single-center retrospective analysis.","authors":"Su Hyung Park, Ji Su Kim, Yeon Su Kim, Seung Soo Hong, Sung Hyun Kim, Chang Moo Kang, Kyung Sik Kim, Ho Kyoung Hwang","doi":"10.14701/ahbps.26-068","DOIUrl":"10.14701/ahbps.26-068","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The optimal surgical approach for middle-third extrahepatic cholangiocarcinoma (MCC)-bile duct segmental resection (BDSR) or pancreaticoduodenectomy (PD)-remains controversial. This study aimed to compare the short- and long-term outcomes of BDSR and PD in patients with MCC.</p><p><strong>Methods: </strong>We retrospectively analyzed 570 patients who underwent curative-intent surgery for MCC between January 2010 and December 2022. Clinicopathological characteristics, surgical outcomes, and oncologic outcomes (progression-free survival [PFS] and overall survival [OS]) were compared after 1:3 propensity score matching.</p><p><strong>Results: </strong>Among 570 patients, 112 underwent BDSR and 458 PD. After propensity score matching, BDSR showed shorter operative time and hospital stay (both <i>p</i> < 0.001), but fewer retrieved lymph nodes and higher local recurrence rates (both <i>p</i> < 0.001). PFS was inferior after BDSR (27.4 vs. 34.3 months, <i>p</i> = 0.004), whereas OS was comparable (36.7 vs. 55.5 months, <i>p</i> = 0.117). In patients with R0 resection, both PFS and OS were similar between groups.</p><p><strong>Conclusions: </strong>BDSR may offer perioperative advantages over PD, but is associated with inferior PFS, with no significant difference in OS. In patients who achieved R0 resection, the PFS and OS did not reach statistical significance. This suggests that BDSR should be considered only in highly selected patients in whom R0 resection is achievable.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"331-340"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490727/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Feasibility of using head up patient position in maintaining low central venous pressure and restricting the need for pharmacological agents during major hepatectomy.","authors":"Sundeep Jain, Deepak Kumar Gupta, Akhil Agarwal, Anjali Nigam, Jyotsna Bhargava, Rajeev Gupta, Shubham Agarwal","doi":"10.14701/ahbps.26-080","DOIUrl":"10.14701/ahbps.26-080","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Head-up position is used with fluid restriction and medications to achieve low central venous pressure (LCVP). We evaluated application of head-up position for its effectiveness, safety and potential to reduce need for complex drug interventions in achieving LCVP during hepatectomy.</p><p><strong>Methods: </strong>This prospective study included 50 patients undergoing major hepatectomies from 2019 to 2024. CVP was measured in supine, 10 cm and 20 cm head-up positions during liver resection. We assessed relationship between supine CVP and head-up positions with the need for supplemental pharmacological intervention using regression analysis. Additionally, we evaluated correlation between LCVP fluctuation, blood loss, and head-up position.</p><p><strong>Results: </strong>Mean blood loss was 204.6 ± 29.2 mL, with no incidents of air embolism, hemodynamic instability, renal dysfunction, blood transfusion, or 90-day mortality. Mean CVP values were 7.370 ± 4.094 mmHg in supine, 3.360 ± 4.304 mmHg at head-up 10 cm, and -0.780 ± 4.663 mmHg at head-up 20 cm positions, demonstrating a progressive reduction with each position (<i>p</i> < 0.001). High adjusted R² identified supine CVP as significant predictor of CVP at head-up positions, indicating strong linear relationship (<i>p</i> < 0.001). LCVP was achieved in 47/50 patients using 20 cm head-up position, while in 3/50 patients with supine CVP > 10 mmHg, additional medications were required. Correlation between blood loss and LCVP fluctuation (ρ = 0.169) was insignificant (<i>p</i> = 0.240), while that between head-up position and LCVP fluctuation (ρ = 0.383) was significant (<i>p</i> = 0.006).</p><p><strong>Conclusions: </strong>LCVP can be effectively achieved using a 20 cm head-up position, with the potential to limit drug usage in the majority of patients.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"296-303"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490732/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147935872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy of targeted hepatocellular carcinoma therapy using modified response evaluation criteria in solid tumors and alpha-fetoprotein: A single center retrospective exploratory study.","authors":"Kangqiang Lin, Lin Ye, Zhao Jiang, Renjian Li, Hao Shi, Yaqun Yu","doi":"10.14701/ahbps.26-087","DOIUrl":"10.14701/ahbps.26-087","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>To evaluate the combination of modified response evaluation criteria in solid tumors (mRECIST) with alpha-fetoprotein (AFP) in patients with intermediate-advanced hepatocellular carcinoma receiving combination therapy with a tyrosine kinase inhibitor (TKI) and a programmed cell death protein-1 (PD-1) inhibitor, focusing on stable disease (SD) patients with low AFP levels.</p><p><strong>Methods: </strong>We analyzed 79 patients who received TKI plus PD-1 inhibitor combination therapy from 2018 to 2021. Based on AFP at 8 weeks, patients were divided into Group A (AFP ≥200 ng/mL, n = 26) and Group B (AFP <200 ng/mL, n = 53). Kaplan-Meier and Cox models assessed overall survival (OS) and progression-free survival (PFS).</p><p><strong>Results: </strong>Only Barcelona Clinic Liver Cancer stage C independently predicted OS (hazard ratio [HR] 7.193, <i>p</i> < 0.001). For PFS, independent predictors included tumor diameter (HR 1.009, <i>p</i> = 0.025), mRECIST response (global likelihood-ratio <i>p</i> = 0.070), and AFP group (HR 0.474, <i>p</i> = 0.049). Virus type was excluded due to collinearity with antiviral therapy. Among SD patients, low AFP was associated with longer PFS than high AFP (24.0 vs. 3.0 months, <i>p</i> < 0.001). In Group B, low-AFP SD showed numerically longer PFS than partial response (24.0 vs. 15.0 months; HR 0.389; <i>p</i> = 0.116).</p><p><strong>Conclusions: </strong>This exploratory analysis suggests that the prognostic value of AFP is largely mediated by tumor burden. While mRECIST response predicted PFS but not OS, low-AFP SD patients exhibited favorable outcomes in both PFS and OS. These findings indicate that integrating mRECIST with AFP may enhance response stratification, though prospective validation is necessary.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"304-316"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490733/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148201301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"MicroRNA profiling in serum and correlation with tumor tissue and clinicopathological parameters in periampullary carcinoma.","authors":"Vaibhav Kumar Varshney, Shailja Sharma, Sudha Anjali, Muna Afroz Shaikh, Balakrishnan Selvakumar, Peeyush Varshney, Lokesh Agarwal, Subhash Soni, Shilpi Gupta Dixit, Sundeep Singh Saluja","doi":"10.14701/ahbps.26-088","DOIUrl":"10.14701/ahbps.26-088","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>MicroRNAs (miRNAs) have emerged as biomarkers for cancer diagnosis and progression. This pilot study evaluated whether circulating miRNAs correlate with tumor tissue expression and clinicopathological parameters in periampullary carcinoma (PACA) patients.</p><p><strong>Methods: </strong>Thirty-nine PACA patients who underwent pancreatoduodenectomy (April 2021-March 2024) were enrolled. Total RNA from preoperative serum and tumor tissue was isolated using the miRNeasy kit (Qiagen). Quantitative reverse-transcription polymerase chain reaction was performed for 14 PACA-related miRNAs, with U6 small nuclear RNA as a reference (ΔCt = CtmiRNA - CtU6 for normalization); relative expression was calculated as ΔΔCt = ΔCtcases - ΔCtcontrols.</p><p><strong>Results: </strong>The study comprised 28 male patients with median age of 56 years (interquartile range 51-63). The predominant tumor location was ampulla (43.6%), followed by distal common bile duct (23.1%). Serum ΔCt analysis showed significant differences for miR‑199, miR‑31, miR‑329, and miR‑19, with downregulation of miR‑195 and miR‑375; after false discovery rate adjustment, miR‑199, miR‑31, miR‑329, miR‑195 and miR‑375 remained significant, whereas the serum miR‑19 difference was only nominal (<i>p</i> = 0.050). In tumor tissue, miR‑199, miR‑329, and miR‑19 were upregulated (ΔΔCt -2.75, -0.87, and -1.82, respectively), while miR‑31 was downregulated (ΔΔCt 2.27) compared with controls. Serum miR‑19 ΔCt showed a weak correlation with CA 19-9 (Spearman's ρ = 0.31, <i>p</i> = 0.049). Subgroup analyses revealed no significant differences in miRNA expression across histological subtypes or tumor stages.</p><p><strong>Conclusions: </strong>Serum miR‑199 and miR‑19 showed exploratory concordance between circulating and tumor tissue expression in PACA, but their clinical utility remains limited and requires validation in a larger cohort.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"360-366"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490730/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148260748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Resect first in resectable colorectal liver metastases: Recalibrating the default.","authors":"Rathin Gosavi, Mithra Sritharan, Stephen Bell, Paul McMurrick, William Teoh, Vignesh Narasimhan","doi":"10.14701/ahbps.26-103","DOIUrl":"10.14701/ahbps.26-103","url":null,"abstract":"<p><p>Perioperative chemotherapy is frequently used for resectable colorectal liver metastases (CRLM), despite persistent uncertainty regarding the extent of its survival benefit. This perspective revisits the evidence supporting this practice and asks whether upfront liver-directed treatment should be more strongly considered in selected patients. A central paradox underpins this debate: although adjuvant chemotherapy improves OS in stage III colon cancer, randomized trials in resectable CRLM have consistently failed to demonstrate an OS advantage for perioperative or adjuvant systemic therapy. Instead, chemotherapy primarily appears to delay recurrence while exposing patients to potential harms. These harms include treatment-related hepatic injury, increased perioperative morbidity, and, in some cases, progression during induction therapy that may preclude curative resection. Several explanations may account for this discrepancy, including clonal selection of resistant disease, the influence of the hepatic metastatic microenvironment, and the availability of salvage local therapy at recurrence. Nevertheless, systemic therapy remains relevant in selected patients with technically or biologically complex disease, such as those requiring staged liver surgery, downsizing for resectability, or treatment sequencing in synchronous primary and liver disease. Additionally, thermal ablation is emerging as a valid early liver-directed option for carefully selected small-volume metastases. Looking forward, circulating tumor DNA and other molecular tools may better identify the subgroup most likely to benefit from perioperative treatment. Treatment sequencing in resectable CRLM should therefore be guided by anatomy, tumour biology, and emerging molecular markers of residual risk, with systemic therapy used selectively rather than as a universal default.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"271-275"},"PeriodicalIF":1.8,"publicationDate":"2026-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13490726/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148304218","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}