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Background: Conditional survival offers dynamic, time-adjusted prognostic information but remains understudied in extrahepatic cholangiocarcinoma (EHCC). This study evaluated conditional overall survival (COS), conditional recurrence-free survival (CRFS), and conditional relative survival (CRS) after curative-intent resection for EHCC.

Methods: We conducted a retrospective cohort study of 1266 patients who underwent curative-intent resection for EHCC (hilar, n = 424; common bile duct cancer [CBDC], n = 842) at a single institution between 2005 and 2019. Conditional 5-year COS, CRFS, and CRS were calculated annually using Kaplan-Meier methods and compared across demographic, clinical, and tumor-related subgroups.

Results: At baseline, 5-year COS, CRFS, and CRS were 41.3 %, 29.3 %, and 47.9 %, respectively, improving to 51.9 %, 50.0 %, and 59.3 % at five years post-surgery. Stage III patients demonstrated the largest gains in COS (24.7 %-51.0 %) and CRFS (14.6 %-53.3 %). Younger patients and females consistently had superior outcomes, whereas obese patients and those receiving adjuvant therapy showed less favorable long-term trends. Conditional survival patterns were similar between hilar and CBDC.

Conclusion: Conditional survival in EHCC improves substantially with time survived, particularly among advanced-stage, younger, and female patients. However, nearly 40 % remain at risk of recurrence even after 5 recurrence-free years. Conditional estimates provide dynamic insights to guide counseling and surveillance.

Background: This systematic review aims to identify the core outcome domains and assessment methods currently used in randomised controlled trials (RCTs) for acute postoperative pain following pancreatic surgery.

Methods: PubMed, Embase, Web of Science, and the Cochrane Library were searched without restrictions. Eligible studies were screened and data extracted for pain assessment tools, analgesic outcomes, adverse effects, pain interference and quality-of-life measures.

Results: Fifteen RCTs involving 1034 patients were included. All trials assessed pain intensity using a visual analogue scale (n = 11) or a numerical rating scale (n = 4). Analgesic consumption was reported in 13 trials, with significant variability in the reporting, rescue analgesia and adverse effects. Pain interference or physical function was described in 10 trials, including pain on coughing (n = 4), mobilisation (n = 3), % gait speed and % peak cough flow (n = 2). Multidimensional tools were rarely used, with a single RCT employing three different scales. Psychological function was assessed in one trial using anxiety and depression scales.

Conclusion: There was notable heterogeneity in pain domains assessed and the tools used across pain management RCTs post-pancreatectomy. This highlights the need for standardized core outcome domains and multidimensional tools specific to pancreatic surgery to enable comparability of data and robust analysis.

Background: Postoperative unplanned intensive care unit (ICU) admission is associated with increased cost and poor survival. The impact of perioperative factors on unplanned ICU admission after hepatectomy is unclear.

Methods: An analysis of participants in the Hemorrhage During Liver Resection: Tranexamic Acid (HeLiX) randomized trial was conducted. Participants were stratified by ICU admission status: no, planned, and unplanned. Multivariable multinomial logistic regression analysis was performed to determine variables associated with unplanned ICU admission and 90-day mortality was calculated.

Results: Of 1240 patients included, 868 (70 %) had no, 322 (26 %) had planned, and 50 (4 %) had unplanned ICU admission. On multivariable multinomial logistic regression analysis, prior cardiovascular disease (Relative Risk Ratio (RRR) 2.03; 95 % Confidence Interval (CI) 1.01-4.08), major liver resection (RRR 2.18; 95 % CI 1.12-4.27) and estimated blood loss per 500 mL (RRR 1.38; 95 % CI 1.23-1.55) were significantly associated with unplanned ICU admission. 90-day mortality rate for no, planned, and unplanned ICU admission was 1 %, 5 % and 16 %, respectively.

Conclusion: Prior cardiovascular disease, major liver resection, and higher estimated blood loss were associated with unplanned ICU admission and increased perioperative mortality after hepatectomy. Consideration should be given to early monitoring of patients with these risk factors to decrease mortality.

Introduction: Robotic liver resection has become increasingly adopted for minor hepatectomies, including lesions in the anatomically challenging posterosuperior (PS) segments. This study compares the perioperative and pathological outcomes of robotic minor resections in PS versus anterolateral (AL) segments across high-volume centers in Europe.

Materials and methods: A multicenter database of 730 robotic liver resections performed from 2011 to 2023 in nine European institutions was reviewed. After excluding major hepatectomies, patients were analyzed in three steps: overall cohort, comparison of PS vs AL resections, and two consecutive propensity score matches.

Results: PS resections consistently had longer operative times, increased blood loss, and increased frequency and duration of Pringle maneuver use in all analyses. Following propensity matching, postoperative outcome measures such as overall morbidity, major complications, readmission, mortality, length of stay, and R1 rates were similar for PS and AL resections.

Discussion: Despite greater intraoperative complexity, robotic surgery seems to offset the technical disadvantages of PS segments to obtain postoperative and pathological results comparable to AL resections.

Conclusion: Robotic minor liver resections in PS segments are safe and feasible when performed in experienced centers, supporting their broader adoption in advanced minimally invasive hepatobiliary surgery.

Background: Reporting standards for pancreaticoduodenectomy (PD) in low- and middle-income countries remain uneven, and regional data continues to be scarce. In this study, we summarize 15 years of experience from a high-volume center in Peru using internationally recognized surgical quality metrics.

Methods: We reviewed 414 PDs performed between 2009 and 2023. Outcomes were examined across three 5-year periods, using established definitions for morbidity, mortality, and key pancreatic complications. Composite indicators-Failure to Rescue (FTR) and Ideal Outcome (IO)-were also applied.

Results: Overall morbidity was 54.1 %; major morbidity was 30.7 %, and in-hospital mortality was 4.8 %. Ninety-day mortality was 6.0 %, FTR 15.7 %, and IO 60.1 %, all without significant temporal changes. Clinically relevant POPF occurred at 22 %, decreasing early on and rising again during the pandemic period. Delayed gastric emptying occurred at 10.4 %, while PPH (8.5 %), readmission (5.8 %), reoperation (10.6 %), and length of stay (11 days) remained stable. Periampullary adenocarcinoma accounted for most indications (78 %), with ampullary tumors being the most frequent.

Conclusions: This series-the largest contemporary Latin American report applying IO and FTR-shows outcomes comparable to international reference centers. These results were sustained despite increasing case complexity, the introduction of minimally invasive PD, and the disruptions caused by the COVID-19 pandemic.

Background: A decade of pancreas procedure-targeted NSQIP data can reveal trends in pancreatoduodenectomy (PD) at participating centers.

Methods: The pancreatectomy PUFs 2014-2023 were queried for PDs performed for pancreatic adenocarcinoma (PDAC). Trends in neoadjuvant therapy (NAT), minimally invasive surgical (MIS) approach, vascular resection, positive margins, length of stay (LOS), unplanned conversion, post-operative pancreatic fistula (POPF), delayed gastric emptying (DGE), and 30-day mortality were evaluated across years with Chi-square and Mann-Kendall trend tests.

Results: With 24,067 patients identified, NAT and MIS rates doubled 24.0%-50.0% and 6.3%-14.7% respectively, with the latter driven by robotic approach. Unplanned conversion rates remained stable at 24.0% with higher rates in laparoscopic vs. robotic (36.2% vs. 17.0%, p<0.001). Vascular resections increased 23.1%-26.5%. POPF rates improved 13.6%-10.2% (p=0.049). Thirty-day mortality and DGE remained stable at 1.8% and 15.0% respectively. Median LOS decreased from 9 to 7 days. Positive margin rate (available starting in 2021) increased 16.0%-18.1% (p=0.039). Laparoscopic had the highest positive margin rate, 25.4% vs. open 17.2% and robotic 15.4% (p=0.004).

Conclusion: Over the last decade, NAT, robotic MIS, and vascular resection increased while 30-day mortality and complication rates remained stable for PDAC PDs. Robotic had lower rates of unplanned conversion and positive margins compared to laparoscopic.

Background: Gallbladder carcinoma has dismal prognosis with <20 % resectability at presentation. The role of Neoadjuvant chemotherapy (NACT) remains undefined.

Methods: This is a prospective single center study of 226 gallbladder carcinoma patients receiving NACT. Gemcitabine-platinum combinations were administered followed by response assessment. Primary endpoints included resectability and survival outcomes.

Results: Of 226 patients, 135 (59.7 %) completed NACT. Intention-to-treat resection rate was 36.2 % (82/226), increasing to 60.7 % (82/135) among treatment completers. R0 resection achieved in 95.1 % (78/82). Grade ≥3 toxicity occurred in 9.7 % with 1.7 % treatment-related mortality. Median overall survival: 27 months (resectable) versus 13 months (unresectable) (p < 0.001). Two-year overall survival: 62.1 % versus 31.4 % respectively. Perioperative mortality: 3.7 %; major morbidity: 13.5 %. Incidental gallbladder cancer showed higher resectability (44.1 % vs 33.7 %) with 2-year overall survival 75 % versus 55.6 %. Multivariate analysis identified resectability (HR 2.714, p = 0.0002), perineural invasion (HR 2.986, p = 0.018), and advanced T-stage (HR 1.940, p = 0.041) as independent prognostic factors.

Conclusions: NACT enables curative resection in 60.7 % completing treatment with acceptable toxicity, supporting incorporation into treatment algorithms for locally advanced gallbladder cancer.