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Liver venous deprivation (LVD) or ALPPS in the treatment of colorectal liver metastasis (CRLM): a comparison of oncological outcome 肝静脉剥夺（LVD）或ALPPS治疗结直肠癌肝转移（CRLM）：肿瘤预后的比较

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-21 DOI: 10.1016/j.hpb.2025.11.011

Mehdi Boubaddi , Rami Rhaiem , Florian Pecquenard , Emmanuel Buc , Fabrice Muscari , Safi Dokmak , Mehdi El Amrani , Ahmet Ayav , Alexandre Chebaro , Laurent Sulpice , René Adam , Christophe Laurent , Stéphanie Truant

Background

Patients with a high metastatic tumor burden may be candidates for extensive liver resection with a liver augmentation technique. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and liver venous deprivation (LVD) are the most effective techniques for stimulating liver growth. However, postoperative and oncological outcomes of these approaches require further clarification in large cohorts. This study assessed the oncological outcomes of patients treated for colorectal liver metastases (CRLM) using ALPPS or LVD.

Methods

All consecutive patients who underwent LVD and/or ALPPS for CRLM at eight French centers between 2011 and 2022 were included in a retrospective database. The primary endpoint was oncological outcomes according to the intention-to-treat principle. Secondary endpoints included the resection rate, intraoperative and postoperative outcomes, and a per-protocol analysis excluding patients requiring rescue ALPPS after LVD failure.

Results

In total, 214 patients with CRLM were included from the eight centers; 127 (59.3 %) underwent LVD and 87 (40.7 %) underwent ALPPS. Resectability rates, based on the intention-to-treat principle, were 84.3 % (n = 107) in the LVD group and 98.9 % (n = 86) in the ALPPS group. In the intention-to-treat analysis, median overall survival durations were 42 months in the LVD group and 30 months in the ALPPS group. Median disease-free survival durations were 7 months in the LVD group and 6 months in the ALPPS group.

Conclusion

Overall and disease-free survival did not substantially differ between LVD and ALPPS prior to major liver resection for CRLM. This study represents the largest comparison of postoperative and oncological outcomes between LVD and ALPPS in patients with CRLM; it may serve as a foundation for a randomized controlled trial.

背景：高转移性肿瘤负荷患者可能是肝增强技术广泛肝切除的候选者。分阶段肝切除术（ALPPS）和肝静脉剥夺（LVD）联合肝分区和门静脉结扎是刺激肝脏生长最有效的技术。然而，这些方法的术后和肿瘤学结果需要在大型队列中进一步澄清。本研究评估了使用ALPPS或LVD治疗结直肠癌肝转移（CRLM）患者的肿瘤学结果。方法：2011年至2022年期间在法国8个中心连续接受LVD和/或ALPPS治疗CRLM的所有患者纳入回顾性数据库。根据意向治疗原则，主要终点是肿瘤预后。次要终点包括切除率，术中和术后结果，以及排除LVD失败后需要抢救ALPPS的患者的每个方案分析。结果：8个中心共纳入214例CRLM患者；127例（59.3%）行LVD， 87例（40.7%）行ALPPS。根据意向治疗原则，LVD组的可切除率为84.3% (n = 107)， ALPPS组的可切除率为98.9% （n = 86）。在意向治疗分析中，LVD组的中位总生存期为42个月，ALPPS组的中位总生存期为30个月。LVD组中位无病生存期为7个月，ALPPS组中位无病生存期为6个月。结论：CRLM大肝切除术前LVD和ALPPS患者的总生存率和无病生存率无显著差异。这项研究是CRLM患者中LVD和ALPPS之间的术后和肿瘤预后的最大比较；它可以作为随机对照试验的基础。

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引用次数: 0

Targeted antibiotic prophylaxis strategy for pancreatectomies: an analysis of the National Surgical Quality Improvement Program 针对胰腺切除术的抗生素预防策略：国家手术质量改进计划的分析。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-15 DOI: 10.1016/j.hpb.2025.11.005

Cynthia E. Burke , Joanna T. Buchheit , Rushin D. Brahmbhatt , June S. Peng

Background

Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP.

Methods

PD and DP patients were identified from the 2015–2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses.

Results

We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72–0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates.

Conclusion

BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.

背景：最近的研究支持在开腹胰十二指肠切除术（PD）中使用广谱抗生素（BSA）预防。微创手术（MIS）和远端胰腺切除术（DP）与较少的手术部位感染（SSI）相关，相对而言，对这些手术的抗生素选择知之甚少。本研究旨在确定开放式和MIS PD和DP的最佳抗生素预防策略。方法：从2015-2020年国家外科质量改进计划数据库中识别PD和DP患者。使用单变量和多变量分析评估基线特征、抗生素选择和SSI发生率。结果：我们纳入了19535例pd（92.3%开放，7.7% MIS）和10844例dp（53%开放，47% MIS）。在开放性PD中，与头孢菌素相比，BSA与SSI发生率降低相关（OR 0.79, 95% CI: 0.72-0.82）。在MIS PD、开放式DP和MIS DP中，抗生素的选择与SSI发生率无显著相关。结论：预防BSA与开放性PD的SSI减少有关，但与MIS PD或开放式或MIS DP无关。常规头孢菌素预防可为这些人群提供足够的覆盖率，应避免过度使用牛血清白蛋白。

{"title":"Targeted antibiotic prophylaxis strategy for pancreatectomies: an analysis of the National Surgical Quality Improvement Program","authors":"Cynthia E. Burke , Joanna T. Buchheit , Rushin D. Brahmbhatt , June S. Peng","doi":"10.1016/j.hpb.2025.11.005","DOIUrl":"10.1016/j.hpb.2025.11.005","url":null,"abstract":"<div><h3>Background</h3><div>Recent research supports broad-spectrum antibiotic (BSA) prophylaxis in open pancreatoduodenectomy (PD). Minimally invasive surgery (MIS) and distal pancreatectomy (DP) are associated with fewer surgical site infections (SSI), and comparatively less is known about antibiotic choice for these operations. This study seeks to define optimal antibiotic prophylaxis strategy in open and MIS PD and DP.</div></div><div><h3>Methods</h3><div>PD and DP patients were identified from the 2015–2020 National Surgical Quality Improvement Program database. Baseline characteristics, antibiotic choice, and SSI rates were evaluated using univariate and multivariate analyses.</div></div><div><h3>Results</h3><div>We included 19535 PDs (92.3% open, 7.7% MIS) and 10844 DPs (53% open, 47% MIS). In open PD, BSA was associated with decreased odds of SSI compared to cephalosporins (OR 0.79, 95% CI: 0.72–0.82). In MIS PD, open DP, and MIS DP, antibiotic choice was not significantly associated with SSI rates.</div></div><div><h3>Conclusion</h3><div>BSA prophylaxis was associated with fewer SSI in open PD, but not MIS PD or either open or MIS DP. Routine prophylaxis with cephalosporins provides adequate coverage for these groups and overuse of BSA should be avoided.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 2","pages":"Pages 178-188"},"PeriodicalIF":2.4,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145700823","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}

引用次数: 0

IBC: Paid MBP advert_26 02 Singapore Call for Papers advert IBC：付费MBP广告26 02新加坡征文广告

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2026-02-12 DOI: 10.1016/S1365-182X(26)00026-2

引用次数: 0

Liver venous deprivation: bridging volume and function in future liver remnant hypertrophy 肝静脉剥夺：桥接容量和功能在未来肝残余肥厚。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-05 DOI: 10.1016/j.hpb.2025.10.015

Evangelia Florou , Andreas Prachalias

引用次数: 0

Direct comparison of efficacy and safety of metallic stents versus plastic stents for endoscopic drainage of pancreatic pseudocysts: a systematic review and meta-analysis 金属支架与塑料支架用于胰腺假性囊肿内镜引流的疗效和安全性的直接比较：系统回顾和荟萃分析。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-11 DOI: 10.1016/j.hpb.2025.11.003

Hualei Chen, Yuanyuan Ding, Xiaoming Xu

Background

Pancreatic pseudocyst (PPC) is a type of pancreatic fluid collection (PFCs), and endoscopic ultrasound-guided drainage is a common treatment. This study analyzed the efficacy and safety of plastic and metallic stents in managing PPC to provide evidence for clinical practice.

Methods

PubMed, EMBASE, and Cochrane Library were searched for observational studies (Jan 1, 2014–Mar 1, 2025) on metallic/plastic stent treatment for PPC. Primary outcomes were technical and clinical success; recurrence and adverse events (AEs) were secondary. Data were synthesized using fixed-effect models.

Results

Ten studies were included. Pooled analysis showed metallic stents had higher clinical success (RR = 1.07, 95 % CI 1.03–1.11, p = 0.001) and lower recurrence (RR = 0.41, 95 % CI 0.20–0.85, p = 0.02) than plastic stents. Technical success did not differ significantly (RR = 1.01, 95 % CI 0.99–1.04, p = 0.35). Metallic stents also had fewer total AEs (RR = 0.51, 95 % CI 0.36–0.73, p = 0.0003) and infections (RR = 0.33, 95 % CI 0.16–0.68, p = 0.003).

Conclusion

Metallic stents improve clinical success, reduce AEs and infection risk versus plastic stents. Robust prospective studies with long-term follow-up are needed for validation.

背景：胰腺假性囊肿（PPC）是一种胰腺积液（pfc），超声内镜引导下引流是一种常见的治疗方法。本研究分析塑料和金属支架治疗PPC的有效性和安全性，为临床实践提供依据。方法：检索PubMed、EMBASE和Cochrane图书馆关于金属/塑料支架治疗PPC的观察性研究（2014年1月1日- 2025年3月1日）。主要结局是技术和临床成功；复发和不良事件（ae）是次要的。数据采用固定效应模型合成。结果：纳入10项研究。综合分析显示，金属支架的临床成功率（RR = 1.07, 95% CI 1.03 ~ 1.11, p = 0.001）高于塑料支架，复发率（RR = 0.41, 95% CI 0.20 ~ 0.85, p = 0.02）低于塑料支架。技术成功率无显著差异（RR = 1.01, 95% CI 0.99-1.04, p = 0.35）。金属支架总ae （RR = 0.51, 95% CI 0.36 ~ 0.73, p = 0.0003）和感染（RR = 0.33, 95% CI 0.16 ~ 0.68, p = 0.003）也较少。结论：与塑料支架相比，金属支架提高了临床成功率，降低了不良反应和感染风险。需要有长期随访的强有力的前瞻性研究来验证。

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引用次数: 0

Response to “correspondence: “impact of post-hepatectomy liver failure on recurrence following major hepatectomy for colorectal cancer liver metastases” 对“通信”的回应：“肝切除术后肝功能衰竭对大肠癌肝转移术后复发的影响”。

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-21 DOI: 10.1016/j.hpb.2025.11.009

Johanna Sterner, Jennie Engstrand

引用次数: 0

IFC: Editorial Board / Aims and Scope 国际金融公司：编委会/目标和范围

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2026-02-12 DOI: 10.1016/S1365-182X(26)00019-5

引用次数: 0

OFC: Cover 离岸金融中心:封面

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2026-02-12 DOI: 10.1016/S1365-182X(26)00018-3

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OBC: Paid MBP advert_26 02 Membership Renewal Congress Abstracts Open advert OBC：付费MBP advert_26 02会员更新大会摘要开放广告

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2026-02-12 DOI: 10.1016/S1365-182X(26)00027-4

引用次数: 0

Long-term outcome after liver surgery for colorectal metastases in elderly patients: a nationwide population-based study 老年患者肝手术治疗结直肠癌转移后的长期预后：一项基于全国人群的研究

IF 2.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2026-02-01 Epub Date: 2025-11-27 DOI: 10.1016/j.hpb.2025.10.011

Victor van Woerden , Michelle R. de Graaff , Arthur K.E. Elfrink , Dirk J. Grünhagen , Niels F.M. Kok , Steven W.M. Olde Damink , Ronald M. van Dam , Joost M. Klaase , Carlijn I. Buis , Jeroen Hagendoorn , Cornelis Verhoef , Henk H. Hartgrink , Rutger-Jan Swijnenburg , Joris Erdmann , Peter B. van den Boezem , Paul D. Gobardhan , Hans Torrenga , Mike S.L. Liem , Wouter K.G. Leclercq , Koop Bosscha , Steven J. Oosterling

Background

Age alone is no longer a contraindication for resection of colorectal liver metastases (CRLM). The aim of this study was to compare survival after resection of CRLM across different age groups.

Methods

A population-based study of patients who underwent resection of CRLM in the Netherlands between 2014 and 2022 was performed. For survival analyses, data from 2014 to 2018 were used. Patients were divided into three groups: <70, 70–80, and ≥80 years. Main outcomes were overall survival (OS) and relative survival (RS), defined as survival relative to age-matched survival in the general population. Secondary outcomes included short-term postoperative outcome and risk factors influencing survival.

Results

Among 6415 patients, 3874 (60.3 %) were <70 years, 2042 (31.8 %) were 70–80, and 499 (7.7 %) were ≥80 years. Median OS was 54.2 months (<70), 47.1 months (70–80), and 40.7 months (≥80). Five-year RS was 51.8 %, 57.9 %, and 64.0 %, respectively. In multivariable analysis, age 70–80 (aHR 1.20) and ≥80 (aHR 1.50) were associated with worse OS. Other independent risk factors included Charlson score ≥2, ASA ≥3, >3 CRLM, largest CRLM >4 cm, synchronous or extrahepatic disease, and major complications.

Conclusion

Resection of CRLM in selected elderly patients results in acceptable overall survival.

背景：年龄不再是结肠直肠肝转移瘤（CRLM）切除术的禁忌症。本研究的目的是比较不同年龄组的CRLM切除术后的生存率。方法：对2014年至2022年在荷兰接受CRLM切除术的患者进行了一项基于人群的研究。对于生存分析，使用了2014年至2018年的数据。结果：6415例患者中，有3874例（60.3%）为3个CRLM，最大CRLM bb0 ~ 4cm，伴有同步或肝外病变，主要并发症。结论：选择老年患者行CRLM切除可获得可接受的总生存率。

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