Pub Date : 2025-11-01DOI: 10.1016/j.hpb.2025.08.003
Jane McClements , Amanda Koh , Harivinthan Sellappan , Lauren Blackburn , Adam Brooks , Jake Clements , Nabeel Merali , Adam Frampton , Syeda Gulbahar , Brian Davidson , Eyas Almomani , David Bartlett , Georgios Papadopoulos , Dimitrios Karavias , Alistair Rowcroft , James Lucocq , Ewen M. Harrison , Victoria Morrison-Jones , Fenella Welsh , Adithya Pathanki , Shahin Hajibandeh
Background
The role of liver transplantation as a treatment option for de novo resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.
Methods
Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.
Results
Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 % (n = 54) and 90-day mortality was 10.1 % (n = 14). Sixty-four (46.4 %) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (n = 17, 31.5 %). Early-stage tumours had a significantly lower vascular invasion (n = 57, 41.3 %) and R1 margin (n = 46, 33.3 %) compared to later-stage pCCA [62.2 % (n = 194) and 54.2 % (n = 169) respectively, p < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (p < 0.001). Male gender (p = 0.039) and Post-Hepatectomy Liver Failure (PHLF, p = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (p = 0.013), PHLF (p < 0.001) and vascular invasion (p = 0.030) were associated with significantly poorer overall survival.
Conclusion
Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.
{"title":"Peri-hilar cholangiocarcinoma: results from the UK nationwide CAPBIL study","authors":"Jane McClements , Amanda Koh , Harivinthan Sellappan , Lauren Blackburn , Adam Brooks , Jake Clements , Nabeel Merali , Adam Frampton , Syeda Gulbahar , Brian Davidson , Eyas Almomani , David Bartlett , Georgios Papadopoulos , Dimitrios Karavias , Alistair Rowcroft , James Lucocq , Ewen M. Harrison , Victoria Morrison-Jones , Fenella Welsh , Adithya Pathanki , Shahin Hajibandeh","doi":"10.1016/j.hpb.2025.08.003","DOIUrl":"10.1016/j.hpb.2025.08.003","url":null,"abstract":"<div><h3><strong>Background</strong></h3><div>The role of liver transplantation as a treatment option for <em>de novo</em> resectable peri-hilar cholangiocarcinoma (pCCA) is controversial. This study investigated the outcomes following resection of early-stage pCCA in the UK.</div></div><div><h3>Methods</h3><div>Patients undergoing resection for pCCA between 2014 and 2022 across 22 UK centres were included. Early-stage pCCA was defined as tumour size<3cm with no nodal disease (N0) on histopathology analysis. Clinical and survival data were collated.</div></div><div><h3>Results</h3><div>Of the 450 patients included, 138 patients underwent resection for early-stage pCCA. In the early-stage pCCA group, CD ≥ IIIa morbidity was 39.1 % (<em>n</em> = 54) and 90-day mortality was 10.1 % (<em>n</em> = 14). Sixty-four (46.4 %) patients received adjuvant chemotherapy, but this was reduced in those with CD ≥ IIIa morbidity (<em>n</em> = 17, 31.5 %). Early-stage tumours had a significantly lower vascular invasion (<em>n</em> = 57, 41.3 %) and R1 margin (<em>n</em> = 46, 33.3 %) compared to later-stage pCCA [62.2 % (<em>n</em> = 194) and 54.2 % (<em>n</em> = 169) respectively, <em>p</em> < 0.001). The median disease-free and overall survival was significantly better in patients with early-stage pCCA compared to more advanced tumours (<em>p</em> < 0.001). Male gender (<em>p</em> = 0.039) and Post-Hepatectomy Liver Failure (PHLF, <em>p</em> = 0.010) were associated with significantly worse disease-free survival, while biliary drainage (<em>p</em> = 0.013), PHLF (<em>p</em> < 0.001) and vascular invasion (<em>p</em> = 0.030) were associated with significantly poorer overall survival.</div></div><div><h3>Conclusion</h3><div>Resection of early-stage pCCA tumours is associated with good clinical and survival outcomes in centralised HPB centres.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1367-1378"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145023122","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.08.013
Giancarlo Ceccarelli, Francesco Branda, Marta Giovanetti, Fabio Scarpa, Massimo Ciccozzi
{"title":"Between cutting-edge guidelines and neglected vulnerabilities: an implementation agenda for HCC in the Asia–Pacific","authors":"Giancarlo Ceccarelli, Francesco Branda, Marta Giovanetti, Fabio Scarpa, Massimo Ciccozzi","doi":"10.1016/j.hpb.2025.08.013","DOIUrl":"10.1016/j.hpb.2025.08.013","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1479-1480"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145052387","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.07.016
Sarah B. Hays , Kristine Kuchta , Andres A. Abreu , Asmita Chopra , Emile Farah , Amudhan Kannan , Syed A. Mehdi , Imad Radi , Kristen Ranson , Aram E. Rojas , Adam Tcharni , Brian A. Boone , Alessandro Paniccia , Patricio M. Polanco , Carl R. Schmidt , Mark S. Talamonti , Herbert J. Zeh , Amer H. Zureikat , Melissa E. Hogg
Background
Morbidity and mortality following pancreaticoduodenectomy (PD) have improved; however, the population is aging, and the use of robotic surgery is expanding. This study compares the selection of octogenarians who underwent PD, their outcomes, and whether robotic surgery provides an advantage.
Methods
This is a multi-institutional retrospective review from 2007 to 2023 of patients who underwent PD, including open and robotic approach. Pre-, intra-, and post-operative outcomes were analyzed; multivariable analysis (MVA) and propensity score matching (PSM) were performed.
Results
2175 patients underwent PD for all causes; <80 years: n=1,952, >80 (octogenarians): n=223. Octogenarians had higher age unadjusted Charlson Comorbidity Index (2.8 vs 2.6, p<0.001), and more prior surgeries (67.9 % vs 56.1 %, p<0.001). On univariate analysis, octogenarians had higher average Clavien-Dindo grade (2.0 vs 1.7, p=0.002) and higher 90-day mortality (9.9 % vs 3.1 %, p<0.001). On MVA, age >80 was associated with increased risk of major morbidity (OR 1.50 [1.10–2.04], p=0.011) and 90-day mortality (OR 3.20 [1.85–5.54], p<0.001). Robotic PD (RPD) was associated with decreased risk of major morbidity (OR 0.69 [0.56–0.86], p<0.001). After PSM of octogenarians who underwent RPD, there was no statistically significant difference in mortality.
Conclusion
Pancreaticoduodenectomy has increased but acceptable morbidity in octogenarians. The increased risk may be mitigated by RPD.
背景：胰十二指肠切除术（PD）后的发病率和死亡率有所改善；然而，人口正在老龄化，机器人手术的使用正在扩大。本研究比较了接受PD治疗的80多岁老人的选择，他们的结果，以及机器人手术是否提供了优势。方法：这是一项2007年至2023年接受PD治疗的患者的多机构回顾性研究，包括开放和机器人入路。分析术前、术中、术后结果；进行多变量分析（MVA）和倾向评分匹配（PSM）。结果：2175例患者因各种原因接受PD治疗；80（80岁以上）：n=223。八旬老人的年龄未经调整的Charlson合并症指数更高(2.8 vs 2.6， p80与主要发病风险增加（OR 1.50 [1.10-2.04], p=0.011）和90天死亡率增加（OR 3.20[1.85-5.54]）相关。结论：胰十二指肠切除术增加了八旬老人的发病率，但可接受。RPD可以减轻增加的风险。
{"title":"Does a robotic approach decrease morbidity and mortality following pancreaticoduodenectomy for octogenarians? An American multi-center analysis","authors":"Sarah B. Hays , Kristine Kuchta , Andres A. Abreu , Asmita Chopra , Emile Farah , Amudhan Kannan , Syed A. Mehdi , Imad Radi , Kristen Ranson , Aram E. Rojas , Adam Tcharni , Brian A. Boone , Alessandro Paniccia , Patricio M. Polanco , Carl R. Schmidt , Mark S. Talamonti , Herbert J. Zeh , Amer H. Zureikat , Melissa E. Hogg","doi":"10.1016/j.hpb.2025.07.016","DOIUrl":"10.1016/j.hpb.2025.07.016","url":null,"abstract":"<div><h3>Background</h3><div>Morbidity and mortality following pancreaticoduodenectomy (PD) have improved; however, the population is aging, and the use of robotic surgery is expanding. This study compares the selection of octogenarians who underwent PD, their outcomes, and whether robotic surgery provides an advantage.</div></div><div><h3>Methods</h3><div>This is a multi-institutional retrospective review from 2007 to 2023 of patients who underwent PD, including open and robotic approach. Pre-, intra-, and post-operative outcomes were analyzed; multivariable analysis (MVA) and propensity score matching (PSM) were performed.</div></div><div><h3>Results</h3><div>2175 patients underwent PD for all causes; <80 years: <em>n</em>=1,952, >80 (octogenarians): <em>n</em>=223. Octogenarians had higher age unadjusted Charlson Comorbidity Index (2.8 vs 2.6, <em>p</em><0.001), and more prior surgeries (67.9 % vs 56.1 %, <em>p</em><0.001). On univariate analysis, octogenarians had higher average Clavien-Dindo grade (2.0 vs 1.7, <em>p</em>=0.002) and higher 90-day mortality (9.9 % vs 3.1 %, <em>p</em><0.001). On MVA, age >80 was associated with increased risk of major morbidity (OR 1.50 [1.10–2.04], <em>p</em>=0.011) and 90-day mortality (OR 3.20 [1.85–5.54], <em>p</em><0.001). Robotic PD (RPD) was associated with decreased risk of major morbidity (OR 0.69 [0.56–0.86], <em>p</em><0.001). After PSM of octogenarians who underwent RPD, there was no statistically significant difference in mortality.</div></div><div><h3>Conclusion</h3><div>Pancreaticoduodenectomy has increased but acceptable morbidity in octogenarians. The increased risk may be mitigated by RPD.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1400-1409"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144855105","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.08.006
Miho Akabane , Jun Kawashima , Selamawit Woldesenbet , Razeen Thammachack , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik
Background
No validated model incorporates surgical parameters for complication risk in hepatocellular carcinoma (HCC) resection. We evaluated a novel Surgical Burden Score (SBS), integrating adjusted blood loss (aBL; mL/kg) and operative time (hours) via a Pythagorean formula, and developed an SBS-based model to predict complications.
Methods
Patients undergoing curative-intent hepatectomy for HCC(2000–2023) were identified from an international database. SBS was calculated as SBS2=(operative time)2+(aBL)2. Outcomes were any and severe complications (Clavien-Dindo ≥ III). ROC curves and AUCs evaluated performance. A 3:1 training/testing split was used for model development, incorporating SBS plus clinical variables.
Results
Among 801 patients, complications occurred in 39.1 %, and severe complications in 11.0 %. On multivariable analysis, operative time (HR:1.231; 95%CI:1.113–1.365; p < 0.001) and aBL (HR:1.021; 95%CI:1.002–1.041; p = 0.036) were independent predictors of any complications. SBS(median:6.07 [IQR:4.08–10.07]) outperformed its components (AUC:0.71vs0.67 for operative time and 0.69 for aBL). Stratified SBS groups demonstrated a dose-dependent increase in complications (p < 0.001). The SBS-based model achieved AUCs of 0.73 (training) and 0.76 (testing), outperforming existing models. An online calculator is available (https://makbn.shinyapps.io/SBS_shiny/).
Conclusions
SBS, a Pythagorean-based metric combining operative time and aBL, accurately predicts complications. The SBS-based model offers strong predictive utility for risk stratification.
背景：没有一个经过验证的模型包含肝细胞癌（HCC）切除术并发症风险的手术参数。我们评估了一种新的手术负担评分（SBS），通过毕达哥拉公式整合调整失血量（aBL; mL/kg）和手术时间（小时），并开发了一种基于SBS的模型来预测并发症。方法：从国际数据库中确定2000-2023年接受HCC治疗意图肝切除术的患者。SBS计算为SBS2=（手术时间）2+(aBL)2。结果为任何和严重并发症（Clavien-Dindo≥III）。ROC曲线和auc评估性能。模型开发采用3:1的训练/测试分割，包括SBS和临床变量。结果：801例患者中，并发症发生率为39.1%，严重并发症发生率为11.0%。在多变量分析中，手术时间（HR:1.231; 95%CI:1.113 ~ 1.365; p < 0.001）和aBL （HR:1.021; 95%CI:1.002 ~ 1.041; p = 0.036）是并发症的独立预测因子。SBS（中位数：6.07 [IQR:4.08-10.07]）优于其组成部分（AUC:0.71vs0.67手术时间和0.69 aBL）。分层SBS组并发症呈剂量依赖性增加（p < 0.001）。基于sbs的模型实现了0.73（训练）和0.76（测试）的auc，优于现有模型。可以使用在线计算器（https://makbn.shinyapps.io/SBS_shiny/）。结论：SBS是一种以毕达哥拉斯为基础，结合手术时间和aBL的指标，能准确预测并发症。基于sbs的模型为风险分层提供了强大的预测效用。
{"title":"The surgical burden score: a novel continuous metric to predict postoperative complications after hepatectomy for hepatocellular carcinoma","authors":"Miho Akabane , Jun Kawashima , Selamawit Woldesenbet , Razeen Thammachack , François Cauchy , Federico Aucejo , Irinel Popescu , Minoru Kitago , Guillaume Martel , Francesca Ratti , Luca Aldrighetti , George A. Poultsides , Yuki Imaoka , Andrea Ruzzenente , Itaru Endo , Ana Gleisner , Hugo P. Marques , Vincent Lam , Tom Hugh , Nazim Bhimani , Timothy M. Pawlik","doi":"10.1016/j.hpb.2025.08.006","DOIUrl":"10.1016/j.hpb.2025.08.006","url":null,"abstract":"<div><h3>Background</h3><div>No validated model incorporates surgical parameters for complication risk in hepatocellular carcinoma (HCC) resection. We evaluated a novel Surgical Burden Score (SBS), integrating adjusted blood loss (aBL; mL/kg) and operative time (hours) via a Pythagorean formula, and developed an SBS-based model to predict complications.</div></div><div><h3>Methods</h3><div>Patients undergoing curative-intent hepatectomy for HCC(2000–2023) were identified from an international database. SBS was calculated as SBS<sup>2</sup>=(operative time)<sup>2</sup>+(aBL)<sup>2</sup>. Outcomes were any and severe complications (Clavien-Dindo ≥ III). ROC curves and AUCs evaluated performance. A 3:1 training/testing split was used for model development, incorporating SBS plus clinical variables.</div></div><div><h3>Results</h3><div>Among 801 patients, complications occurred in 39.1 %, and severe complications in 11.0 %. On multivariable analysis, operative time (HR:1.231; 95%CI:1.113–1.365; p < 0.001) and aBL (HR:1.021; 95%CI:1.002–1.041; p = 0.036) were independent predictors of any complications. SBS(median:6.07 [IQR:4.08–10.07]) outperformed its components (AUC:0.71vs0.67 for operative time and 0.69 for aBL). Stratified SBS groups demonstrated a dose-dependent increase in complications (p < 0.001). The SBS-based model achieved AUCs of 0.73 (training) and 0.76 (testing), outperforming existing models. An online calculator is available (<span><span>https://makbn.shinyapps.io/SBS_shiny/</span><svg><path></path></svg></span>).</div></div><div><h3>Conclusions</h3><div>SBS, a Pythagorean-based metric combining operative time and aBL, accurately predicts complications. The SBS-based model offers strong predictive utility for risk stratification.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1445-1454"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145006027","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.08.014
Jose D. de Meira Junior , Gabriela Del Angel-Millán , Gabriela Ochoa , Morgan Bonds , Nicolas Jarufe , Carlos Chan , Brendan Visser , Adnan Alseidi , Martin Dib , Wellington Andraus , Paulo Herman , Ismael Dominguez-Rosado
Background
Hepatopancreatobiliary (HPB) surgery is a complex subspecialty requiring high-volume centers and structured training. In Latin America (LA), comprehensive training programs are scarce, leading many surgeons to seek education abroad, often limited by financial, certification, or migration barriers. This study describes the development and implementation of the first multinational, multicentric HPB fellowship in LA, established through collaboration among institutions in Brazil, Chile, and Mexico, and accredited by the Fellowship Council and the Americas Hepato-Pancreato-Biliary Association (AHPBA).
Methods
This two-year program consists of three 8-month rotations, allowing fellows exposure to diverse surgical environments. Each center offers complementary strengths, including minimally invasive techniques, living donor liver transplantation, and complex biliary reconstruction. Program outcomes were evaluated using case logs, structured exit interviews, and faculty reports. Fellows were also assessed on educational activities, research participation, adaptability, and cultural integration.
Results
All inaugural fellows exceeded surgical volume requirements and engaged in academic activities, simulation training, and research. Challenges such as migration, certification, and language barriers were eased by institutional support and peer collaboration.
Conclusion
The LA HPB Fellowship shows that a multinational, multicenter rotational model can provide high-quality, accredited training in resource-limited settings, fostering professional growth and regional collaboration.
{"title":"Feasibility of an international multicentric HPB fellowship training program in Latin America","authors":"Jose D. de Meira Junior , Gabriela Del Angel-Millán , Gabriela Ochoa , Morgan Bonds , Nicolas Jarufe , Carlos Chan , Brendan Visser , Adnan Alseidi , Martin Dib , Wellington Andraus , Paulo Herman , Ismael Dominguez-Rosado","doi":"10.1016/j.hpb.2025.08.014","DOIUrl":"10.1016/j.hpb.2025.08.014","url":null,"abstract":"<div><h3>Background</h3><div>Hepatopancreatobiliary (HPB) surgery is a complex subspecialty requiring high-volume centers and structured training. In Latin America (LA), comprehensive training programs are scarce, leading many surgeons to seek education abroad, often limited by financial, certification, or migration barriers. This study describes the development and implementation of the first multinational, multicentric HPB fellowship in LA, established through collaboration among institutions in Brazil, Chile, and Mexico, and accredited by the Fellowship Council and the Americas Hepato-Pancreato-Biliary Association (AHPBA).</div></div><div><h3>Methods</h3><div>This two-year program consists of three 8-month rotations, allowing fellows exposure to diverse surgical environments. Each center offers complementary strengths, including minimally invasive techniques, living donor liver transplantation, and complex biliary reconstruction. Program outcomes were evaluated using case logs, structured exit interviews, and faculty reports. Fellows were also assessed on educational activities, research participation, adaptability, and cultural integration.</div></div><div><h3>Results</h3><div>All inaugural fellows exceeded surgical volume requirements and engaged in academic activities, simulation training, and research. Challenges such as migration, certification, and language barriers were eased by institutional support and peer collaboration.</div></div><div><h3>Conclusion</h3><div>The LA HPB Fellowship shows that a multinational, multicenter rotational model can provide high-quality, accredited training in resource-limited settings, fostering professional growth and regional collaboration.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1465-1471"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145039924","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 impact of preoperative mood on complications remains poorly understood in hepato-biliary-pancreatic (HBP) surgery.
Methods
This prospective cohort study included patients who underwent resection for pancreatic ductal carcinoma and cholangiocarcinoma. Preoperative positive mood were measured by Vigor-Activity score according to Profile of Mood States, 2nd edition. The primary outcome was the whole burden of complications, represented by the comprehensive complication index (CCI). Patients were divided into low- and high-positive mood groups by the median Vigor-Activity score. The impact of mood state on CCI was assessed by restricted cubic spline regression.
Results
Between July 2021 and June 2022, 127 consecutive patients were enrolled. Preoperative findings and surgical procedures did not significantly differ between the low-positive (n = 64) and high-positive (n = 63) mood groups. The high-positive mood group had a significantly lower median CCI than the low-positive mood group (41.1 vs. 48.2, P = 0.026). The Vigor-Activity score had a nearly linear negative correlation with CCI and independently decreased CCI (P = 0.034).
Conclusion
Patients with preoperative high-positive mood had a lower CCI than those with low-positive mood after major HBP surgery. A patient’s preoperative mood could affect the total burden of postoperative complications.
{"title":"Close correlation between patients' positive mood and postoperative complication burden in hepato-biliary-pancreatic cancer: a prospective comparative cohort trial","authors":"Shunsuke Onoe , Yukihiro Yokoyama , Tsuyoshi Igami , Junpei Yamaguchi , Takashi Mizuno , Yoshikuni Inokawa , Hideki Takami , Masaki Sunagawa , Nobuyuki Watanabe , Shoji Kawakatsu , Tatsuya Tokura , Takahiro Imaizumi , Tomoki Ebata","doi":"10.1016/j.hpb.2025.07.015","DOIUrl":"10.1016/j.hpb.2025.07.015","url":null,"abstract":"<div><h3>Background</h3><div>The impact of preoperative mood on complications remains poorly understood in hepato-biliary-pancreatic (HBP) surgery.</div></div><div><h3>Methods</h3><div>This prospective cohort study included patients who underwent resection for pancreatic ductal carcinoma and cholangiocarcinoma. Preoperative positive mood were measured by Vigor-Activity score according to Profile of Mood States, 2nd edition. The primary outcome was the whole burden of complications, represented by the comprehensive complication index (CCI). Patients were divided into low- and high-positive mood groups by the median Vigor-Activity score. The impact of mood state on CCI was assessed by restricted cubic spline regression.</div></div><div><h3>Results</h3><div>Between July 2021 and June 2022, 127 consecutive patients were enrolled. Preoperative findings and surgical procedures did not significantly differ between the low-positive (<em>n</em> = 64) and high-positive (<em>n</em> = 63) mood groups. The high-positive mood group had a significantly lower median CCI than the low-positive mood group (41.1 vs. 48.2, <em>P</em> = 0.026). The Vigor-Activity score had a nearly linear negative correlation with CCI and independently decreased CCI (<em>P</em> = 0.034).</div></div><div><h3>Conclusion</h3><div>Patients with preoperative high-positive mood had a lower CCI than those with low-positive mood after major HBP surgery. A patient’s preoperative mood could affect the total burden of postoperative complications.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1390-1399"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834985","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.07.012
Matthew I. Ebia, Anser A. Abbas, Abrahm Levi, John Davelaar, Elissa Rosenberg, Katelyn M. Atkins, Mitchell Kamrava, Simon Lo, Srinivas Gaddam, Alexandra Gangi, Kambiz Kosari, Arpit Arora, Nanor Haladjian, Meghan Laszlo, Steven Oppenheim, Karen L. Reckamp, Nicholas Nissen, Brent K. Larson, Ashley Wachsman, Jun Gong, Arsen Osipov
Background
Pancreatic cancer (PC) requires a multimodal treatment approach. We evaluated the impact of our same-day pancreatic multidisciplinary clinic (PMDC) on genetic testing, ancillary service access, treatment timelines, clinical trial enrollment, and survival.
Methods
We retrospectively compared guideline directed care, clinical metrics and outcomes in patients managed through our PMDC (n = 87; Oct 2021–June 2023) versus an age- and resectability-matched cohort from our internal registry who received standard sequential care non-PMDC (n = 87; Jan–Dec 2020).
Results
PMDC patients were significantly more likely to undergo somatic (OR 3.69, p < 0.001) and germline testing (OR 15.41, p < 0.001), receive upfront access palliative care (OR 7.86, p < 0.001) and social services (OR 4.48, p = 0.028), initiate treatment sooner (14.3 vs. 30.9 days, p = 0.002), and enroll in clinical trials (OR 2.30, p = 0.042). Among newly diagnosed metastatic PC patients, PMDC care was independently associated with improved survival (487 vs. 267 days, p = 0.021).
Conclusion
A same-day PMDC significantly improves access to guideline-recommended care and prolongs survival in patients with metastatic pancreatic cancer.
背景：胰腺癌（PC）需要多模式治疗。我们评估了当日胰腺多学科临床（PMDC）对基因检测、辅助服务获取、治疗时间表、临床试验登记和生存的影响。方法：我们回顾性地比较了指南指导下的护理、临床指标和通过PMDC管理的患者的结局(n = 87；（2021年10月至2023年6月），与来自我们内部注册中心的年龄和切除率匹配的队列进行比较，这些队列接受了标准顺序护理非pmdc (n = 87；Jan-Dec 2020)。结果：PMDC患者更有可能接受躯体（OR 3.69, p < 0.001）和种系检测（OR 15.41, p < 0.001），接受前期姑息治疗（OR 7.86, p < 0.001）和社会服务（OR 4.48, p = 0.028），更早开始治疗（OR 14.3 vs. 30.9天，p = 0.002），并参加临床试验（OR 2.30, p = 0.042）。在新诊断的转移性PC患者中，PMDC护理与生存率的提高独立相关（487天vs 267天，p = 0.021）。结论：当日PMDC显著改善了转移性胰腺癌患者获得指南推荐治疗的机会，延长了患者的生存期。
{"title":"Enhancing management of pancreatic cancer: impact of a same day multidisciplinary clinic on access to guideline-directed care","authors":"Matthew I. Ebia, Anser A. Abbas, Abrahm Levi, John Davelaar, Elissa Rosenberg, Katelyn M. Atkins, Mitchell Kamrava, Simon Lo, Srinivas Gaddam, Alexandra Gangi, Kambiz Kosari, Arpit Arora, Nanor Haladjian, Meghan Laszlo, Steven Oppenheim, Karen L. Reckamp, Nicholas Nissen, Brent K. Larson, Ashley Wachsman, Jun Gong, Arsen Osipov","doi":"10.1016/j.hpb.2025.07.012","DOIUrl":"10.1016/j.hpb.2025.07.012","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic cancer (PC) requires a multimodal treatment approach. We evaluated the impact of our same-day pancreatic multidisciplinary clinic (PMDC) on genetic testing, ancillary service access, treatment timelines, clinical trial enrollment, and survival.</div></div><div><h3>Methods</h3><div>We retrospectively compared guideline directed care, clinical metrics and outcomes in patients managed through our PMDC (n = 87; Oct 2021–June 2023) versus an age- and resectability-matched cohort from our internal registry who received standard sequential care non-PMDC (n = 87; Jan–Dec 2020).</div></div><div><h3>Results</h3><div>PMDC patients were significantly more likely to undergo somatic (OR 3.69, p < 0.001) and germline testing (OR 15.41, p < 0.001), receive upfront access palliative care (OR 7.86, p < 0.001) and social services (OR 4.48, p = 0.028), initiate treatment sooner (14.3 vs. 30.9 days, p = 0.002), and enroll in clinical trials (OR 2.30, p = 0.042). Among newly diagnosed metastatic PC patients, PMDC care was independently associated with improved survival (487 vs. 267 days, p = 0.021).</div></div><div><h3>Conclusion</h3><div>A same-day PMDC significantly improves access to guideline-recommended care and prolongs survival in patients with metastatic pancreatic cancer.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1379-1389"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859136","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.08.015
Patrick W. Underwood , Thomas Leuschner , Amanda K. Walsh , Eric D. Miller , Kenneth L. Pitter , Anne M. Noonan , Ashish Manne , Shafia Rahman , Pannaga Malalur , Arjun Mittra , Mary E. Dillhoff , Susan Tsai , Timothy M. Pawlik , Jordan M. Cloyd
Background
Neoadjuvant therapy (NT) is increasingly utilized for localized pancreatic ductal adenocarcinoma (PDAC). The incidence of hospital admission during NT and its impact on clinical outcomes is poorly understood.
Methods
Patients with localized PDAC who received intent-to-treat NT between 2018 and 2023 at a single institution were retrospectively reviewed. Hospital admission rates, reasons, and the impact on overall survival (OS) were assessed.
Results
Among 305 patients, 58.4 % were male, 90.7 % were white, and median age was 66. Patients had potentially resectable (31.1 %), borderline resectable (36.7 %), and locally advanced disease (32.1 %). The median duration of NT was 119 days. Overall, 80 (26.2 %) patients required hospital admission during NT (range 1–5). The most common reasons for admission were fever/infection (33.8 %) and gastrointestinal symptoms (20.8 %). Factors associated with hospital admission included LA anatomic stage (OR 2.56; 95%CI: 1.22–5.39; p = 0.013) and BMI (OR 1.09; 95%CI: 1.04–1.15; p < 0.001). Hospital admission was associated with reduced odds of undergoing surgical resection (OR 0.27; 95%CI: 0.14–0.54; p < 0.001) and worse OS (median 14.6 months; 95%CI: 11.3–18.0 vs 22.6 months; 95%CI: 17.2–28.1; p < 0.001).
Conclusion
Hospital admission is common among patients with PDAC receiving NT and associated with worse outcomes. Further research on optimizing care delivery during NT is critical to improve outcomes.
背景：新辅助治疗（NT）越来越多地用于局限性胰腺导管腺癌（PDAC）。NT期间住院的发生率及其对临床结果的影响尚不清楚。方法：回顾性分析2018年至2023年间在单一机构接受NT治疗的局限性PDAC患者。评估住院率、原因和对总生存期（OS）的影响。结果：305例患者中，男性58.4%，白人90.7%，中位年龄66岁。患者有潜在可切除（31.1%）、边缘性可切除（36.7%）和局部晚期（32.1%）。NT的中位持续时间为119天。总体而言，80例（26.2%）患者在NT期间需要住院（范围1-5）。最常见的入院原因是发热/感染（33.8%）和胃肠道症状（20.8%）。与住院相关的因素包括LA解剖分期（OR 2.56; 95%CI: 1.22-5.39; p = 0.013）和BMI （OR 1.09; 95%CI: 1.04-1.15; p < 0.001）。住院与手术切除的几率降低（OR 0.27; 95%CI: 0.14-0.54; p < 0.001）和更差的OS（中位14.6个月；95%CI: 11.3-18.0 vs 22.6个月；95%CI: 17.2-28.1; p < 0.001）相关。结论：住院在接受NT治疗的PDAC患者中很常见，且与较差的预后相关。进一步研究优化NT期间的护理服务对改善结果至关重要。
{"title":"Hospital admission during neoadjuvant therapy for pancreatic ductal adenocarcinoma: prevalence, predictors, and prognosis","authors":"Patrick W. Underwood , Thomas Leuschner , Amanda K. Walsh , Eric D. Miller , Kenneth L. Pitter , Anne M. Noonan , Ashish Manne , Shafia Rahman , Pannaga Malalur , Arjun Mittra , Mary E. Dillhoff , Susan Tsai , Timothy M. Pawlik , Jordan M. Cloyd","doi":"10.1016/j.hpb.2025.08.015","DOIUrl":"10.1016/j.hpb.2025.08.015","url":null,"abstract":"<div><h3>Background</h3><div>Neoadjuvant therapy (NT) is increasingly utilized for localized pancreatic ductal adenocarcinoma (PDAC). The incidence of hospital admission during NT and its impact on clinical outcomes is poorly understood.</div></div><div><h3>Methods</h3><div>Patients with localized PDAC who received intent-to-treat NT between 2018 and 2023 at a single institution were retrospectively reviewed. Hospital admission rates, reasons, and the impact on overall survival (OS) were assessed.</div></div><div><h3>Results</h3><div>Among 305 patients, 58.4 % were male, 90.7 % were white, and median age was 66. Patients had potentially resectable (31.1 %), borderline resectable (36.7 %), and locally advanced disease (32.1 %). The median duration of NT was 119 days. Overall, 80 (26.2 %) patients required hospital admission during NT (range 1–5). The most common reasons for admission were fever/infection (33.8 %) and gastrointestinal symptoms (20.8 %). Factors associated with hospital admission included LA anatomic stage (OR 2.56; 95%CI: 1.22–5.39; <em>p</em> = 0.013) and BMI (OR 1.09; 95%CI: 1.04–1.15; <em>p</em> < 0.001). Hospital admission was associated with reduced odds of undergoing surgical resection (OR 0.27; 95%CI: 0.14–0.54; <em>p</em> < 0.001) and worse OS (median 14.6 months; 95%CI: 11.3–18.0 vs 22.6 months; 95%CI: 17.2–28.1; <em>p</em> < 0.001).</div></div><div><h3>Conclusion</h3><div>Hospital admission is common among patients with PDAC receiving NT and associated with worse outcomes. Further research on optimizing care delivery during NT is critical to improve outcomes.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1472-1478"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145064679","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 : 2025-11-01DOI: 10.1016/j.hpb.2025.07.013
Adianto Nugroho , Arnetta N. Lalisang , Toar J.M. Lalisang , Mohamed Rela , Pierce K.H. Chow , Stephen Chang , Koh P. Soon , Tin T. Mar , Amornetta Casupang , Rawisak Chanwat , Erik Prabowo , Indah Jamtani , Song-Huy Nguyen-Dinh , Norihiro Kokudo , Catherine Teh
Background
Approximately 80 % of primary liver cancer cases happen in Asia–Pacific and become the leading cause of cancer-related mortality. However, there is no consensus on defining and standardizing the optimal management of large HCCs.
Methods
The Asia–Pacific Consensus Conference employed the Modified Delphi method, consisting of three rounds of surveys followed by a discussion panel. In this process, 31 experts anonymously contributed their opinions to refine statements and achieve a consensus on large HCC.
Results
A large hepatocellular carcinoma (HCC) is a nodule measuring ≥5 cm. A distinct BCLC staging system is recommended for solitary large HCC (SLHCC) without vascular invasion or tumor dissemination, as these cases show prolonged survival and lower recurrence rates post-liver resection. Portal vein tumor thrombosis (PVTT) is a crucial prognostic factor. Diagnosis of SLHCC can rely on multiphasic contrast-enhancing radiology (CT/MRI) and AFP levels ≥400. Preoperative liver function assessments guide resection planning where liver volumetry is unavailable. Major hepatectomy and laparoscopic approaches are viable for SLHCC, and postoperative radiological surveillance is essential.
Conclusion
Tailoring surgical approaches, ensuring readiness, and optimizing resources are key to successful single large HCC management. This consensus aims to guide surgeons, especially in the Asia–Pacific region.
{"title":"Asia–Pacific modified Delphi consensus conference on large hepatocellular carcinoma","authors":"Adianto Nugroho , Arnetta N. Lalisang , Toar J.M. Lalisang , Mohamed Rela , Pierce K.H. Chow , Stephen Chang , Koh P. Soon , Tin T. Mar , Amornetta Casupang , Rawisak Chanwat , Erik Prabowo , Indah Jamtani , Song-Huy Nguyen-Dinh , Norihiro Kokudo , Catherine Teh","doi":"10.1016/j.hpb.2025.07.013","DOIUrl":"10.1016/j.hpb.2025.07.013","url":null,"abstract":"<div><h3>Background</h3><div>Approximately 80 % of primary liver cancer cases happen in Asia–Pacific and become the leading cause of cancer-related mortality. However, there is no consensus on defining and standardizing the optimal management of large HCCs.</div></div><div><h3>Methods</h3><div>The Asia–Pacific Consensus Conference employed the Modified Delphi method, consisting of three rounds of surveys followed by a discussion panel. In this process, 31 experts anonymously contributed their opinions to refine statements and achieve a consensus on large HCC.</div></div><div><h3>Results</h3><div>A large hepatocellular carcinoma (HCC) is a nodule measuring ≥5 cm. A distinct BCLC staging system is recommended for solitary large HCC (SLHCC) without vascular invasion or tumor dissemination, as these cases show prolonged survival and lower recurrence rates post-liver resection. Portal vein tumor thrombosis (PVTT) is a crucial prognostic factor. Diagnosis of SLHCC can rely on multiphasic contrast-enhancing radiology (CT/MRI) and AFP levels ≥400. Preoperative liver function assessments guide resection planning where liver volumetry is unavailable. Major hepatectomy and laparoscopic approaches are viable for SLHCC, and postoperative radiological surveillance is essential.</div></div><div><h3>Conclusion</h3><div>Tailoring surgical approaches, ensuring readiness, and optimizing resources are key to successful single large HCC management. This consensus aims to guide surgeons, especially in the Asia–Pacific region.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 11","pages":"Pages 1355-1366"},"PeriodicalIF":2.4,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144834984","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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