Hepatobiliary surgery and nutrition最新文献

Background: Pancreaticoduodenectomy (PD) is the only potentially curative treatment for distal cholangiocarcinoma (DCC). This multicenter propensity score matching (PSM) study aimed to compare the perioperative and oncological outcomes of laparoscopic PD (LPD) and robotic PD (RPD) after the learning curve of surgeons.

Methods: Consecutive patients with DCC who underwent curative LPD or RPD at eight Chinese centers between January 2016 and December 2022 were included. PSM was performed to minimize selection bias. Univariate and multivariate logistic regression analyses were used to identify independent prognostic factors for textbook outcome (TO) in these patients.

Results: Overall, 529 patients who underwent PD for DCC were included, of which 251 underwent LPD and 278 underwent RPD. After PSM, 227 patients were enrolled into each group. There were no significant differences in estimated blood loss (EBL), lymph node harvest, intraoperative transfusion, vascular resection, R0 resection, severe complications, readmission, 30-day mortality, or long-term survival between the two groups. However, after the learning curve, RPD had a perioperative advantage over LPD, especially in terms of operation time (270 vs. 300 min, P<0.001). Similar conclusions were drawn in the subgroup analysis. Multivariable analysis showed that comorbidities (P=0.001), main pancreatic duct (MPD) >3 mm (P=0.001), and operative time >360 min (P=0.006) were significantly associated with TO.

Conclusions: After the surgeon's learning curve, the feasibility and safety of LPD and RPD for DCC patients are comparable. Randomized controlled trials (RCTs) should be performed to confirm these findings.

Background and objective: Hepatocellular carcinoma (HCC) is one of the most common cancers with high mortality rate worldwide. Surgical resection, liver transplantation (LT), and thermal ablation are primary curative methods for early-stage HCC. However, the high recurrence rate following surgical intervention is the primary factor contributing to the unfavorable prognosis. Therefore, the critical aspect in improving the overall survival of HCC lies in reducing the postoperative recurrence rate. This review is aimed at summarizing the current evidence base regarding the safety and efficacy of systemic therapy administered in the neoadjuvant context for patients with resectable HCC. Furthermore, we will offer a perspective on the potential future trajectories of systemic therapy as a neoadjuvant modality in the management of HCC.

Methods: We searched PubMed with terms: hepatocellular carcinoma, neoadjuvant, preoperative, chemotherapy, hepatic arterial infusion chemotherapy, targeted therapy, systemic therapy, immunotherapy. Relevant ongoing clinical trials registered at ClinicalTrials.gov are included.

Key content and findings: In the context of resectable solid organ cancers, neoadjuvant therapy is frequently administered to delay disease progression, ensure appropriate patient selection, reduce tumor burden and potentially eradicate micrometastases prior to surgical procedures. In recent years, the advancements in systemic therapy for advanced HCC, especially with anti-vascular endothelial growth factor antibodies, tyrosine-kinase inhibitors and immunotherapy combination, have significantly contributed to notable improvements in overall survival. These breakthroughs have prompted the exploration and implementation of systemic therapy in the setting of neoadjuvant and adjuvant therapy for HCC. In this review, we aim to briefly summarize the current available evidence on the safety and efficacy of systemic therapy in neoadjuvant settings designed to improve the outcome of curative-intent liver resection or LT for patients with resectable HCC. Additionally, we discuss the challenges and issues that need to be further clarified before widespread adoption of neoadjuvant therapies, providing an outlook on future directions of systemic therapy as neoadjuvant treatment in HCC.

Conclusions: Neoadjuvant therapy involving immunotherapy, particularly immune checkpoint inhibitors, seems to exhibit the most promising characteristics of preventing recurrence and improving long-term survival of HCC patients following curative hepatectomy or LT, especially when combined with anti-angiogenic therapies and locoregional therapy. Further research is needed to identify suitable candidates, predictive biomarkers, optimal regimens for neoadjuvant therapy, and ideal timing for surgery.