Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.006
Inhyuck Lee , Younsoo Seo , Go-Won Choi , Yoon Soo Chae , Won-Gun Yun , Youngmin Han , Hye-Sol Jung , Young Jae Cho , Wooil Kwon , Jin-Young Jang , Joon Seong Park
Background
Distal cholangiocarcinoma (DCC) has poor prognosis, with >50% affected patients experiencing early recurrence (ER) within 12 months after curative-intent surgery. This retrospective study analyzed ER characteristics, survival outcomes, and risk factors of DCC.
Methods
We categorized 519 patients with DCC who underwent curative-intent surgery at Seoul National University Hospital (2008–2023) into ER (n=115) and non-ER (n=404) groups. Primary endpoints were ER and overall survival (OS). We compared OS between ER and an additional non-curative reference cohort (R2/M1, n=53). Cutoffs for continuous variables were derived using the receiver operating characteristic (ROC) curve/Youden.
Results
Median OS and recurrence-free survival were 53.6 and 52.4 months, respectively. Independent ER predictors were preoperative CA19-9 of >70 U/mL (hazard ratio [HR], 1.58), BMI of ≤21.0 kg/m² (HR, 2.04) or >25.0 kg/m² (HR 1.81), LNR of >15% (HR, 2.01), and postoperative CA19-9 of >37 U/mL (HR, 1.71). OS was similar between ER and R2/M1 groups (16.8 vs 15.6 months; p=0.998). In subgroup analyses stratified by ER status, adjuvant chemotherapy (including 5-FU), radiotherapy, and concurrent chemoradiotherapy were not associated with improved OS.
Conclusion
ER after curative-intent resection has outcomes comparable to non-curative disease, supporting risk-adapted staging and evaluation of neoadjuvant strategies for high-risk patients.
{"title":"Risk factors and early recurrence patterns following curative-intent resection of distal cholangiocarcinoma","authors":"Inhyuck Lee , Younsoo Seo , Go-Won Choi , Yoon Soo Chae , Won-Gun Yun , Youngmin Han , Hye-Sol Jung , Young Jae Cho , Wooil Kwon , Jin-Young Jang , Joon Seong Park","doi":"10.1016/j.hpb.2025.10.006","DOIUrl":"10.1016/j.hpb.2025.10.006","url":null,"abstract":"<div><h3>Background</h3><div>Distal cholangiocarcinoma (DCC) has poor prognosis, with >50% affected patients experiencing early recurrence (ER) within 12 months after curative-intent surgery. This retrospective study analyzed ER characteristics, survival outcomes, and risk factors of DCC.</div></div><div><h3>Methods</h3><div>We categorized 519 patients with DCC who underwent curative-intent surgery at Seoul National University Hospital (2008–2023) into ER (n=115) and non-ER (n=404) groups. Primary endpoints were ER and overall survival (OS). We compared OS between ER and an additional non-curative reference cohort (R2/M1, n=53). Cutoffs for continuous variables were derived using the receiver operating characteristic (ROC) curve/Youden.</div></div><div><h3>Results</h3><div>Median OS and recurrence-free survival were 53.6 and 52.4 months, respectively. Independent ER predictors were preoperative CA19-9 of >70 U/mL (hazard ratio [HR], 1.58), BMI of ≤21.0 kg/m² (HR, 2.04) or >25.0 kg/m² (HR 1.81), LNR of >15% (HR, 2.01), and postoperative CA19-9 of >37 U/mL (HR, 1.71). OS was similar between ER and R2/M1 groups (16.8 vs 15.6 months; p=0.998). In subgroup analyses stratified by ER status, adjuvant chemotherapy (including 5-FU), radiotherapy, and concurrent chemoradiotherapy were not associated with improved OS.</div></div><div><h3><strong>Conclusion</strong></h3><div>ER after curative-intent resection has outcomes comparable to non-curative disease, supporting risk-adapted staging and evaluation of neoadjuvant strategies for high-risk patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 50-59"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482078","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.012
Diamantis I. Tsilimigras , Selamawit Woldesenbet , Dimitrios Moris , Shahzaib Zindani , Jordan M. Cloyd , Mary Dillhoff , Susan Tsai , Timothy M. Pawlik
Background
Antimicrobial prophylaxis with piperacillin-tazobactam was recently demonstrated to reduce the incidence of surgical site infections (SSI) and pancreatic fistula following open pancreatoduodenectomy (PD) compared with cefoxitin. Larger scale, real-world data to confirm effectiveness of piperacillin-tazobactam are lacking.
Methods
Patients undergoing open PD between 2016 and 2024 were identified in the EPIC Cosmos database. Exposure included perioperative administration of piperacillin-tazobactam versus cefoxitin as antimicrobial prophylaxis. Outcomes included development of SSI, pancreatic fistula, sepsis, multidrug-resistant (MDR) infections, and mortality (all 30-day outcomes).
Results
Among 4039 patients who underwent open PD, 2496 (61.8 %) received perioperative cefoxitin, while 1543 (38.2 %) received piperacillin-tazobactam. Over time, piperacillin-tazobactam replaced cefoxitin as the predominant antimicrobial prophylaxis (p-trend <0.001). Patients who received piperacillin-tazobactam had a higher Charlson comorbidity index, more frequently had a history of diabetes, smoking and more frequently had preoperative biliary stent placed compared with individuals who received cefoxitin (all p < 0.05). Patients receiving piperacillin-tazobactam had a lower incidence of any SSI, superficial SSI, deep incisional/organ space SSI, pancreatic fistula and sepsis compared with cefoxitin (all p < 0.05). No difference was observed in 30-day MDR infections or mortality (p > 0.05).
Conclusions
The use of prophylactic piperacillin-tazobactam was associated with better perioperative outcomes compared with cefoxitin among patients undergoing open PD.
{"title":"Piperacillin-tazobactam versus cefoxitin as perioperative prophylaxis for pancreatoduodenectomy: real world evidence from the EPIC Cosmos database","authors":"Diamantis I. Tsilimigras , Selamawit Woldesenbet , Dimitrios Moris , Shahzaib Zindani , Jordan M. Cloyd , Mary Dillhoff , Susan Tsai , Timothy M. Pawlik","doi":"10.1016/j.hpb.2025.10.012","DOIUrl":"10.1016/j.hpb.2025.10.012","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial prophylaxis with piperacillin-tazobactam was recently demonstrated to reduce the incidence of surgical site infections (SSI) and pancreatic fistula following open pancreatoduodenectomy (PD) compared with cefoxitin. Larger scale, real-world data to confirm effectiveness of piperacillin-tazobactam are lacking.</div></div><div><h3>Methods</h3><div>Patients undergoing open PD between 2016 and 2024 were identified in the EPIC Cosmos database. Exposure included perioperative administration of piperacillin-tazobactam versus cefoxitin as antimicrobial prophylaxis. Outcomes included development of SSI, pancreatic fistula, sepsis, multidrug-resistant (MDR) infections, and mortality (all 30-day outcomes).</div></div><div><h3>Results</h3><div>Among 4039 patients who underwent open PD, 2496 (61.8 %) received perioperative cefoxitin, while 1543 (38.2 %) received piperacillin-tazobactam. Over time, piperacillin-tazobactam replaced cefoxitin as the predominant antimicrobial prophylaxis (p-trend <0.001). Patients who received piperacillin-tazobactam had a higher Charlson comorbidity index, more frequently had a history of diabetes, smoking and more frequently had preoperative biliary stent placed compared with individuals who received cefoxitin (all p < 0.05). Patients receiving piperacillin-tazobactam had a lower incidence of any SSI, superficial SSI, deep incisional/organ space SSI, pancreatic fistula and sepsis compared with cefoxitin (all p < 0.05). No difference was observed in 30-day MDR infections or mortality (p > 0.05).</div></div><div><h3>Conclusions</h3><div>The use of prophylactic piperacillin-tazobactam was associated with better perioperative outcomes compared with cefoxitin among patients undergoing open PD.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 70-77"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556820","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.002
Andrew A. Gumbs , Niki Rashidian , Andrew J. Healey , Aiste Gulla , Francesca Ratti , Alessandro Esposito , Andrea Belli , Stefan A. Bouwense , Angelakoudis Apostolos , Sven A. Lang , Victor López-López , Gregor A. Stavrou , Isabella Frigerio , Martina Guerra , Matteo de Pastena , Oliver Strobel , Karol Rawicz-Pruszyński
Background
As artificial intelligence (AI) continues to influence surgical practice, its role in Hepato-Pancreato and Biliary (HPB) surgery is becoming increasingly significant. This paper proposes a structured framework for understanding surgical autonomy, with implications for training, departmental organization, and the future of HPB surgery.
Methods
An international survey was distributed to 1100 members of the European and African Hepatic Pancreatic and Biliary Association (E-AHPBA). The survey comprised 38 questions, designed by the Innovation Committee and the Artificial Intelligence Surgery Task Force. It assessed surgeon opinions on surgical definitions, technology, and the evolving role of AI. Responses were analyzed for agreement levels, with a level of agreement greater than 75% considered high.
Results
A total of 206 responses (18.7%) were collected. There was support for using terms like collaborative robotic surgery (levels 2–4 autonomy) and artificial intelligence surgery (AIS) for levels 2–5. Significant specialty-based differences emerged on some definitions, particularly regarding RAS and autonomy.
Conclusion
The future of HPB surgery may require surgeons to be trained not only in traditional and minimally invasive techniques but also AI-assisted interventions. As AI becomes more integral, clear definitions and expanded training are essential to prepare the next generation of HPB surgeons properly.
{"title":"E-AHPBA innovation committee position paper on the future of hepato-pancreato and biliary surgery and artificial intelligence","authors":"Andrew A. Gumbs , Niki Rashidian , Andrew J. Healey , Aiste Gulla , Francesca Ratti , Alessandro Esposito , Andrea Belli , Stefan A. Bouwense , Angelakoudis Apostolos , Sven A. Lang , Victor López-López , Gregor A. Stavrou , Isabella Frigerio , Martina Guerra , Matteo de Pastena , Oliver Strobel , Karol Rawicz-Pruszyński","doi":"10.1016/j.hpb.2025.10.002","DOIUrl":"10.1016/j.hpb.2025.10.002","url":null,"abstract":"<div><h3>Background</h3><div>As artificial intelligence (AI) continues to influence surgical practice, its role in Hepato-Pancreato and Biliary (HPB) surgery is becoming increasingly significant. This paper proposes a structured framework for understanding surgical autonomy, with implications for training, departmental organization, and the future of HPB surgery.</div></div><div><h3>Methods</h3><div>An international survey was distributed to 1100 members of the European and African Hepatic Pancreatic and Biliary Association (E-AHPBA). The survey comprised 38 questions, designed by the Innovation Committee and the Artificial Intelligence Surgery Task Force. It assessed surgeon opinions on surgical definitions, technology, and the evolving role of AI. Responses were analyzed for agreement levels, with a level of agreement greater than 75% considered high.</div></div><div><h3>Results</h3><div>A total of 206 responses (18.7%) were collected. There was support for using terms like collaborative robotic surgery (levels 2–4 autonomy) and artificial intelligence surgery (AIS) for levels 2–5. Significant specialty-based differences emerged on some definitions, particularly regarding RAS and autonomy.</div></div><div><h3>Conclusion</h3><div>The future of HPB surgery may require surgeons to be trained not only in traditional and minimally invasive techniques but also AI-assisted interventions. As AI becomes more integral, clear definitions and expanded training are essential to prepare the next generation of HPB surgeons properly.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 26-34"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145661127","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.003
Filip Gryspeerdt , Luís Filipe Abreu de Carvalho , Niki Rashidian , Suzane Ribeiro , Anne Hoorens , Karen Geboes , Frederik Berrevoet
Background
For unexpected locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) found during surgical exploration, surgeons can risk an incomplete resection or abort surgery to administer salvage neoadjuvant chemotherapy (sNACT). We aim to evaluate the outcomes of sNACT.
Methods
Upfront PDAC resections between 2015-2022 were identified, focusing on surgery aborted due to local inoperability. Demographics, treatment, and survival rates were compared with patients who had upfront vascular or R1-direct resection.
Results
Among 382 resections, 33 surgeries were aborted due to local inoperability (8.7 %). Only 20/33 of the patients with intraoperative decision for sNACT received it, mostly FOLFIRINOX (17/33). Patients who did not undergo sNACT were older [73 (64–80) vs 64 (56–71), p = 0.027] and had a higher ASA-score [ASA III-IV: 8 (61.5) vs 5 (38.5), p = 0.005]. Thirteen patients underwent re-exploration after sNACT and ten had a resection, with no major complications. Median overall survival was 14.9 months (95 % CI 9.5–20.3) for the salvage group and 20.1 months for the upfront vascular/R1-direct group (95 % CI 12.8–27.4) (p = 0.107).
Conclusion
Salvage NACT shows 30 % resection rate, low operative morbidity, and non-inferior survival outcomes. Frail patients are less likely to undergo sNACT and may benefit from upfront surgery if technically feasible.
背景：对于在手术探查过程中意外发现的局部晚期（LA）胰腺导管腺癌（PDAC），外科医生可能会冒险进行不完全切除或手术流产，以实施补救性新辅助化疗（sNACT）。我们的目标是评估sNACT的结果。方法：选取2015-2022年间的PDAC前期手术，重点关注因局部不可操作而流产的手术。人口统计学，治疗和生存率比较患者的前期血管或r1直接切除。结果：382例手术中，因局部不能手术而流产33例（8.7%）。术中决定sNACT的患者中只有20/33接受了sNACT治疗，其中大多数是FOLFIRINOX（17/33）。未接受sNACT治疗的患者年龄较大[73 (64-80)vs 64 (56-71), p = 0.027]， ASA评分较高[ASA III-IV: 8 (61.5) vs 5 (38.5), p = 0.005]。13例患者在sNACT后进行了再次探查，10例进行了切除，无重大并发症。挽救组的中位总生存期为14.9个月（95% CI 9.5-20.3），而血管/ r1直接组的中位总生存期为20.1个月（95% CI 12.8-27.4） （p = 0.107）。结论：补救性NACT手术切除率达30%，手术发病率低，生存预后良好。体弱患者不太可能接受sNACT，如果技术可行，可能会从前期手术中受益。
{"title":"Success rate of salvage neoadjuvant chemotherapy for unexpectedly identified locally advanced pancreatic ductal adenocarcinoma during surgical exploration","authors":"Filip Gryspeerdt , Luís Filipe Abreu de Carvalho , Niki Rashidian , Suzane Ribeiro , Anne Hoorens , Karen Geboes , Frederik Berrevoet","doi":"10.1016/j.hpb.2025.10.003","DOIUrl":"10.1016/j.hpb.2025.10.003","url":null,"abstract":"<div><h3>Background</h3><div>For unexpected locally advanced (LA) pancreatic ductal adenocarcinoma (PDAC) found during surgical exploration, surgeons can risk an incomplete resection or abort surgery to administer salvage neoadjuvant chemotherapy (sNACT). We aim to evaluate the outcomes of sNACT.</div></div><div><h3>Methods</h3><div>Upfront PDAC resections between 2015-2022 were identified, focusing on surgery aborted due to local inoperability. Demographics, treatment, and survival rates were compared with patients who had upfront vascular or R1-direct resection.</div></div><div><h3>Results</h3><div>Among 382 resections, 33 surgeries were aborted due to local inoperability (8.7 %). Only 20/33 of the patients with intraoperative decision for sNACT received it, mostly FOLFIRINOX (17/33). Patients who did not undergo sNACT were older [73 (64–80) vs 64 (56–71), p = 0.027] and had a higher ASA-score [ASA III-IV: 8 (61.5) vs 5 (38.5), p = 0.005]. Thirteen patients underwent re-exploration after sNACT and ten had a resection, with no major complications. Median overall survival was 14.9 months (95 % CI 9.5–20.3) for the salvage group and 20.1 months for the upfront vascular/R1-direct group (95 % CI 12.8–27.4) (p = 0.107).</div></div><div><h3>Conclusion</h3><div>Salvage NACT shows 30 % resection rate, low operative morbidity, and non-inferior survival outcomes. Frail patients are less likely to undergo sNACT and may benefit from upfront surgery if technically feasible.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 35-42"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145389130","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.09.008
Nynke Michiels , Jenny FK Tromp , Daan J Comes , Maite NE Liem , Jesse V Groen , Marc G Besselink , Koop Bosscha , Lodewijk AA Brosens , Olivier R Busch , Marcel den Dulk , Sebastiaan Festen , Foke van Delft , Bas Groot Koerkamp , Erwin van der Harst , John Hermans , Ignace H de Hingh , Cees JHM van Laarhoven , Mike SL Liem , Eric Manusama , Vincent E de Meijer , Martijn WJ Stommel
Background
Venous resection (VR) during left-sided pancreatic resection (LPR) is typically more challenging than during pancreatoduodenectomy, because the pancreatic head remains in situ. Theoretically, converting from LPR to total pancreatectomy (TP) could resolve this issue. This study compared clinical outcomes after LPR and TP with and without VR.
Methods
This nationwide retrospective study included all patients who underwent LPR for all indications or single-stage TP in the Netherlands from 2014 to 2019.
Results
One-thousand-seventy-five patients were analyzed: 996 underwent LPR and 79 TP. Twenty-eight (3%) LPRs were with VR (VR+), of which 17 wedge and 11 segmental resections. Of 21 (27%) TPs with VR, 11 were wedge and 10 segmental resections. In the LPR-group, VR+ was associated with a higher incidence of portomesenteric venous thrombosis (PVT) than VR- (3/28 vs. 5/968, p < 0.001), but not with major complications or mortality. Similarly, in the TP-group, higher rates of PVT were reported after VR+ (2/21 vs. 0/58, p = 0.004). The incidence of major complications and PVT were comparable between LPR-VR+ and TP-VR+, but postoperative mortality was higher in TP-VR+ (6/21 vs. 1/28 p = 0.032).
Conclusion
Our findings suggest that, despite technical impediments of VR during LPR, switching to TP may not benefit patients.
背景：左侧胰腺切除术（LPR）中的静脉切除术（VR）通常比胰十二指肠切除术更具挑战性，因为胰头仍在原位。从理论上讲，从LPR转向全胰切除术（TP）可以解决这个问题。本研究比较了有VR和没有VR的LPR和TP的临床结果。方法：这项全国性的回顾性研究纳入了2014年至2019年荷兰所有适应症或单期TP的LPR患者。结果：共分析了1775例患者，其中LPR 996例，TP 79例。采用VR+的lpr 28例（3%），其中楔形切除17例，节段性切除11例。在21例（27%）伴有VR的TPs中，11例为楔形切除，10例为节段性切除。在lpr组中，VR+组的portomesenteric venous thrombosis （PVT）发生率高于VR-组（3/28 vs. 5/968, p < 0.001），但与主要并发症或死亡率无关。同样，在tp组中，VR+后PVT发生率较高（2/21 vs. 0/58, p = 0.004）。LPR-VR+和TP-VR+的主要并发症和PVT发生率相当，但TP-VR+的术后死亡率更高（6/21比1/28 p = 0.032）。结论：我们的研究结果表明，尽管在LPR期间VR存在技术障碍，但改用TP可能对患者没有好处。
{"title":"Short- and long-term outcomes after venous resection during left-sided and total pancreatic resection: a nationwide cohort study","authors":"Nynke Michiels , Jenny FK Tromp , Daan J Comes , Maite NE Liem , Jesse V Groen , Marc G Besselink , Koop Bosscha , Lodewijk AA Brosens , Olivier R Busch , Marcel den Dulk , Sebastiaan Festen , Foke van Delft , Bas Groot Koerkamp , Erwin van der Harst , John Hermans , Ignace H de Hingh , Cees JHM van Laarhoven , Mike SL Liem , Eric Manusama , Vincent E de Meijer , Martijn WJ Stommel","doi":"10.1016/j.hpb.2025.09.008","DOIUrl":"10.1016/j.hpb.2025.09.008","url":null,"abstract":"<div><h3>Background</h3><div>Venous resection (VR) during left-sided pancreatic resection (LPR) is typically more challenging than during pancreatoduodenectomy, because the pancreatic head remains <em>in situ</em>. Theoretically, converting from LPR to total pancreatectomy (TP) could resolve this issue. This study compared clinical outcomes after LPR and TP with and without VR.</div></div><div><h3>Methods</h3><div>This nationwide retrospective study included all patients who underwent LPR for all indications or single-stage TP in the Netherlands from 2014 to 2019.</div></div><div><h3>Results</h3><div>One-thousand-seventy-five patients were analyzed: 996 underwent LPR and 79 TP. Twenty-eight (3%) LPRs were with VR (VR+), of which 17 wedge and 11 segmental resections. Of 21 (27%) TPs with VR, 11 were wedge and 10 segmental resections. In the LPR-group, VR+ was associated with a higher incidence of portomesenteric venous thrombosis (PVT) than VR- (3/28 vs. 5/968, <em>p</em> < 0.001), but not with major complications or mortality. Similarly, in the TP-group, higher rates of PVT were reported after VR+ (2/21 vs. 0/58, <em>p</em> = 0.004). The incidence of major complications and PVT were comparable between LPR-VR+ and TP-VR+, but postoperative mortality was higher in TP-VR+ (6/21 vs. 1/28 <em>p</em> = 0.032).</div></div><div><h3>Conclusion</h3><div>Our findings suggest that, despite technical impediments of VR during LPR, switching to TP may not benefit patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 10-18"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145312147","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.014
Claudio Ricci , Laura Alberici , Vincenzo D'Ambra , Carlo Ingaldi , Marco Fichera , Riccardo Casadei
Background
The cost-effectiveness of a laparoscopic (LPD) and robotic pancreaticoduodenectomy (RPD), compared with the open approach (OPD), is still under debate.
Methods
A Markov decision model was developed to compare OPD, LPD, and RPD. The healthcare costs and quality-adjusted life years (QALYs) were estimated by calculating the incremental cost-effectiveness ratio (ICER) per QALY gained. A willingness-to-pay (WTP) of $130,049 was assumed as the threshold. A probabilistic sensitivity analysis (PSA) was performed to reflect the uncertainty of various parameters.
Results
In the base case scenario, LPD and RPD were associated with increased costs of US $30,047 and US $30,822, respectively, leading to an ICER of US $-3,911,669 and US $-1,164,992 per QALY. When comparing LPD with OPD, three main factors influence the model: OPD costs (68.8 %), LPD costs (27.9 %), and the complication rate after LPD (2.3 %). In comparing RPD with OPD, two main factors affect the model: RPD costs (75.2 %) and OPD costs (23.3 %). PSA analysis confirmed that OPD was the most cost-effective choice in most cases (62.6 %), while RPD and LPD were the most cost-effective procedures in 26.2 % and 11.9 %, respectively.
Conclusion
The RDP and LPD were not cost-effective. OPD remained the best approach.
{"title":"The “Big short” of minimally invasive pancreaticoduodenectomy for pancreatic ductal adenocarcinoma. A cost-effectiveness analysis based on randomized trials","authors":"Claudio Ricci , Laura Alberici , Vincenzo D'Ambra , Carlo Ingaldi , Marco Fichera , Riccardo Casadei","doi":"10.1016/j.hpb.2025.10.014","DOIUrl":"10.1016/j.hpb.2025.10.014","url":null,"abstract":"<div><h3>Background</h3><div>The cost-effectiveness of a laparoscopic (LPD) and robotic pancreaticoduodenectomy (RPD), compared with the open approach (OPD), is still under debate.</div></div><div><h3>Methods</h3><div>A Markov decision model was developed to compare OPD, LPD, and RPD. The healthcare costs and quality-adjusted life years (QALYs) were estimated by calculating the incremental cost-effectiveness ratio (ICER) per QALY gained. A willingness-to-pay (WTP) of $130,049 was assumed as the threshold. A probabilistic sensitivity analysis (PSA) was performed to reflect the uncertainty of various parameters.</div></div><div><h3>Results</h3><div>In the base case scenario, LPD and RPD were associated with increased costs of US $30,047 and US $30,822, respectively, leading to an ICER of US $-3,911,669 and US $-1,164,992 per QALY. When comparing LPD with OPD, three main factors influence the model: OPD costs (68.8 %), LPD costs (27.9 %), and the complication rate after LPD (2.3 %). In comparing RPD with OPD, two main factors affect the model: RPD costs (75.2 %) and OPD costs (23.3 %). PSA analysis confirmed that OPD was the most cost-effective choice in most cases (62.6 %), while RPD and LPD were the most cost-effective procedures in 26.2 % and 11.9 %, respectively.</div></div><div><h3>Conclusion</h3><div>The RDP and LPD were not cost-effective. OPD remained the best approach.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 78-88"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145534341","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}
Pub Date : 2026-01-01DOI: 10.1016/S1365-182X(25)01737-X
{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)01737-X","DOIUrl":"10.1016/S1365-182X(25)01737-X","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Page iii"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145883373","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}
The significance of aggressive hepatic vein (HV) resection and suitable reconstruction for colorectal liver metastases (CLMs) remains unclear.
Methods
The retrospectively collected hospital surgical patient data were obtained from consecutive patients who underwent liver resections for CLM between January 2010 and December 2022. A total of 628 liver resections were performed for CLMs and 395 of these were first liver resections. Fifty-four patients underwent HV or inferior vena cava resection and reconstruction for CLM invasion (VR group), and the remaining 341 patients had no venous reconstruction (NR group).
Results
Multivariate analysis showed that only tumor size ≥5 cm and R1 vascular were prognostic risk factors for overall survival (OS). Although the 1-, 3-, and 5-year OS of the VR group was poorer than that of the NR group (92.2 %, 67.2 %, 37.9 % vs 97.0 %, 76.6 %, 64.4 %, P < 0.001), there was no significant difference between the NR-propensity score matching (PSM) and VR-PSM analysis groups (P = 0.220).
Conclusions
R0-intent aggressive hepatic vein (HV) resection and appropriate reconstruction for CLMs may still be essential. Achieving an R0 resection remains a key objective, while the acceptability of R1 vascular resection continues to be debated.
背景：侵袭性肝静脉（HV）切除和适当重建对结直肠肝转移瘤（CLMs）的意义尚不清楚。方法：回顾性收集2010年1月至2022年12月连续行CLM肝切除术的医院外科患者资料。CLMs共进行了628例肝切除，其中395例为首次肝切除。54例患者因CLM侵袭行HV或下腔静脉切除重建（VR组），341例患者未行静脉重建（NR组）。结果：多因素分析显示，肿瘤大小≥5cm和R1血管是影响总生存期（OS）的预后危险因素。尽管VR组的1、3、5年OS较NR组差（92.2%、67.2%、37.9% vs 97.0%、76.6%、64.4%,P < 0.001），但NR-倾向评分匹配（PSM）和VR-PSM分析组之间无显著差异（P = 0.220）。结论：r0意图侵袭性肝静脉（HV）切除和适当的CLMs重建可能仍然是必要的。实现R0切除仍然是一个关键目标，而R1血管切除的可接受性仍然存在争议。
{"title":"Aggressive hepatic vein resection aimed at achieving R0 resection for colorectal liver metastases remains crucial","authors":"Yoshihito Hayashi, Junichi Kaneko, Yui Sawa, Yuhi Yoshizaki, Yusuke Kazami, Yujiro Nishioka, Akinori Miyata, Akihiko Ichida, Takeshi Takamoto, Nobuhisa Akamatsu, Yoshikuni Kawaguchi, Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2025.10.007","DOIUrl":"10.1016/j.hpb.2025.10.007","url":null,"abstract":"<div><h3>Background</h3><div>The significance of aggressive hepatic vein (HV) resection and suitable reconstruction for colorectal liver metastases (CLMs) remains unclear.</div></div><div><h3>Methods</h3><div>The retrospectively collected hospital surgical patient data were obtained from consecutive patients who underwent liver resections for CLM between January 2010 and December 2022. A total of 628 liver resections were performed for CLMs and 395 of these were first liver resections. Fifty-four patients underwent HV or inferior vena cava resection and reconstruction for CLM invasion (VR group), and the remaining 341 patients had no venous reconstruction (NR group).</div></div><div><h3>Results</h3><div>Multivariate analysis showed that only tumor size ≥5 cm and R1 vascular were prognostic risk factors for overall survival (OS). Although the 1-, 3-, and 5-year OS of the VR group was poorer than that of the NR group (92.2 %, 67.2 %, 37.9 % vs 97.0 %, 76.6 %, 64.4 %, P < 0.001), there was no significant difference between the NR-propensity score matching (PSM) and VR-PSM analysis groups (P = 0.220).</div></div><div><h3>Conclusions</h3><div>R0-intent aggressive hepatic vein (HV) resection and appropriate reconstruction for CLMs may still be essential. Achieving an R0 resection remains a key objective, while the acceptability of R1 vascular resection continues to be debated.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 60-69"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145476687","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}
Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.001
Walter R.F. Donica , Kyle R. Stephens , Suhail Nath , Erin E. Priddy , Prejesh Philips , Robert C.G. Martin III , Timothy M. Pawlik , Jordan M. Cloyd , Charles R. Scoggins , Micheal E. Egger
Background
Previous work has reported similar safety profiles and efficacy outcomes between transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of primary liver tumors and certain liver metastases. We performed a cost-analysis comparing TACE and TARE to help guide treatment decisions from an economic standpoint.
Methods
A retrospective review of data from a single academic medical center of patients undergoing TACE or TARE for primary or metastatic liver tumors between 2018 and 2023 was performed. Estimates of the procedural costs were obtained from hospital financial payment data for fully adjudicated accounts. Costs were adjusted for inflation and compared between treatment types.
Results
There were 44 patients treated with TACE and 33 treated with TARE. No statistically significant differences were noted in age, sex, or payer type between treatment modalities. Length of stay was longer in the TACE group (p = 0.029). Median total payments received for a single TARE procedure was higher than that of a single TACE treatment ($37,780 vs. $10,606, p < 0.001).
Discussion
When there is equivalent clinical efficacy of TACE and TARE, as is the case for patients with neuroendocrine liver metastases or hepatocellular carcinoma for example, TACE is a more cost-effective treatment.
{"title":"Value in the treatment of primary and metastatic liver tumors: comparative cost-analysis of transarterial chemoembolization to transarterial radioembolization","authors":"Walter R.F. Donica , Kyle R. Stephens , Suhail Nath , Erin E. Priddy , Prejesh Philips , Robert C.G. Martin III , Timothy M. Pawlik , Jordan M. Cloyd , Charles R. Scoggins , Micheal E. Egger","doi":"10.1016/j.hpb.2025.10.001","DOIUrl":"10.1016/j.hpb.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Previous work has reported similar safety profiles and efficacy outcomes between transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of primary liver tumors and certain liver metastases. We performed a cost-analysis comparing TACE and TARE to help guide treatment decisions from an economic standpoint.</div></div><div><h3>Methods</h3><div>A retrospective review of data from a single academic medical center of patients undergoing TACE or TARE for primary or metastatic liver tumors between 2018 and 2023 was performed. Estimates of the procedural costs were obtained from hospital financial payment data for fully adjudicated accounts. Costs were adjusted for inflation and compared between treatment types.</div></div><div><h3>Results</h3><div>There were 44 patients treated with TACE and 33 treated with TARE. No statistically significant differences were noted in age, sex, or payer type between treatment modalities. Length of stay was longer in the TACE group (p = 0.029). Median total payments received for a single TARE procedure was higher than that of a single TACE treatment ($37,780 vs. $10,606, p < 0.001).</div></div><div><h3>Discussion</h3><div>When there is equivalent clinical efficacy of TACE and TARE, as is the case for patients with neuroendocrine liver metastases or hepatocellular carcinoma for example, TACE is a more cost-effective treatment.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 19-25"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458668","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}
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