Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.010
Sarah L. Yager, Akin Erol, Linda L. Wong
Background
Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.
Methods
National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.
Results
Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 103/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.
Conclusions
While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.
背景：肝细胞癌（HCC）的治疗正在迅速发展，全身/局部治疗增加了手术选择。本研究探讨新辅助治疗是否会影响早期手术结果。方法：使用国家手术质量改进计划（NSQIP）数据库，识别2020年至2023年因HCC接受大肝切除术的患者。我们定义了两组；前期肝切除术和新辅助治疗。分析患者特点、术前、术中因素及术后结果。结果：837例患者中，673例（80.4%）行前期肝切除术，164例（19.6%）行新辅助治疗。新辅助治疗患者术前白蛋白3/jL （17.2 vs 10.6%, p = 0.016）、输血（36.6 vs 23.2%, p < 0.001）、胆道重建（9.8 vs 5.5%, p = 0.04）和手术时间bb0 300 min （51.2 vs 34.7%, p < 0.001）的可能性更大。住院时间和30天死亡率相似。多因素分析显示，动脉内治疗和乙型肝炎更能预测发生B/C级肝衰竭。结论：虽然肝细胞癌的新辅助治疗可能增加手术的可能性，但患者在切除时病情可能更重，病例可能更具挑战性。虽然早期死亡率相似，但新辅助治疗可能会影响肝功能。需要更多的研究来最佳地选择患者进行转化治疗。
{"title":"The impact of neoadjuvant therapy on postoperative outcomes in patients undergoing hepatectomies for hepatocellular carcinoma","authors":"Sarah L. Yager, Akin Erol, Linda L. Wong","doi":"10.1016/j.hpb.2025.11.010","DOIUrl":"10.1016/j.hpb.2025.11.010","url":null,"abstract":"<div><h3>Background</h3><div>Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.</div></div><div><h3>Methods</h3><div>National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.</div></div><div><h3>Results</h3><div>Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 10<sup>3</sup>/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.</div></div><div><h3>Conclusions</h3><div>While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 218-224"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145695930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.012
Francisco Tustumi , Lucia Calthorpe , Nora Fotoohi , Thiago Costa Ribeiro , Lucas Cata Preta Stolzemburg , Andre L. Bettiati Junior , Caroline de Almeida Gonçalves , Ana P. Cursino Briet de Almeida , Allana M. Gomes Giordano , André Luís de Godoy , Dante Altenfelder , Julia Nicioli , Alexandre C. Guimarães , Alejandro S. Requejo , Alessandro Landskron Diniz , Alexandre Ferreira Oliveira , Alice C. Wei , André de Moricz , Andre L. Montagnini , Brendan C. Visser , Felipe José Fernández Coimbra
Background
Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.
Methods
A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.
Results
From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.
Discussion
The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.
{"title":"The São Paulo International Consensus on Minimally Invasive Pancreatic Surgery for Cancer","authors":"Francisco Tustumi , Lucia Calthorpe , Nora Fotoohi , Thiago Costa Ribeiro , Lucas Cata Preta Stolzemburg , Andre L. Bettiati Junior , Caroline de Almeida Gonçalves , Ana P. Cursino Briet de Almeida , Allana M. Gomes Giordano , André Luís de Godoy , Dante Altenfelder , Julia Nicioli , Alexandre C. Guimarães , Alejandro S. Requejo , Alessandro Landskron Diniz , Alexandre Ferreira Oliveira , Alice C. Wei , André de Moricz , Andre L. Montagnini , Brendan C. Visser , Felipe José Fernández Coimbra","doi":"10.1016/j.hpb.2025.11.012","DOIUrl":"10.1016/j.hpb.2025.11.012","url":null,"abstract":"<div><h3>Background</h3><div>Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.</div></div><div><h3>Methods</h3><div>A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.</div></div><div><h3>Results</h3><div>From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.</div></div><div><h3>Discussion</h3><div>The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 105-118"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145793754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.007
Kate Couzens-Bohlin , Sanju Sobnach , Jake Krige , Urda Kotze , Christo Kloppers , Marc Bernon , Stefano Cacciatore , Eduard Jonas
Background
Hepatic cystic echinococcosis (HCE) appears more severe in human immunodeficiency virus (HIV) co-infected (HIV+) patients with a more complicated clinical presentation (larger, multifocal cysts, biliary obstruction, secondary infection, cyst rupture), often necessitating urgent treatment with higher post-operative complications. This case-cohort study compared HCE treatment outcomes in HIV+ and HIV negative (HIV-) patients.
Methods
Patients with known HIV status who underwent HCE surgery at our tertiary institution between 2011 and 2023 were assessed for pre-, intra-, and post-operative outcomes. Surgical complications were compared using the Accordion severity scores.
Results
The majority of the 87 operated patients were HIV+ (51.7 %). Complication rates were comparable between the HIV+ and HIV- groups with similar Accordion severity scores. Cholangitis was statistically less frequent in HIV+ (6.7 %) vs. HIV- patients (26.2 %), p = 0.019. Cyst infection rates were lower in HIV+ (20.0 %) than in HIV- (38.1 %) patients. Five HIV+ and three HIV- patients required re-operation. Mortality occurred in two HIV+ and five HIV- patients.
Conclusion
Although outcomes were similar, the disproportionately high number of HIV+ patients (51.7 %) compared to the general population HIV prevalence (12.7 %) suggests that HCE is less self-limiting with HIV co-infection, supporting a potential link between co-infection and severity of disease presentation.
{"title":"Surgical treatment outcomes of hepatic cystic echinococcosis in HIV-positive and HIV-negative patients: a South African cohort study","authors":"Kate Couzens-Bohlin , Sanju Sobnach , Jake Krige , Urda Kotze , Christo Kloppers , Marc Bernon , Stefano Cacciatore , Eduard Jonas","doi":"10.1016/j.hpb.2025.11.007","DOIUrl":"10.1016/j.hpb.2025.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Hepatic cystic echinococcosis (HCE) appears more severe in human immunodeficiency virus (HIV) co-infected (HIV+) patients with a more complicated clinical presentation (larger, multifocal cysts, biliary obstruction, secondary infection, cyst rupture), often necessitating urgent treatment with higher post-operative complications. This case-cohort study compared HCE treatment outcomes in HIV+ and HIV negative (HIV-) patients.</div></div><div><h3>Methods</h3><div>Patients with known HIV status who underwent HCE surgery at our tertiary institution between 2011 and 2023 were assessed for pre-, intra-, and post-operative outcomes. Surgical complications were compared using the Accordion severity scores.</div></div><div><h3>Results</h3><div>The majority of the 87 operated patients were HIV+ (51.7 %). Complication rates were comparable between the HIV+ and HIV- groups with similar Accordion severity scores. Cholangitis was statistically less frequent in HIV+ (6.7 %) vs. HIV- patients (26.2 %), p = 0.019. Cyst infection rates were lower in HIV+ (20.0 %) than in HIV- (38.1 %) patients. Five HIV+ and three HIV- patients required re-operation. Mortality occurred in two HIV+ and five HIV- patients.</div></div><div><h3>Conclusion</h3><div>Although outcomes were similar, the disproportionately high number of HIV+ patients (51.7 %) compared to the general population HIV prevalence (12.7 %) suggests that HCE is less self-limiting with HIV co-infection, supporting a potential link between co-infection and severity of disease presentation.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 199-208"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145677534","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.005
Cynthia E. Burke , Joanna T. Buchheit , Rushin D. Brahmbhatt , June S. Peng
Background
Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP.
Methods
PD and DP patients were identified from the 2015–2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses.
Results
We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72–0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates.
Conclusion
BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.
{"title":"Targeted antibiotic prophylaxis strategy for pancreatectomies: an analysis of the National Surgical Quality Improvement Program","authors":"Cynthia E. Burke , Joanna T. Buchheit , Rushin D. Brahmbhatt , June S. Peng","doi":"10.1016/j.hpb.2025.11.005","DOIUrl":"10.1016/j.hpb.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP.</div></div><div><h3>Methods</h3><div>PD and DP patients were identified from the 2015–2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72–0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates.</div></div><div><h3>Conclusion</h3><div>BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 178-188"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.011
Mehdi Boubaddi , Rami Rhaiem , Florian Pecquenard , Emmanuel Buc , Fabrice Muscari , Safi Dokmak , Mehdi El Amrani , Ahmet Ayav , Alexandre Chebaro , Laurent Sulpice , René Adam , Christophe Laurent , Stéphanie Truant
Background
Patients with a high metastatic tumor burden may be candidates for extensive liver resection with a liver augmentation technique. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are the most effective techniques for stimulating liver growth. However, postoperative and oncological outcomes of these approaches require further clarification in large cohorts. This study assessed the oncological outcomes of patients treated for colorectal liver metastases (CRLM) using ALPPS or LVD.
Methods
All consecutive patients who underwent LVD and/or ALPPS for CRLM at eight French centers between 2011 and 2022 were included in a retrospective database. The primary endpoint was oncological outcomes according to the intention-to-treat principle. Secondary endpoints included the resection rate, intraoperative and postoperative outcomes, and a per-protocol analysis excluding patients requiring rescue ALPPS after LVD failure.
Results
In total, 214 patients with CRLM were included from the eight centers; 127 (59.3 %) underwent LVD and 87 (40.7 %) underwent ALPPS. Resectability rates, based on the intention-to-treat principle, were 84.3 % (n = 107) in the LVD group and 98.9 % (n = 86) in the ALPPS group. In the intention-to-treat analysis, median overall survival durations were 42 months in the LVD group and 30 months in the ALPPS group. Median disease-free survival durations were 7 months in the LVD group and 6 months in the ALPPS group.
Conclusion
Overall and disease-free survival did not substantially differ between LVD and ALPPS prior to major liver resection for CRLM. This study represents the largest comparison of postoperative and oncological outcomes between LVD and ALPPS in patients with CRLM; it may serve as a foundation for a randomized controlled trial.
{"title":"Liver venous deprivation (LVD) or ALPPS in the treatment of colorectal liver metastasis (CRLM): a comparison of oncological outcome","authors":"Mehdi Boubaddi , Rami Rhaiem , Florian Pecquenard , Emmanuel Buc , Fabrice Muscari , Safi Dokmak , Mehdi El Amrani , Ahmet Ayav , Alexandre Chebaro , Laurent Sulpice , René Adam , Christophe Laurent , Stéphanie Truant","doi":"10.1016/j.hpb.2025.11.011","DOIUrl":"10.1016/j.hpb.2025.11.011","url":null,"abstract":"<div><h3>Background</h3><div>Patients with a high metastatic tumor burden may be candidates for extensive liver resection with a liver augmentation technique. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are the most effective techniques for stimulating liver growth. However, postoperative and oncological outcomes of these approaches require further clarification in large cohorts. This study assessed the oncological outcomes of patients treated for colorectal liver metastases (CRLM) using ALPPS or LVD.</div></div><div><h3>Methods</h3><div>All consecutive patients who underwent LVD and/or ALPPS for CRLM at eight French centers between 2011 and 2022 were included in a retrospective database. The primary endpoint was oncological outcomes according to the intention-to-treat principle. Secondary endpoints included the resection rate, intraoperative and postoperative outcomes, and a per-protocol analysis excluding patients requiring rescue ALPPS after LVD failure.</div></div><div><h3>Results</h3><div>In total, 214 patients with CRLM were included from the eight centers; 127 (59.3 %) underwent LVD and 87 (40.7 %) underwent ALPPS. Resectability rates, based on the intention-to-treat principle, were 84.3 % (<em>n</em> = 107) in the LVD group and 98.9 % (<em>n</em> = 86) in the ALPPS group. In the intention-to-treat analysis, median overall survival durations were 42 months in the LVD group and 30 months in the ALPPS group. Median disease-free survival durations were 7 months in the LVD group and 6 months in the ALPPS group.</div></div><div><h3>Conclusion</h3><div>Overall and disease-free survival did not substantially differ between LVD and ALPPS prior to major liver resection for CRLM. This study represents the largest comparison of postoperative and oncological outcomes between LVD and ALPPS in patients with CRLM; it may serve as a foundation for a randomized controlled trial.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 225-235"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145862961","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.12.004
Tung Hoang , Hyeree Park , Youngmin Han , Jin-Young Jang , Aesun Shin , Hojoon Sohn
Background
High-resolution imaging techniques are recommended for screening and surveillance of pancreatic cystic neoplasms (PCNs). This study aimed to systematically review current evidence on the economic aspects of PCN management.
Methods
Original studies published up to November 2023 were identified from PubMed, Embase, and Cochrane databases. Included studies conducted economic evaluations or modeled the natural history of pancreatic diseases. Data on costs, effectiveness, and model parameters were extracted.
Results
A total of 33 studies were eligible for this review. Of 26 model-based studies, only three included histopathological features of pancreatic ductal adenocarcinoma (PDAC), and five incorporated different cancer stages. Compared to no screening or surveillance, the IAP 2006 guideline was cost-effective ($26,158/QALY), whereas IAP 2017 was not ($180,395/QALY). Using imaging modalities (computed tomography, magnetic resonance imaging, and endoscopic ultrasound) was more cost-effective than the full-watching strategy in populations of high-risk pancreatic cancer (e.g., 3-year PDAC risk of at least 1 %, familial or hereditary diseases, or new onset diabetes). In contrast, immediate resection-based strategies were not cost-effective at the level of willingness-to-pay of $100,000.
Conclusion
Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.
{"title":"A systematic review of economic evaluation in pancreatic cystic neoplasms","authors":"Tung Hoang , Hyeree Park , Youngmin Han , Jin-Young Jang , Aesun Shin , Hojoon Sohn","doi":"10.1016/j.hpb.2025.12.004","DOIUrl":"10.1016/j.hpb.2025.12.004","url":null,"abstract":"<div><h3>Background</h3><div>High-resolution imaging techniques are recommended for screening and surveillance of pancreatic cystic neoplasms (PCNs). This study aimed to systematically review current evidence on the economic aspects of PCN management.</div></div><div><h3>Methods</h3><div>Original studies published up to November 2023 were identified from PubMed, Embase, and Cochrane databases. Included studies conducted economic evaluations or modeled the natural history of pancreatic diseases. Data on costs, effectiveness, and model parameters were extracted.</div></div><div><h3>Results</h3><div>A total of 33 studies were eligible for this review. Of 26 model-based studies, only three included histopathological features of pancreatic ductal adenocarcinoma (PDAC), and five incorporated different cancer stages. Compared to no screening or surveillance, the IAP 2006 guideline was cost-effective ($26,158/QALY), whereas IAP 2017 was not ($180,395/QALY). Using imaging modalities (computed tomography, magnetic resonance imaging, and endoscopic ultrasound) was more cost-effective than the full-watching strategy in populations of high-risk pancreatic cancer (e.g., 3-year PDAC risk of at least 1 %, familial or hereditary diseases, or new onset diabetes). In contrast, immediate resection-based strategies were not cost-effective at the level of willingness-to-pay of $100,000.</div></div><div><h3>Conclusion</h3><div>Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 119-132"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145889200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01DOI: 10.1016/j.hpb.2025.11.003
Hualei Chen, Yuanyuan Ding, Xiaoming Xu
Background
Pancreatic pseudocyst (PPC) is a type of pancreatic fluid collection (PFCs), and endoscopic ultrasound-guided drainage is a common treatment. This study analyzed the efficacy and safety of plastic and metallic stents in managing PPC to provide evidence for clinical practice.
Methods
PubMed, EMBASE, and Cochrane Library were searched for observational studies (Jan 1, 2014–Mar 1, 2025) on metallic/plastic stent treatment for PPC. Primary outcomes were technical and clinical success; recurrence and adverse events (AEs) were secondary. Data were synthesized using fixed-effect models.
Results
Ten studies were included. Pooled analysis showed metallic stents had higher clinical success (RR = 1.07, 95 % CI 1.03–1.11, p = 0.001) and lower recurrence (RR = 0.41, 95 % CI 0.20–0.85, p = 0.02) than plastic stents. Technical success did not differ significantly (RR = 1.01, 95 % CI 0.99–1.04, p = 0.35). Metallic stents also had fewer total AEs (RR = 0.51, 95 % CI 0.36–0.73, p = 0.0003) and infections (RR = 0.33, 95 % CI 0.16–0.68, p = 0.003).
Conclusion
Metallic stents improve clinical success, reduce AEs and infection risk versus plastic stents. Robust prospective studies with long-term follow-up are needed for validation.
背景：胰腺假性囊肿（PPC）是一种胰腺积液（pfc），超声内镜引导下引流是一种常见的治疗方法。本研究分析塑料和金属支架治疗PPC的有效性和安全性，为临床实践提供依据。方法：检索PubMed、EMBASE和Cochrane图书馆关于金属/塑料支架治疗PPC的观察性研究（2014年1月1日- 2025年3月1日）。主要结局是技术和临床成功；复发和不良事件（ae）是次要的。数据采用固定效应模型合成。结果：纳入10项研究。综合分析显示，金属支架的临床成功率（RR = 1.07, 95% CI 1.03 ~ 1.11, p = 0.001）高于塑料支架，复发率（RR = 0.41, 95% CI 0.20 ~ 0.85, p = 0.02）低于塑料支架。技术成功率无显著差异（RR = 1.01, 95% CI 0.99-1.04, p = 0.35）。金属支架总ae （RR = 0.51, 95% CI 0.36 ~ 0.73, p = 0.0003）和感染（RR = 0.33, 95% CI 0.16 ~ 0.68, p = 0.003）也较少。结论：与塑料支架相比，金属支架提高了临床成功率，降低了不良反应和感染风险。需要有长期随访的强有力的前瞻性研究来验证。
{"title":"Direct comparison of efficacy and safety of metallic stents versus plastic stents for endoscopic drainage of pancreatic pseudocysts: a systematic review and meta-analysis","authors":"Hualei Chen, Yuanyuan Ding, Xiaoming Xu","doi":"10.1016/j.hpb.2025.11.003","DOIUrl":"10.1016/j.hpb.2025.11.003","url":null,"abstract":"<div><h3>Background</h3><div>Pancreatic pseudocyst (PPC) is a type of pancreatic fluid collection (PFCs), and endoscopic ultrasound-guided drainage is a common treatment. This study analyzed the efficacy and safety of plastic and metallic stents in managing PPC to provide evidence for clinical practice.</div></div><div><h3>Methods</h3><div>PubMed, EMBASE, and Cochrane Library were searched for observational studies (Jan 1, 2014–Mar 1, 2025) on metallic/plastic stent treatment for PPC. Primary outcomes were technical and clinical success; recurrence and adverse events (AEs) were secondary. Data were synthesized using fixed-effect models.</div></div><div><h3>Results</h3><div>Ten studies were included. Pooled analysis showed metallic stents had higher clinical success (RR = 1.07, 95 % CI 1.03–1.11, <em>p</em> = 0.001) and lower recurrence (RR = 0.41, 95 % CI 0.20–0.85, <em>p</em> = 0.02) than plastic stents. Technical success did not differ significantly (RR = 1.01, 95 % CI 0.99–1.04, <em>p</em> = 0.35). Metallic stents also had fewer total AEs (RR = 0.51, 95 % CI 0.36–0.73, <em>p</em> = 0.0003) and infections (RR = 0.33, 95 % CI 0.16–0.68, <em>p</em> = 0.003).</div></div><div><h3>Conclusion</h3><div>Metallic stents improve clinical success, reduce AEs and infection risk versus plastic stents. Robust prospective studies with long-term follow-up are needed for validation.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 133-142"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587266","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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