Pub Date : 2025-02-06DOI: 10.1016/j.hpb.2025.01.010
Abdullah Altaf, Miho Akabane, Mujtaba Khalil, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Andrea Ruzzenente, Luca Aldrighetti, Todd W Bauer, Hugo P Marques, Guillaume Martel, Irinel Popescu, Mathew J Weiss, Minoru Kitago, George Poultsides, Shishir K Maithel, Vincent Lam, Tom Hugh, Ana Gleisner, Kazunari Sasaki, Federico Aucejo, Carlo Pulitano, Feng Shen, François Cauchy, Bas G Koerkamp, Itaru Endo, Timothy M Pawlik
Background: We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer.
Methods: Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications.
Results: A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10-30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg.
Conclusion: A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.
{"title":"Impact of intraoperative blood loss on postoperative morbidity after liver resection for primary and secondary liver cancer.","authors":"Abdullah Altaf, Miho Akabane, Mujtaba Khalil, Zayed Rashid, Shahzaib Zindani, Jun Kawashima, Andrea Ruzzenente, Luca Aldrighetti, Todd W Bauer, Hugo P Marques, Guillaume Martel, Irinel Popescu, Mathew J Weiss, Minoru Kitago, George Poultsides, Shishir K Maithel, Vincent Lam, Tom Hugh, Ana Gleisner, Kazunari Sasaki, Federico Aucejo, Carlo Pulitano, Feng Shen, François Cauchy, Bas G Koerkamp, Itaru Endo, Timothy M Pawlik","doi":"10.1016/j.hpb.2025.01.010","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.010","url":null,"abstract":"<p><strong>Background: </strong>We sought to determine the association between intraoperative blood loss (IBL) and postoperative morbidity among patients undergoing surgery for liver cancer.</p><p><strong>Methods: </strong>Patients undergoing surgery for primary and secondary liver cancer were identified from a multi-institutional database. Adjusted blood loss (aBL) was calculated by normalizing IBL to body weight; the comprehensive complication index (CCI) was used to evaluate postoperative complications.</p><p><strong>Results: </strong>A total of 2491 patients were included. Mean CCI was 10.6 (±5.2) for patients with aBL <10 mL/kg versus 15.2 (±7.2) for individuals with aBL ≥10 mL/kg (p < 0.001). On cubic spline regression, a nonlinear correlation between aBL and CCI was observed. CCI increased exponentially for aBL ranging from 5 to 10 mL/kg, then reached a plateau between an aBL of 10-30 mL/kg before dramatically increasing for aBL >30 mL/kg. Recursive partitioning technique demonstrated that an aBL threshold of 8.5 mL/kg best distinguished CCI (p < 0.001). Additionally, patients with an aBL ≥8.5 mL/kg had worse recurrence-free and overall survival versus patients with an aBL <8.5 mL/kg.</p><p><strong>Conclusion: </strong>A nonlinear incremental correlation between aBL and CCI was identified among patients undergoing surgery for liver cancer. Maintaining an aBL <8.5 mL/kg during LR may help reduce postoperative morbidity.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143433177","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 : 2025-02-04DOI: 10.1016/j.hpb.2025.01.013
Annie Talbot, Denise Danos, Yong Yi, Lauren Maniscalco, Xiao-Cheng Wu, Omeed Moaven, Mary Maluccio, John Lyons
Background: The mortality rate of Hepatocellular cancer (HCC) in Louisiana is second worst in the United States. This has been linked to underutilization of curative treatment (CT). This study aimed to identify risk factors associated with underutilization of CT in Louisiana.
Methods: Patients with AJCC T1 HCC diagnosed from 2011 to 2020 were identified from the Louisiana Tumor Registry (LTR) using site and histology codes. Patients who underwent CT (ablation, resection, and transplantation) were compared to those who did not undergo CT. Logistic regression was performed and results reported as adjusted odds ratios.
Results: CT was utilized in 462 (37 %) of 1247 patients with T1 HCC. There were no significant differences observed in age, race, BMI, poverty, or rurality between CT and non-CT patients. The percentage of cirrhosis was similar in both groups (35.3 % vs. 37.7 %, NS). On multivariant analysis, lack of CT was independently associated with low socioeconomic status (SES; p = 0.040), treatment outside a COC center (p < 0.001), and lack commercial/private insurance (p < 0.001).
Conclusion: Utilization of CT is driven not by comorbidities, but by insurance type, low SES, and treatment facility indicating the profound effect that care disparities have on HCC treatment.
{"title":"Decision to operate on hepatocellular cancer patients is not driven by comorbidities in Louisiana.","authors":"Annie Talbot, Denise Danos, Yong Yi, Lauren Maniscalco, Xiao-Cheng Wu, Omeed Moaven, Mary Maluccio, John Lyons","doi":"10.1016/j.hpb.2025.01.013","DOIUrl":"https://doi.org/10.1016/j.hpb.2025.01.013","url":null,"abstract":"<p><strong>Background: </strong>The mortality rate of Hepatocellular cancer (HCC) in Louisiana is second worst in the United States. This has been linked to underutilization of curative treatment (CT). This study aimed to identify risk factors associated with underutilization of CT in Louisiana.</p><p><strong>Methods: </strong>Patients with AJCC T1 HCC diagnosed from 2011 to 2020 were identified from the Louisiana Tumor Registry (LTR) using site and histology codes. Patients who underwent CT (ablation, resection, and transplantation) were compared to those who did not undergo CT. Logistic regression was performed and results reported as adjusted odds ratios.</p><p><strong>Results: </strong>CT was utilized in 462 (37 %) of 1247 patients with T1 HCC. There were no significant differences observed in age, race, BMI, poverty, or rurality between CT and non-CT patients. The percentage of cirrhosis was similar in both groups (35.3 % vs. 37.7 %, NS). On multivariant analysis, lack of CT was independently associated with low socioeconomic status (SES; p = 0.040), treatment outside a COC center (p < 0.001), and lack commercial/private insurance (p < 0.001).</p><p><strong>Conclusion: </strong>Utilization of CT is driven not by comorbidities, but by insurance type, low SES, and treatment facility indicating the profound effect that care disparities have on HCC treatment.</p>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":" ","pages":""},"PeriodicalIF":2.7,"publicationDate":"2025-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143482799","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}
This study is a retrospective review aimed to identify pancreatic juice-specific fluorescent probes to visualize pancreatic juice using a library of 381 aminopeptidase/protease-activatable fluorescent probes and 30 phosphatase/phosphodiesterase probes. In 2013, we developed a fluorescence imaging technique using a chymotrypsin probe to visualize pancreatic juice, linked to postoperative pancreatic fistula (POPF). This probe required addition of trypsin to convert pancreatic chymotrypsinogen to chymotrypsin. Recently we accessed libraries of enzyme-activatable fluorescent probes to find probes that facilitated target-specific imaging.
Methods
Pancreatic juice and ascitic fluid samples were collected in eight patients undergoing pancreaticoduodenectomy. Reaction rates of pancreatic juice to background ascitic fluids were calculated for these 411 fluorescent probes.
Results
Forty-four fluorescent probes were screened in terms of high reactivity with pancreatic juice. Only one candidate probe targeting ectonucleotide pyrophosphatase/phosphodiesterase (ENPP) 1 was selected for a pancreatic juice-specific fluorescent probe. Inhibitor experiments and Western blotting supported the presence of ENPP1 in the pancreatic juice.
Conclusion
ENPP1-targeting fluorescent probe may have the potential to visualize pancreatic juice leakage during surgery. This finding may allow surgeons to suture leaking sites and decide the necessity of prophylactic abdominal drains; however, the role of ENPP1 in pancreatic juice remains to be clarified.
{"title":"Identification of a pancreatic juice-specific fluorescent probe through 411 probes activated by aminopeptidases/proteases or phosphatases/phosphodiesterases","authors":"Yusuke Seki , Takeaki Ishizawa , Genki Watanabe , Toru Komatsu , Aika Nanjo , Tasuku Ueno , Yasuteru Urano , Mitsuyasu Kawaguchi , Hidehiko Nakagawa , Kiyoshi Hasegawa","doi":"10.1016/j.hpb.2024.10.012","DOIUrl":"10.1016/j.hpb.2024.10.012","url":null,"abstract":"<div><h3>Background</h3><div>This study is a retrospective review aimed to identify pancreatic juice-specific fluorescent probes to visualize pancreatic juice using a library of 381 aminopeptidase/protease-activatable fluorescent probes and 30 phosphatase/phosphodiesterase probes. In 2013, we developed a fluorescence imaging technique using a chymotrypsin probe to visualize pancreatic juice, linked to postoperative pancreatic fistula (POPF). This probe required addition of trypsin to convert pancreatic chymotrypsinogen to chymotrypsin. Recently we accessed libraries of enzyme-activatable fluorescent probes to find probes that facilitated target-specific imaging.</div></div><div><h3>Methods</h3><div>Pancreatic juice and ascitic fluid samples were collected in eight patients undergoing pancreaticoduodenectomy. Reaction rates of pancreatic juice to background ascitic fluids were calculated for these 411 fluorescent probes.</div></div><div><h3>Results</h3><div>Forty-four fluorescent probes were screened in terms of high reactivity with pancreatic juice. Only one candidate probe targeting ectonucleotide pyrophosphatase/phosphodiesterase (ENPP) 1 was selected for a pancreatic juice-specific fluorescent probe. Inhibitor experiments and Western blotting supported the presence of ENPP1 in the pancreatic juice.</div></div><div><h3>Conclusion</h3><div>ENPP1-targeting fluorescent probe may have the potential to visualize pancreatic juice leakage during surgery. This finding may allow surgeons to suture leaking sites and decide the necessity of prophylactic abdominal drains; however, the role of ENPP1 in pancreatic juice remains to be clarified.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 150-158"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142778963","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 : 2025-02-01DOI: 10.1016/j.hpb.2024.10.015
Yong Jae Kwon , Ji Hye Min , Jeong Ah Hwang , Seong Hyun Kim , Young Kon Kim , Honsoul Kim , Kyowon Gu , Jeong Hyun Lee , Jaeseung Shin , Seo-Youn Choi , Sun-Young Baek
Background
This study aimed to assess the significance of elevated carbohydrate antigen (CA) 19-9 in postoperative surveillance of extrahepatic bile duct cancer and to identify short-term recurrence predictors.
Methods
This retrospective study included patients with elevated CA 19-9 post-curative surgery. Patients were categorized into positive and negative CT groups based on the detection of recurrence at CA 19-9 elevation. Short-term recurrence was defined as recurrence within 6 months in the negative CT group. We identified the factors associated with short-term recurrence and devised a predictive nomogram.
Results
Among the 190 patients, 91 (47.9 %) exhibited tumor recurrence with CA 19-9 elevation (CT-positive group), whereas 99 (52.1 %) showed no recurrence (CT-negative group). In the CT-negative group (n = 99), 22 (22.2 %) experienced short-term tumor recurrence within 6 months. Preoperative CA 19-9 (odds ratio [OR]: 1.5, p = 0.016), postoperative CA 19-9 (OR: 1.9, p = 0.047), adjuvant treatment (OR: 3.5, p = 0.032), and the absence of inflammation (OR: 3.5, p = 0.045) were predictors of short-term recurrence. The area under the curve of the nomogram was 0.80 (95 % CI: 0.69–0.90).
Conclusion
Despite elevated CA 19-9 levels, approximately 50 % of patients exhibited no recurrence during postoperative surveillance for extrahepatic bile duct cancer. Factors influencing short-term recurrence encompass pre- and postoperative CA 19-9, adjuvant treatment, and inflammatory status.
背景：本研究旨在评估肝外胆管癌术后监测中碳水化合物抗原（CA 19-9）升高的意义，并确定短期复发的预测因素：本研究旨在评估碳水化合物抗原（CA）19-9 升高在肝外胆管癌术后监测中的意义，并确定短期复发预测因素：这项回顾性研究纳入了手术后CA 19-9升高的患者。根据 CA 19-9 升高时复发的检测结果，将患者分为 CT 阳性组和 CT 阴性组。CT 阴性组的短期复发定义为 6 个月内的复发。我们确定了短期复发的相关因素，并设计了一个预测提名图：在 190 例患者中，91 例（47.9%）肿瘤复发并伴有 CA 19-9 升高（CT 阳性组），99 例（52.1%）无复发（CT 阴性组）。在 CT 阴性组（n = 99）中，有 22 例（22.2%）在 6 个月内出现短期肿瘤复发。术前 CA 19-9（几率比 [OR]：1.5，P = 0.016）、术后 CA 19-9（OR：1.9，P = 0.047）、辅助治疗（OR：3.5，P = 0.032）和无炎症（OR：3.5，P = 0.045）是短期复发的预测因素。提名图的曲线下面积为 0.80（95 % CI：0.69-0.90）：结论：尽管CA 19-9水平升高，但约50%的肝外胆管癌患者在术后监测期间没有复发。影响短期复发的因素包括术前和术后 CA 19-9、辅助治疗和炎症状态。
{"title":"Clinical significance of CA 19-9 elevation during postoperative surveillance for extrahepatic bile duct cancer: a nomogram-based approach for the prediction of short-term recurrence","authors":"Yong Jae Kwon , Ji Hye Min , Jeong Ah Hwang , Seong Hyun Kim , Young Kon Kim , Honsoul Kim , Kyowon Gu , Jeong Hyun Lee , Jaeseung Shin , Seo-Youn Choi , Sun-Young Baek","doi":"10.1016/j.hpb.2024.10.015","DOIUrl":"10.1016/j.hpb.2024.10.015","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to assess the significance of elevated carbohydrate antigen (CA) 19-9 in postoperative surveillance of extrahepatic bile duct cancer and to identify short-term recurrence predictors.</div></div><div><h3>Methods</h3><div>This retrospective study included patients with elevated CA 19-9 post-curative surgery. Patients were categorized into positive and negative CT groups based on the detection of recurrence at CA 19-9 elevation. Short-term recurrence was defined as recurrence within 6 months in the negative CT group. We identified the factors associated with short-term recurrence and devised a predictive nomogram.</div></div><div><h3>Results</h3><div>Among the 190 patients, 91 (47.9 %) exhibited tumor recurrence with CA 19-9 elevation (CT-positive group), whereas 99 (52.1 %) showed no recurrence (CT-negative group). In the CT-negative group (n = 99), 22 (22.2 %) experienced short-term tumor recurrence within 6 months. Preoperative CA 19-9 (odds ratio [OR]: 1.5, <em>p</em> = 0.016), postoperative CA 19-9 (OR: 1.9, <em>p</em> = 0.047), adjuvant treatment (OR: 3.5, <em>p</em> = 0.032), and the absence of inflammation (OR: 3.5, <em>p</em> = 0.045) were predictors of short-term recurrence. The area under the curve of the nomogram was 0.80 (95 % CI: 0.69–0.90).</div></div><div><h3>Conclusion</h3><div>Despite elevated CA 19-9 levels, approximately 50 % of patients exhibited no recurrence during postoperative surveillance for extrahepatic bile duct cancer. Factors influencing short-term recurrence encompass pre- and postoperative CA 19-9, adjuvant treatment, and inflammatory status.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 195-205"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142716228","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 : 2025-02-01DOI: 10.1016/j.hpb.2024.11.004
Phu V. La , Hieu T. Le , Thang M. Tran , Quan M. Tran , Phuc V. La , Vu A. Doan
Background
Laparoscopic common bile duct exploration (LCBDE) is commonly used for hepatolithiasis and/or choledocholithiasis, but the ideal method for common bile duct closure remains uncertain, especially for elderly patients (≥65 years). This study compared outcomes of primary closure versus T-tube drainage following LCBDE in elderly patients.
Methods
Data from elderly patients undergoing LCBDE for hepatolithiasis and/or choledocholithiasis between May 2016 and December 2020 at two Vietnamese hospitals were analyzed. Patients were divided into groups A (T-tube drainage, n = 52) and B (primary closure, n = 57). Propensity score matching (PSM) was utilized to adjust for baseline characteristics, comparing short- and long-term outcomes between groups.
Results
PSM yielded 56 matched patients. Pre-PSM, group A had longer operating times and hospital stays than Group B (p = 0.001). Group A had higher postoperative complications (17.9 % vs. 7.1 %) but was not statistically significant (p = 0.422). Group A also had more complex biliary stones. Post-PSM, Group B maintained shorter operating times and hospital stays. Regarding long-term results, stone recurrence rates were similar (5.8 % vs. 3.5 %, p = 0.668).
Conclusion
Primary closure following LCBDE is a safe and effective alternative to T-tube drainage for treating hepatolithiasis and/or choledocholithiasis in elderly patients.
背景：腹腔镜胆总管探查（LCBDE）常用于肝结石和/或胆总管结石，但胆总管闭合的理想方法仍不确定，特别是对于老年患者（≥65岁）。本研究比较了老年患者LCBDE术后首次闭合与t管引流的结果。方法：分析2016年5月至2020年12月在越南两家医院接受肝内胆管结石和/或胆总管结石手术的老年患者的数据。患者分为A组（t管引流，n = 52）和B组（一期闭合，n = 57）。使用倾向评分匹配（PSM）来调整基线特征，比较两组之间的短期和长期结果。结果：PSM获得56例匹配患者。psm前，A组手术时间和住院时间较B组长（p = 0.001）。A组术后并发症发生率较高（17.9% vs. 7.1%），但差异无统计学意义（p = 0.422）。A组也有更复杂的胆结石。psm后，B组手术时间和住院时间较短。至于长期结果，结石复发率相似（5.8% vs. 3.5%, p = 0.668）。结论：LCBDE术后一期闭合是治疗老年肝内胆管结石和/或胆总管结石安全有效的替代方法。
{"title":"Primary closure compared with T-tube drainage following laparoscopic common bile duct exploration among elderly patients with hepatolithiasis and/or choledocholithiasis: a comparative study using a propensity score matching","authors":"Phu V. La , Hieu T. Le , Thang M. Tran , Quan M. Tran , Phuc V. La , Vu A. Doan","doi":"10.1016/j.hpb.2024.11.004","DOIUrl":"10.1016/j.hpb.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic common bile duct exploration (LCBDE) is commonly used for hepatolithiasis and/or choledocholithiasis, but the ideal method for common bile duct closure remains uncertain, especially for elderly patients (≥65 years). This study compared outcomes of primary closure versus T-tube drainage following LCBDE in elderly patients.</div></div><div><h3>Methods</h3><div>Data from elderly patients undergoing LCBDE for hepatolithiasis and/or choledocholithiasis between May 2016 and December 2020 at two Vietnamese hospitals were analyzed. Patients were divided into groups A (T-tube drainage, n = 52) and B (primary closure, n = 57). Propensity score matching (PSM) was utilized to adjust for baseline characteristics, comparing short- and long-term outcomes between groups.</div></div><div><h3>Results</h3><div>PSM yielded 56 matched patients. Pre-PSM, group A had longer operating times and hospital stays than Group B (p = 0.001). Group A had higher postoperative complications (17.9 % vs. 7.1 %) but was not statistically significant (p = 0.422). Group A also had more complex biliary stones. Post-PSM, Group B maintained shorter operating times and hospital stays. Regarding long-term results, stone recurrence rates were similar (5.8 % vs. 3.5 %, p = 0.668).</div></div><div><h3>Conclusion</h3><div>Primary closure following LCBDE is a safe and effective alternative to T-tube drainage for treating hepatolithiasis and/or choledocholithiasis in elderly patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 232-239"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768375","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 : 2025-02-01DOI: 10.1016/j.hpb.2024.11.007
Jun Kawashima , Abdullah Altaf , Yutaka Endo , Selamawit Woldesenbet , Diamantis I. Tsilimigras , Zayed Rashid , Alfredo Guglielmi , Hugo P. Marques , Shishir K. Maithel , Bas Groot Koerkamp , Carlo Pulitano , Federico Aucejo , Itaru Endo , Timothy M. Pawlik
Background
We sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index.
Methods
Data on patients who underwent curative-intent resection for pCCA were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy.
Results
Among 341 patients, median number of lymph nodes (LNs) evaluated was 7 (IQR: 4–11). A total of 127 (37.2 %) patients underwent lymphadenectomy of station 12 only, while 146 (42.8 %) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32–0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥6 LNs harvested (26.3).
Conclusion
At the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate ≥6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.
{"title":"Lymphadenectomy for perihilar cholangiocarcinoma: therapeutic benefit of lymph node number and station","authors":"Jun Kawashima , Abdullah Altaf , Yutaka Endo , Selamawit Woldesenbet , Diamantis I. Tsilimigras , Zayed Rashid , Alfredo Guglielmi , Hugo P. Marques , Shishir K. Maithel , Bas Groot Koerkamp , Carlo Pulitano , Federico Aucejo , Itaru Endo , Timothy M. Pawlik","doi":"10.1016/j.hpb.2024.11.007","DOIUrl":"10.1016/j.hpb.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>We sought to characterize the benefit of lymphadenectomy among patients undergoing curative-intent surgery for perihilar cholangiocarcinoma (pCCA) utilizing the therapeutic index.</div></div><div><h3>Methods</h3><div>Data on patients who underwent curative-intent resection for pCCA were obtained from 8 high-volume international hepatobiliary centers. Multivariable Cox regression analysis was used to assess clinicopathological factors associated with overall survival (OS). The therapeutic index was determined to assess the therapeutic benefit of lymphadenectomy.</div></div><div><h3>Results</h3><div>Among 341 patients, median number of lymph nodes (LNs) evaluated was 7 (IQR: 4–11). A total of 127 (37.2 %) patients underwent lymphadenectomy of station 12 only, while 146 (42.8 %) patients had LNs from stations 12 plus 8 ± 13 harvested. On multivariable analysis, lymphadenectomy of stations 12 plus 8 ± 13 was associated with improved OS (referent, station 12 only: HR 0.51, 95%CI 0.32–0.80). The therapeutic index was highest among patients who underwent LN evaluation of stations 12 plus 8 ± 13 (33.1) and had ≥6 LNs harvested (26.3).</div></div><div><h3>Conclusion</h3><div>At the time of surgery of pCCA, lymphadenectomy should include station 12, as well as stations 8 and 13, with the goal to evaluate ≥6 LNs to ensure optimal staging and maximize the therapeutic benefit for patients.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 250-259"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142791607","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 : 2025-02-01DOI: 10.1016/S1365-182X(25)00009-7
{"title":"Highlights in this issue","authors":"","doi":"10.1016/S1365-182X(25)00009-7","DOIUrl":"10.1016/S1365-182X(25)00009-7","url":null,"abstract":"","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Page iii"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143135673","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 : 2025-02-01DOI: 10.1016/j.hpb.2024.11.001
Alice Zhu , Marisa Louridas , Sean P. Cleary , Shiva Jayaraman
Background
Surgical coaching is valuable for disseminating knowledge, refining skills, and fostering continuous professional development for surgeons in practice. This work aims to implement a national coaching program for Canadian HPB surgeons, emphasizing advanced laparoscopic techniques, and to assess subsequent adoption. Secondary objectives include evaluating surgeon perceptions, barriers, and experiences.
Methods
Mid-to-late career HPB surgeons across Canada joined a peer surgical coaching program for advanced laparoscopic skills. The program included didactic sessions followed by practical coaching with case observation, simulation labs, and real-time coaching in the operating room. One lead surgeon from each center was invited to participate in the exit interview.
Results
Eight centers across four provinces completed the program, and one lead surgeon from each site was interviewed. Surgeons reported a 34.9 % increase in self-perceived comfort levels in laparoscopic HPB surgeries, with a 24.2 % and 56.7 % increase in laparoscopic liver and pancreas resections, respectively. Participants acknowledged challenges in implementing surgical coaching, citing barriers related to surgeon and societal factors. Overcoming these challenges required mutual respect, openness to learning, and building sustained change through team collaboration and long-term coach relationships.
Discussion
This work demonstrated the practicality of a nationwide coaching program and its capacity to effect substantial, long-term change in clinical practice.
{"title":"Advancing excellence: a national peer-coaching program for advanced laparoscopic HPB techniques","authors":"Alice Zhu , Marisa Louridas , Sean P. Cleary , Shiva Jayaraman","doi":"10.1016/j.hpb.2024.11.001","DOIUrl":"10.1016/j.hpb.2024.11.001","url":null,"abstract":"<div><h3>Background</h3><div>Surgical coaching is valuable for disseminating knowledge, refining skills, and fostering continuous professional development for surgeons in practice. This work aims to implement a national coaching program for Canadian HPB surgeons, emphasizing advanced laparoscopic techniques, and to assess subsequent adoption. Secondary objectives include evaluating surgeon perceptions, barriers, and experiences.</div></div><div><h3>Methods</h3><div>Mid-to-late career HPB surgeons across Canada joined a peer surgical coaching program for advanced laparoscopic skills. The program included didactic sessions followed by practical coaching with case observation, simulation labs, and real-time coaching in the operating room. One lead surgeon from each center was invited to participate in the exit interview.</div></div><div><h3>Results</h3><div>Eight centers across four provinces completed the program, and one lead surgeon from each site was interviewed. Surgeons reported a 34.9 % increase in self-perceived comfort levels in laparoscopic HPB surgeries, with a 24.2 % and 56.7 % increase in laparoscopic liver and pancreas resections, respectively. Participants acknowledged challenges in implementing surgical coaching, citing barriers related to surgeon and societal factors. Overcoming these challenges required mutual respect, openness to learning, and building sustained change through team collaboration and long-term coach relationships.</div></div><div><h3>Discussion</h3><div>This work demonstrated the practicality of a nationwide coaching program and its capacity to effect substantial, long-term change in clinical practice.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 206-213"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-02-01DOI: 10.1016/j.hpb.2024.10.010
Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal
Background
Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.
Methods
A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.
Results
Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to −51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to −4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to −1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.
Conclusion
Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.
{"title":"Perioperative safety and oncological efficacy of simultaneous versus colorectal and liver first two-staged resections in patients with synchronous colorectal liver metastases: a systematic review and network meta-analysis","authors":"Jasper P. Sijberden , Maria S. Alvarez Escribano , Meidai Kasai , Carlotta Ferretti , Paola Cesaro , Claudio Bnà , Alberto Zaniboni , Ajith K. Siriwardena , Pieter J. Tanis , Mohammed Abu Hilal","doi":"10.1016/j.hpb.2024.10.010","DOIUrl":"10.1016/j.hpb.2024.10.010","url":null,"abstract":"<div><h3>Background</h3><div>Previous meta-analyses have yielded conflicting results on the optimal surgical treatment strategy in patients with synchronous colorectal liver metastases (sCRLM). This network meta-analysis aims to provide an overview on colorectal-, liver first and simultaneous resections to treat sCRLM.</div></div><div><h3>Methods</h3><div>A search was conducted in MEDLINE, Embase and Cochrane CENTRAL (inception-July 11,2023). Pairwise and network meta-analyses were conducted to compare the three strategies, using colorectal-first resections as reference group.</div></div><div><h3>Results</h3><div>Overall, 46 studies with a total of 20,991 patients were included, a significant portion at a high risk of bias. Simultaneous resections were associated with less blood loss (MD -145.44 ml, 95%CI -239.40 to −51.48) and shorter hospital stays (MD -6.39 days, 95%CI -7.78 to −4.99). Liver-first resections were associated with more transfusions (OR 1.89, 95%CI 1.04 to 3.42) and shorter hospital stays (MD -4.53 days, 95%CI -7.99 to −1.06). Simultaneous resections were associated with less incomplete macroscopic disease clearances (OR 0.33, 95%CI 0.12 to 0.92), while liver-first resections were associated with more incomplete macroscopic disease clearances (OR 2.80, 95%CI 1.16 to 6.73) and less microscopically radical (R0) resections (OR 0.64, 95%CI 0.45 to 0.90). There were no significant differences in morbidity, mortality, disease-free or overall survival.</div></div><div><h3>Conclusion</h3><div>Based on meta-analysis of mainly observational studies, simultaneous resections were associated with less blood loss, shorter length of stay and more complete macroscopic disease clearances.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 135-149"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142710036","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 : 2025-02-01DOI: 10.1016/j.hpb.2024.11.002
Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen
Introduction
Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS).
Methods
This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS.
Results
A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25–3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04–3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found.
Conclusion
Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.
{"title":"Association of chemotherapy completion rates and overall survival with postoperative complications after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma","authors":"Sophie L.G. Kollbeck , Carsten P. Hansen , Emilie E. Dencker , Paul S. Krohn , Jan H. Storkholm , Stefan K. Burgdorf , Andreas S. Millarch , Thomas B. Piper , Jens G. Hillingsø , Martin Sillesen","doi":"10.1016/j.hpb.2024.11.002","DOIUrl":"10.1016/j.hpb.2024.11.002","url":null,"abstract":"<div><h3>Introduction</h3><div>Despite the benefits of surgical resection and adjuvant chemotherapy for pancreatic ductal adenocarcinoma (PDAC), over 30 % of patients fail to complete adjuvant oncological treatment. Whether postoperative complications affect chemotherapy completion rates and overall survival remains uncertain. We hypothesized that postoperative complications would be associated with chemotherapy delays, omission, and reduced overall survival (OS).</div></div><div><h3>Methods</h3><div>This was a retrospective analysis of patients undergoing pancreaticoduodenectomy for PDAC from 2008 to 2022 to assess whether serious surgical complications, defined as Clavien Dindo Grade 3b or higher, were associated with the omission or delay of adjuvant oncologic treatment as well as OS.</div></div><div><h3>Results</h3><div>A total of 920 patients were available for analysis. Pancreatic and bile leakage were associated with risk of chemotherapy omission (OR 1.97 [CI 95 % 1.25–3.12], p = 0.004 and OR 1.96 [CI 95 % 1.04–3.67], p = 0.032, respectively). No delay of adjuvant chemotherapy >90 days nor change in OS was found.</div></div><div><h3>Conclusion</h3><div>Major surgical complications influence the likelihood of omitting adjuvant chemotherapy but not delaying it > 90 days. Patients with pancreatic or bile leakage were at greater risk of not completing planned chemotherapy but had the same OS.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"27 2","pages":"Pages 222-231"},"PeriodicalIF":2.7,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142739132","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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