Hpb最新文献 - Book学术

Phase-specific operative times in robotic distal pancreatectomy: impact of body mass index and learning experience. 机器人远端胰腺切除术的阶段特异性手术时间：体重指数和学习经验的影响。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-07 DOI: 10.1016/j.hpb.2026.02.010

Koichi Tomita, Michael P Kim, Laura R Prakash, Adriana Gamboa, Jessica E Maxwell, Rebecca A Snyder, Ching-Wei D Tzeng, Matthew H G Katz, Naruhiko Ikoma

Background: Robotic distal pancreatectomy (RDP) in obese patients is technically demanding, but the phase-specific impact of body mass index (BMI) remains unclear.

Methods: We analyzed 164 patients who underwent RDP with splenectomy between October 2018 and September 2025. Twelve surgical phases were predefined, and all recorded frames were assigned to one phase. Based on the lead surgeon's cumulative sum (CUSUM) curve, the learning period was defined as the first 34 cases. Multivariable linear regression identified determinants of total operative time, and associations between BMI and phase durations were tested.

Results: Median operative time was 269 min. The learning period and BMI ≥30 independently prolonged operative time, with a larger effect in men than in women (β = 59.8 vs 37.5 min; both P < 0.05). After the learning period, phase durations decreased in "greater curvature dissection and splenic flexure mobilization" and "pancreatic tunneling with encircling" (46.6 vs 23.0 min and 13.8 vs 8.5 min; both P < 0.001). In men, higher BMI was associated with longer durations in these phases (β = 2.0 and 1.0 min per BMI unit, respectively), whereas no significant association was observed in women.

Conclusion: Targeted proctoring of these two phases, particularly for obese male patients, may help surgeons maintain efficiency during RDP implementation.

背景：肥胖患者的机器人远端胰腺切除术（RDP）在技术上要求很高，但体重指数（BMI）的阶段特异性影响尚不清楚。方法：我们分析了2018年10月至2025年9月期间接受RDP合并脾切除术的164例患者。预先设定12个手术阶段，并将所有记录帧分配到一个阶段。根据主刀医师的累积和（CUSUM）曲线，将学习期定义为前34例。多变量线性回归确定了总手术时间的决定因素，并测试了BMI和阶段持续时间之间的关系。结果：中位手术时间269 min。学习时间和BMI≥30分别延长手术时间，且对男性的影响大于女性（β = 59.8 vs 37.5 min， P均< 0.05）。学习期结束后，“大曲率夹层和脾曲动员”和“胰腺隧道围合”的相持续时间缩短（46.6 vs 23.0 min, 13.8 vs 8.5 min， P均< 0.001）。在男性中，较高的BMI与这些阶段的持续时间较长相关（分别为每BMI单位β = 2.0和1.0分钟），而在女性中没有观察到显著的关联。结论：有针对性地监测这两个阶段，特别是对肥胖男性患者，可能有助于外科医生在RDP实施过程中保持效率。

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IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2026-02-28 DOI: 10.1016/S1365-182X(26)00067-5

引用次数: 0

Timing of revision surgery for incidental gallbladder cancer: a systematic review and individual patient data meta-analysis 偶发性胆囊癌翻修手术的时机：一项系统综述和个体患者数据荟萃分析。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-05 DOI: 10.1016/j.hpb.2025.12.017

B. Selvakumar , Shraddha Patkar , Phani K. Nekarakanti , Muhammed A. Shamim , Shaleen Agarwal , Paleswan J. Lakhey , Orlando Jorge M. Torres , Mahesh Goel , Vinay K. Kapoor

Aims

We conducted this systematic review to answer the questions: a. what are the timing categories for revision surgery (RS) in incidental gallbladder cancer (iGBC)? b. which RS timing achieves better oncological outcomes?

Methods

We performed literature search in 4 databases (PubMed, Scopus, Google Scholar and Cochrane Reviews) till 10th October 2025 and included studies which reported patient outcomes based on RS timing. Study characteristics, timing category definitions and RS outcomes were collected. (Study protocol PROSPERO ID CRD42023453990).

Results

Twelve retrospective studies were included, with 2067 iGBC patients (566 males and 1346 females). On the ‘Joanna Briggs Institute’ (JBI) tool, most studies scored a ‘Yes’ to 7–8 out of 10 questions. There was no consensus on the definitions of ‘early’, ‘intermediate’ and ‘delayed’ timings for RS. Successful RS, perioperative morbidity, R0 resection were similar. On individual patient data meta-analysis, there was no difference in overall survival between RS at ‘</ = 4 weeks’ and ‘>4 weeks’ [hazard ratio: 1.29, 95 % CI: 0.79–2.10].

Conclusion

There was no consensus on the definitions of timing categories and optimum timing for RS in iGBC. Definitions of timing categories need to be standardised and future studies based on these categories may identify the ideal timing of RS in iGBC.

目的：我们进行了这项系统综述，以回答以下问题：a.意外胆囊癌（iGBC）翻修手术（RS）的时机类别是什么？b.哪个RS时间可以获得更好的肿瘤预后？方法：截至2025年10月10日，我们在PubMed、Scopus、谷歌Scholar和Cochrane Reviews 4个数据库中进行文献检索，并纳入了基于RS时间报告患者结局的研究。收集研究特征、时间分类定义和RS结果。（研究协议PROSPERO ID CRD42023453990）。结果：12项回顾性研究纳入了2067例iGBC患者（男性566例，女性1346例）。在“乔安娜布里格斯研究所”（JBI）的工具上，大多数研究在10个问题中得到了7-8分的肯定分。对于RS的“早期”、“中期”和“延迟”时间的定义尚无共识。成功的RS、围手术期发病率、R0切除术相似。在个体患者数据荟萃分析中，RS在“4周”时的总生存率无差异[风险比：1.29,95% CI: 0.79-2.10]。结论：对iGBC患者RS的时间类别和最佳时间的定义尚未达成共识。时间类别的定义需要标准化，未来基于这些类别的研究可能会确定iGBC中RS的理想时间。

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引用次数: 0

Associating liver partition and portal vein ligation for staged hepatectomy in patients with hepatocellular carcinoma: laparoscopic versus open approach and its impact on future remnant hypertrophy 肝分区和门静脉结扎联合用于肝细胞癌患者的分期肝切除术：腹腔镜与开放入路及其对未来残余肥厚的影响

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1016/j.hpb.2025.12.013

Kin P. Au , Wing C. Dai , Allan H. Kin Lam , Yee H. Shum , Crystal L. Yan Kwan , Miu Y. Chan , Sui L. Sin , Tiffany C. Lam Wong , Wong H. She , Tan T. Cheung , Albert C.Y. Chan

Background

There is a scarcity of data on the feasibility of laparoscopic approach to associating liver partition and portal vein ligation for staged hepatectomy (Lap-ALPPS) regarding its impact on functional liver remnant (FLR) hypertrophy when compared with the open approach.

Methods

A retrospective study of patients who underwent open or lap-ALPPS for hepatocellular carcinoma (HCC) in a tertiary referral centre in Hong Kong during the period from December 2013 to April 2023.

Results

Fifty-seven (42 open and 15 laparoscopic) ALPPS were performed for HCC. The open group had more blood loss during stage I (500 ml vs. 300 ml, p = 0.001). The morbidity (Clavien-Dindo grade ≥ 3a) (14.3 % vs. 26.7 %, p = 0.43) and Grade B/C post-hepatectomy liver failure rates (20.0 % vs 35.7 %, p = 0.34) were similar. The open group had a higher percentage increment in remnant volume (50.6 % vs. 34.8 %, p = 0.02). Linear regression revealed that a small pre-operative FLR/ESLV (B = −1.75, 95 % CI -2.82–0.678, p < 0.001) and an open approach at stage I B = −20.2, 95 % CI -37.7–2.68, p < 0.001) predicted a higher percentage increment in remnant volume.

Conclusion

Lap-ALPPS had less blood loss but was associated with slower hypertrophy. Hence, a longer waiting time to stage II ALPPS may be required in selected patients

背景：与开放入路相比，腹腔镜入路联合肝分区和门静脉结扎分阶段肝切除术（Lap-ALPPS）对功能性残肝（FLR）肥厚的影响方面的可行性数据缺乏。方法：对2013年12月至2023年4月期间在香港一家三级转诊中心接受开放或lap-ALPPS治疗肝细胞癌（HCC）的患者进行回顾性研究。结果：57例（42例为开腹手术，15例为腹腔镜手术）行肝细胞癌ALPPS。开放组在I期失血量更多（500 ml vs 300 ml, p = 0.001）。发病率（Clavien-Dindo分级≥3a）（14.3% vs 26.7%, p = 0.43）和B/C级肝切除术后肝衰竭发生率（20.0% vs 35.7%, p = 0.34）相似。开放组的残余体积增加百分比更高（50.6%比34.8%,p = 0.02）。线性回归显示，术前较小的FLR/ESLV （B = -1.75, 95% CI -2.82-0.678, p < 0.001）和I期开放入路B = -20.2, 95% CI -37.7-2.68, p < 0.001)预示着较高的残余体积增加百分比。结论：Lap-ALPPS失血量少，但肥厚较慢。因此，在选定的患者中，可能需要更长的等待时间来进行II期ALPPS。

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引用次数: 0

Comparing hypertrophy of the future liver remnant for two different strategies of portal vein embolization in patients with bilobar colorectal liver metastases – a retrospective European multicentre study 比较两种不同门静脉栓塞策略对双叶结直肠肝转移患者未来肝残余肥厚的影响——一项欧洲多中心回顾性研究。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-03 DOI: 10.1016/j.hpb.2025.12.006

Dennis Björk , Tim Reese , Anne M. Holmen Longva , Kristian S. Kiim , Maximilian Evers , Peter N. Larsen , Nicolai Aagaard Schultz , Bård I. Røsok , Ulrik Carling , Fredrik Holmquist , Gert Lindell , Per Sandström , Jörg Böcker , Stefan Gilg , Jennie Engstrand , Christian Sturesson , Karl J. Oldhafer , Ernesto Sparrelid , Bergthor Björnsson

Background

Portal vein embolization (PVE) is a well-established technique for inducing liver hypertrophy in the future liver remnant (FLR) before major hepatectomy. A frequently used method in bilobar disease is the two-stage hepatectomy (TSH) technique combined with PVE (TSH-PVE). A novel approach is PVE, followed by a one-stage hepatectomy (OSH), combining major hepatectomy with clearing of the FLR (PVE-OSH). This study aimed to compare FLR hypertrophy between these two strategies for induced liver hypertrophy.

Material/methods

Patients with bilobar colorectal liver metastases (CRLM) who underwent PVE from January 2013 to December 2021 were included in this retrospective, multicenter study. Aspects of hypertrophy of the FLR were compared between the groups.

Results

The study included 188 patients, 127 in the PVE-OSH group and 61 in the TSH-PVE group. There were no statistically significant differences between the two groups regarding FLR hypertrophy measured by absolute and relative growth, degree of hypertrophy or kinetic growth rate. No major complications were reported.

Discussion/conclusion

No differences in FLR hypertrophy were demonstrated between the two different treatment strategies of TSH-PVE or PVE-OSH. This supports PVE-OSH as a feasible treatment option that reduces the surgical burden for patients with advanced, bilobar CRLM disease.

背景：门静脉栓塞（PVE）是一种成熟的技术，用于诱导未来肝残（FLR）肝切除术前的肝肥厚。双叶疾病常用的治疗方法是两期肝切除术（TSH）联合PVE （TSH-PVE）。一种新的方法是PVE，然后是一期肝切除术（OSH），结合主要肝切除术和清除FLR （PVE-OSH）。本研究旨在比较这两种策略对诱导肝肥大的FLR肥大的影响。材料/方法：2013年1月至2021年12月期间接受PVE治疗的双叶结直肠肝转移（CRLM）患者纳入本回顾性多中心研究。比较两组间FLR肥大的情况。结果：共纳入188例患者，其中PVE-OSH组127例，TSH-PVE组61例。两组间以绝对生长和相对生长、肥大程度、运动生长速率测量的FLR肥大差异无统计学意义。无重大并发症报道。讨论/结论：TSH-PVE或PVE-OSH两种不同治疗策略在FLR肥大方面无差异。这支持PVE-OSH作为一种可行的治疗选择，可以减轻晚期双叶CRLM患者的手术负担。

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引用次数: 0

The role of artificial intelligence in enhancing safety assessment of laparoscopic cholecystectomy: a systematic review 人工智能在加强腹腔镜胆囊切除术安全性评估中的作用：系统综述。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1016/j.hpb.2025.12.014

Michael El Boghdady , Shahmir Temori , Dena Khaireldin , Béatrice M. Ewalds-Kvist , Mustansar A. Ghazanfar , Somaiah Aroori

Background

Laparoscopic cholecystectomy (LC), a common abdominal operation, is associated with significant morbidity, particularly bile duct injury. Artificial intelligence (AI) can enable real-time monitoring, assist decision-making, increase safety, and improve patient outcomes. This study systematically reviews AI applications in LC, evaluating different models and their performance.

Methods

A systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted using PubMed and ScienceDirect databases for studies published between 2014 and 2024. All studies assessing AI applications in LC were included. Data extraction focused on the study aims, types of AI tools, datasets, anatomical recognition capabilities, and accuracy metrics.

Results

The search yielded 413 citations; a final list of 43 citations was compiled after applying the inclusion and exclusion criteria. Different datasets and developed AI tools were used in LC. AI tools were utilised in risk-scoring models for complication identification and outcome prediction, as well as for recognising anatomical landmarks during LC and subdividing the procedure into subtasks.

Conclusion

AI integration in LC is promising for improving intraoperative guidance, enhancing surgical education, and supporting decision-making processes. Future large-scale studies are warranted to validate the role of AI in improving patient safety and outcomes in LC.

背景：腹腔镜胆囊切除术（LC）是一种常见的腹部手术，发病率高，尤其是胆管损伤。人工智能（AI）可以实现实时监控、辅助决策、提高安全性并改善患者的治疗效果。本研究系统回顾了人工智能在LC中的应用，评估了不同的模型及其性能。方法：按照PRISMA指南进行系统评价。使用PubMed和ScienceDirect数据库对2014年至2024年间发表的研究进行了全面的文献检索。所有评估人工智能在LC中的应用的研究都被纳入。数据提取侧重于研究目标、人工智能工具类型、数据集、解剖识别能力和准确性指标。结果：检索得到413条引用；在应用纳入和排除标准后，编制了43条引用的最终清单。LC中使用了不同的数据集和开发的AI工具。人工智能工具被用于风险评分模型，用于并发症识别和结果预测，以及识别LC过程中的解剖标志，并将过程细分为子任务。结论：人工智能集成在LC中有希望改善术中指导，加强手术教育，支持决策过程。未来有必要进行大规模研究，以验证人工智能在改善LC患者安全性和预后方面的作用。

{"title":"The role of artificial intelligence in enhancing safety assessment of laparoscopic cholecystectomy: a systematic review","authors":"Michael El Boghdady , Shahmir Temori , Dena Khaireldin , Béatrice M. Ewalds-Kvist , Mustansar A. Ghazanfar , Somaiah Aroori","doi":"10.1016/j.hpb.2025.12.014","DOIUrl":"10.1016/j.hpb.2025.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic cholecystectomy (LC), a common abdominal operation, is associated with significant morbidity, particularly bile duct injury. Artificial intelligence (AI) can enable real-time monitoring, assist decision-making, increase safety, and improve patient outcomes. This study systematically reviews AI applications in LC, evaluating different models and their performance.</div></div><div><h3>Methods</h3><div>A systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted using PubMed and ScienceDirect databases for studies published between 2014 and 2024. All studies assessing AI applications in LC were included. Data extraction focused on the study aims, types of AI tools, datasets, anatomical recognition capabilities, and accuracy metrics.</div></div><div><h3>Results</h3><div>The search yielded 413 citations; a final list of 43 citations was compiled after applying the inclusion and exclusion criteria. Different datasets and developed AI tools were used in LC. AI tools were utilised in risk-scoring models for complication identification and outcome prediction, as well as for recognising anatomical landmarks during LC and subdividing the procedure into subtasks.</div></div><div><h3>Conclusion</h3><div>AI integration in LC is promising for improving intraoperative guidance, enhancing surgical education, and supporting decision-making processes. Future large-scale studies are warranted to validate the role of AI in improving patient safety and outcomes in LC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 266-275"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862926","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}

引用次数: 0

Efficacy and safety of TRIANGLE operation for pancreatic head and body cancer: a systematic review and meta-analysis 三角手术治疗胰头体癌的疗效和安全性：系统回顾和荟萃分析。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-24 DOI: 10.1016/j.hpb.2025.12.030

Rui Cao, Yuerong Xuan, Xiaowen Gong, Chengshuai Pang, Chenyang Dong, Chaojie Liang

Background

Despite growing adoption of the Heidelberg TRIANGLE operation for pancreatic head/body tumors, comprehensive analysis of its safety and outcomes remains lacking.

Methods

Systematic searches using predefined criteria (inception-May 2024) across PubMed, Cochrane, Web of Science, Embase, Medline, CNKI and Wan-Fang databases identified eligible studies. Primary outcomes were R0 resection rates and survival; secondary outcomes were complications and recurrence. Meta-analysis utilized Stata 18.0.

Results

This meta-analysis included 8 studies (1,106 patients). Compared to standard resection, the TRIANGLE group had longer operative times and higher postoperative diarrhea rates (P < 0.001), but demonstrated reduced 1-year (P = 0.001) and 3-year recurrence (P = 0.036), lower perioperative mortality (P = 0.032), and more extensive lymph node dissection (P = 0.004). No differences were observed in R0 rates (P = 0.171), survival (1-year P = 0.730; 3-year P = 0.136), or primary complications. Overall survival (P = 0.075) and recurrence rates (P = 0.137) showed no statistical significance.

Conclusion

TRIANGLE operation reduces 1/3-year recurrence rates vs standard resection but increases postoperative diarrhea, while achieving similar R0/R1 rates and survival outcomes. Its clinical benefits require validation through large multicenter RCTs.

背景：尽管越来越多的人采用Heidelberg三角手术治疗胰腺头/体肿瘤，但对其安全性和结果的综合分析仍然缺乏。方法：使用预定义标准（inception- 2024年5月）在PubMed、Cochrane、Web of Science、Embase、Medline、CNKI和万方数据库中进行系统搜索，确定符合条件的研究。主要结局为R0切除率和生存率；次要结果为并发症和复发。meta分析采用Stata 18.0。结果：本荟萃分析包括8项研究（1106例患者）。与标准切除相比，TRIANGLE组手术时间更长，术后腹泻率更高（P < 0.001），但1年（P = 0.001）和3年复发率（P = 0.036）降低，围手术期死亡率（P = 0.032）降低，淋巴结清扫更广泛（P = 0.004）。R0率（P = 0.171）、生存率（1年P = 0.730； 3年P = 0.136）、原发性并发症均无差异。总生存率（P = 0.075）和复发率（P = 0.137）差异无统计学意义。结论：与标准手术相比，三角手术减少了1/3年的复发率，但增加了术后腹泻，同时获得了相似的R0/R1率和生存结果。其临床益处需要通过大型多中心随机对照试验验证。

{"title":"Efficacy and safety of TRIANGLE operation for pancreatic head and body cancer: a systematic review and meta-analysis","authors":"Rui Cao, Yuerong Xuan, Xiaowen Gong, Chengshuai Pang, Chenyang Dong, Chaojie Liang","doi":"10.1016/j.hpb.2025.12.030","DOIUrl":"10.1016/j.hpb.2025.12.030","url":null,"abstract":"<div><h3>Background</h3><div>Despite growing adoption of the Heidelberg TRIANGLE operation for pancreatic head/body tumors, comprehensive analysis of its safety and outcomes remains lacking.</div></div><div><h3>Methods</h3><div>Systematic searches using predefined criteria (inception-May 2024) across PubMed, Cochrane, Web of Science, Embase, Medline, CNKI and Wan-Fang databases identified eligible studies. Primary outcomes were R0 resection rates and survival; secondary outcomes were complications and recurrence. Meta-analysis utilized Stata 18.0.</div></div><div><h3>Results</h3><div>This meta-analysis included 8 studies (1,106 patients). Compared to standard resection, the TRIANGLE group had longer operative times and higher postoperative diarrhea rates (P < 0.001), but demonstrated reduced 1-year (P = 0.001) and 3-year recurrence (P = 0.036), lower perioperative mortality (P = 0.032), and more extensive lymph node dissection (P = 0.004). No differences were observed in R0 rates (P = 0.171), survival (1-year P = 0.730; 3-year P = 0.136), or primary complications. Overall survival (P = 0.075) and recurrence rates (P = 0.137) showed no statistical significance.</div></div><div><h3>Conclusion</h3><div>TRIANGLE operation reduces 1/3-year recurrence rates vs standard resection but increases postoperative diarrhea, while achieving similar R0/R1 rates and survival outcomes. Its clinical benefits require validation through large multicenter RCTs.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 286-295"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965898","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}

引用次数: 0

Incidence and consequences of chyle leak after pancreatectomy for pancreatic cancer 胰腺癌切除术后乳糜漏的发生率及后果。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-10-24 DOI: 10.1016/j.hpb.2025.10.004

Jun Ishida , Oskar Franklin , Salvador R. Franco , Hiroyuki Ishida , Andrii Khomiak , Toshitaka Sugawara , Samuele Grandi , Thomas F. Stoop , Michael J. Kirsch , Richard D. Schulick , Marco Del Chiaro

Background

Chyle leak after pancreatic surgery is linked to malnutrition, but its impact on oncological outcomes is unclear. This study assessed if postoperative clinically relevant chyle leak (CR-chyle leak) affects adjuvant chemotherapy receipt rates and overall survival (OS) in pancreatic cancer patients.

Methods

Patients who underwent resection for localized pancreatic ductal adenocarcinoma at the University of Colorado Hospital (2015–2023) were included. Year of surgery was divided in two time periods based on changes in dissection techniques, increased neoadjuvant therapies, and more surgeries for advanced disease in 2019. Risk factors for CR-chyle leak (grade B–C) and their relation to OS and adjuvant chemotherapy were analyzed using logistic and Cox regression models.

Results

Among 487 patients, 93 (19.5 %) developed CR-chyle leak. Patients with CR-chyle leak more often had borderline/locally advanced disease, neoadjuvant chemotherapy, vascular resections, longer surgeries, and operated in 2019–2023. There were no differences in hospital stay (median 10 vs 10 days), adjuvant chemotherapy rates (70.5 % vs 70.2 %, p = 0.917), or median OS (28.5 vs 29.9 months, p = 0.477). CR-chyle leak was not associated with OS (HR 0.81; 95 % CI: 0.57–1.16) in the adjusted model.

Conclusion

CR-chyle leak is common after pancreatic cancer surgery but does not negatively impact oncological outcomes.

背景：胰腺手术后乳糜漏与营养不良有关，但其对肿瘤预后的影响尚不清楚。本研究评估胰腺癌患者术后临床相关乳糜漏（cr -乳糜漏）是否影响辅助化疗接受率和总生存期（OS）。方法：纳入2015-2023年在科罗拉多大学医院行局限性胰腺导管腺癌切除术的患者。根据2019年解剖技术的变化、新辅助治疗的增加和晚期疾病手术的增加，将手术年份分为两个时间段。采用logistic和Cox回归模型分析cr -乳糜漏（B-C级）的危险因素及其与OS和辅助化疗的关系。结果：487例患者中93例（19.5%）发生cr -乳糜漏。cr -乳糜漏患者多为交界期/局部进展期、新辅助化疗、血管切除、手术时间较长，2019-2023年行手术。住院时间（中位10天vs中位10天）、辅助化疗率（70.5% vs 70.2%, p = 0.917）或中位OS （28.5 vs 29.9个月，p = 0.477）均无差异。在调整后的模型中，cr -乳糜漏与OS无关（HR 0.81; 95% CI: 0.57-1.16）。结论：cr -乳糜漏在胰腺癌术后很常见，但对肿瘤预后没有负面影响。

{"title":"Incidence and consequences of chyle leak after pancreatectomy for pancreatic cancer","authors":"Jun Ishida , Oskar Franklin , Salvador R. Franco , Hiroyuki Ishida , Andrii Khomiak , Toshitaka Sugawara , Samuele Grandi , Thomas F. Stoop , Michael J. Kirsch , Richard D. Schulick , Marco Del Chiaro","doi":"10.1016/j.hpb.2025.10.004","DOIUrl":"10.1016/j.hpb.2025.10.004","url":null,"abstract":"<div><h3>Background</h3><div>Chyle leak after pancreatic surgery is linked to malnutrition, but its impact on oncological outcomes is unclear. This study assessed if postoperative clinically relevant chyle leak (CR-chyle leak) affects adjuvant chemotherapy receipt rates and overall survival (OS) in pancreatic cancer patients.</div></div><div><h3>Methods</h3><div>Patients who underwent resection for localized pancreatic ductal adenocarcinoma at the University of Colorado Hospital (2015–2023) were included. Year of surgery was divided in two time periods based on changes in dissection techniques, increased neoadjuvant therapies, and more surgeries for advanced disease in 2019. Risk factors for CR-chyle leak (grade B–C) and their relation to OS and adjuvant chemotherapy were analyzed using logistic and Cox regression models.</div></div><div><h3>Results</h3><div>Among 487 patients, 93 (19.5 %) developed CR-chyle leak. Patients with CR-chyle leak more often had borderline/locally advanced disease, neoadjuvant chemotherapy, vascular resections, longer surgeries, and operated in 2019–2023. There were no differences in hospital stay (median 10 vs 10 days), adjuvant chemotherapy rates (70.5 % vs 70.2 %, <em>p</em> = 0.917), or median OS (28.5 vs 29.9 months, <em>p</em> = 0.477). CR-chyle leak was not associated with OS (HR 0.81; 95 % CI: 0.57–1.16) in the adjusted model.</div></div><div><h3>Conclusion</h3><div>CR-chyle leak is common after pancreatic cancer surgery but does not negatively impact oncological outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 369-378"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147343934","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}

引用次数: 0

Predicting surgical difficulty in robotic liver resection: applicability of laparoscopic scores 预测机器人肝切除术的手术难度：腹腔镜评分的适用性。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1016/j.hpb.2025.12.007

Chiara Gatto , Lorenzo Tofani , Luca Tirloni , Andrea Oddi , Ilenia Bartolini , Matteo Risaliti , Bruno Bertaccini , Gian L. Grazi

Background

Predicting surgical difficulty in robotic liver resection (RLR) is crucial for optimizing resource allocation, training programs, and patient outcomes. While several difficulty scoring systems (DSSs) have been validated for laparoscopic liver resection (LLR), their applicability to RLR remains uncertain. This study evaluates the predictive performance of five DSSs: Halls Southampton Score (HSS), Ban Iwate Score (BIS), Hasegawa Score (HGS), Institut Mutualiste Montsouris Score (IMM), and Tampa Difficulty Score (TAS), in the robotic setting.

Methods

A retrospective study was conducted on 124 patients who underwent RLR between January 2011 and June 2024 at two high-volume centers. Each DSS was retrospectively applied. Predictive accuracy for operative duration, intraoperative blood loss (>400 mL), transfusion need, postoperative complications, surgical reintervention, and 90-day readmission was assessed using R² (continuous variables) and AUC (categorical outcomes).

Results

HSS demonstrated the highest overall predictive power, particularly for transfusion need (AUC = 0,85), postoperative complications (AUC = 0,74), and 90-day readmission (AUC = 0,86). BIS was the most accurate for intraoperative blood loss (R² = 0,32). TAS showed the lowest predictive performance across most outcomes.

Conclusion

Laparoscopic DSSs are applicable to RLR, with HSS emerging as the most reliable. TAS requires further validation. A combined DSS approach could improve surgical planning and patient management.

背景：预测机器人肝切除术（RLR）的手术难度对于优化资源分配、培训计划和患者预后至关重要。虽然一些难度评分系统（DSSs）已被验证用于腹腔镜肝切除术（LLR），但它们对RLR的适用性仍不确定。本研究评估了五种DSSs的预测性能：Halls Southampton评分（HSS）， Ban Iwate评分（BIS）， Hasegawa评分（HGS）， Institut Mutualiste Montsouris评分（IMM）和Tampa难度评分（TAS），在机器人环境下。方法：对2011年1月至2024年6月在两个大容量中心接受RLR治疗的124例患者进行回顾性研究。每个DSS回顾性应用。使用R2（连续变量）和AUC（分类结果）评估手术时间、术中出血量（>400 mL）、输血需求、术后并发症、手术再干预和90天再入院的预测准确性。结果：HSS显示出最高的总体预测能力，特别是对于输血需求（AUC = 0.85）、术后并发症（AUC = 0.74）和90天再入院（AUC = 0.86）。BIS对术中出血量最准确（R2 = 0,32）。TAS在大多数结果中表现出最低的预测性能。结论：腹腔镜DSSs适用于RLR，其中HSS最可靠。TAS需要进一步验证。联合DSS方法可以改善手术计划和患者管理。

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引用次数: 0

Perioperative changes in ALBI and platelets (CAP): association with postoperative complications among patients undergoing surgery for hepatocellular carcinoma 肝细胞癌手术患者围手术期ALBI和血小板（CAP）的变化：与术后并发症的关系

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-03-01 Epub Date: 2025-12-04 DOI: 10.1016/j.hpb.2025.12.011

Odysseas P. Chatzipanagiotou , Giovanni Catalano , Khalil Mujtaba , Jun Kawashima , Abdullah Altaf , Francois Cauchy , Federico Aucejo , Hugo P. Marques , Vincent Lam , Tom Hugh , Irinel Popescu , Minoru Kitago , Matthew Weiss , Guillaume Martel , Francesca Ratti , George A. Poultsides , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Timothy M. Pawlik

Background

Prognostic models for patients with hepatocellular carcinoma (HCC) undergoing surgery often fail to account for perioperative changes in liver function. This study evaluated a novel dynamic index that integrates changes in the albumin-bilirubin (ALBI) grade and platelet count to predict postoperative morbidity.

Methods

A multi-institutional database was queried for patients undergoing surgery for HCC (2000–2023). “Changes in ALBI and platelets” (CAP) were calculated as CAP =

(\sqrt{{Δ A L B I}^{2} + {Δ P l a t e l e t s}^{2}}

), comparing preoperative values with those from postoperative day 3. Associations between CAP and the Comprehensive Complication Index (CCI) were examined using restricted cubic spline and Rand Forest analyses.

Results

A total of 1155 patients were included. The median CAP was 1.1 (IQR 0.8–1.5). Postoperative complications occurred in ∼40 % of patients, with a mean CCI of 15. Recursive partitioning determined CAP = 1.0 and CAP = 1.6 as the primary and secondary optimal cut-offs. In adjusted analysis, each unit increase in CAP corresponded to a 4.90 (95%CI 0.98–8.82) increase in CCI. CAP>1.6 was associated with higher likelihood of any (aOR 2.35, 95%CI 1.66–3.34) and severe complications (aOR 2.27, 95%CI 1.61–3.20).

Conclusion

CAP independently predicted morbidity following HCC surgery, highlighting the prognostic utility of dynamic indices. An online calculator was made available at: https://jk-osu.shinyapps.io/CAP_Chatzipanagiotou/.

背景：肝细胞癌（HCC）手术患者的预后模型往往不能考虑肝功能围手术期的变化。本研究评估了一种新的动态指标，该指标结合了白蛋白胆红素（ALBI）分级和血小板计数的变化来预测术后发病率。方法：查询2000-2023年肝癌手术患者的多机构数据库。“ALBI和血小板的变化”（CAP）计算为CAP = （ΔALBI2+ΔPlatelets2），比较术前和术后第3天的值。CAP与综合并发症指数（CCI）之间的关系采用限制性三次样条和兰德森林分析进行了检验。结果：共纳入1155例患者。中位CAP为1.1 （IQR为0.8-1.5）。术后并发症发生率约为40%，平均CCI为15。递归分区确定CAP = 1.0和CAP = 1.6作为主要和次要最优截止值。在调整分析中，CAP每增加一个单位对应CCI增加4.90 （95%CI 0.98-8.82）。CAP>1.6与任何并发症（aOR 2.35, 95%CI 1.66-3.34）和严重并发症（aOR 2.27, 95%CI 1.61-3.20）的可能性较高相关。结论：CAP独立预测HCC手术后的发病率，突出了动态指标的预后效用。在线计算器可在：https://jk-osu.shinyapps.io/CAP_Chatzipanagiotou/上获得。

{"title":"Perioperative changes in ALBI and platelets (CAP): association with postoperative complications among patients undergoing surgery for hepatocellular carcinoma","authors":"Odysseas P. Chatzipanagiotou , Giovanni Catalano , Khalil Mujtaba , Jun Kawashima , Abdullah Altaf , Francois Cauchy , Federico Aucejo , Hugo P. Marques , Vincent Lam , Tom Hugh , Irinel Popescu , Minoru Kitago , Matthew Weiss , Guillaume Martel , Francesca Ratti , George A. Poultsides , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Timothy M. Pawlik","doi":"10.1016/j.hpb.2025.12.011","DOIUrl":"10.1016/j.hpb.2025.12.011","url":null,"abstract":"<div><h3>Background</h3><div>Prognostic models for patients with hepatocellular carcinoma (HCC) undergoing surgery often fail to account for perioperative changes in liver function. This study evaluated a novel dynamic index that integrates changes in the albumin-bilirubin (ALBI) grade and platelet count to predict postoperative morbidity.</div></div><div><h3>Methods</h3><div>A multi-institutional database was queried for patients undergoing surgery for HCC (2000–2023). “Changes in ALBI and platelets” (CAP) were calculated as CAP = <span><math><mrow><mo>(</mo><msqrt><mrow><msup><mrow><mo>Δ</mo><mi>A</mi><mi>L</mi><mi>B</mi><mi>I</mi></mrow><mn>2</mn></msup><mo>+</mo><msup><mrow><mo>Δ</mo><mi>P</mi><mi>l</mi><mi>a</mi><mi>t</mi><mi>e</mi><mi>l</mi><mi>e</mi><mi>t</mi><mi>s</mi></mrow><mn>2</mn></msup></mrow></msqrt></mrow></math></span>), comparing preoperative values with those from postoperative day 3. Associations between CAP and the Comprehensive Complication Index (CCI) were examined using restricted cubic spline and Rand Forest analyses.</div></div><div><h3>Results</h3><div>A total of 1155 patients were included. The median CAP was 1.1 (IQR 0.8–1.5). Postoperative complications occurred in ∼40 % of patients, with a mean CCI of 15. Recursive partitioning determined CAP = 1.0 and CAP = 1.6 as the primary and secondary optimal cut-offs. In adjusted analysis, each unit increase in CAP corresponded to a 4.90 (95%CI 0.98–8.82) increase in CCI. CAP>1.6 was associated with higher likelihood of any (aOR 2.35, 95%CI 1.66–3.34) and severe complications (aOR 2.27, 95%CI 1.61–3.20).</div></div><div><h3>Conclusion</h3><div>CAP independently predicted morbidity following HCC surgery, highlighting the prognostic utility of dynamic indices. An online calculator was made available at: <span><span>https://jk-osu.shinyapps.io/CAP_Chatzipanagiotou/</span><svg><path></path></svg></span>.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 389-398"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793763","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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