Pub Date : 2026-03-01Epub Date: 2025-12-05DOI: 10.1016/j.hpb.2025.12.010
Yi Zhou , Silue Zeng , Peilin Cai , Jinsheng Mai , Xinci Li , Hao Zhong , Zhenju Huang , Jian Yang , Zhihao Liu , Ning Zeng
Background
Iatrogenic bile duct injuries (IBDIs) remain complex and diverse, presenting significant challenges for preoperative evaluation and surgical repair.
Methods
Patients who underwent hepaticojejunostomy (HJ) for IBDIs from May 2019 to June 2024 were enrolled. Preoperatively, all patients underwent preoperative individualized 3D modelling of bile duct injury (3DM-BDI) for assessment. During surgery, augmented reality navigation (ARN) combined with indocyanine green fluorescence imaging (ICG-FI) was used for guidance. Perioperative indicators and short-term postoperative outcomes were evaluated to verify the safety and feasibility of this novel approach.
Results
In all patients, the 3DM-BDI accurately predicted the type and extent of bile duct and vascular injuries. The mean operation time was 380.7 ± 83.9 min, and the mean intraoperative blood loss was 135.0 ± 169.7 mL, with no patients requiring intraoperative blood transfusion. The mean postoperative hospital stay was 9.3 ± 2.1 days. The navigation efficiency was 75 % for ICG-FI and 87.5 % for ARN. The success rate of reconstruction was 85.7 % based on follow-up within 90 days.
Conclusion
The combination of ARN and ICG-FI as an auxiliary method in the reconstruction of IBDIs may be feasible and safe. These modalities may provide technical advantages in preoperative evaluation and precise dissection of hilar vessels and bile ducts during surgery.
{"title":"Augmented reality navigation combined with indocyanine green fluorescence imaging to assist reconstruction of iatrogenic bile duct injuries: a retrospective single-arm cohort study (with video)","authors":"Yi Zhou , Silue Zeng , Peilin Cai , Jinsheng Mai , Xinci Li , Hao Zhong , Zhenju Huang , Jian Yang , Zhihao Liu , Ning Zeng","doi":"10.1016/j.hpb.2025.12.010","DOIUrl":"10.1016/j.hpb.2025.12.010","url":null,"abstract":"<div><h3>Background</h3><div>Iatrogenic bile duct injuries (IBDIs) remain complex and diverse, presenting significant challenges for preoperative evaluation and surgical repair.</div></div><div><h3>Methods</h3><div>Patients who underwent hepaticojejunostomy (HJ) for IBDIs from May 2019 to June 2024 were enrolled. Preoperatively, all patients underwent preoperative individualized 3D modelling of bile duct injury (3DM-BDI) for assessment. During surgery, augmented reality navigation (ARN) combined with indocyanine green fluorescence imaging (ICG-FI) was used for guidance. Perioperative indicators and short-term postoperative outcomes were evaluated to verify the safety and feasibility of this novel approach.</div></div><div><h3>Results</h3><div>In all patients, the 3DM-BDI accurately predicted the type and extent of bile duct and vascular injuries. The mean operation time was 380.7 ± 83.9 min, and the mean intraoperative blood loss was 135.0 ± 169.7 mL, with no patients requiring intraoperative blood transfusion. The mean postoperative hospital stay was 9.3 ± 2.1 days. The navigation efficiency was 75 % for ICG-FI and 87.5 % for ARN. The success rate of reconstruction was 85.7 % based on follow-up within 90 days.</div></div><div><h3>Conclusion</h3><div>The combination of ARN and ICG-FI as an auxiliary method in the reconstruction of IBDIs may be feasible and safe. These modalities may provide technical advantages in preoperative evaluation and precise dissection of hilar vessels and bile ducts during surgery.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 379-388"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145810094","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 : 2026-03-01Epub Date: 2026-02-28DOI: 10.1016/S1365-182X(26)00070-5
{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(26)00070-5","DOIUrl":"10.1016/S1365-182X(26)00070-5","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Page iii"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147426841","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 : 2026-03-01Epub Date: 2025-12-06DOI: 10.1016/j.hpb.2025.12.001
Thomas F. Stoop , Kishan R.D. Lutchman , Rutger T. Theijse , Patrik Larsson , Atsushi Oba , Bas Groot Koerkamp , Casper H.J. van Eijck , Christopher L. Wolfgang , Elena Rangelova , Giovanni Marchegiani , Itaru Endo , Jin-Young Jang , John M. Primrose , Jose M. Ramia , Matthew H.G. Katz , Mohammed Abu Hilal , Poya Ghorbani , Shailesh V. Shrikhande , Thilo Hackert , William H. Nealon , Sohei Satoi
Background
Staging laparoscopy (SL) is performed to detect occult metastases in patients with localized pancreatic cancer. However, current guideline recommendations vary widely on routinely performing SL. This global survey investigated use and indications of SL.
Methods
An online survey was sent to members of nine international societies and working groups. Information was obtained about SL use, indications SL and adjunct diagnostic modalities across four clinical scenarios.
Results
Among 617 responding surgeons (76 countries, six continents), 82% used SL which varied between regions (Americas 90%, Asia 85%, Oceania 81%, Europe 76%, Africa 59%; P < 0.050). Most perform SL during the same session as the scheduled laparotomy (63–79%). A SL was mainly performed at the time of upfront surgery (71%), after (60%) or before (37%) neoadjuvant/induction therapy, and before radiotherapy (31%). SL was mainly performed in selected patients, either based on indeterminate/suspicious lesions on cross-sectional imaging (78–87%), resectability status (54–64%), and/or elevated CA19-9 level (60–69%). Most common used adjuncts were cytological lavage (37–55%) and intra-abdominal liver ultrasonography (36–50%).
Conclusion
Despite considerable global variability, SL is widely used to detect occult metastases in pancreatic cancer, mainly in high-risk patients and often during the scheduled laparotomy. The observed variability highlights the need for more evidence leading to stronger guideline recommendations.
{"title":"Staging laparoscopy to detect occult metastases in localized pancreatic cancer: global survey among nine international societies","authors":"Thomas F. Stoop , Kishan R.D. Lutchman , Rutger T. Theijse , Patrik Larsson , Atsushi Oba , Bas Groot Koerkamp , Casper H.J. van Eijck , Christopher L. Wolfgang , Elena Rangelova , Giovanni Marchegiani , Itaru Endo , Jin-Young Jang , John M. Primrose , Jose M. Ramia , Matthew H.G. Katz , Mohammed Abu Hilal , Poya Ghorbani , Shailesh V. Shrikhande , Thilo Hackert , William H. Nealon , Sohei Satoi","doi":"10.1016/j.hpb.2025.12.001","DOIUrl":"10.1016/j.hpb.2025.12.001","url":null,"abstract":"<div><h3>Background</h3><div>Staging laparoscopy (SL) is performed to detect occult metastases in patients with localized pancreatic cancer. However, current guideline recommendations vary widely on routinely performing SL. This global survey investigated use and indications of SL.</div></div><div><h3>Methods</h3><div>An online survey was sent to members of nine international societies and working groups. Information was obtained about SL use, indications SL and adjunct diagnostic modalities across four clinical scenarios.</div></div><div><h3>Results</h3><div>Among 617 responding surgeons (76 countries, six continents), 82% used SL which varied between regions (Americas 90%, Asia 85%, Oceania 81%, Europe 76%, Africa 59%; <em>P</em> < 0.050). Most perform SL during the same session as the scheduled laparotomy (63–79%). A SL was mainly performed at the time of upfront surgery (71%), after (60%) or before (37%) neoadjuvant/induction therapy, and before radiotherapy (31%). SL was mainly performed in selected patients, either based on indeterminate/suspicious lesions on cross-sectional imaging (78–87%), resectability status (54–64%), and/or elevated CA19-9 level (60–69%). Most common used adjuncts were cytological lavage (37–55%) and intra-abdominal liver ultrasonography (36–50%).</div></div><div><h3>Conclusion</h3><div>Despite considerable global variability, SL is widely used to detect occult metastases in pancreatic cancer, mainly in high-risk patients and often during the scheduled laparotomy. The observed variability highlights the need for more evidence leading to stronger guideline recommendations.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 313-323"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145800427","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 : 2026-03-01Epub Date: 2025-12-03DOI: 10.1016/j.hpb.2025.12.003
Min Woo Lee , Seong-Hun Kim , Woo Hyun Paik , Se Woo Park , Dong Wook Oh , Dong Kee Jang , Hyung Ku Chon , Sung Ill Jang , Jin Ho Choi , In Rae Cho , Ji Kon Ryu , Jae Hee Cho , Sang Hyub Lee
Background
There are limited data on the usefulness of endoscopic ultrasonography (EUS) in determining malignancy in gallbladder wall thickening.
Methods
In this multicenter retrospective study, patients who underwent EUS for gallbladder wall thickening from 2011 to 2021 at seven tertiary hospitals were reviewed. The main outcome was the diagnostic performance of EUS in differentiating gallbladder tumors. Logistic regression analyses were performed to identify key EUS findings.
Results
We reviewed 309 patients who underwent EUS for gallbladder wall thickening and excluded 83 patients who did not undergo surgical resection. Among 226 patients who underwent cholecystectomy, 48 patients were diagnosed with gallbladder tumors and 176 patients were diagnosed with benign diseases. EUS showed a sensitivity of 79.31 % and a specificity of 92.86 % for diagnosing gallbladder tumors. Multivariate analysis revealed that wall thickness greater than 14 mm (P < 0.001) and disrupted layer (P < 0.001) were associated with gallbladder tumors. On the other hand, the presence of intramuscular cysts (P = 0.013) and comet tail sign (P = 0.004) were associated with benign diseases.
Conclusion
EUS is a useful method for differential diagnosis of gallbladder wall thickening. Wall thickness greater than 14 mm and layer disruption are key findings of gallbladder tumors.
{"title":"Role of endoscopic ultrasonography in differential diagnosis of gallbladder wall thickening: a multi-center retrospective study","authors":"Min Woo Lee , Seong-Hun Kim , Woo Hyun Paik , Se Woo Park , Dong Wook Oh , Dong Kee Jang , Hyung Ku Chon , Sung Ill Jang , Jin Ho Choi , In Rae Cho , Ji Kon Ryu , Jae Hee Cho , Sang Hyub Lee","doi":"10.1016/j.hpb.2025.12.003","DOIUrl":"10.1016/j.hpb.2025.12.003","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data on the usefulness of endoscopic ultrasonography (EUS) in determining malignancy in gallbladder wall thickening.</div></div><div><h3>Methods</h3><div>In this multicenter retrospective study, patients who underwent EUS for gallbladder wall thickening from 2011 to 2021 at seven tertiary hospitals were reviewed. The main outcome was the diagnostic performance of EUS in differentiating gallbladder tumors. Logistic regression analyses were performed to identify key EUS findings.</div></div><div><h3>Results</h3><div>We reviewed 309 patients who underwent EUS for gallbladder wall thickening and excluded 83 patients who did not undergo surgical resection. Among 226 patients who underwent cholecystectomy, 48 patients were diagnosed with gallbladder tumors and 176 patients were diagnosed with benign diseases. EUS showed a sensitivity of 79.31 % and a specificity of 92.86 % for diagnosing gallbladder tumors. Multivariate analysis revealed that wall thickness greater than 14 mm (<em>P</em> < 0.001) and disrupted layer (<em>P</em> < 0.001) were associated with gallbladder tumors. On the other hand, the presence of intramuscular cysts (<em>P</em> = 0.013) and comet tail sign (<em>P</em> = 0.004) were associated with benign diseases.</div></div><div><h3>Conclusion</h3><div>EUS is a useful method for differential diagnosis of gallbladder wall thickening. Wall thickness greater than 14 mm and layer disruption are key findings of gallbladder tumors.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 324-332"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145819158","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 : 2026-03-01Epub 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":"10.1016/j.hpb.2025.12.036","url":null,"abstract":"<div><h3>Background</h3><div>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.</div></div><div><h3>Objective</h3><div>To evaluate whether quantitative perfusion parameters derived from ICG fluorescence angiography are associated with POPF.</div></div><div><h3>Methods</h3><div>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.</div></div><div><h3>Results</h3><div>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).</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 3","pages":"Pages 426-435"},"PeriodicalIF":2.4,"publicationDate":"2026-03-01","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}
Pub Date : 2026-02-27DOI: 10.1016/j.hpb.2026.02.008
Qaidar Alizai, Odysseas P Chatzipanagiotou, Areesh Mevawalla, Meher Angez, Abdulaziz Elemosho, Rida Ejaz, Timothy M Pawlik
Background: Unplanned postoperative reintubation (UPR) may be associated with subsequent complications and increased mortality. We sought to characterize risk factors and outcomes associated with UPR after liver or pancreatic resections.
Methods: Adult patients who underwent elective liver or pancreatic surgery were identified in the National Surgical Quality Improvement Project Database (2014-2021). Univariate and multivariable regression analyses were conducted.
Results: Among 85,077 patients (liver = 34,892, pancreas = 50,185), 2.3 % (n = 1929) individuals required UPR with a median time to reintubation of 5 days (IQR 2-10). On multivariable regression, risk factors associated with UPR after liver resection included age ≥80 years (aOR = 4.24, 95%CI [2.81-6.38]) and total right lobectomy (aOR = 1.69, 95%CI [1.35-2.13]) while in the pancreatic surgery cohort, the risk factors included Whipple procedure (aOR = 1.64, 95%CI [1.40-1.92]) and pancreatic fistula (aOR = 2.50, 95%CI [2.11-2.97]). UPR was strongly associated with longer LOS (Liver∼+8.00 days; Pancreas∼+6.33 days) and 30-day mortality (aOR, Liver = 38.26; Pancreas = 17.38).
Conclusion: UPR occurred in ∼2 % of patients after liver and pancreatic resection. Risk factors and outcomes differed by organ, but UPR consistently marked severe postoperative deterioration substantially high mortality.
{"title":"Incidence, timing, risk factors, and outcomes of unplanned reintubation after liver and pancreatic resection.","authors":"Qaidar Alizai, Odysseas P Chatzipanagiotou, Areesh Mevawalla, Meher Angez, Abdulaziz Elemosho, Rida Ejaz, Timothy M Pawlik","doi":"10.1016/j.hpb.2026.02.008","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.02.008","url":null,"abstract":"<p><strong>Background: </strong>Unplanned postoperative reintubation (UPR) may be associated with subsequent complications and increased mortality. We sought to characterize risk factors and outcomes associated with UPR after liver or pancreatic resections.</p><p><strong>Methods: </strong>Adult patients who underwent elective liver or pancreatic surgery were identified in the National Surgical Quality Improvement Project Database (2014-2021). Univariate and multivariable regression analyses were conducted.</p><p><strong>Results: </strong>Among 85,077 patients (liver = 34,892, pancreas = 50,185), 2.3 % (n = 1929) individuals required UPR with a median time to reintubation of 5 days (IQR 2-10). On multivariable regression, risk factors associated with UPR after liver resection included age ≥80 years (aOR = 4.24, 95%CI [2.81-6.38]) and total right lobectomy (aOR = 1.69, 95%CI [1.35-2.13]) while in the pancreatic surgery cohort, the risk factors included Whipple procedure (aOR = 1.64, 95%CI [1.40-1.92]) and pancreatic fistula (aOR = 2.50, 95%CI [2.11-2.97]). UPR was strongly associated with longer LOS (Liver∼+8.00 days; Pancreas∼+6.33 days) and 30-day mortality (aOR, Liver = 38.26; Pancreas = 17.38).</p><p><strong>Conclusion: </strong>UPR occurred in ∼2 % of patients after liver and pancreatic resection. Risk factors and outcomes differed by organ, but UPR consistently marked severe postoperative deterioration substantially high mortality.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480631","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 : 2026-02-18DOI: 10.1016/j.hpb.2026.02.007
Keun Soo Ahn, Daniel O'Brien, Yoo Na Kang, Taofic Mounajjed, Hye Won Lee, Yong Hoon Kim, Tae-Seok Kim, Min Jae Kim, Jin-Yi Han, Mitesh J Borad, Lewis R Roberts
Background: Pathologically, cholangiocarcinoma (CCA) can be classified into small duct type and large duct type. This study evaluated clinical and molecular features of CCA according to its pathological subtype.
Methods: We analyzed 107 patients with CCA from three independent cohorts who underwent curative surgical resection. Clinical data, gene expression profiles, and mutation status were compared between pathological subtypes.
Results: Sixty four (59.8 %) and 43 (30.2 %) patients were categorized as small duct type and large duct type, respectively. The large duct type was significantly associated with N1 stage and higher preoperative serum CEA and CA 19-9 levels. Survival outcomes were significantly poorer in patients with large duct type CCA. Transcriptomic analysis identified 146 differentially expressed genes between the two subtypes, which were validated in an independent cohort. Pathway analysis demonstrated enrichment of inflammation-related and AKT/KRAS-associated signaling pathways in the large duct type. Mutation analysis showed that KRAS and PIK3CA mutations were more frequent in the large duct type, while IDH1/2 mutations and FGFR2 fusions were more common in the small duct type.
Conclusions: Pathological subtypes of CCA exhibit distinct clinical outcomes and molecular characteristics. Classification based on pathological subtype provides a useful framework for understanding the clinical and molecular heterogeneity of CCA.
{"title":"Comprehensive molecular-clinical profiling of cholangiocarcinoma according to pathologic subtypes.","authors":"Keun Soo Ahn, Daniel O'Brien, Yoo Na Kang, Taofic Mounajjed, Hye Won Lee, Yong Hoon Kim, Tae-Seok Kim, Min Jae Kim, Jin-Yi Han, Mitesh J Borad, Lewis R Roberts","doi":"10.1016/j.hpb.2026.02.007","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.02.007","url":null,"abstract":"<p><strong>Background: </strong>Pathologically, cholangiocarcinoma (CCA) can be classified into small duct type and large duct type. This study evaluated clinical and molecular features of CCA according to its pathological subtype.</p><p><strong>Methods: </strong>We analyzed 107 patients with CCA from three independent cohorts who underwent curative surgical resection. Clinical data, gene expression profiles, and mutation status were compared between pathological subtypes.</p><p><strong>Results: </strong>Sixty four (59.8 %) and 43 (30.2 %) patients were categorized as small duct type and large duct type, respectively. The large duct type was significantly associated with N1 stage and higher preoperative serum CEA and CA 19-9 levels. Survival outcomes were significantly poorer in patients with large duct type CCA. Transcriptomic analysis identified 146 differentially expressed genes between the two subtypes, which were validated in an independent cohort. Pathway analysis demonstrated enrichment of inflammation-related and AKT/KRAS-associated signaling pathways in the large duct type. Mutation analysis showed that KRAS and PIK3CA mutations were more frequent in the large duct type, while IDH1/2 mutations and FGFR2 fusions were more common in the small duct type.</p><p><strong>Conclusions: </strong>Pathological subtypes of CCA exhibit distinct clinical outcomes and molecular characteristics. Classification based on pathological subtype provides a useful framework for understanding the clinical and molecular heterogeneity of CCA.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147480641","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 : 2026-02-16DOI: 10.1016/j.hpb.2026.02.003
Patrick W Underwood, Weiwei Ma, Ziqiao Xu, Zhengjia Chen, Bradley White, Mary Dillhoff, Jordan M Cloyd, Susan Tsai, Timothy M Pawlik, Aslam Ejaz
Background: Minimally-invasive approaches to pancreatic surgery are increasingly utilized. We aimed to evaluate the implementation of robotic pancreatoduodenectomy (RPD) across the United States.
Methods: The National Cancer Database was queried for all patients undergoing pancreatoduodenectomy (PD) for pancreatic cancer in the United States between 2010 and 2020. The primary outcome was utlization of robotic PD. Secondary outcomes included perioperative outcomes following PD.
Results: There were 48,781 patients who underwent PD with 78.0 % and 5.2 % performed by an open and robotic approach, respectively. Utilization of RPD increased from 1.1 % to 10.3 % between 2010 and 2020 (p < 0.001). Robotic converted to open PD decreased from 22.2 % to 11.1 % over the study period (p = 0.006). Patients undergoing open or RPD had similar R0 resection, 30-day unplanned readmission, and 90-day mortality. The 10 highest volume centers for RPD performed 41.8 % of all RPD and had lower rates of conversion to open, post-operative length of stay, and a higher number of lymph nodes examined compared with other centers performing RPD (all p < 0.001).
Conclusion: Robotic PD is increasingly utilized in the United States but still represents a small fraction of patients undergoing PD. Given improved outcomes observed in high-volume centers, deliberate initiatives to expand RPD programs while ensuring continued centralization are important.
{"title":"National utilization and outcomes of robotic pancreatoduodenectomy.","authors":"Patrick W Underwood, Weiwei Ma, Ziqiao Xu, Zhengjia Chen, Bradley White, Mary Dillhoff, Jordan M Cloyd, Susan Tsai, Timothy M Pawlik, Aslam Ejaz","doi":"10.1016/j.hpb.2026.02.003","DOIUrl":"https://doi.org/10.1016/j.hpb.2026.02.003","url":null,"abstract":"<p><strong>Background: </strong>Minimally-invasive approaches to pancreatic surgery are increasingly utilized. We aimed to evaluate the implementation of robotic pancreatoduodenectomy (RPD) across the United States.</p><p><strong>Methods: </strong>The National Cancer Database was queried for all patients undergoing pancreatoduodenectomy (PD) for pancreatic cancer in the United States between 2010 and 2020. The primary outcome was utlization of robotic PD. Secondary outcomes included perioperative outcomes following PD.</p><p><strong>Results: </strong>There were 48,781 patients who underwent PD with 78.0 % and 5.2 % performed by an open and robotic approach, respectively. Utilization of RPD increased from 1.1 % to 10.3 % between 2010 and 2020 (p < 0.001). Robotic converted to open PD decreased from 22.2 % to 11.1 % over the study period (p = 0.006). Patients undergoing open or RPD had similar R0 resection, 30-day unplanned readmission, and 90-day mortality. The 10 highest volume centers for RPD performed 41.8 % of all RPD and had lower rates of conversion to open, post-operative length of stay, and a higher number of lymph nodes examined compared with other centers performing RPD (all p < 0.001).</p><p><strong>Conclusion: </strong>Robotic PD is increasingly utilized in the United States but still represents a small fraction of patients undergoing PD. Given improved outcomes observed in high-volume centers, deliberate initiatives to expand RPD programs while ensuring continued centralization are important.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.4,"publicationDate":"2026-02-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147325965","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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