Hpb最新文献

Background: Obesity is increasing in the U.S., with more liver donors having body mass index (BMI)≥35. BMI is an imperfect indicator of visceral obesity and hepatosteatosis, complicating its impact on graft survival (GS).

Methods: Adult deceased donor data from the United Network for Organ Sharing database (2010-2023) were analyzed. The impact of donor obesity (BMI≥35) on short- and long-term GS was examined, stratified by donor gender and age, two factors related to visceral obesity.

Results: Donors with BMI≥35 doubled over the study period, comprising 18.2 % of donation after brain death donors in 2023. Grafts from male donors with BMI≥35 had worse 30-day GS than grafts from donors with BMI<35 (hazard ratio 1.47, P < 0.01), but not in grafts from female donors with BMI≥35 or in 5-year GS. Donor obesity increased risk only in grafts from male donors under 55 (hazard ratio 1.58, P < 0.01), with no effect in grafts from older male or female donors.

Discussion: Donor BMI≥35 was associated with increased risk of short-term graft loss, especially among grafts from male donors. However, grafts from female donors with BMI≥35 and from male donors aged≥55 with BMI≥35 may warrant broader use.

Background: Recurrence after Whipple for ampullary carcinoma remains incompletely defined; this retrospective cohort aimed to delineate patterns and predictors of failure to guide adjuvant strategies.

Methods: Consecutive patients undergoing standard Whipple for histologically proven ampullary adenocarcinoma (January 2018-December 2024) were analyzed (n=189); recurrence patterns were classified, survival estimated by Kaplan-Meier, and predictors assessed by multivariable logistic regression.

Results: Over a median 30.6 months, recurrence occurred in 29.6% (distant 23.3%, local 6.3%); independent predictors of distant recurrence included CA19‑9 >79 U/mL (aOR 2.62; P=0.027), nodal positivity (aOR 2.50; P=0.037), and delayed gastric emptying (aOR 3.17; P=0.006), while adjuvant therapy reduced risk (aOR 0.37; P=0.018). Perineural invasion predicted local recurrence on univariate analysis (OR 8.83; P<0.001); 3‑ and 5‑year overall survival were 69% and 46.1%, respectively, and adjuvant therapy in node‑positive patients reduced distant recurrence from 65.0% to 15.4% (OR 0.098; P<0.001).

Conclusion: Recurrence is predominantly systemic and driven by nodal status and CA19‑9, adjuvant chemotherapy mitigates distant failure-particularly in N1-and the identification of delayed gastric emptying as an independent predictor underscores the oncologic importance of perioperative optimization; histologic subtype was not independently prognostic.

Background: hypertrophy techniques expanded surgical indications, but some patients still experience limited clinical benefit. We aimed to identify futility predictive factors in major hepatectomies after liver venous deprivation (LVD) or ALPPS-variants (tourniquet-ALPPS or hybrid-ALPPS).

Methods: a bi-institutional cohort study conducted between 01/2015 and 07/2024 including major hepatectomies for oncologic disease following one of the three augmentation strategies.

Exclusion criteria: age <18, benign pathology, follow-up < 6-months, and interstage dropout. Futility corresponded to 90-days mortality or very early recurrence (≤6 months). Predictors of futile outcomes were identified by uni- and multi-variate analyses and utilized to build a futility score (0-10).

Results: 84 patients completed the surgical process (dropout rate: 21.1 %): 40.5 % underwent LVD, 33.3 % tourniquet-ALPPS, and 26.2 % hybrid-ALPPS. Futility was observed in 35 patients (41.7 %) and logistic regression identified baseline sFLR (OR 0.89, p = 0.013), associated procedures (OR 3.07, p = 0.046), right trisectionectomy (OR 5.61, p = 0.031), and non-radical resection (OR 4.31, p = 0.01) as independent predictors. A futility score ≥4 (n = 36) predicted a futile outcome with good discrimination (AUC 0.802; p < 0.001).

Conclusion: Technical success after hypertrophy techniques not always equates clinical benefit. Recognizing predictors of futility may improve patient selection and guide more personalized therapeutic strategies.

Background: The safety of living donor liver transplantation (LDLT) has improved over the years, and yet biliary anastomotic complications remain substantial occurring in up to 25%, affecting short-term and long-term outcomes. The meta-analyses is performed to compare biliary complication rates, based on the number of ducts, including bile leaks and strictures, in right-lobe living donor liver transplantation (RLLDLT) using duct-to-duct (DD) anastomosis versus Roux en Y Hepaticojejunostomy (HJ).

Methods: PubMed, Cochrane and Embase databases were searched comprehensively for studies on adult LDLT, focusing on the bile duct reconstruction method for RLLDLT.

Results: Fifteen retrospective studies with 1770 patients were included. DD anastomosis is associated with a significantly reduced rate of all biliary complications compared to HJ (OR 1.16, 95% CI (0.82-1.64), p= 0.40), and particularly a lower incidence of bile leak (OR 0.61, 95% CI (0.38-0.98), p=0.04), while the rates of biliary strictures (OR 1.49, 95% CI (0.83-2.69), p=0.18) did not differ significantly. Grafts with multiple bile ducts (1 vs. >1) were associated with higher complication rates (OR 0.80, 95% CI (0.54-1.19), p=0.27).

Conclusion: The meta-analyses supports DD over HJ where both are feasible, and highlights the importance of individualised biliary reconstruction strategies to improve patient outcomes in RLLDLT.

Background: Optimal perioperative analgesia for upper gastrointestinal (UGI) surgery remains uncertain despite multiple available options. This network meta-analysis (NMA) evaluated the comparative effectiveness of local and regional analgesic techniques on postoperative pain and opiate consumption following open UGI surgery.

Methods: A Bayesian NMA of randomised controlled trials (RCTs) was performed using MEDLINE, Embase, PubMed, and CENTRAL (January 2010-November 2023). The primary outcome was postoperative pain intensity at rest at 24 h.

Results: Fifty-three RCTs (n = 4207 patients) were included. Epidural analgesia provided the greatest reduction in 24-h pain (Mean Difference (MD) -0.976; Credible Interval (CrI) -0.558,-1.401) and opiate consumption (MD -24.717; CrI -16.541,-33.355). The transversus abdominis plane (TAP) block significantly reduced pain at 24 and 48 h, while local wound infiltration and continuous wound catheter infusion demonstrated strong opioid-sparing effects. Only the TAP block resulted in a significant reduction in hospital length of stay. Sensitivity and procedure-specific analyses showed results consistent with the primary analysis.

Conclusion: Epidural analgesia provides the greatest early analgesic and opioid-sparing benefit following open UGI surgery, though these effects do not consistently translate into improved recovery outcomes. TAP block and wound-based analgesic techniques offer effective, less invasive alternatives that may be preferable in selected patients.

Purpose: HBV-related HCC shows prognostic heterogeneity not fully captured by current staging. We developed and validated the APHPBA score, a laboratory-based model for patients undergoing curative hepatectomy.

Methods: This multicenter retrospective study included patients who underwent hepatectomy for HBV-related HCC between 2018 and 2023. The APHPBA score incorporated six routine preoperative parameters: alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), HBV-DNA, prothrombin time (PT), bilirubin (BIL), and albumin (ALB). Patients were stratified into three stages: Stage I (0-1 point), Stage II (2-3 points), and Stage III (4-6 points). Prognostic performance was compared with conventional systems using Cox regression and time-dependent receiver operating characteristic (ROC) analyses.

Results: Among 1100 patients, 36.7 % were Stage I, 48.5 % Stage II, and 14.8 % Stage III. After a median follow-up of 48.0 months, 5-year overall survival was 63.4 %, 43.3 %, and 26.4 % across Stages I-III (P < 0.001). The APHPBA score remained independently associated with overall survival after adjustment for clinicopathologic factors and consistently outperformed established staging systems with higher time-dependent AUCs.

Conclusion: The APHPBA score provides robust postoperative risk stratification for HBV-related HCC using routinely available laboratory parameters.