Hpb最新文献

Background: Obesity is increasing in the U.S., with more liver donors having body mass index (BMI)≥35. BMI is an imperfect indicator of visceral obesity and hepatosteatosis, complicating its impact on graft survival (GS).

Methods: Adult deceased donor data from the United Network for Organ Sharing database (2010-2023) were analyzed. The impact of donor obesity (BMI≥35) on short- and long-term GS was examined, stratified by donor gender and age, two factors related to visceral obesity.

Results: Donors with BMI≥35 doubled over the study period, comprising 18.2 % of donation after brain death donors in 2023. Grafts from male donors with BMI≥35 had worse 30-day GS than grafts from donors with BMI<35 (hazard ratio 1.47, P < 0.01), but not in grafts from female donors with BMI≥35 or in 5-year GS. Donor obesity increased risk only in grafts from male donors under 55 (hazard ratio 1.58, P < 0.01), with no effect in grafts from older male or female donors.

Discussion: Donor BMI≥35 was associated with increased risk of short-term graft loss, especially among grafts from male donors. However, grafts from female donors with BMI≥35 and from male donors aged≥55 with BMI≥35 may warrant broader use.

Background: Neoadjuvant chemotherapy (NAC) may improve outcomes in perihilar cholangiocarcinoma (PHC); however, its efficacy compared with upfront surgery (US) for resectable PHC remains unclear. We compared survival and clinicopathological characteristics between NAC and US in patients with technically resectable PHC, using propensity score matching (PSM).

Methods: We retrospectively analyzed 261 patients with resectable PHC who underwent surgical treatment (2016-2024) across multiple institutions. Among them, 50 received NAC and 199 underwent US. The 38 patients receiving NAC were matched 1:1 with patients undergoing US using PSM. Overall survival (OS) and progression-free survival (PFS) were compared between groups. Pathological response to NAC and its association with chemotherapy doses were also evaluated.

Results: Before PSM, OS and PFS did not differ significantly between the US and NAC groups. After PSM, OS did not differ significantly between groups, but PFS was significantly longer in the NAC group, where patients with a therapeutic-effect grade ≥1b had better PFS than those with US. Grade ≥1b response was associated with receiving ≥7 NAC doses.

Discussion: NAC may improve PFS in selected patients with resectable PHC, especially those showing major pathological responses. Prospective studies should validate these findings and define optimal selection criteria and regimens.

Background: Recurrence after Whipple for ampullary carcinoma remains incompletely defined; this retrospective cohort aimed to delineate patterns and predictors of failure to guide adjuvant strategies.

Methods: Consecutive patients undergoing standard Whipple for histologically proven ampullary adenocarcinoma (January 2018-December 2024) were analyzed (n=189); recurrence patterns were classified, survival estimated by Kaplan-Meier, and predictors assessed by multivariable logistic regression.

Results: Over a median 30.6 months, recurrence occurred in 29.6% (distant 23.3%, local 6.3%); independent predictors of distant recurrence included CA19‑9 >79 U/mL (aOR 2.62; P=0.027), nodal positivity (aOR 2.50; P=0.037), and delayed gastric emptying (aOR 3.17; P=0.006), while adjuvant therapy reduced risk (aOR 0.37; P=0.018). Perineural invasion predicted local recurrence on univariate analysis (OR 8.83; P<0.001); 3‑ and 5‑year overall survival were 69% and 46.1%, respectively, and adjuvant therapy in node‑positive patients reduced distant recurrence from 65.0% to 15.4% (OR 0.098; P<0.001).

Conclusion: Recurrence is predominantly systemic and driven by nodal status and CA19‑9, adjuvant chemotherapy mitigates distant failure-particularly in N1-and the identification of delayed gastric emptying as an independent predictor underscores the oncologic importance of perioperative optimization; histologic subtype was not independently prognostic.

Background: hypertrophy techniques expanded surgical indications, but some patients still experience limited clinical benefit. We aimed to identify futility predictive factors in major hepatectomies after liver venous deprivation (LVD) or ALPPS-variants (tourniquet-ALPPS or hybrid-ALPPS).

Methods: a bi-institutional cohort study conducted between 01/2015 and 07/2024 including major hepatectomies for oncologic disease following one of the three augmentation strategies.

Exclusion criteria: age <18, benign pathology, follow-up < 6-months, and interstage dropout. Futility corresponded to 90-days mortality or very early recurrence (≤6 months). Predictors of futile outcomes were identified by uni- and multi-variate analyses and utilized to build a futility score (0-10).

Results: 84 patients completed the surgical process (dropout rate: 21.1 %): 40.5 % underwent LVD, 33.3 % tourniquet-ALPPS, and 26.2 % hybrid-ALPPS. Futility was observed in 35 patients (41.7 %) and logistic regression identified baseline sFLR (OR 0.89, p = 0.013), associated procedures (OR 3.07, p = 0.046), right trisectionectomy (OR 5.61, p = 0.031), and non-radical resection (OR 4.31, p = 0.01) as independent predictors. A futility score ≥4 (n = 36) predicted a futile outcome with good discrimination (AUC 0.802; p < 0.001).

Conclusion: Technical success after hypertrophy techniques not always equates clinical benefit. Recognizing predictors of futility may improve patient selection and guide more personalized therapeutic strategies.

Background: The safety of living donor liver transplantation (LDLT) has improved over the years, and yet biliary anastomotic complications remain substantial occurring in up to 25%, affecting short-term and long-term outcomes. The meta-analyses is performed to compare biliary complication rates, based on the number of ducts, including bile leaks and strictures, in right-lobe living donor liver transplantation (RLLDLT) using duct-to-duct (DD) anastomosis versus Roux en Y Hepaticojejunostomy (HJ).

Methods: PubMed, Cochrane and Embase databases were searched comprehensively for studies on adult LDLT, focusing on the bile duct reconstruction method for RLLDLT.

Results: Fifteen retrospective studies with 1770 patients were included. DD anastomosis is associated with a significantly reduced rate of all biliary complications compared to HJ (OR 1.16, 95% CI (0.82-1.64), p= 0.40), and particularly a lower incidence of bile leak (OR 0.61, 95% CI (0.38-0.98), p=0.04), while the rates of biliary strictures (OR 1.49, 95% CI (0.83-2.69), p=0.18) did not differ significantly. Grafts with multiple bile ducts (1 vs. >1) were associated with higher complication rates (OR 0.80, 95% CI (0.54-1.19), p=0.27).

Conclusion: The meta-analyses supports DD over HJ where both are feasible, and highlights the importance of individualised biliary reconstruction strategies to improve patient outcomes in RLLDLT.

Background: Optimal perioperative analgesia for upper gastrointestinal (UGI) surgery remains uncertain despite multiple available options. This network meta-analysis (NMA) evaluated the comparative effectiveness of local and regional analgesic techniques on postoperative pain and opiate consumption following open UGI surgery.

Methods: A Bayesian NMA of randomised controlled trials (RCTs) was performed using MEDLINE, Embase, PubMed, and CENTRAL (January 2010-November 2023). The primary outcome was postoperative pain intensity at rest at 24 h.

Results: Fifty-three RCTs (n = 4207 patients) were included. Epidural analgesia provided the greatest reduction in 24-h pain (Mean Difference (MD) -0.976; Credible Interval (CrI) -0.558,-1.401) and opiate consumption (MD -24.717; CrI -16.541,-33.355). The transversus abdominis plane (TAP) block significantly reduced pain at 24 and 48 h, while local wound infiltration and continuous wound catheter infusion demonstrated strong opioid-sparing effects. Only the TAP block resulted in a significant reduction in hospital length of stay. Sensitivity and procedure-specific analyses showed results consistent with the primary analysis.

Conclusion: Epidural analgesia provides the greatest early analgesic and opioid-sparing benefit following open UGI surgery, though these effects do not consistently translate into improved recovery outcomes. TAP block and wound-based analgesic techniques offer effective, less invasive alternatives that may be preferable in selected patients.

Purpose: HBV-related HCC shows prognostic heterogeneity not fully captured by current staging. We developed and validated the APHPBA score, a laboratory-based model for patients undergoing curative hepatectomy.

Methods: This multicenter retrospective study included patients who underwent hepatectomy for HBV-related HCC between 2018 and 2023. The APHPBA score incorporated six routine preoperative parameters: alpha-fetoprotein (AFP), protein induced by vitamin K absence-II (PIVKA-II), HBV-DNA, prothrombin time (PT), bilirubin (BIL), and albumin (ALB). Patients were stratified into three stages: Stage I (0-1 point), Stage II (2-3 points), and Stage III (4-6 points). Prognostic performance was compared with conventional systems using Cox regression and time-dependent receiver operating characteristic (ROC) analyses.

Results: Among 1100 patients, 36.7 % were Stage I, 48.5 % Stage II, and 14.8 % Stage III. After a median follow-up of 48.0 months, 5-year overall survival was 63.4 %, 43.3 %, and 26.4 % across Stages I-III (P < 0.001). The APHPBA score remained independently associated with overall survival after adjustment for clinicopathologic factors and consistently outperformed established staging systems with higher time-dependent AUCs.

Conclusion: The APHPBA score provides robust postoperative risk stratification for HBV-related HCC using routinely available laboratory parameters.