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Background: Few population-based studies exist for gallbladder cancer (GBC). This study explored incidence, diagnostics, treatment, and survival of patients with GBC in a national cohort.

Methods: Patients with GBC during 2006-2019 in Finland were included from Finnish Cancer Registry with manual patient data verification.

Results: GBC was diagnosed in 1183 patients. Overall incidence was 1.56:100,000 and it decreased over time (from 1.81 to 1.35, p < 0.001). For detailed analysis, 1016 patients were included. The proportion of patients with T2-T3 increased (from 46 % to 65 %; p < 0.001) and T4 decreased (from 35 % to 18 %; p < 0.001). Similarly, the proportion of patients with stage IVA decreased (from 10 % to 4 %, p = 0.002) and stage II increased (from 12 % to 20 %, p = 0.006). In total, 185 (18 %) patients underwent curative-intent surgery with a 92 % R0 resection rate. The proportion of curative-intent surgery increased (from 15 % to 23 %, p = 0.013), as well as use of adjuvant (from 19 % to 54 %, p < 0.001) and systemic chemotherapy (from 31.4 % to 42.1 %, p = 0.014). Median overall survival was 7 months and 5-year overall survival 14 %, which improved during the study period (from 12 % to 14 %, p = 0.007).

Conclusion: The incidence of GBC decreased, and overall survival improved, likely due to increased surgical and oncological treatments.

Background: Patients with gallbladder polyps (GPs) are frequently subject to surveillance or cholecystectomy due to a risk of malignancy. As most GPs prove to be benign, potential overtreatment may impact quality of life (QoL). This study aimed to evaluate QoL in patients with GPs, compare it to the general population, and identify factors associated with QoL.

Methods: Patients diagnosed with GPs were included from 26 Dutch centres from 2018 to 2020, and followed until 2024. QoL was assessed at multiple time points using generic (EQ-5D) and disease-specific (GIQLI) instruments. Demographics, imaging, and surgical data were analysed.

Results: Among 207 patients, 42 (20.3 %) underwent cholecystectomy; neoplastic polyps were found in 3 (1.4 %). Overall, baseline EQ-5D scores were similar to the general population (0.85 vs 0.87; p = 0.20), while GIQLI scores were lower (116.1 vs 122.6; p < 0.001). Anxiety was reported by 39 % and was the strongest predictor of reduced QoL (EQ-5D: β = -0.095; GIQLI: β = -15.49; p < 0.001). QoL was not associated with GP characteristics.

Conclusion: GPs are associated with reduced QoL, driven predominantly by anxiety. Structured counselling on low malignancy risk and less intensive surveillance may alleviate anxiety and reduce overtreatment.

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.

Aims: We conducted this systematic review to answer the questions: a. what are the timing categories for revision surgery (RS) in incidental gallbladder cancer (iGBC)? b. which RS timing achieves better oncological outcomes?

Methods: We performed literature search in 4 databases (PubMed, Scopus, Google Scholar and Cochrane Reviews) till 10th October 2025 and included studies which reported patient outcomes based on RS timing. Study characteristics, timing category definitions and RS outcomes were collected. (Study protocol PROSPERO ID CRD42023453990).

Results: Twelve retrospective studies were included, with 2067 iGBC patients (566 males and 1346 females). On the 'Joanna Briggs Institute' (JBI) tool, most studies scored a 'Yes' to 7-8 out of 10 questions. There was no consensus on the definitions of 'early', 'intermediate' and 'delayed' timings for RS. Successful RS, perioperative morbidity, R0 resection were similar. On individual patient data meta-analysis, there was no difference in overall survival between RS at '4 weeks' [hazard ratio: 1.29, 95 % CI: 0.79-2.10].

Conclusion: There was no consensus on the definitions of timing categories and optimum timing for RS in iGBC. Definitions of timing categories need to be standardised and future studies based on these categories may identify the ideal timing of RS in iGBC.

Background: Although biliary brush cytology has a high specificity (95-100 %), the sensitivity is poor (41-67 %). This study aimed to evaluate whether the use of an optimized protocol for brush cytology improves the results in patients with suspected perihilar or intrahepatic cholangiocarcinoma (pCCA/iCCA).

Methods: Patients were prospectively included after changing the protocol (June 2021-June 2023) and compared with a historical cohort (January 2017-May 2021). Changes included different brush processing, addition of next-generation sequencing (NGS), and additional sampling (two brush samples and intraductal biopsies). Primary outcome was the sensitivity and the specificity of the procedure.

Results: A total of 175 patients were evaluated (62 prospective, 113 historical) of which 165 patients had malignant disease (94 %). After implementation of the protocol, the sensitivity was 88.3 % (95%CI, 76.8-94.8 %) versus 50.5 % (95%CI, 40.6-60.3 %) prior to implementation. Sensitivity of only the first brush sample with the optimized processing did also significantly increase (78 %; 95%CI, 65.5-87.5 %). Specificity was 100 % in both groups (2/2 vs 8/8).

Conclusions: A modification in the processing of cytopathology led to a significant improvement in the sensitivity of the first bile duct brush to 78 %. Furthermore, adding NGS increased sensitivity to 83 %, an extra brush sample to 85 %, and intraductal biopsies to 88 %.

Background: The advantages of robotic hepatectomy (Rob-H) over laparoscopic hepatectomy (Lap-H) remain unclear. This study compares the outcomes between Rob-H and Lap-H in a single-center setting.

Methods: A retrospective analysis was conducted on patients who underwent minimally invasive liver resection between 2014 and 2023. Patient demographics, perioperative parameters, and postoperative outcomes were reviewed. Propensity score matching (PSM) was employed to reduce selection bias.

Results: A total of 2999 patients were included in this study. 2375 patients underwent Lap-H and 624 patients underwent Rob-H. After PSM, 42 patients who underwent right hemihepatectomy. The results showed that, compared to the Lap-H group, the Rob-H group had lower intraoperative blood loss (P = 0.016). A total of 108 patients who underwent left hemihepatectomy were included. The Rob-H group had shorter operative time (P = 0.005), lower intraoperative blood loss (P = 0.049).For 108 patients who underwent right posterior segmentectomy, the Rob-H group showed shorter operative time (P < 0.001), less intraoperative blood loss (P = 0.012), shorter Pringle duration (P = 0.008).

Conclusion: Compared with the Lap-H group, intraoperative blood loss and operative time were lower in the Rob-H group, and the results were consistent with previous studies, suggesting that the robotic platform overcome the limitations of laparoscopic liver resection.

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.

Background: There is a scarcity of data on the feasibility of laparoscopic approach to associating liver partition and portal vein ligation for staged hepatectomy (Lap-ALPPS) regarding its impact on functional liver remnant (FLR) hypertrophy when compared with the open approach.

Methods: A retrospective study of patients who underwent open or lap-ALPPS for hepatocellular carcinoma (HCC) in a tertiary referral centre in Hong Kong during the period from December 2013 to April 2023.

Results: Fifty-seven (42 open and 15 laparoscopic) ALPPS were performed for HCC. The open group had more blood loss during stage I (500 ml vs. 300 ml, p = 0.001). The morbidity (Clavien-Dindo grade ≥ 3a) (14.3 % vs. 26.7 %, p = 0.43) and Grade B/C post-hepatectomy liver failure rates (20.0 % vs 35.7 %, p = 0.34) were similar. The open group had a higher percentage increment in remnant volume (50.6 % vs. 34.8 %, p = 0.02). Linear regression revealed that a small pre-operative FLR/ESLV (B = -1.75, 95 % CI -2.82-0.678, p < 0.001) and an open approach at stage I B = -20.2, 95 % CI -37.7-2.68, p < 0.001) predicted a higher percentage increment in remnant volume.

Conclusion: Lap-ALPPS had less blood loss but was associated with slower hypertrophy. Hence, a longer waiting time to stage II ALPPS may be required in selected patients.

Background: Laparoscopic cholecystectomy (LC), a common abdominal operation, is associated with significant morbidity, particularly bile duct injury. Artificial intelligence (AI) can enable real-time monitoring, assist decision-making, increase safety, and improve patient outcomes. This study systematically reviews AI applications in LC, evaluating different models and their performance.

Methods: A systematic review was conducted in accordance with the PRISMA guidelines. A comprehensive literature search was conducted using PubMed and ScienceDirect databases for studies published between 2014 and 2024. All studies assessing AI applications in LC were included. Data extraction focused on the study aims, types of AI tools, datasets, anatomical recognition capabilities, and accuracy metrics.

Results: The search yielded 413 citations; a final list of 43 citations was compiled after applying the inclusion and exclusion criteria. Different datasets and developed AI tools were used in LC. AI tools were utilised in risk-scoring models for complication identification and outcome prediction, as well as for recognising anatomical landmarks during LC and subdividing the procedure into subtasks.

Conclusion: AI integration in LC is promising for improving intraoperative guidance, enhancing surgical education, and supporting decision-making processes. Future large-scale studies are warranted to validate the role of AI in improving patient safety and outcomes in LC.