Annals of hepato-biliary-pancreatic surgery最新文献

{"title":"The impact of myosteatosis on postoperative outcomes and survival of patients undergoing pancreatoduodenectomy for suspected/confirmed malignancy.","authors":"Paul Jenkins, Andrew MacCormick, Adam Streeter, Mark Puckett, Gemma Miles, Somaiah Aroori","doi":"10.14701/ahbps.23-115","DOIUrl":"10.14701/ahbps.23-115","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>While the effects of myosteatosis are emerging, the evidence for its use as a predictor of outcomes in patients undergoing pancreatoduodenectomy (PD) still needs to be established. The study aims to evaluate the effect of myosteatosis on the shortand long-term outcomes of PD.</p><p><strong>Methods: </strong>We analyzed the effect of myosteatosis on the short- and long-term outcomes of patients who underwent PD between July 2006 and May 2013. Myosteatosis was measured retrospectively from preoperative computed tomography (CT) at the L3 vertebra level, and dichotomized as a binary exposure variable as < 38.5 Hounsfield unit (HU) for males, and < 36.1 HU for females.</p><p><strong>Results: </strong>A total of 214 patient (median age 62 years, range: 41-80 years) CTs were analyzed for myosteatosis. Overall, 120/214 (56.1%) patients were classed as having myosteatosis. Both groups had similar comorbidity profiles. The presence of myosteatosis was not shown to increase the rate of any short- or long-term complication. However, pancreatic leak (29.8% vs. 13.3%; <i>p</i> = 0.006) and postoperative bleeding (13.8% vs. 5.0%; <i>p</i> = 0.034) were higher in the non-myosteatosis group. The median intensive care (2 days) and hospital stay (12 days) were the same in both groups. The 30-day mortality (myosteatosis: 3.3% vs. non-myosteatosis: 3.2%; <i>p</i> = 0.95), and 5-year overall survival (myosteatosis: 26.7% vs. non-myosteatosis: 31.9%; <i>p</i> = 0.5), were similar in both groups.</p><p><strong>Conclusions: </strong>We have found no evidence supporting myosteatosis affecting either the short-term or long-term outcomes of patients undergoing PD for suspected/confirmed malignant tumors.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"494-499"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599814/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094258","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":"Perioperative outcomes of robot-assisted pancreatoduodenectomy (PD) and totally laparoscopic PD after overcoming learning curves with comparison of oncologic outcomes between open PD and minimally invasive PD.","authors":"Jae Seung Kang, Mirang Lee, Jun Suh Lee, Youngmin Han, Hee Ju Sohn, Boram Lee, Moonhwan Kim, Wooil Kwon, Ho-Seong Han, Yoo-Seok Yoon, Jin-Young Jang","doi":"10.14701/ahbps.24-121","DOIUrl":"10.14701/ahbps.24-121","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Minimally invasive pancreatoduodenectomy (MIPD), such as totally laparoscopic pancreatoduodenectomy (TLPD) or robot-assisted pancreatoduodenectomy (RAPD), is increasingly performed worldwide. This study aimed to compare the perioperative outcomes of TLPD and RAPD, and compare the oncologic outcomes between MIPD and open pancreatoduodenectomy (OPD) for malignant disease.</p><p><strong>Methods: </strong>This retrospective study was conducted at two hospitals that followed similar oncological surgical principles, including the extent of resection. RAPD was performed at Seoul National University Hospital, and TLPD at Seoul National University Bundang Hospital. Patient demographics, perioperative outcomes, and oncological outcomes were analyzed. Propensity score matching (PSM) analysis was performed to compare oncologic outcomes between MIPD and OPD.</p><p><strong>Results: </strong>Between 2015 and 2020, 332 RAPD and 178 TLPD were performed. The rates of Clavian-Dindo grade ≥ 3 complications (19.3% vs. 20.2%, <i>p</i> = 0.816), clinically relevant postoperative pancreatic fistula (9.9% vs. 11.8%, <i>p</i> = 0.647), and open conversions (6.6% vs. 10.5%, <i>p</i> = 0.163) were comparable between the two groups. The mean operation time (341 minutes vs. 414 minutes, <i>p</i> < 0.001) and postoperative hospital stay were shorter in the RAPD group (11 days vs. 14 days, <i>p</i> = 0.034). After PSM, the 5-year overall survival rate was comparable between MIPD and OPD for overall malignant disease (58.4% vs. 55.5%, <i>p</i> = 0.180).</p><p><strong>Conclusions: </strong>Both RAPD and TLPD are safe and feasible, and MIPD has clinical outcomes that are comparable to those of OPD. Although RAPD exhibits some advantages, its perioperative outcomes are similar to those associated with TLPD. A surgical method may be selected based on the convenience of surgical movements, medical costs, and operator experience.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"508-515"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599824/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309233","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":"Comparative accuracy of four guidelines to predict high-grade dysplasia or malignancy in surgically resected pancreatic intraductal papillary mucinous neoplasms: Small nuances between guidelines lead to vastly different results.","authors":"Irene C Perez, Andrew Bigelow, Vanessa M Shami, Bryan G Sauer, Andrew Y Wang, Daniel S Strand, Alexander J Podboy, Todd W Bauer, Victor M Zaydfudim, Allan Tsung, Ross C D Buerlein","doi":"10.14701/ahbps.24-049","DOIUrl":"10.14701/ahbps.24-049","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The guidelines regarding the management of intraductal papillary mucinous neoplasms (IPMNs) all have slightly different surgical indications for high-risk lesions. We aim to retrospectively compare the accuracy of four guidelines in recommending surgery for high-risk IPMNs, and assess the accuracy of elevated CA-19-9 levels and imaging characteristics of IPMNs considered high-risk in predicting malignancy or high-grade dysplasia (HGD).</p><p><strong>Methods: </strong>The final histopathological diagnosis of surgically resected high-risk IPMNs during 2013-2020 were compared to preoperative surgical indications, as enumerated in four guidelines: the 2015 American Gastroenterological Association (AGA), 2017 International Consensus, 2018 European Study Group, and 2018 American College of Gastroenterology (ACG). Surgery was considered \"justified\" if histopathology of the surgical specimen showed HGD/malignancy, or there was postoperative symptomatic improvement.</p><p><strong>Results: </strong>Surgery was postoperatively justified in 26/65 (40.0%) cases. All IPMNs with HGD/malignancy were detected by the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines. The combined (\"high-risk stigmata\" and \"worrisome features\") 2017 International guideline missed 1/19 (5.3%) IPMNs with HGD/malignancy. The 2015 AGA guideline missed the most cases (11/19, 57.9%) of IPMNs with HGD/malignancy. We found the features most-associated with HGD/malignancy were pancreatic ductal dilation, and elevated CA-19-9 levels.</p><p><strong>Conclusions: </strong>Following the 2015 AGA guideline results in the highest rate of missed HGD/malignancy, but the lowest rate of operating on IPMNs without these features; meanwhile, the 2018 ACG and the combined (absolute and relative criteria) 2018 European guidelines result in more operations for IPMNs without HGD/malignancy, but the lowest rates of missed HGD/malignancy in IPMNs.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"483-493"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599813/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428390","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":"Impact of post-hepatectomy biliary leaks on long-term survival in different liver tumors: A single institute experience.","authors":"Devesh Sanjeev Ballal, Shraddha Patkar, Aditya Kunte, Sridhar Sundaram, Nitin Shetty, Kunal Gala, Suyash Kulkarni, Mahesh Goel","doi":"10.14701/ahbps.24-078","DOIUrl":"10.14701/ahbps.24-078","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>A postoperative biliary leak is one of the most morbid complications occurring after a liver resection, the long-term impact of which remains unknown.</p><p><strong>Methods: </strong>Retrospective analysis of consecutive liver resections performed from 1 January 2011 to 31 December 2021. Primary endpoint of disease-free survival (DFS) was compared between patients with and without a bile leak, stratifying for tumor type. Survival curves were plotted using Kaplan-Meier estimates, and differences between them were analyzed using the log-rank test.</p><p><strong>Results: </strong>In toto, 862 patients were analyzed, and included 306 (35.5%) hepatocellular carcinomas, 212 (24.6%) metastatic colorectal cancers, and 111 (12.9%) cholangiocarcinomas (69 intrahepatic cholangiocarcinomas, 42 hilar cholangiocarcinomas). Occurrence of a bile leak was associated with significantly poorer DFS only in patients with cholangiocarcinoma (median DFS 9.9 months vs. 24.9 months, <i>p</i> = 0.013), and further analysis was restricted to this cohort. A Cox regression performed for factors associated with DFS detriment in patients with cholangiocarcinoma showed that apart from node positivity (hazard ratio [HR]: 2.482, <i>p</i> = 0.033) and margin positivity (HR: 2.65, <i>p</i> = 0.021), development of a bile leak was independently associated with worsening DFS on both univariate and multiple regression analyses (HR: 1.896, <i>p</i> = 0.033).</p><p><strong>Conclusions: </strong>Post-hepatectomy biliary leaks are associated with significantly poorer DFS only in patients with cholangiocarcinoma, but not in patients with hepatocellular carcinoma or metastatic colorectal cancer. Methods to mitigate this survival detriment need to be explored.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"451-457"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141629366","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":"Deep learning-based surgical phase recognition in laparoscopic cholecystectomy.","authors":"Hye Yeon Yang, Seung Soo Hong, Jihun Yoon, Bokyung Park, Youngno Yoon, Dai Hoon Han, Gi Hong Choi, Min-Kook Choi, Sung Hyun Kim","doi":"10.14701/ahbps.24-091","DOIUrl":"10.14701/ahbps.24-091","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Artificial intelligence (AI) technology has been used to assess surgery quality, educate, and evaluate surgical performance using video recordings in the minimally invasive surgery era. Much attention has been paid to automating surgical workflow analysis from surgical videos for an effective evaluation to achieve the assessment and evaluation. This study aimed to design a deep learning model to automatically identify surgical phases using laparoscopic cholecystectomy videos and automatically assess the accuracy of recognizing surgical phases.</p><p><strong>Methods: </strong>One hundred and twenty cholecystectomy videos from a public dataset (Cholec80) and 40 laparoscopic cholecystectomy videos recorded between July 2022 and December 2022 at a single institution were collected. These datasets were split into training and testing datasets for the AI model at a 2:1 ratio. Test scenarios were constructed according to structural characteristics of the trained model. No pre- or post-processing of input data or inference output was performed to accurately analyze the effect of the label on model training.</p><p><strong>Results: </strong>A total of 98,234 frames were extracted from 40 cases as test data. The overall accuracy of the model was 91.2%. The most accurate phase was Calot's triangle dissection (F1 score: 0.9421), whereas the least accurate phase was clipping and cutting (F1 score: 0.7761).</p><p><strong>Conclusions: </strong>Our AI model identified phases of laparoscopic cholecystectomy with a high accuracy.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"466-473"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599821/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141790161","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":"Construction and validation of a preoperative prognostic model integrating the novel aspartate aminotransferase-albumin score for hepatocellular carcinoma patients undergoing liver resection.","authors":"Shinichi Ikuta, Tsukasa Aihara, Meidai Kasai, Takayoshi Nakajima, Naoki Yamanaka","doi":"10.14701/ahbps.24-110","DOIUrl":"10.14701/ahbps.24-110","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>Patients undergoing liver resection for hepatocellular carcinoma (HCC) often possess good liver reserve, which may limit the prognostic effectiveness of existing liver function scores. This study aimed to develop a novel liver function score and a preoperative prognostic model specifically for HCC resection patients.</p><p><strong>Methods: </strong>Eight hundred twenty-seven HCC patients undergoing initial liver resection were segregated into training and validation cohorts in a 6:4 ratio. Cox regression analysis was employed to identify significant parameters influencing overall survival. The efficacy of the liver function score and prognostic model was evaluated using metrics such as the area under the receiver operating characteristic curve.</p><p><strong>Results: </strong>Aspartate aminotransferase (AST) and albumin emerged as significant prognostic indicators. The AST-albumin (ASAL) score, calculated as exp [AST (IU/L) × 0.005 - albumin (g/dL) × 1.043] × 100, outperformed existing scores such as Child-Turcotte-Pugh, albumin-bilirubin, platelet-albumin, and AST-platelet ratio index in both training and validation cohorts. Additionally, a scoring model that combined the ASAL score with alpha-fetoprotein and the up-to-seven criterion exhibited superior discriminatory capabilities compared to the American Joint Committee on Cancer tumor, node, metastasis stage, and Barcelona Clinic Liver Cancer stage.</p><p><strong>Conclusions: </strong>The proposed prognostic model that integrates the novel ASAL score offers promising prognostic potential for HCC patients undergoing liver resection.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"440-450"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599819/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141918221","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":"Minimally invasive versus open central pancreatectomy: A systematic review and meta-analysis.","authors":"Shahab Hajibandeh, Shahin Hajibandeh, Nicholas George Mowbray, Matthew Mortimer, Guy Shingler, Amir Kambal, Bilal Al-Sarireh","doi":"10.14701/ahbps.24-093","DOIUrl":"10.14701/ahbps.24-093","url":null,"abstract":"<p><p>To compare the procedural outcomes of minimally invasive and open central pancreatectomy. A systematic review in compliance with PRISMA statement standards was conducted to identify and analyze studies comparing the procedural outcomes of minimally invasive (laparoscopic or robotic) central pancreatectomy with the open approach. Random effects modeling using intention to treat data, and individual patient as unit of analysis, was used for analyses. Seven comparative studies including 289 patients were included. The two groups were comparable in terms of baseline characteristics. The minimally invasive approach was associated with less intraoperative blood loss (mean difference [MD]: -153.13 mL, <i>p</i> = 0.0004); however, this did not translate into less need for blood transfusion (odds ratio [OR]: 0.30, <i>p</i> = 0.06). The minimally invasive approach resulted in less grade B-C postoperative pancreatic fistula (OR: 0.54, <i>p</i> = 0.03); this did not remain consistent through sensitivity analyses. There was no difference between the two approaches in operative time (MD: 60.17 minutes, <i>p</i> = 0.31), Clavien-Dindo ≥ 3 complications (OR: 1.11, <i>p</i> = 0.78), postoperative mortality (risk difference: -0.00, <i>p</i> = 0.81), and length of stay in hospital (MD: -3.77 days, <i>p</i> = 0.08). Minimally invasive central pancreatectomy may be as safe as the open approach; however, whether it confers advantage over the open approach remains the subject of debate. Type 2 error is a possibility, hence adequately powered studies are required for definite conclusions; future studies may use our data for power analysis.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"412-422"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447600","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":"Primary treatments for solitary hepatocellular carcinoma ≤ 3 cm: A systematic review and network meta-analysis.","authors":"Sang-Hoon Kim, Ki-Hun Kim, Byeong-Gon Na, Sung Min Kim, Rak-Kyun Oh","doi":"10.14701/ahbps.24-103","DOIUrl":"10.14701/ahbps.24-103","url":null,"abstract":"<p><p>Various treatment modalities are available for small solitary hepatocellular carcinoma (HCC), yet the optimal primary treatment strategy for tumors ≤ 3 cm remains unclear. This network meta-analysis investigates the comparative efficacy of various interventions on the long-term outcomes of patients with solitary HCC ≤ 3 cm. A systematic search of electronic databases from January 2000 to December 2023 was conducted to identify studies that compared at least two of the following treatments: surgical resection (SR), radiofrequency ablation (RFA), microwave ablation (MWA), and transarterial chemoembolization (TACE). Survival data were extracted, and pooled hazard ratios with 95% confidence intervals were calculated using a frequentist network meta-analysis. A total of 30 studies, comprising 2 randomized controlled trials and 28 retrospective studies, involving 8,053 patients were analyzed. Surgical resection showed the highest overall survival benefit with a <i>p</i>-score of 0.95, followed by RFA at 0.59, MWA at 0.23, and TACE, also at 0.23. Moreover, SR provided the most significant recurrence-free survival advantage, with a <i>p</i>-score of 0.95, followed by RFA at 0.31 and MWA at 0.19. Sensitivity analyses, excluding low-quality or retrospective non-matched studies, corroborated these findings. This network meta-analysis demonstrates that SR is the most effective first-line curative treatment for single HCC ≤ 3 cm, followed by RFA in patients with preserved liver function. The limited data on MWA and TACE underscore the need for further studies.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"397-411"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142037881","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":"Survival after vascular resections in patients with borderline resectable or locally advanced pancreatic head cancer: A systematic review.","authors":"Menelaos Papakonstantinou, Stylianos Fiflis, Alexandros Giakoustidis, Grigorios Christodoulidis, Athanasia Myriskou, Eleni Louri, Lavrentios Papalavrentios, Vasileios N Papadopoulos, Dimitrios Giakoustidis","doi":"10.14701/ahbps.24-118","DOIUrl":"10.14701/ahbps.24-118","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma (PDAC) is one of the most aggressive tumors, and the most common cause of cancer-related deaths. In the past, vascular infiltration of the tumor rendered the disease unresectable. However, today, venous or arterial involvement of a PDAC is classified as borderline resectable (BR) or locally advanced (LA) disease. Pancreaticoduodenectomy (PD) with vascular resections is a promising intervention intended for complete resection of BR- and LA-PDAC. This study aims to assess the overall survival of patients undergoing PD with vascular resections, compared to those without. A PubMed search was conducted for cohort studies that included patients with BR- or LA-PDAC treated with vascular resections. The retrieved publications were screened following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist. The study protocol was registered at the International Prospective Register for Systematic Reviews (PROSPERO). Sixteen cohort studies were included in our systematic review. Fourteen of them included patients undergoing PD with venous-only resections for PDAC. The 5-year overall survival rates ranged from 8.0% to 22.2% for vascular resection patients, and 4.0% to 24.3% for standard PD patients. Three cohorts included patients with PDAC and arterial and/or venous involvement who were treated with arterial resections. Their median overall survival ranged from 13.7 to 17.0 months, similar to that of patients who did not undergo vascular resections. PD with vascular resections in patients with BR- and LA-PDAC could lead to similar overall survival to that after standard PD.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"423-432"},"PeriodicalIF":1.1,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11599818/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977398","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":"Effect of neoadjuvant transarterial chemoembolization followed by resection versus upfront liver resection on the survival of single large hepatocellular carcinoma patients: A systematic review and meta-analysis.","authors":"Indah Jamtani, Toar Jean Maurice Lalisang, Wawan Mulyawan","doi":"10.14701/ahbps.24-009","DOIUrl":"10.14701/ahbps.24-009","url":null,"abstract":"<p><strong>Backgrounds/aims: </strong>The efficacy of neoadjuvant transarterial chemoembolization (N-TACE) in resectable hepatocellular carcinoma (HCC) remains open to debate. While N-TACE may reduce tumor size, its impact on long-term outcomes is inconclusive.</p><p><strong>Methods: </strong>This meta-analysis reviewed studies on N-TACE before surgical resection vs. liver resection (LR) single large hepatocellular carcinoma (SLHCC) up to March 2023 from four online databases.</p><p><strong>Results: </strong>Five studies with 1,556 patients were analyzed. No significant differences between N-TACE and LR groups were observed in 1-, 3-, or 5-year overall survival (OS) and disease-free survival (DFS). No significant differences were noted in intraoperative blood loss between groups. Subgroup analysis showed favorable 1-, 3-, and 5-year OS with combination chemotherapy N-TACE (combination group), and better 1-year OS in the LR group with single-agent chemotherapy N-TACE (single-agent group). Five-year DFS favored LR in the single-agent group, and N-TACE in the combination group.</p><p><strong>Conclusions: </strong>Managing SLHCC requires intricate considerations, and the treatment strategies for this challenging subgroup of HCC need to be improved. The influence of N-TACE on long-term survival depends on the specific chemotherapy regimen employed, and its impact on intraoperative blood loss in SLHCC appears limited.</p>","PeriodicalId":72220,"journal":{"name":"Annals of hepato-biliary-pancreatic surgery","volume":" ","pages":"325-336"},"PeriodicalIF":1.1,"publicationDate":"2024-08-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11341878/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140913555","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}