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Background: Postoperative complications (POC) in surgery for hepatic cystic echinococcosis (HCE) still being frequent. Comorbidities as a risk factor has not yet been studied. The aim of this study was to evaluate the predictive value of CCI for POC in surgically treated HCE patients.

Methods: Nested case-control study. Patients undergoing elective surgery for HCE between 2011 and 2019; matched (1:1) by sex, cyst diameter and time follow-up were included. Cases were patients with CCI≥3; and controls, patients with CCI≤2. Primary outcome was POC. Descriptive statistics and bivariate analyses were applied. Logistic regression was used, odds ratios (OR) and their respective 95 % confidence intervals (CI95 %), were calculated.

Results: 226 patients (113 cases and 113 controls) were analyzed. Significant differences were verified between cases and controls in frequency of evolutionary complications of HCE (OR: 5.5; p = 0.0003); and major rate of ASA I-II in controls (OR: 0.07; p < 0.0001). A great rate of POC (OR: 3.58; p = 0.0002); and Clavien ≥ IIIb POC more frequent in cases were found (OR: 7.00; p = 0.031). Applying logistic regression model, CCI score≥3 was identified as an independent prognostic factor for POC (OR: 6.29 [CI95 %: 2.1-18.8; p < 0.01]).

Conclusion: In this study, cases showed higher frequency and severity of POC than controls.

Background: A universally accepted quality measure for gallstone surgery is lacking. In this retrospective study, we evaluated the duration of postoperative care, completion with laparoscopic approach, absence of procedure-related complications, and no readmission as criteria for Textbook Outcome (TO).

Methods: Data was collected from the Swedish National Register for Gallstone Surgery (GallRiks) 2007-2022. We analyzed postoperative stay as exposure and postoperative complications as outcome using Receiver Operation Characteristic (ROC). TO was defined as laparoscopically completed operations, discharge within three days after surgery, no postoperative complication > Clavien-Dindo 2, no contact with the care provider or new readmission/intervention within 30 days post-surgery. The outcome of TO was further validated based on patients 6 months postoperatively answering SF-36.

Results: A total of 193 201 cholecystectomies were analyzed. Using discharge within three days postoperatively as threshold, the sensitivity was 50 % and the specificity 87 % for predicting a surgery-related complication. The rate of TO in the entire cohort was 79,4 %. Those who met the TO criteria rated notably higher on physical and mental scoring 6 months postoperatively (both p < 0.05) than those who did not.

Conclusion: The postoperative period of care and TO are robust outcome measures for evaluating results after gallstone surgery.

Background: The aim of theis study was toevaluate impact of duration of neoadjuvant treatment (NAT) on surgical resection rate, resection margin, response to treatment, and survival in patients with pancreatic ductal adenocarcinoma (PDAC).

Methods: All randomised controlled trials (RCTs) of NAT in patients with PDAC were included. Effect sizes were determined for surgical resection rate, R0 resection, radiological response to NAT and 1- to 5-years survival.

Results: Twenty-three RCTs (1880 patients) were included. NAT duration≤8 weeks was associated with significantly higher surgical resection rate [66.7 % (95 % CI 57.4 %-76.1 %)] compared with NAT duration >8 weeks [33.5 % (95 % CI 22.1 %-45.0 %)]. The difference remained significant when only resectable [73.9 % (95 % CI 64.3 %-83.5 %) vs 44.7 % (95 % CI 15.9 %-60.6.%)], borderline resectable [66.4 % (95 % CI 46.6 %-86.1 %) vs 22.5 % (95 % CI 18.2 %-26.8 %)], or mixed borderline resectable/locally advanced PDAC [60.6 % (95 % CI 48.2 %-73.0 %) vs 35.0 % (95 % CI 27.6 %-42.4 %)] were considered. Moreover, when only NAT with chemotherapy considered, resection rate remained significant in favour of NAT duration≤8. No significant difference was found in R0 resection rate, partial response, stable disease, or disease progression between two groups. Intention-to-treat respected 1-, 3-, 5-years survival were comparable.

Conclusions: NAT duration >8 weeks may be associated with a reduced surgical resection rate and no apparent improvement in negative resection margin in patients with PDAC, particularly borderline resectable cases. However, it may have comparable survival to NAT duration ≤8 weeks. Future randomised evidence is needed to overcome the limitations associated with current evidence.

Background: Borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) carries a high risk of early recurrence (ER) despite neoadjuvant chemotherapy (NAC) and surgery. Identifying ER predictors is essential to optimize surgical indication.

Methods: We retrospectively analyzed 70 patients with BR-PDAC, of whom 48 underwent resection. ER was defined as recurrence within 8 months. Pre- and post-NAC carbohydrate antigen 19-9 (CA19-9) levels were assessed using Cox regression and receiver operating characteristic (ROC) curve analysis.

Results: ER occurred in 18 patients (38%). Both pre-NAC (median, 699 vs. 71 U/mL; P = 0.010) and post-NAC CA19-9 levels (149 vs. 27 U/mL; P = 0.002) were significantly higher in ER patients. ROC curve analysis identified a post-NAC CA19-9 cutoff of 100 U/mL (area under the curve, 0.77) predicting ER. Patients with post-NAC CA19-9 ≥100 U/mL had significantly worse progression-free (hazard ratio [HR], 5.84; P < 0.001) and overall survival (HR, 6.36; P = 0.002). Notably, patients with ER had a similar OS to those who did not undergo surgery (HR, 0.93; P = 0.87).

Conclusions: Persistently elevated CA19-9 after NAC predicts ER and poor survival, suggesting limited benefit from resection. Post-NAC CA19-9 may help prevent futile pancreatectomy.

Background: Pancreatic cancer with early onset is increasing but comparisons with average onset cases have yielded mixed results (EOPC versus AOPC; age <50 versus ≥50). We compared clinicopathologic features, prognosis, and molecular traits of resected EOPC versus AOPC.

Methods: We retrospectively included patients with PDAC resected between 2010 and 2017 from The National Cancer Database (NCDB). Clinicopathologic data were compared across EOPC versus AOPC. Kaplan-Meier curves and cox-regression were used to perform survival analysis. Molecular features were compared using data from the cBioPortal.

Results: 24,078 patients with resected PDAC were included, of whom 1698 (7.1 %) had EOPC. Poor prognostic factors, including high grade, advanced T-stage, and lymphovascular invasion, were less prevalent in EOPC (All p < 0.05). Patients with EOPC more frequently received neoadjuvant (28 % vs. 22 %; p < 0.001) and adjuvant chemotherapy (68 % vs. 58 %; p < 0.001) and experienced improved OS (median OS 29.5 vs 25.9 months, p = 0.023; 5-year OS: 26.9 % vs 20.8 %). No differences in the presence of key driver mutations were observed between the two groups but some distinct oncogenic mutations were observed in EOPC.

Conclusion: EOPC and AOPC are clinically similar but some cases of EOPC may harbor divergent molecular changes. These patients may have only marginally improved survival.

Background: Hepatitis C virus (HCV)-discordant liver transplants (LT), nonviremic and viremic, were first shown at our center as safe and efficacious for HCV-negative recipients in the short-term. This review evaluates HCV-discordant LT long-term outcomes.

Methods: All HCV-discordant deceased donor LT from 03/2016-06/2023 were reviewed in this retrospective, single-center study.

Results: 194 HCV-discordant LTs (96 (49.5 %) nucleic acid test (NAT)-negative and 98 (50.5 %) NAT-positive) were evaluated with a median follow-up of 53 months. Baseline liver biopsies of 139 (71.6 %) allografts, report 47 (24.2 %) no fibrosis, 27 (13.9 %) stage 1 fibrosis, and 65 (33.5 %) stage 2 fibrosis. Stage 2 fibrosis was higher among NAT-positive allografts (46.9 % vs. 19.8 %). Seven (6.3 %) NAT-negative allograft recipients experienced HCV transmission. One (1.1 %) NAT-positive allograft recipient experienced early HCV relapse, requiring additional treatment. All treated recipients achieved sustained viral response (SVR). There was no difference in patient or graft survival by allograft NAT status or fibrosis stage.

Conclusion: This is first report to show HCV-discordant LT exhibit low rates of relapse, achieve long-term SVR and have similar patient and graft survival regardless of allograft HCV viremia or fibrosis; thus, justifying their use for transplantation in the long-term.

Background: The optimal timing of laparoscopic cholecystectomy (LC) in mild acute biliary pancreatitis (MABP) remains debated. This study compared early (within 72 h) versus delayed LC outcomes.

Methods: A randomized trial at Zhejiang Hospital assigned 120 MABP patients to early or delayed LC. Demographics, complications, operative outcomes, and hospital stay were analyzed.

Results: There were no differences in baseline demographics, overall complication rates (10 % vs. 8.3 %; P = 0.752), intraoperative blood loss (33.93 ± 17.68 mL vs. 37.08 ± 30.97 mL; P = 0.593) or conversion to open surgery rate (3.3 % vs. 5.0 %; P = 1.00) between the two groups. There were no recurrent biliary events, postoperative readmissions, reoperations, or deaths in either group; However, the early LC group demonstrated significant advantages in intraoperative adhesions (80 % vs. 93.3 %; P < 0.05), procedure time (61.87 ± 12.54 vs. 66.77 ± 12.11 min, P < 0.05) and the length of hospital stay (5 days vs. 7 days, P < 0.05).

Conclusion: For patients with MABP, early LC performed within 72 h of admission significantly reduces hospital length of stay and procedure time, without increasing perioperative complication rates or measures of procedural difficulty.

Background: Solitary colorectal liver metastasis (SCRLM) exhibits substantial heterogeneity in recurrence patterns after hepatic resection, yet individualized prediction tools for recurrence-free survival (RFS) are lacking.

Methods: In this multicenter retrospective study, 698 SCRLM patients undergoing hepatic resection were analyzed (training cohort: n=574; validation cohort: n=124). RFS was the primary endpoint. Three predictive models-random survival forest (RSF), Gradient Boosting Machine (GBM), and eXtreme Gradient Boosting (XGBoost)-were developed and compared. Model performance was assessed via concordance index (C-index), time-dependent area under the ROC curve (AUROC), and calibration plots.

Results: The XGBoost model achieved the best performance, with AUROCs of 0.93 and 0.87 at 1 year, and 0.89 and 0.86 at 3 years, in the training and validation cohorts, respectively. Compared with the modified Clinical Score (m-CS), the model demonstrated significantly higher discrimination at 1, 2, and 3 years (all P < 0.001), and also identified a subgroup of patients more likely to benefit from postoperative chemotherapy. A user-friendly online tool was developed for clinical application: https://scrlm.shinyapps.io/scrlmapp/.

Conclusion: We developed and validated a machine learning-based model for SCRLM, enabling individualized recurrence risk prediction and guiding postoperative chemotherapy decisions. This approach may improve outcomes while reducing overtreatment.

Background: Intraoperative localization of pancreatic neuroendocrine tumors (pNETs) is challenging, particularly for small lesions during minimally invasive surgery due to the lack of tactile feedback. Indocyanine green (ICG) fluorescence imaging is a promising technique to enhance tumor visualization and surgical guidance. This systematic review evaluates current evidence on ICG use in pNET surgery, focusing on indications, timing, dosage, and intraoperative strategies.

Methods: A systematic search of PubMed, Embase, and Web of Science was conducted up to May 2025, following PRISMA guidelines. Included studies reported intraoperative ICG use in pNET surgery. Preclinical studies, non-English articles, and those lacking data on ICG protocol or dosage were excluded.

Results: Fifteen studies involving 43 patients were included. Diagnoses were insulinoma (39.5 %), unspecified pNETs (58.2 %), and one case of neuroendocrine hyperplasia. ICG identified tumors in 88.4 % of cases, with a positive predictive value of 95.0 %. ICG was mostly administered intravenously after pancreatic exposure, with doses ranging from 1 to 25 mg. Fluorescence appeared within 5 min and was homogeneous in 97.4 % of cases. No adverse events were reported.

Discussion: ICG fluorescence is a safe and effective tool for localizing pNETs. Further studies are needed to standardize protocols and optimize clinical use.