Pub Date : 2025-04-01DOI: 10.1016/j.hpb.2024.12.023
Fenella Welsh , Senthil Sundaravadanan , Pulkit Sethi , Mohammad Kazeroun , Alessandro Fichera , Irdina Nadziruddin , Sarah J. Larkin , Naser Ansari-Pour , Tim Maughan , Michael Brady , Rajarshi Banerjee , Sarah Gooding , Myrddin Rees
Background
The optimal strategy for patients with colorectal liver metastases (CRLM) is unclear. The Precision1 prospective, observational trial assessed whether pre-operative functional imaging and whole genome sequencing (WGS), could enhance individualized decision-making.
Methods
Patients with CRLM considered for hepatectomy were recruited. In addition to standard staging, patients underwent a quantitative multiparametric MRI (mpMRI) scan, to assess liver function. Use of mpMRI to aid surgical decision-making, was prospectively recorded, as were short-term clinical outcomes in patients who underwent hepatectomy. In the first 45 patients, WGS was performed on blood and liver tumour samples collected per-operatively.
Results
95 mpMRI scans were performed in 84 patients, who underwent 87 resections. The mpMRI scan affected surgical decision-making in 41 % (39/95) of scans, with 11 undergoing dual-vein embolization, 16 undergoing more conservative parenchymal-sparing surgery, 11 having more extensive surgery, and one patient following a low calorie diet pre-operatively. There were significant (Clavien-Dindo grades 3/4) complications in 5 % of patients, no Grade C post-hepatectomy liver failure, and zero 90-day mortality. WGS suggested additional therapeutic options and prognostic factors for 22 of 35 (63 %) evaluable patients.
Conclusion
Precision1 shows mpMRI can aid surgical decision-making, and optimise clinical outcomes. WGS provides additional information, to further enhance personalised decision-making.
{"title":"Quantitative liver function imaging and whole genome sequencing – Effective modalities for a new era in personalised decision-making for operable colorectal liver metastases?","authors":"Fenella Welsh , Senthil Sundaravadanan , Pulkit Sethi , Mohammad Kazeroun , Alessandro Fichera , Irdina Nadziruddin , Sarah J. Larkin , Naser Ansari-Pour , Tim Maughan , Michael Brady , Rajarshi Banerjee , Sarah Gooding , Myrddin Rees","doi":"10.1016/j.hpb.2024.12.023","DOIUrl":"10.1016/j.hpb.2024.12.023","url":null,"abstract":"<div><h3>Background</h3><div>The optimal strategy for patients with colorectal liver metastases (CRLM) is unclear. The Precision1 prospective, observational trial assessed whether pre-operative functional imaging and whole genome sequencing (WGS), could enhance individualized decision-making.</div></div><div><h3>Methods</h3><div>Patients with CRLM considered for hepatectomy were recruited. In addition to standard staging, patients underwent a quantitative multiparametric MRI (mpMRI) scan, to assess liver function. Use of mpMRI to aid surgical decision-making, was prospectively recorded, as were short-term clinical outcomes in patients who underwent hepatectomy. In the first 45 patients, WGS was performed on blood and liver tumour samples collected per-operatively.</div></div><div><h3>Results</h3><div>95 mpMRI scans were performed in 84 patients, who underwent 87 resections. The mpMRI scan affected surgical decision-making in 41 % (39/95) of scans, with 11 undergoing dual-vein embolization, 16 undergoing more conservative parenchymal-sparing surgery, 11 having more extensive surgery, and one patient following a low calorie diet pre-operatively. There were significant (Clavien-Dindo grades 3/4) complications in 5 % of patients, no Grade C post-hepatectomy liver failure, and zero 90-day mortality. WGS suggested additional therapeutic options and prognostic factors for 22 of 35 (63 %) evaluable patients.</div></div><div><h3>Conclusion</h3><div>Precision1 shows mpMRI can aid surgical decision-making, and optimise clinical outcomes. WGS provides additional information, to further enhance personalised decision-making.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 553-561"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways.
Methods
This retrospective analysis included 406 hepatic CE patients treated at our center (2009–2021). Clinical, imaging, and treatment data were used to develop a Cox regression and a decision tree model to identify factors influencing surgical intervention, with model performance validated using K-fold cross-validation, train/test split, bootstrapping.
Results
Imaging findings and symptomatology emerged as the most significant predictors. The Cox model demonstrated a concordance index of 0.94 and an AUC of 0.96, while the decision tree model identified imaging, cyst stage, and symptoms as critical factors, achieving strong performance across validation techniques (mean AUC 0.950; 95% CI: [0.889, 0.978]).
Conclusion
This study presents validated predictive models for assessing surgical risk in hepatic CE. Integrating these models into clinical practice offers a dynamic tool that surpasses static guidelines, optimizing patient allocation to surgical or non-surgical pathways and potentially improving outcomes.
{"title":"Machine learning to predict the decision to perform surgery in hepatic echinococcosis","authors":"Raffaella Lissandrin , Ottavia Cicerone , Ambra Vola , Gianluca D’Alessandro , Simone Frassini , Tommaso Manciulli , Simone Famularo , Annalisa De Silvestri , Jacopo Viganò , Pietro Quaretti , Luca Ansaloni , Enrico Brunetti , Marcello Maestri","doi":"10.1016/j.hpb.2024.12.014","DOIUrl":"10.1016/j.hpb.2024.12.014","url":null,"abstract":"<div><h3>Background</h3><div>Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways.</div></div><div><h3>Methods</h3><div>This retrospective analysis included 406 hepatic CE patients treated at our center (2009–2021). Clinical, imaging, and treatment data were used to develop a Cox regression and a decision tree model to identify factors influencing surgical intervention, with model performance validated using K-fold cross-validation, train/test split, bootstrapping.</div></div><div><h3>Results</h3><div>Imaging findings and symptomatology emerged as the most significant predictors. The Cox model demonstrated a concordance index of 0.94 and an AUC of 0.96, while the decision tree model identified imaging, cyst stage, and symptoms as critical factors, achieving strong performance across validation techniques (mean AUC 0.950; 95% CI: [0.889, 0.978]).</div></div><div><h3>Conclusion</h3><div>This study presents validated predictive models for assessing surgical risk in hepatic CE. Integrating these models into clinical practice offers a dynamic tool that surpasses static guidelines, optimizing patient allocation to surgical or non-surgical pathways and potentially improving outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 480-488"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927242","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 : 2025-04-01DOI: 10.1016/j.hpb.2024.12.018
Montserrat Chavez , Xabier de Aretxabala , Hector Losada , Norberto Portillo , Felipe Castillo , Luis Bustos , Ivan Roa
Background
Although the prognosis for gallbladder cancer (GBCA) improves with early diagnosis and aggressive surgical treatment, the management of patients with muscle layer invasion (T1b) remains controversial. This study aimed to analyze the optimal surgical approach for these patients.
Methods
A database was queried for patients with early T1b GBCA treated at four Chilean hospitals. Patients were prospectively treated and registered by the same surgical team at each hospital. Clinical outcomes, including survival rates according to the type of surgery, were analyzed.
Results
Between 1988 and 2023, 129 Chilean patients were pathologically diagnosed with T1b GBCA. Simple cholecystectomy (SC) was performed in 86 patients (66.7 %), while extended cholecystectomy (EC) was performed in 43 patients. The overall 5-year survival rate was 83 %, with no significant difference between SC and EC patients.
Conclusion
Simple cholecystectomy demonstrated survival rates comparable to extended cholecystectomy for patients with T1b GBCA. More extensive resections did not improve the prognosis.
{"title":"T1b gallbladder cancer: is extended resection warranted?","authors":"Montserrat Chavez , Xabier de Aretxabala , Hector Losada , Norberto Portillo , Felipe Castillo , Luis Bustos , Ivan Roa","doi":"10.1016/j.hpb.2024.12.018","DOIUrl":"10.1016/j.hpb.2024.12.018","url":null,"abstract":"<div><h3>Background</h3><div>Although the prognosis for gallbladder cancer (GBCA) improves with early diagnosis and aggressive surgical treatment, the management of patients with muscle layer invasion (T1b) remains controversial. This study aimed to analyze the optimal surgical approach for these patients.</div></div><div><h3>Methods</h3><div>A database was queried for patients with early T1b GBCA treated at four Chilean hospitals. Patients were prospectively treated and registered by the same surgical team at each hospital. Clinical outcomes, including survival rates according to the type of surgery, were analyzed.</div></div><div><h3>Results</h3><div>Between 1988 and 2023, 129 Chilean patients were pathologically diagnosed with T1b GBCA. Simple cholecystectomy (SC) was performed in 86 patients (66.7 %), while extended cholecystectomy (EC) was performed in 43 patients. The overall 5-year survival rate was 83 %, with no significant difference between SC and EC patients.</div></div><div><h3>Conclusion</h3><div>Simple cholecystectomy demonstrated survival rates comparable to extended cholecystectomy for patients with T1b GBCA. More extensive resections did not improve the prognosis.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 523-529"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004791","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 : 2025-04-01DOI: 10.1016/j.hpb.2024.12.020
Sandra de Kalbermatten, David Martin, Emilie Uldry, Emmanuel Melloul, Nicolas Demartines, David Fuks, Gaëtan-Romain Joliat
Background
Enhanced Recovery After Surgery (ERAS) protocols decrease postoperative complications, but data on their effect on diabetic patients undergoing pancreatectomy are scarce. This study assessed whether diabetes mellitus (DM) was a morbidity predictor after pancreatectomy within an ERAS program.
Methods
A cross-sectional study including all patients who underwent pancreatectomy (2012–2022) and followed an ERAS pathway was performed. Multivariable analysis was used to determine whether DM was a morbidity predictor. Association between ERAS compliance and morbidity rate was assessed.
Results
A total of 558 patients were included (266 women, median age 66, median body-mass index 25). Most patients underwent open pancreatoduodenectomy (n=369, 66%). In diabetic patients with overall ERAS compliance60 %, morbidity was 38/40 (95%), whereas in diabetic patients with overall ERAS compliance>60 %, it decreased to 37/50 (74%, p=0.008). DM was not found as an independent complication predictor (OR 0.7, 95%CI 0.4–1.2, p=0.186), while body-mass index>25 kg/m2 and preoperative biliary stenting were preoperative morbidity predictors (OR 1.1, 95%CI 1.0–1.1, p=0.049; OR 1.7, 95%CI 1.0–2.5, p=0.044).
Conclusion
This study showed that DM was not associated with postoperative complications after pancreatectomy within an ERAS program. It highlighted the importance of a good ERAS compliance to decrease the risk of postoperative complications in DM patients.
{"title":"Impact of diabetes mellitus on postoperative complications in patients undergoing pancreatic surgery","authors":"Sandra de Kalbermatten, David Martin, Emilie Uldry, Emmanuel Melloul, Nicolas Demartines, David Fuks, Gaëtan-Romain Joliat","doi":"10.1016/j.hpb.2024.12.020","DOIUrl":"10.1016/j.hpb.2024.12.020","url":null,"abstract":"<div><h3>Background</h3><div>Enhanced Recovery After Surgery (ERAS) protocols decrease postoperative complications, but data on their effect on diabetic patients undergoing pancreatectomy are scarce. This study assessed whether diabetes mellitus (DM) was a morbidity predictor after pancreatectomy within an ERAS program.</div></div><div><h3>Methods</h3><div>A cross-sectional study including all patients who underwent pancreatectomy (2012–2022) and followed an ERAS pathway was performed. Multivariable analysis was used to determine whether DM was a morbidity predictor. Association between ERAS compliance and morbidity rate was assessed.</div></div><div><h3>Results</h3><div>A total of 558 patients were included (266 women, median age 66, median body-mass index 25). Most patients underwent open pancreatoduodenectomy (<em>n</em>=369, 66%). In diabetic patients with overall ERAS compliance<span><math><mrow><mo>≤</mo></mrow></math></span>60 %, morbidity was 38/40 (95%), whereas in diabetic patients with overall ERAS compliance>60 %, it decreased to 37/50 (74%, <em>p</em>=0.008). DM was not found as an independent complication predictor (OR 0.7, 95%CI 0.4–1.2, <em>p</em>=0.186), while body-mass index>25 kg/m<sup>2</sup> and preoperative biliary stenting were preoperative morbidity predictors (OR 1.1, 95%CI 1.0–1.1, <em>p</em>=0.049; OR 1.7, 95%CI 1.0–2.5, <em>p</em>=0.044).</div></div><div><h3>Conclusion</h3><div>This study showed that DM was not associated with postoperative complications after pancreatectomy within an ERAS program. It highlighted the importance of a good ERAS compliance to decrease the risk of postoperative complications in DM patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 530-537"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970670","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hpb.2024.11.014
Anne Claire Henry , F. Jasmijn Smits , Lois A. Daamen , Olivier R. Busch , Koop Bosscha , Ronald M. van Dam , Coen J.L. van Dam , Casper H. van Eijck , Sebastiaan Festen , Erwin van der Harst , Ignace H.J.T. de Hingh , Geert Kazemier , Mike S. Liem , Vincent E. de Meijer , Peter Noordzij , Gijs A. Patijn , Jennifer M.J. Schreinemakers , Martijn W.J. Stommel , Bert A. Bonsing , Bas G. Koerkamp , I. Quintus Molenaar
Background
This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement.
Methods
This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures.
Results
Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %).
Conclusion
Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.
{"title":"Root-cause analysis of mortality after pancreatic resection in a nationwide cohort","authors":"Anne Claire Henry , F. Jasmijn Smits , Lois A. Daamen , Olivier R. Busch , Koop Bosscha , Ronald M. van Dam , Coen J.L. van Dam , Casper H. van Eijck , Sebastiaan Festen , Erwin van der Harst , Ignace H.J.T. de Hingh , Geert Kazemier , Mike S. Liem , Vincent E. de Meijer , Peter Noordzij , Gijs A. Patijn , Jennifer M.J. Schreinemakers , Martijn W.J. Stommel , Bert A. Bonsing , Bas G. Koerkamp , I. Quintus Molenaar","doi":"10.1016/j.hpb.2024.11.014","DOIUrl":"10.1016/j.hpb.2024.11.014","url":null,"abstract":"<div><h3>Background</h3><div>This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement.</div></div><div><h3>Methods</h3><div>This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures.</div></div><div><h3>Results</h3><div>Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %).</div></div><div><h3>Conclusion</h3><div>Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 461-469"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hpb.2024.12.016
Niki Rashidian , Mohammed Abu Hilal , Isabella Frigerio , Martina Guerra , Sigrid Sterckx , Francesca Tozzi , Giulia Capelli , Daunia Verdi , Gaya Spolverato , Aiste Gulla , Francesca Ratti , Andrew J. Healey , Alessandro Esposito , Matteo De Pastena , Andrea Belli , Stefan A. Bouwense , Angelakoudis Apostolos , Sven A. Lang , Victor López-López , Gregor A. Stavrou , Andrew A. Gumbs
Background
Hepato-Pancreato-Biliary (HPB) surgery is a complex specialty and Artificial Intelligence (AI) applications have the potential to improve pre- intra- and postoperative outcomes of HPB surgery. While ethics guidelines have been developed for the use of AI in clinical surgery, the ethical implications and reliability of AI in HPB surgery remain specifically unexplored.
Methods
An online survey was developed by the Innovation Committee of the E-AHPBA to investigate the current perspectives on the ethical principles and trustworthiness of AI in HPB Surgery among E-AHPBA membership. The survey consisted of 22 questions, based on guidelines outlined by the Artificial Intelligence Surgery Journal Task Force on AI Ethics in clinical surgery and was disseminated via email to all E-AHPBA members.
Results
A total of 84 members of the E-AHPBA participated in the survey. Seventeen out of 22 questions achieved more than 80 % agreement, with nine of those exceeding 90 %. Five questions had agreement levels between 70 % and 80 %.
Conclusion
While HPB surgeons are aware of the need to regulate the use of AI devices, robots, and to protect patient data, consensus appears to be heterogeneous regarding AI's role in mitigating gender-related and minority biases, as well as ensuring fairness and equity.
{"title":"Ethics and trustworthiness of artificial intelligence in Hepato-Pancreato-Biliary surgery: a snapshot of insights from the European-African Hepato-Pancreato-Biliary Association (E-AHPBA) survey","authors":"Niki Rashidian , Mohammed Abu Hilal , Isabella Frigerio , Martina Guerra , Sigrid Sterckx , Francesca Tozzi , Giulia Capelli , Daunia Verdi , Gaya Spolverato , Aiste Gulla , Francesca Ratti , Andrew J. Healey , Alessandro Esposito , Matteo De Pastena , Andrea Belli , Stefan A. Bouwense , Angelakoudis Apostolos , Sven A. Lang , Victor López-López , Gregor A. Stavrou , Andrew A. Gumbs","doi":"10.1016/j.hpb.2024.12.016","DOIUrl":"10.1016/j.hpb.2024.12.016","url":null,"abstract":"<div><h3>Background</h3><div>Hepato-Pancreato-Biliary (HPB) surgery is a complex specialty and Artificial Intelligence (AI) applications have the potential to improve pre- intra- and postoperative outcomes of HPB surgery. While ethics guidelines have been developed for the use of AI in clinical surgery, the ethical implications and reliability of AI in HPB surgery remain specifically unexplored.</div></div><div><h3>Methods</h3><div>An online survey was developed by the Innovation Committee of the E-AHPBA to investigate the current perspectives on the ethical principles and trustworthiness of AI in HPB Surgery among E-AHPBA membership. The survey consisted of 22 questions, based on guidelines outlined by the Artificial Intelligence Surgery Journal Task Force on AI Ethics in clinical surgery and was disseminated via email to all E-AHPBA members.</div></div><div><h3>Results</h3><div>A total of 84 members of the E-AHPBA participated in the survey. Seventeen out of 22 questions achieved more than 80 % agreement, with nine of those exceeding 90 %. Five questions had agreement levels between 70 % and 80 %.</div></div><div><h3>Conclusion</h3><div>While HPB surgeons are aware of the need to regulate the use of AI devices, robots, and to protect patient data, consensus appears to be heterogeneous regarding AI's role in mitigating gender-related and minority biases, as well as ensuring fairness and equity.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 502-510"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143004774","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 : 2025-04-01DOI: 10.1016/j.hpb.2024.12.007
Mirco Küchler , Mareike Ehmke , Kai Jaquet , Peter Wohlmuth , Johannes M. Feldhege , Tim Reese , Thilo Hartmann , Richard Drexler , Tessa Huber , Thorsten Burmester , Karl J. Oldhafer
Background
The two-stage surgical technique of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) enables extensive liver resection and promotes future liver remnant regeneration (FLR), in part by inhibiting the Hippo signalling pathway. Its main effector, Yes-associated protein (YAP), has low intrinsic transcriptional activity and requires the transcription enhanced associated domain factor (TEAD) family members as cofactors for target gene transcription. We evaluated the intracellular localization and expression of TEAD1-4, hypothesized to regulate the activity of YAP and, consequently, liver regeneration.
Methods
The intracellular localization of TEAD1-4 was characterized in tumor-free liver (TFL) tissue samples from 44 ALPPS patients obtained during the two stages of ALPPS surgery. Expression levels were correlated with clinical and pathological data as well as liver regeneration metrics.
Results
TEAD family members are simultaneously expressed in individual hepatocytes and show relations with liver regeneration, clinical outcome and outcome parameters when comparing TFL tissue obtained at different stages of ALPPS surgery. Furthermore, differences in TEAD expression and localization within hepatocytes appeared to be independent of global factors.
Conclusion
TEAD1-4 expression correlates with liver regeneration outcomes. Specifically, cytoplasmic and nuclear expression scores of TEAD1 serve as predictive markers for clinical outcomes following ALPPS.
{"title":"Transcription enhanced associate domain factor 1 (TEAD1) predicts liver regeneration outcome of ALPPS-treated patients","authors":"Mirco Küchler , Mareike Ehmke , Kai Jaquet , Peter Wohlmuth , Johannes M. Feldhege , Tim Reese , Thilo Hartmann , Richard Drexler , Tessa Huber , Thorsten Burmester , Karl J. Oldhafer","doi":"10.1016/j.hpb.2024.12.007","DOIUrl":"10.1016/j.hpb.2024.12.007","url":null,"abstract":"<div><h3>Background</h3><div>The two-stage surgical technique of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) enables extensive liver resection and promotes future liver remnant regeneration (FLR), in part by inhibiting the Hippo signalling pathway. Its main effector, Yes-associated protein (YAP), has low intrinsic transcriptional activity and requires the transcription enhanced associated domain factor (TEAD) family members as cofactors for target gene transcription. We evaluated the intracellular localization and expression of TEAD1-4, hypothesized to regulate the activity of YAP and, consequently, liver regeneration.</div></div><div><h3>Methods</h3><div>The intracellular localization of TEAD1-4 was characterized in tumor-free liver (TFL) tissue samples from 44 ALPPS patients obtained during the two stages of ALPPS surgery. Expression levels were correlated with clinical and pathological data as well as liver regeneration metrics.</div></div><div><h3>Results</h3><div>TEAD family members are simultaneously expressed in individual hepatocytes and show relations with liver regeneration, clinical outcome and outcome parameters when comparing TFL tissue obtained at different stages of ALPPS surgery. Furthermore, differences in TEAD expression and localization within hepatocytes appeared to be independent of global factors.</div></div><div><h3>Conclusion</h3><div>TEAD1-4 expression correlates with liver regeneration outcomes. Specifically, cytoplasmic and nuclear expression scores of TEAD1 serve as predictive markers for clinical outcomes following ALPPS.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 470-479"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052370","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 : 2025-04-01DOI: 10.1016/j.hpb.2025.01.001
Muhammad Emmamally , Urda Kotze , Marc Bernon , Barbara Robertson , Rufaida Khan , Sanju Sobnach , Mark Sonderup , C Wendy Spearman , Eduard Jonas
Background
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally, particularly in developing countries in Southeast Asia and sub-Saharan Africa (SSA), where chronic hepatitis B virus (HBV) dominates as a major aetiological factor.
Methods
We conducted a retrospective cohort study to quantify the metastatic profile of HCC in a South African patient population managed at a tertiary centre. Demographic, clinical and treatment data were extracted from an institutional registry. Patients with and without metastases were compared to identify factors associated with an increased risk of developing metastases.
Results
Of 676 patients, 194 (28.7 %) had metastases. Patients with metastases were younger (46.37 vs. 52.23 years; p < 0.00001) and more frequently had chronic HBV, HIV co-infection and schistosomiasis compared to non-metastatic patients. The most common metastatic sites were lungs, skeletal, and peritoneum. For non-treated patients, skeletal metastases had the poorest survival.
Conclusion
This study confirms a typical SSA disease profile of aggressive HCC in a young population. We reported on the metastatic profile of HCC and the impact of different metastases on survival. Future research should focus on defining the concept of oligometastatic disease in HCC to identify patients where intervention targeting metastatic disease may be of benefit.
{"title":"The spectrum and outcome of metastatic hepatocellular carcinoma in a South African patient cohort","authors":"Muhammad Emmamally , Urda Kotze , Marc Bernon , Barbara Robertson , Rufaida Khan , Sanju Sobnach , Mark Sonderup , C Wendy Spearman , Eduard Jonas","doi":"10.1016/j.hpb.2025.01.001","DOIUrl":"10.1016/j.hpb.2025.01.001","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death globally, particularly in developing countries in Southeast Asia and sub-Saharan Africa (SSA), where chronic hepatitis B virus (HBV) dominates as a major aetiological factor.</div></div><div><h3>Methods</h3><div>We conducted a retrospective cohort study to quantify the metastatic profile of HCC in a South African patient population managed at a tertiary centre. Demographic, clinical and treatment data were extracted from an institutional registry. Patients with and without metastases were compared to identify factors associated with an increased risk of developing metastases.</div></div><div><h3>Results</h3><div>Of 676 patients, 194 (28.7 %) had metastases. Patients with metastases were younger (46.37 vs. 52.23 years; <em>p</em> < 0.00001) and more frequently had chronic HBV, HIV co-infection and schistosomiasis compared to non-metastatic patients. The most common metastatic sites were lungs, skeletal, and peritoneum. For non-treated patients, skeletal metastases had the poorest survival.</div></div><div><h3>Conclusion</h3><div>This study confirms a typical SSA disease profile of aggressive HCC in a young population. We reported on the metastatic profile of HCC and the impact of different metastases on survival. Future research should focus on defining the concept of oligometastatic disease in HCC to identify patients where intervention targeting metastatic disease may be of benefit.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 572-581"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143059017","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 : 2025-04-01DOI: 10.1016/j.hpb.2025.01.011
Mikolaj R. Kowal , Varuni Bhatnagar , James Pine , Samir Pathak , Andrew Smith , Iestyn Shapey
Aims
Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.
Methods
Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.
Results
210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.
Conclusions
PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.
{"title":"Systematic review of peritoneal lavage and dialysis for patients with severe acute pancreatitis","authors":"Mikolaj R. Kowal , Varuni Bhatnagar , James Pine , Samir Pathak , Andrew Smith , Iestyn Shapey","doi":"10.1016/j.hpb.2025.01.011","DOIUrl":"10.1016/j.hpb.2025.01.011","url":null,"abstract":"<div><h3>Aims</h3><div>Severe acute pancreatitis (SAP) remains a lethal condition with a rising incidence worldwide. Recent randomised trials suggest that peritoneal lavage and/or dialysis (PLD), when administered early in SAP, may be beneficial to improve patient outcomes. This study aimed to review this data systematically.</div></div><div><h3>Methods</h3><div>Studies featuring PLD for the treatment of SAP were searched systematically (2012 Atlanta classification to 2023). A traditional approach to reporting data was augmented by a narrative synthesis.</div></div><div><h3>Results</h3><div>210 articles were reviewed, of which six studies featuring 499 patients were included. The technical approach, duration and type of lavage varied in each study and no safety concerns were reported. In patients undergoing PLD, improvements in inflammatory markers and length of stay were seen in all studies. Where reported, fewer invasive procedures for peri-pancreatic fluid collections were required after PLD. Lower mortality was seen in cohorts receiving laparoscopic lavage alone and combined lavage and dialysis when compared with standard treatment. All studies were rated at moderate or high risk of bias.</div></div><div><h3>Conclusions</h3><div>PLD demonstrates potential as an early therapy to improve outcomes for patients with SAP. Further research is required to define intervention delivery, explore acceptability and investigate efficacy through a powered randomised controlled trial.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 425-433"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143407343","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.hpb.2024.11.015
Peter L.Z. Labib , Thomas B. Russell , Jemimah L. Denson , Mark A. Puckett , Fabio Ausania , Elizabeth Pando , Keith J. Roberts , Ambareen Kausar , Vasileios K. Mavroeidis , Ricky H. Bhogal , Gabriele Marangoni , Sarah C. Thomasset , Adam E. Frampton , Duncan R. Spalding , Pavlos Lykoudis , Manuel Maglione , Nassir Alhaboob , Parthi Srinivasan , Hassaan Bari , Andrew Smith , Sandra Paterna-López
Background
Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.
Methods
Patients who underwent PD for PDAC between June 2012 and May 2015 (29 centres, eight countries) were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on demographics, comorbidities, investigations, operation details, complications, histology, adjuvant therapies, recurrence and survival. Univariable tests and regression analysis investigated factors associated with any-site and local-only recurrence.
Results
Of 866 patients, 573 (66 %) developed recurrence: 170 (20 %) developed local-only recurrence, 164 (19 %) developed mixed local/distant recurrence, and 239 (28 %) developed distant-only recurrence. Local-only or lung-only recurrence had a more favourable prognosis than other recurrence patterns. Predictors of any-site recurrence were preoperative biliary stenting, venous resection and poorly-differentiated, node-positive tumours. Predictors of local-only recurrence were preoperative radiological lymphadenopathy, well-differentiated tumours, fewer than 15 resected lymph nodes and intraoperative blood transfusion.
Discussion
Ensuring radical resection and avoiding intraoperative blood transfusion may reduce the risk of local-only recurrence following PD for PDAC.
{"title":"Patterns, timing and predictors of recurrence following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma: an international multicentre retrospective cohort study","authors":"Peter L.Z. Labib , Thomas B. Russell , Jemimah L. Denson , Mark A. Puckett , Fabio Ausania , Elizabeth Pando , Keith J. Roberts , Ambareen Kausar , Vasileios K. Mavroeidis , Ricky H. Bhogal , Gabriele Marangoni , Sarah C. Thomasset , Adam E. Frampton , Duncan R. Spalding , Pavlos Lykoudis , Manuel Maglione , Nassir Alhaboob , Parthi Srinivasan , Hassaan Bari , Andrew Smith , Sandra Paterna-López","doi":"10.1016/j.hpb.2024.11.015","DOIUrl":"10.1016/j.hpb.2024.11.015","url":null,"abstract":"<div><h3>Background</h3><div>Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.</div></div><div><h3>Methods</h3><div>Patients who underwent PD for PDAC between June 2012 and May 2015 (29 centres, eight countries) were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on demographics, comorbidities, investigations, operation details, complications, histology, adjuvant therapies, recurrence and survival. Univariable tests and regression analysis investigated factors associated with any-site and local-only recurrence.</div></div><div><h3>Results</h3><div>Of 866 patients, 573 (66 %) developed recurrence: 170 (20 %) developed local-only recurrence, 164 (19 %) developed mixed local/distant recurrence, and 239 (28 %) developed distant-only recurrence. Local-only or lung-only recurrence had a more favourable prognosis than other recurrence patterns. Predictors of any-site recurrence were preoperative biliary stenting, venous resection and poorly-differentiated, node-positive tumours. Predictors of local-only recurrence were preoperative radiological lymphadenopathy, well-differentiated tumours, fewer than 15 resected lymph nodes and intraoperative blood transfusion.</div></div><div><h3>Discussion</h3><div>Ensuring radical resection and avoiding intraoperative blood transfusion may reduce the risk of local-only recurrence following PD for PDAC.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 4","pages":"Pages 445-460"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143052369","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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