Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"Validation of the parkland grading scale in predicting the critical view of safety during laparoscopic cholecystectomy: A prospective cohort study with implications for future artificial intelligence ground truth establishment.","authors":"Hoai Kim Nguyen, Thien Lai Vo, Ho Tran, Thanh Phuoc Bui, Xuan Binh Dau, Phuoc Cong Thanh Nguyen","doi":"10.14701/ahbps.26-012","DOIUrl":"https://doi.org/10.14701/ahbps.26-012","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The critical view of safety (CVS) prevents bile duct injury, but severe inflammation hinders its achievement. This study evaluated the parkland grading scale (PGS) as a real-time intraoperative predictor of CVS attainment in a Southeast Asian population, establishing standardized clinical data for future artificial intelligence applications.</p><p><strong>Methods: </strong>This prospective observational study (January-June 2025) included 88 consecutive patients undergoing laparoscopic cholecystectomy by a single surgeon. PGS was assessed upon initial laparoscopic inspection. We analyzed correlations between PGS, CVS attainment (Strasberg's criteria), operative time, and bail-out procedures using Spearman's correlation and multivariate logistic regression.</p><p><strong>Results: </strong>Severe inflammation (PGS grade 4-5) was observed in 31.8% of patients. PGS exhibited a strong negative correlation with CVS score (<i>p</i> = -0.652; <i>p</i> < 0.001) and strong positive correlations with operative time and blood loss. A PGS threshold of 4 accurately predicted CVS failure (area under the curve = 0.863). Bail-out procedures were necessary in 11 cases (12.5%), all occurring in the PGS ≥ 4 group. Advanced age and diabetes mellitus were independent risk factors for CVS failure.</p><p><strong>Conclusions: </strong>The PGS serves as a precise intraoperative early warning system. A score ≥ 4 indicates a significant risk of CVS failure, prompting safer bail-out strategies. Additionally, this study provides a standardized dataset vital for training future autonomous surgical risk assessment models.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147635376","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":"Seeing the invisible: Three-dimensional liver modeling from simulation to the scalpel.","authors":"Serge Chooklin, Serhii Chuklin","doi":"10.14701/ahbps.26-027","DOIUrl":"https://doi.org/10.14701/ahbps.26-027","url":null,"abstract":"<p><p>Liver resection requires precise, millimetric decisions within highly variable, patient-specific vascular and biliary anatomy. As the complexity of procedures increases (such as in major or extended hepatectomies, central lesions, and borderline future liver remnant scenarios), reliance on \"2D cognition\" can heighten the risk of planning errors and postoperative complications. This study aims to synthesize the role of 3D liver technologies, including digital visualization and planning, 3D printing, and intraoperative navigation (such as augmented reality and mixed reality), as a decision-making pipeline. This is a narrative, question-driven review of clinically relevant studies focused on liver resection workflows that utilize 3D visualization/planning, 3D printing, or intraoperative navigation. Across diverse studies, the most significant benefits of 3D planning are observed in anatomically complex or borderline cases. These benefits primarily enhance decision transparency and process-level endpoints (e.g., mapping, plan modifications, intraoperative orientation). However, consistent effects on morbidity and liver-specific outcomes are limited due to confounding factors and inconsistencies in endpoints. Augmented reality and mixed reality navigation face challenges related to registration stability and liver deformation, making uncertainty management and local accuracy reporting crucial. 3D printing appears most beneficial as a selective tool for high-stakes anatomy, as well as for communication and education, with feasibility influenced by time and cost considerations. \"3D\" should be assessed as an end-to-end measurement pipeline with explicit error budgets. Future studies should prespecify decision endpoints, standardize outcome definitions, and report task-relevant accuracy, particularly concerning navigation and critical biliary/vascular structures.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596503","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":"Preoperative biliary drainage versus upfront surgery in moderately jaundiced patients undergoing pancreaticoduodenectomy: A single-institution comparative study.","authors":"Kaushal Singh Rathore, Gaurav Kaushal","doi":"/10.14701/ahbps.25-243","DOIUrl":"https://doi.org//10.14701/ahbps.25-243","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The effect of preoperative biliary drainage (PBD) on outcomes for pancreaticoduodenectomy (PD) patients with moderate jaundice (10-15 mg/dL) remains understudied. While PBD aims to improve hepatic function, it may increase morbidity due to infections.</p><p><strong>Methods: </strong>This study analyzed PDs performed between July 2022 and 2025. Patients with periampullary cancers and bilirubin levels of 10-15 mg/dL were included. We compared patients who underwent upfront PD (upfront surgery [UP] group) with those who received PBD (via endoscopic retrograde cholangiopancreatography or percutaneous transhepatic biliary drainage) regarding perioperative outcomes, morbidity, mortality, bile microbiology, antibiotic use, and costs.</p><p><strong>Results: </strong>Among 92 PD patients, 40 met the inclusion criteria (UP = 16; PBD = 24). Baseline characteristics were comparable, except for higher bilirubin levels in the UP group (12.6 mg/dL vs. 1.35 mg/dL, <i>p</i> = 0.001). The PBD group exhibited a harder pancreatic texture (58.3% vs. 25.0%, <i>p</i> = 0.03), higher surgical site infections (SSIs) (70.8% vs. 18.7%, <i>p</i> = 0.001), and a greater incidence of positive bile cultures (75% vs. 25.0%, <i>p</i> = 0.001). Overall morbidity, Clavien-Dindo grade 3 complications, and 90-day mortality rates were similar between the groups. However, antibiotic costs were significantly higher in the PBD group (₹31,047 vs. ₹20,937; + 50%).</p><p><strong>Conclusions: </strong>In patients with moderate jaundice (10-15 mg/dL), upfront PD can be performed safely. Routine PBD offers no clinical benefit and is associated with higher rates of SSIs, bile contamination, and increased costs.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596513","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":"A 30-year multidisciplinary framework for assessment and consent in total pancreatectomy with islet autotransplantation.","authors":"Javed Latif, Cristina Pollard, Giuseppe Garcea, Ashley Dennison","doi":"10.14701/ahbps.26-021","DOIUrl":"10.14701/ahbps.26-021","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Total pancreatectomy with islet autotransplantation (TPIAT) is an irreversible intervention for selected patients with chronic pancreatitis, associated with significant morbidity and lifelong metabolic consequences. Given the benign nature of the disease, robust assessment, governance, and consent processes are ethically essential. Despite increasing global adoption, there is limited description of how centres implement assessment and consent in routine practice.</p><p><strong>Methods: </strong>We describe a structured assessment and consent pathway for TPIAT developed over 30 years at a single UK hepatopancreatobiliary centre. The pathway is coordinated by a dedicated clinical nurse specialist (CNS) and delivered through a multidisciplinary team including surgery, gastroenterology, endocrinology, pain management, and psychology. A descriptive review of routinely collected clinical data and non-validated patient feedback obtained during standard care was performed to characterise key components of the pathway.</p><p><strong>Results: </strong>Between 1994 and 2025, 97 patients entered the assessment pathway. Four did not complete assessment, and eight were deemed unsuitable following multidisciplinary review due to concerns regarding clinical appropriateness, metabolic reserve, or psychosocial readiness. Eighty-five patients proceeded to TPIAT. Progression through the pathway was iterative and consensus-driven, allowing any team member to pause evaluation. Key features included CNS-led continuity, repeated consultations, structured peer support, and multidisciplinary reassessment. Patient feedback suggested these elements improved understanding of procedural risks and long-term implications.</p><p><strong>Conclusions: </strong>This established, patient-centred assessment and consent framework represents a reproducible governance model for TPIAT in benign pancreatic disease and provides a practical reference for centres developing or refining TPIAT services.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147596527","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":"Single-loop versus double-loop reconstruction after pancreatoduodenectomy: Does it impact on the risk of postoperative pancreatic fistula?","authors":"Giovanni Domenico Tebala, Fanny Massimi, Francesca Duro, Ahmed Abdelsamad, Stefano Avenia, Gian Luca Baiocchi, Andrea Barberis, Chafik Bouzid, Antoine Castel, Graziano Ceccarelli, Andrea Celotti, Nicola Cillara, Nicola Cinardi, Roberto Cirocchi, Maria Conticchio, Giuseppe Currò, Antonella Delvecchio, Raffaele Vincenzo De Rosa, Jacopo Desiderio, Antonio Di Cintio, Fabio Francesco Di Mola, Domenico Di Nardo, Alessia Fassari, Alessandro Gemini, Carlos Augusto Gomes, Gian Luca Grazi, Giuseppe Margani, Alessandro Mazzotta, Luca Morelli, Andrea Muratore, Fabrice Muscari, Edoardo Maria Muttillo, Alberto Patriti, Gaetano Piccolo, Luca Properzi, Alessandro Puzziello, Lucia Romano, Edoardo Rosso, Sara Saeidi, Andrea Sagnotta, Edoardo Saladino, Marcello Giuseppe Spampinato, Laurent Sulpice, Nádia Tenreiro, Paolo Ubiali, Riccardo Memeo","doi":"10.14701/ahbps.26-007","DOIUrl":"https://doi.org/10.14701/ahbps.26-007","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Postoperative pancreatic fistula (POPF) remains a significant complication following pancreatoduodenectomy (PD). It has been hypothesized that single loop (SL) reconstruction may increase the risk of POPF, leading to the proposal of double-loop (DL) reconstruction. In this approach, the pancreatic duct is connected to an isolated loop of bowel in a Roux-en-Y configuration.</p><p><strong>Methods: </strong>We conducted a retrospective multicenter study to compare various types of reconstruction after PD, analyzing data from 1,502 patients who underwent open, laparoscopic, or robotic PD across 28 centers worldwide. Propensity score matching (PSM) was applied to enhance comparability.</p><p><strong>Results: </strong>The overall rate of POPF was 34.89%, with a grade C POPF rate of 4.26%. The type of reconstruction (SL vs. DL) did not significantly impact the rates of POPF or grade C POPF, both before and after PSM. The rate of delayed gastric emptying (DGE) was 20.71%, and patients with DL reconstruction had a lower incidence of DGE both before and after PSM.</p><p><strong>Conclusions: </strong>Our study found no significant differences in the risk of POPF between SL and DL reconstruction. However, DL reconstruction is associated with a reduced risk of DGE, suggesting it may be a preferable option following open PD.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476409","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":"Feasibility and safety of intercostal trocar-assisted laparoscopic liver resection in posterosuperior segments.","authors":"Rodrigo Antonio Gasque, Ramiro Vargas Aignasse, María Eugenia Chianalino, Facundo Ignacio Mandojana, Fernando Andrés Alvarez","doi":"10.14701/ahbps.25-238","DOIUrl":"https://doi.org/10.14701/ahbps.25-238","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Posterosuperior (PS) liver resections present technical challenges, and there is limited evidence on the use of intercostal (IC) trocars. This study aims to describe our technique and assess its feasibility and safety in a series of patients undergoing laparoscopic liver resection (LLR).</p><p><strong>Methods: </strong>We conducted a single-center retrospective analysis between 2022 to 2025. Among 40 patients who underwent LLR of PS segments, an accessory right IC 5-mm port was utilized in 8 cases. Outcomes evaluated included intraoperative complications, conversion rates, blood loss, operative time, length of hospital stay, 90-day morbidity/mortality, and margin status.</p><p><strong>Results: </strong>Eight patients (62.5% female; mean age 50.5 ± 21.39 years; median body mass index 22.27 [IQR 20.8-29.81]) underwent LLR utilizing a single 5-mm IC port. The indications for surgery were liver adenoma (n = 3), colorectal liver metastases (n = 3), neuroendocrine tumor metastasis (n = 1), and hepatolithiasis (n = 1). The mean operative time was 422.5 ± 127.56 minutes, with a mean blood loss of 153.75 ± 58.29 mL, and no transfusions were necessary. There were no intraoperative complications, conversions, or deaths. All patients achieved negative margins (mean 10.25 ± 1.5 mm). The mean length of hospital stay was 4.5 ± 0.93 days, and the 90-day morbidity rate was 0%.</p><p><strong>Conclusions: </strong>The use of a small IC port in LLR for PS segments is both feasible and safe, offering improved exposure without increasing morbidity. Larger, multicenter prospective studies are needed to validate these findings and to standardize indications, port size, and placement.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147476436","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":"Does calculating the textbook outcome based on its negative predictors enhance the transparency of intrahepatic cholangiocarcinoma surgery assessment?","authors":"Mikhail Efanov, Natalia Britskaia, Denis Fisenko, Pavel Tarakanov, Yuliya Kulezneva, Olga Melekhina, Anna Koroleva, Andrey Vankovich, Dmitry Kovalenko, Nikita Solovyev, Victor Tsvirkun, Igor Khatkov","doi":"10.14701/ahbps.25-234","DOIUrl":"https://doi.org/10.14701/ahbps.25-234","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The definition of textbook outcome (TO) for liver surgery in patients with intrahepatic cholangiocarcinoma (ICC) varies depending on the data and TO model utilized in the study. This study aimed to clarify the separate estimation of TO in relation to its negative predictors, using two validated TO models for ICC surgery.</p><p><strong>Methods: </strong>We assessed the rates of achieving TO and failure of TO for both models in liver resection. Independent predictors of non-TO were identified through logistic regression and validated using AUC estimation.</p><p><strong>Results: </strong>TO was achieved in a similar proportion of patients across both models: 40% and 43%. The TO models did not differ in preoperative data affecting TO achievement. Independent predictors of non-TO for both models included tumor size > 10 cm,, open surgical approach, and biliary resection. TO achievement significantly differed among sub-groups that were homogeneous concerning the opposing values of the independent predictors, regardless of the TO model. The ratio of the frequency of negative predictors in the TO and non-TO groups, referred to as the TO coefficient, determines the likelihood of achieving TO given the presence of that predictor. Predictors were ranked by their negative impact on TO achievement, from the highest risk of TO failure (tumor size > 10 cm) to the lowest risk (open approach).</p><p><strong>Conclusions: </strong>Independent predictors of non-TO may improve the transparency of TO assessment and reduce biases related to unaccounted negative prognostic factors. The impact of these independent predictors on TO realization can be estimated and ranked using TO coefficient calculations.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":""},"PeriodicalIF":1.7,"publicationDate":"2026-03-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147391713","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":"Combined liver-kidney transplantation using a situs inversus totalis donor liver: Retroversus implantation: A case report.","authors":"Eya Ben Nejma, Aline Wautier, Anna Goujon, Fabien Robin, Heithem Jeddou","doi":"10.14701/ahbps.25-188","DOIUrl":"10.14701/ahbps.25-188","url":null,"abstract":"<p><p>Situs inversus totalis is a rare congenital anomaly where thoracic and abdominal organs are completely reversed in mirror-image orentation. While it does not preclude transplantation, it presents significant technical challenges, especially in liver transplantation, due to the altered orientation of vascular and biliary structures. We present a case involving a 50-year-old man with end-stage renal disease and advanced cholestatic cirrhosis. His model for end-stage liver disease score was 26, qualifying him for combined liver-kidney transplantation. A donor with SIT became available, and pre-donor evaluation confirmed complete SIT with typical vascular and biliary anatomy. The donor liver weighed 900 g. During orthotopic positioning, the alignment was unfavorable, necessitating the graft to be implanted in a retroversus orientation to restore optimal anatomical relationships. Vascular reconstructions included an end-to-side piggyback cavocaval anastomosis, an end-to-end portal vein reconstruction, and an arterial anastomosis between the donor common hepatic artery and the recipient's right hepatic artery originating from the superior mesenteric artery. Biliary continuity was established through duct-to-duct anastomosis. Subsequently, kidney transplantation was performed in the right iliac fossa using the donor's right kidney. No blood transfusions were needed, and the postoperative recovery was smooth. Both grafts functioned normally, and the patient was discharged on postoperative day 12. At the 9-month follow-up, liver and kidney functions remained excellent. Retroversus implantation enabled successful combined liver-kidney transplantation using a donor liver from a patient with SIT. This case underscores the necessity for meticulous planning, intraoperative adaptability, and technical modifications to ensure safe transplantation in anatomically challenging situations.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"110-114"},"PeriodicalIF":1.7,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958836/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145960803","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":"Hepatic lymph node metastases in patients with colorectal liver metastases undergoing hepatic artery infusion pump placement.","authors":"Aaron J Dinerman, Alyssa V Eade, Kyle J Hitscherich, Cathleen Hannah, Nebojsa Skorupan, Lindsay R Friedman, Ashley Rainey, Andrew M Blakely, Baris Turkbey, Jonathan M Hernandez","doi":"10.14701/ahbps.25-158","DOIUrl":"10.14701/ahbps.25-158","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The status of portal lymph nodes is a critical factor in determining eligibility for hepatic artery infusion pump (HAIP) therapy. However, methods for detecting occult positive nodes and understanding their clinical implications remain inadequately defined.</p><p><strong>Methods: </strong>We conducted a retrospective evaluation of a cohort of patients with metastatic colorectal cancer who underwent HAIP. An independent, blinded radiologist reviewed pre-operative imaging to identify predictors for nodal positivity. We performed Kaplan-Meier survival analyses to explore the relationship between hepatic nodal staging and patient survival.</p><p><strong>Results: </strong>The study comprised 33 patients, with a median follow-up of 23.5 months (range 2-56 months). The imaging review did not accurately identify patients with hepatic nodal disease. Patients without hepatic nodal metastases (n = 23) had a significantly longer median overall survival (OS) of 27 months compared to those with hepatic nodal metastases, who had a median OS of 11 months (hazard ratio = 4.8, <i>p</i> ≤ 0.01). Hepatic nodal positivity (hLN+) was associated with primary nodal positivity (pLN+, <i>p</i> = 0.036), and all patients with hLN+ were also pLN+.</p><p><strong>Conclusions: </strong>Hepatic nodal metastases are a predictor of survival in patients receiving HAIP therapy for colorectal liver metastases. Primary nodal positivity may aid in the selection of HAIP candidates by increasing the suspicion of hepatic nodal positivity.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"15-23"},"PeriodicalIF":1.7,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958837/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145662807","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":"Simultaneous resection of pancreatic cancer and liver metastases following total neoadjuvant therapy: A case series and analysis of the National Cancer Database.","authors":"McKenzie L Schaefer, Patrick L Quinn, Alexander H Shannon, Laith Abushahin, Jordan M Cloyd, Mary E Dillhoff, Ning Jin, Ashish Manne, Arjun Mittra, Anne M Noonan, Timothy M Pawlik, Shafia Rahman, Aslam Ejaz","doi":"10.14701/ahbps.25-209","DOIUrl":"10.14701/ahbps.25-209","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The role of surgery for pancreatic ductal adenocarcinoma (PDAC) with synchronous liver metastases remains controversial. Previous studies assessing the outcomes of combined surgery for primary PDAC and liver metastases have been limited by the inconsistent application of neoadjuvant chemotherapy (NAC).</p><p><strong>Methods: </strong>We identified patients with PDAC and fewer than three liver metastases who received at least six months of NAC and underwent simultaneous pancreas and liver resection between January 2018 and March 2023 at a single institution. Additionally, we queried the National Cancer Database (NCDB) from 2010 to 2019 to identify patients with synchronous metastatic PDAC to the liver who received NAC before simultaneous resection, serving as a comparison group.</p><p><strong>Results: </strong>Ten patients met the inclusion criteria for the institutional case series, with seven ultimately undergoing simultaneous resection. Among 224 patients in the NCDB who underwent simultaneous pancreas and liver resection, 70 patients (31.2%) received NAC. After a median follow-up of 59 months in the institutional cohort, five patients experienced recurrence, resulting in a median disease-free survival of four months (95% confidence interval [CI] 3, not reached). After controlling for confounding factors in the NCDB cohort, the administration of NAC was associated with improved survival (hazard ratio: 0.44, 95% CI 0.29-0.65, <i>p</i> < 0.001) compared to those who underwent upfront surgery.</p><p><strong>Conclusions: </strong>Neoadjuvant therapy followed by simultaneous liver and pancreas resection for metastatic PDAC is safe and feasible, and it may provide a survival benefit in carefully selected patient populations.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"58-66"},"PeriodicalIF":1.7,"publicationDate":"2026-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12958838/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146069064","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}