Pub Date : 2026-01-01DOI: 10.1016/j.hpb.2025.10.001
Walter R.F. Donica , Kyle R. Stephens , Suhail Nath , Erin E. Priddy , Prejesh Philips , Robert C.G. Martin III , Timothy M. Pawlik , Jordan M. Cloyd , Charles R. Scoggins , Micheal E. Egger
Background
Previous work has reported similar safety profiles and efficacy outcomes between transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of primary liver tumors and certain liver metastases. We performed a cost-analysis comparing TACE and TARE to help guide treatment decisions from an economic standpoint.
Methods
A retrospective review of data from a single academic medical center of patients undergoing TACE or TARE for primary or metastatic liver tumors between 2018 and 2023 was performed. Estimates of the procedural costs were obtained from hospital financial payment data for fully adjudicated accounts. Costs were adjusted for inflation and compared between treatment types.
Results
There were 44 patients treated with TACE and 33 treated with TARE. No statistically significant differences were noted in age, sex, or payer type between treatment modalities. Length of stay was longer in the TACE group (p = 0.029). Median total payments received for a single TARE procedure was higher than that of a single TACE treatment ($37,780 vs. $10,606, p < 0.001).
Discussion
When there is equivalent clinical efficacy of TACE and TARE, as is the case for patients with neuroendocrine liver metastases or hepatocellular carcinoma for example, TACE is a more cost-effective treatment.
{"title":"Value in the treatment of primary and metastatic liver tumors: comparative cost-analysis of transarterial chemoembolization to transarterial radioembolization","authors":"Walter R.F. Donica , Kyle R. Stephens , Suhail Nath , Erin E. Priddy , Prejesh Philips , Robert C.G. Martin III , Timothy M. Pawlik , Jordan M. Cloyd , Charles R. Scoggins , Micheal E. Egger","doi":"10.1016/j.hpb.2025.10.001","DOIUrl":"10.1016/j.hpb.2025.10.001","url":null,"abstract":"<div><h3>Background</h3><div>Previous work has reported similar safety profiles and efficacy outcomes between transarterial chemoembolization (TACE) and transarterial radioembolization (TARE) in the treatment of primary liver tumors and certain liver metastases. We performed a cost-analysis comparing TACE and TARE to help guide treatment decisions from an economic standpoint.</div></div><div><h3>Methods</h3><div>A retrospective review of data from a single academic medical center of patients undergoing TACE or TARE for primary or metastatic liver tumors between 2018 and 2023 was performed. Estimates of the procedural costs were obtained from hospital financial payment data for fully adjudicated accounts. Costs were adjusted for inflation and compared between treatment types.</div></div><div><h3>Results</h3><div>There were 44 patients treated with TACE and 33 treated with TARE. No statistically significant differences were noted in age, sex, or payer type between treatment modalities. Length of stay was longer in the TACE group (p = 0.029). Median total payments received for a single TARE procedure was higher than that of a single TACE treatment ($37,780 vs. $10,606, p < 0.001).</div></div><div><h3>Discussion</h3><div>When there is equivalent clinical efficacy of TACE and TARE, as is the case for patients with neuroendocrine liver metastases or hepatocellular carcinoma for example, TACE is a more cost-effective treatment.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 19-25"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145458668","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 : 2026-01-01DOI: 10.1016/j.hpb.2025.10.005
Michael J. Lee , Amir Ashraf Ganjouei , Jane Wang , Thomas E. Love , Jamie DeCicco , Sangrag Ganguli , Laleh Foroutani , Ramiro Cadena-Semanate , Sean Cleary , Pablo E. Serrano , Melissa Hogg , Susanne G. Warner , Mihir Shah , Scott Helton , Adnan Alseidi , T. Peter Kingham , David Geller , Iswanto Sucandy , Kerri A. Simo , Ashwin S. Kamath , Nicole M. McBrier
Background
Robotic liver resections (RLR) are increasingly adopted, but their clinical advantages over laparoscopic liver resections (LLR) remain unclear. This study compared intraoperative and postoperative outcomes between RLR and LLR across surgical difficulty levels and institutions.
Methods
We analyzed 1683 patients (456 RLR [27.1 %] and 1227 LLR [72.9 %]) from the Americas Minimally Invasive Liver Resection (AMILES) database (2011–2024). Mixed-effects regression models accounted for institutional clustering. Outcomes included operative time, estimated blood loss, use of Pringle maneuver, intraoperative transfusion, length of stay, and postoperative complications. Subgroup analyses were performed by IWATE difficulty.
Results
RLR was associated with longer operative times than LLR (227 vs. 157 min; p = 0.004). In advanced-difficulty resections, RLR was associated with fewer major postoperative complications (1.7 % vs. 7.7 %; p = 0.013). Interaction testing demonstrated that the effect of surgical approach on transfusion risk and overall complications differed significantly by difficulty. Between-site heterogeneity in the effect of RLR was observed for operative time, use of Pringle maneuver, and intraoperative transfusion.
Conclusion
RLR was associated with longer operative times overall, but in advanced-difficulty cases, RLR achieved lower rates of major complications. These findings highlight difficulty- and institution-specific variation that may guide adoption of RLR.
{"title":"Comparison of intraoperative and postoperative metrics in robotic vs. laparoscopic liver resections by difficulty – Retrospective cohort analysis of a multi-institutional database","authors":"Michael J. Lee , Amir Ashraf Ganjouei , Jane Wang , Thomas E. Love , Jamie DeCicco , Sangrag Ganguli , Laleh Foroutani , Ramiro Cadena-Semanate , Sean Cleary , Pablo E. Serrano , Melissa Hogg , Susanne G. Warner , Mihir Shah , Scott Helton , Adnan Alseidi , T. Peter Kingham , David Geller , Iswanto Sucandy , Kerri A. Simo , Ashwin S. Kamath , Nicole M. McBrier","doi":"10.1016/j.hpb.2025.10.005","DOIUrl":"10.1016/j.hpb.2025.10.005","url":null,"abstract":"<div><h3>Background</h3><div>Robotic liver resections (RLR) are increasingly adopted, but their clinical advantages over laparoscopic liver resections (LLR) remain unclear. This study compared intraoperative and postoperative outcomes between RLR and LLR across surgical difficulty levels and institutions.</div></div><div><h3>Methods</h3><div>We analyzed 1683 patients (456 RLR [27.1 %] and 1227 LLR [72.9 %]) from the Americas Minimally Invasive Liver Resection (AMILES) database (2011–2024). Mixed-effects regression models accounted for institutional clustering. Outcomes included operative time, estimated blood loss, use of Pringle maneuver, intraoperative transfusion, length of stay, and postoperative complications. Subgroup analyses were performed by IWATE difficulty.</div></div><div><h3>Results</h3><div>RLR was associated with longer operative times than LLR (227 vs. 157 min; <em>p</em> = 0.004). In advanced-difficulty resections, RLR was associated with fewer major postoperative complications (1.7 % vs. 7.7 %; <em>p</em> = 0.013). Interaction testing demonstrated that the effect of surgical approach on transfusion risk and overall complications differed significantly by difficulty. Between-site heterogeneity in the effect of RLR was observed for operative time, use of Pringle maneuver, and intraoperative transfusion.</div></div><div><h3>Conclusion</h3><div>RLR was associated with longer operative times overall, but in advanced-difficulty cases, RLR achieved lower rates of major complications. These findings highlight difficulty- and institution-specific variation that may guide adoption of RLR.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 43-49"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145482021","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 : 2026-01-01DOI: 10.1016/j.hpb.2025.11.002
Maria Conticchio , Francesca Pescol , Martin Hubner , Emilie Uldry , Grégoire Leroy , Alban Denys , Jean-Louis Raisaro , David Fuks
Background
hepatobiliary and pancreatic (HPB) surgery remains one of the most complex fields in oncology, marked by intricate anatomy, high complication rates, and the need for seamless multidisciplinary coordination.
Methods
Artificial intelligence (AI), when ethically implemented and coupled with an understanding of human factors, has the potential toto improve surgical safety, precision, and personalization.
Results
this narrative review integrates clinical evidence, technological innovation, and conceptual insights to examine the current role and future promise of AI in HPB surgery–from preoperative planning and intraoperative guidance to postoperative surveillance, surgical training, and ethical considerations.
Results
We highlight gaps in the literature, explore real-world and emerging tools, and propose directions for safe and meaningful AI integration into the HPB surgical ecosystem. In this evolving paradigm, surgeons are not replaced but augmented–better informed, more precise, and more resilient against avoidable harm.
{"title":"Artificial intelligence in HPB surgery: a narrative review on technological advances and imperatives for ethical integration","authors":"Maria Conticchio , Francesca Pescol , Martin Hubner , Emilie Uldry , Grégoire Leroy , Alban Denys , Jean-Louis Raisaro , David Fuks","doi":"10.1016/j.hpb.2025.11.002","DOIUrl":"10.1016/j.hpb.2025.11.002","url":null,"abstract":"<div><h3>Background</h3><div>hepatobiliary and pancreatic (HPB) surgery remains one of the most complex fields in oncology, marked by intricate anatomy, high complication rates, and the need for seamless multidisciplinary coordination.</div></div><div><h3>Methods</h3><div>Artificial intelligence (AI), when ethically implemented and coupled with an understanding of human factors, has the potential toto improve surgical safety, precision, and personalization.</div></div><div><h3>Results</h3><div>this narrative review integrates clinical evidence, technological innovation, and conceptual insights to examine the current role and future promise of AI in HPB surgery–from preoperative planning and intraoperative guidance to postoperative surveillance, surgical training, and ethical considerations.</div></div><div><h3>Results</h3><div>We highlight gaps in the literature, explore real-world and emerging tools, and propose directions for safe and meaningful AI integration into the HPB surgical ecosystem. In this evolving paradigm, surgeons are not replaced but augmented–better informed, more precise, and more resilient against avoidable harm.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 1-9"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145587255","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 anatomical relationship between the pancreatic tail and splenic vessels influences both pancreatic resection completeness and spleen preservation success in robotic spleen-preserving left-sided pancreatectomy (RSPLP). However, surgical strategies for managing the pancreatic tail during RSPLP remain unreported.
Methods
Clinical data from 46 consecutive patients undergoing robot-assisted left-sided pancreatectomy with intended spleen preservation were analyzed. Pancreatic tails were classified into four anatomical types (I-IV) based on their relationship with splenic vessels or tumors.
Results
The RLP group (spleen preservation failure) exhibited a higher proportion of type IV anatomy than the RSPLP group (spleen preservation success) (76.92 % vs. 18.18 %, P < 0.05). Type III/IV anatomy was associated with significantly lower spleen preservation rates (52.17 % vs. 91.30 %, P = 0.003), larger tumor size [4.0 (3.5–5.8) vs. 2.8 (2.2–4.6) cm, P = 0.026], greater intraoperative blood loss [134 (58–295) vs. 85 (45–180) mL, P = 0.017], and longer operative time (257.3 ± 62.29 vs. 220.78 ± 53.05 min, P = 0.038) compared to type I/II.
Conclusion
We proposed the preoperative classification of pancreatic tail type and the “pendulum separation” technique, and found that it was challenging to preserve the spleen in type III and IV pancreatic tails due to their complex anatomical relationship with the splenic vessel and tumor.
背景：在机器人保脾左胰切除术（RSPLP）中，胰尾与脾血管的解剖关系影响胰腺切除的完整性和保脾的成功。然而，在RSPLP期间处理胰腺尾部的手术策略仍未见报道。方法：分析46例连续行机器人辅助左侧胰腺切除术并保留脾脏的患者的临床资料。根据胰腺尾部与脾血管或肿瘤的关系，将其分为四种解剖类型（I-IV）。结果：RLP组（保脾失败）IV型解剖比例高于RSPLP组（保脾成功）（76.92% vs. 18.18%, P < 0.05）。与I/II型患者相比，III/IV型患者脾脏保存率明显较低（52.17% vs. 91.30%, P = 0.003），肿瘤体积较大[4.0 (3.5-5.8)vs. 2.8 (2.2-4.6) cm, P = 0.026]，术中出血量较大[134 (58-295)vs. 85 (45-180) mL, P = 0.017]，手术时间较长（257.3±62.29 vs. 220.78±53.05 min, P = 0.038）。结论：我们提出术前胰尾分型和“钟摆分离”技术，发现III型和IV型胰尾与脾血管和肿瘤的解剖关系复杂，难以保留脾脏。
{"title":"The management of pancreatic tail during robotic-assisted spleen-preserving left-sided pancreatectomy","authors":"Dan-yang Shen, Xiao-feng Xue, Ding Sun, Jun-yi Qiu, Dao-bin Wang, Jia-yue Zou, Lei Qin, Wei-gang Zhang","doi":"10.1016/j.hpb.2025.10.013","DOIUrl":"10.1016/j.hpb.2025.10.013","url":null,"abstract":"<div><h3>Background</h3><div>The anatomical relationship between the pancreatic tail and splenic vessels influences both pancreatic resection completeness and spleen preservation success in robotic spleen-preserving left-sided pancreatectomy (RSPLP). However, surgical strategies for managing the pancreatic tail during RSPLP remain unreported.</div></div><div><h3>Methods</h3><div>Clinical data from 46 consecutive patients undergoing robot-assisted left-sided pancreatectomy with intended spleen preservation were analyzed. Pancreatic tails were classified into four anatomical types (I-IV) based on their relationship with splenic vessels or tumors.</div></div><div><h3>Results</h3><div>The RLP group (spleen preservation failure) exhibited a higher proportion of type IV anatomy than the RSPLP group (spleen preservation success) (76.92 % vs. 18.18 %, P < 0.05). Type III/IV anatomy was associated with significantly lower spleen preservation rates (52.17 % vs. 91.30 %, P = 0.003), larger tumor size [4.0 (3.5–5.8) vs. 2.8 (2.2–4.6) cm, P = 0.026], greater intraoperative blood loss [134 (58–295) vs. 85 (45–180) mL, P = 0.017], and longer operative time (257.3 ± 62.29 vs. 220.78 ± 53.05 min, P = 0.038) compared to type I/II.</div></div><div><h3>Conclusion</h3><div>We proposed the preoperative classification of pancreatic tail type and the “pendulum separation” technique, and found that it was challenging to preserve the spleen in type III and IV pancreatic tails due to their complex anatomical relationship with the splenic vessel and tumor.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 1","pages":"Pages 89-101"},"PeriodicalIF":2.4,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145582106","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 : 2025-12-31DOI: 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":"https://doi.org/10.1016/j.hpb.2025.12.004","url":null,"abstract":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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.</p><p><strong>Conclusion: </strong>Cost-effectiveness findings varied significantly depending on PCN type, surveillance strategy, and model structure. Standardized approaches to modeling and reporting are needed.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-31","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 : 2025-12-30DOI: 10.1016/j.hpb.2025.12.035
Thijmen H T Broekman, Simone Augustinus, Nanske Biesma, Bert A Bonsing, Geert A Cirkel, Ignace H J T de Hingh, Marjolein Y V Homs, Jeanin E van Hooft, B Marion M van der Kolk, Vincent E de Meijer, Hjalmar van Santvoort, Judith de Vos-Geelen, Miriam L Wumkes, Marc G Besselink, J Hanneke W Wilmink, Lydia G van der Geest
Background: In the Netherlands, cancer care is increasingly organised within oncology networks involving multiple hospitals. This nationwide population-based study aims to assess variation between oncology networks for pancreatic adenocarcinoma (PAC).
Method: Patients with PAC (2015-2020) were included from the Netherlands Cancer Registry and assigned to eight oncology networks based on first hospital visit. Multilevel multivariable logistic and survival regression models were used.
Results: Among 16,130 patients with PAC, tumour-directed treatment was applied in 40 % (range 35 %-44 % across regions), resection in 15 % (12 %-19 %), and chemotherapy in 33 % (29 %-37 %) of patients. Casemix also varied significantly between regions. Compared to the grand mean, the probability to undergo resection was higher in one region (odds ratio [OR] = 1.25, 95 % confidence interval [CI] 1.07-1.45) and lower in another (OR = 0.70, 95%CI: 0.56-0.87). Chemotherapy use followed similar patterns (OR = 1.21, 95%CI 1.06-1.38, and OR = 0.81, 95%CI 0.72-0.92). Median overall survival was 3.7 months (range 3.4-4.3; log-rank p < 0.001), multivariable multilevel analysis revealed no significant survival differences (p = 0.245).
Conclusion: Although the likelihood of receiving chemotherapy and resection for patients with PAC varied between Dutch oncology networks, no clinical meaningful survival differences were found after case-mix adjustment. Concerningly, the majority of patients with PAC do not receive any tumour-directed treatment.
{"title":"Regional variation for tumour-directed treatment and survival in patients with pancreatic adenocarcinoma: a nationwide population-based analysis.","authors":"Thijmen H T Broekman, Simone Augustinus, Nanske Biesma, Bert A Bonsing, Geert A Cirkel, Ignace H J T de Hingh, Marjolein Y V Homs, Jeanin E van Hooft, B Marion M van der Kolk, Vincent E de Meijer, Hjalmar van Santvoort, Judith de Vos-Geelen, Miriam L Wumkes, Marc G Besselink, J Hanneke W Wilmink, Lydia G van der Geest","doi":"10.1016/j.hpb.2025.12.035","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.12.035","url":null,"abstract":"<p><strong>Background: </strong>In the Netherlands, cancer care is increasingly organised within oncology networks involving multiple hospitals. This nationwide population-based study aims to assess variation between oncology networks for pancreatic adenocarcinoma (PAC).</p><p><strong>Method: </strong>Patients with PAC (2015-2020) were included from the Netherlands Cancer Registry and assigned to eight oncology networks based on first hospital visit. Multilevel multivariable logistic and survival regression models were used.</p><p><strong>Results: </strong>Among 16,130 patients with PAC, tumour-directed treatment was applied in 40 % (range 35 %-44 % across regions), resection in 15 % (12 %-19 %), and chemotherapy in 33 % (29 %-37 %) of patients. Casemix also varied significantly between regions. Compared to the grand mean, the probability to undergo resection was higher in one region (odds ratio [OR] = 1.25, 95 % confidence interval [CI] 1.07-1.45) and lower in another (OR = 0.70, 95%CI: 0.56-0.87). Chemotherapy use followed similar patterns (OR = 1.21, 95%CI 1.06-1.38, and OR = 0.81, 95%CI 0.72-0.92). Median overall survival was 3.7 months (range 3.4-4.3; log-rank p < 0.001), multivariable multilevel analysis revealed no significant survival differences (p = 0.245).</p><p><strong>Conclusion: </strong>Although the likelihood of receiving chemotherapy and resection for patients with PAC varied between Dutch oncology networks, no clinical meaningful survival differences were found after case-mix adjustment. Concerningly, the majority of patients with PAC do not receive any tumour-directed treatment.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145984487","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 : 2025-12-26DOI: 10.1016/j.hpb.2025.12.034
İlgin Özden
{"title":"Comment on \"Reappraisal of the impact of resection margin on outcomes after hepatectomy and perioperative treatment for alveolar echinococcosis: a single center experience\" by Notte et al. (HPB 2025;27:1284).","authors":"İlgin Özden","doi":"10.1016/j.hpb.2025.12.034","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.12.034","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145951895","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 : 2025-12-26DOI: 10.1016/j.hpb.2025.12.036
Tutku Tüfekçi, Sena Azamat, Ergün Tiryaki, Samet Yığman, Emre Bozkurt, Orhan Bilge, Gürkan Tellioğlu
Background: Postoperative pancreatic fistula (POPF) remains a major complication following pancreaticoduodenectomy (PD). Indocyanine green (ICG) fluorescence angiography offers real-time perfusion assessment but is underutilized in pancreatic surgery. Although pancreatic stump hypoperfusion has been suggested as a risk factor for POPF, but its role remains underexplored.
Objective: To evaluate whether quantitative perfusion parameters derived from ICG fluorescence angiography are associated with POPF.
Methods: In this prospective cohort study, 30 patients undergoing PD were assessed using ICG near-infrared fluorescence angiography. Fluorescence intensity-time curves were generated using a Python-based algorithm and analyzed for intensity and flow parameters. Associations between perfusion metrics and POPF, classified by ISGPS criteria, were statistically evaluated.
Results: Clinically relevant POPF (CR-POPF) occurred in 30 % of patients. Significant associations were observed between CR-POPF and perfusion parameters including higher fluorescence distribution heterogeneity (p = 0.032) and a slower slope of fluorescence increase (p = 0.008).
Conclusions: Quantitative ICG fluorescence angiography provides objective metrics that correlate with POPF development. Parameters such as slope, peak intensity and fluorescence heterogeneity may serve as intraoperative indicators of perfusion adequacy, supporting surgical decision-making during PD. Larger, multicenter studies are warranted to validate these findings.
{"title":"Objective assessment of remnant pancreatic perfusion using intraoperative indocyanine green angiography: a novel technique to predict postoperative pancreatic fistula.","authors":"Tutku Tüfekçi, Sena Azamat, Ergün Tiryaki, Samet Yığman, Emre Bozkurt, Orhan Bilge, Gürkan Tellioğlu","doi":"10.1016/j.hpb.2025.12.036","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.12.036","url":null,"abstract":"<p><strong>Background: </strong>Postoperative pancreatic fistula (POPF) remains a major complication following pancreaticoduodenectomy (PD). Indocyanine green (ICG) fluorescence angiography offers real-time perfusion assessment but is underutilized in pancreatic surgery. Although pancreatic stump hypoperfusion has been suggested as a risk factor for POPF, but its role remains underexplored.</p><p><strong>Objective: </strong>To evaluate whether quantitative perfusion parameters derived from ICG fluorescence angiography are associated with POPF.</p><p><strong>Methods: </strong>In this prospective cohort study, 30 patients undergoing PD were assessed using ICG near-infrared fluorescence angiography. Fluorescence intensity-time curves were generated using a Python-based algorithm and analyzed for intensity and flow parameters. Associations between perfusion metrics and POPF, classified by ISGPS criteria, were statistically evaluated.</p><p><strong>Results: </strong>Clinically relevant POPF (CR-POPF) occurred in 30 % of patients. Significant associations were observed between CR-POPF and perfusion parameters including higher fluorescence distribution heterogeneity (p = 0.032) and a slower slope of fluorescence increase (p = 0.008).</p><p><strong>Conclusions: </strong>Quantitative ICG fluorescence angiography provides objective metrics that correlate with POPF development. Parameters such as slope, peak intensity and fluorescence heterogeneity may serve as intraoperative indicators of perfusion adequacy, supporting surgical decision-making during PD. Larger, multicenter studies are warranted to validate these findings.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948302","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}
Background: Despite growing adoption of the Heidelberg TRIANGLE operation for pancreatic head/body tumors, comprehensive analysis of its safety and outcomes remains lacking.
Methods: Systematic searches using predefined criteria (inception-May 2024) across PubMed, Cochrane, Web of Science, Embase, Medline, CNKI and Wan-Fang databases identified eligible studies. Primary outcomes were R0 resection rates and survival; secondary outcomes were complications and recurrence. Meta-analysis utilized Stata 18.0.
Results: This meta-analysis included 8 studies (1,106 patients). Compared to standard resection, the TRIANGLE group had longer operative times and higher postoperative diarrhea rates (P < 0.001), but demonstrated reduced 1-year (P = 0.001) and 3-year recurrence (P = 0.036), lower perioperative mortality (P = 0.032), and more extensive lymph node dissection (P = 0.004). No differences were observed in R0 rates (P = 0.171), survival (1-year P = 0.730; 3-year P = 0.136), or primary complications. Overall survival (P = 0.075) and recurrence rates (P = 0.137) showed no statistical significance.
Conclusion: TRIANGLE operation reduces 1/3-year recurrence rates vs standard resection but increases postoperative diarrhea, while achieving similar R0/R1 rates and survival outcomes. Its clinical benefits require validation through large multicenter RCTs.
{"title":"Efficacy and safety of TRIANGLE operation for pancreatic head and body cancer: a systematic review and meta-analysis.","authors":"Rui Cao, Yuerong Xuan, Xiaowen Gong, Chengshuai Pang, Chenyang Dong, Chaojie Liang","doi":"10.1016/j.hpb.2025.12.030","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.12.030","url":null,"abstract":"<p><strong>Background: </strong>Despite growing adoption of the Heidelberg TRIANGLE operation for pancreatic head/body tumors, comprehensive analysis of its safety and outcomes remains lacking.</p><p><strong>Methods: </strong>Systematic searches using predefined criteria (inception-May 2024) across PubMed, Cochrane, Web of Science, Embase, Medline, CNKI and Wan-Fang databases identified eligible studies. Primary outcomes were R0 resection rates and survival; secondary outcomes were complications and recurrence. Meta-analysis utilized Stata 18.0.</p><p><strong>Results: </strong>This meta-analysis included 8 studies (1,106 patients). Compared to standard resection, the TRIANGLE group had longer operative times and higher postoperative diarrhea rates (P < 0.001), but demonstrated reduced 1-year (P = 0.001) and 3-year recurrence (P = 0.036), lower perioperative mortality (P = 0.032), and more extensive lymph node dissection (P = 0.004). No differences were observed in R0 rates (P = 0.171), survival (1-year P = 0.730; 3-year P = 0.136), or primary complications. Overall survival (P = 0.075) and recurrence rates (P = 0.137) showed no statistical significance.</p><p><strong>Conclusion: </strong>TRIANGLE operation reduces 1/3-year recurrence rates vs standard resection but increases postoperative diarrhea, while achieving similar R0/R1 rates and survival outcomes. Its clinical benefits require validation through large multicenter RCTs.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145965898","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 : 2025-12-23DOI: 10.1016/j.hpb.2025.12.033
Víola B Weeda, Khalid Sharif, Girish Gupte, Prabal Mishra, David Hobin, Pat McKiernan, James Bennett, Peter Bromley, Evelyn Ong, Thamara Perera, Bruce Morland, Darius F Mirza
Background: Refinement in perioperative chemotherapy coupled with surgical innovation improves prognosis in children with very high risk hepatoblastoma. Our aim was to evaluate and identify prognostic factors contributing to recurrence in hepatoblastoma resected along with adjacent structures.
Methods: An audit was conducted of patients surgically treated for hepatoblastoma at our center over 25 years.
Results: Thirty-six of 202 patients underwent resection of structures adjacent to the liver for suspected tumor spread. Over half (21/36) of patients underwent hepatectomy with resection of adjacent structures, and orthotopic liver or multi-visceral transplantation. Adjacent structures including lymph nodes, vascular structures, diaphragm, spleen, omentum, and stomach, showed viable tumor tissue in nineteen patients. Both overall survival and recurrence free survival were 75 % at a mean follow up of 113 months. Survival improved with a negative resection margin. Recurrence free survival decreased with tumor viability. Pathology subtypes showed distinct influence on survival.
Conclusion: This series shows favorable survival with aggressive surgical treatment. Adverse histology subtype, lung metastases, and resistance to chemotherapy are associated with higher risk of recurrence. Management at specialist centers with simultaneous hepatic resection and transplantation readily available, achieves optimum outcomes in this niche subgroup of children with advanced hepatoblastoma.
{"title":"Liver resection extended to adjacent structures for advanced hepatoblastoma - a 25 year tertiary hepatobiliary and transplant center experience.","authors":"Víola B Weeda, Khalid Sharif, Girish Gupte, Prabal Mishra, David Hobin, Pat McKiernan, James Bennett, Peter Bromley, Evelyn Ong, Thamara Perera, Bruce Morland, Darius F Mirza","doi":"10.1016/j.hpb.2025.12.033","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.12.033","url":null,"abstract":"<p><strong>Background: </strong>Refinement in perioperative chemotherapy coupled with surgical innovation improves prognosis in children with very high risk hepatoblastoma. Our aim was to evaluate and identify prognostic factors contributing to recurrence in hepatoblastoma resected along with adjacent structures.</p><p><strong>Methods: </strong>An audit was conducted of patients surgically treated for hepatoblastoma at our center over 25 years.</p><p><strong>Results: </strong>Thirty-six of 202 patients underwent resection of structures adjacent to the liver for suspected tumor spread. Over half (21/36) of patients underwent hepatectomy with resection of adjacent structures, and orthotopic liver or multi-visceral transplantation. Adjacent structures including lymph nodes, vascular structures, diaphragm, spleen, omentum, and stomach, showed viable tumor tissue in nineteen patients. Both overall survival and recurrence free survival were 75 % at a mean follow up of 113 months. Survival improved with a negative resection margin. Recurrence free survival decreased with tumor viability. Pathology subtypes showed distinct influence on survival.</p><p><strong>Conclusion: </strong>This series shows favorable survival with aggressive surgical treatment. Adverse histology subtype, lung metastases, and resistance to chemotherapy are associated with higher risk of recurrence. Management at specialist centers with simultaneous hepatic resection and transplantation readily available, achieves optimum outcomes in this niche subgroup of children with advanced hepatoblastoma.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2025-12-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145948373","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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