Hpb最新文献

Background: Accurate liver volumetry is crucial for safe living donor liver transplantation (LDLT). Manual segmentation is time-consuming and delays surgical planning. Artificial intelligence (AI) enables automated 3D volumetry, improving workflow efficiency and accuracy.

Methods: This retrospective study analyzed 583 living liver donor candidates who underwent preoperative CT volumetry between January 2023 and February 2025 at Samsung Medical Center. Donors were grouped into conventional 2D manual segmentation and AI-based 3D volumetry. Volumetric data before and after AI refinement were compared with intraoperative graft weights. Turnaround time, agreement between AI and manual results, and prediction accuracy were assessed. Subgroup analyses excluded donors with segmental resections or >5 % preoperative weight loss.

Results: Of 583 donors, 271 underwent surgery, and 239 met inclusion criteria. The AI group had shorter turnaround times (1.5 ± 1.5 vs. 4.2 ± 3.6 days; p < 0.001). AI and manually edited volumes correlated strongly (R² = 0.992; mean difference 23.7 ± 39.5 mL). After exclusions, AI-based volumetry showed superior predictive performance (R² = 0.818; median error 54.0 mL) versus conventional methods (R² = 0.707; median error 65.0 mL).

Conclusions: AI-assisted 3D volumetry enables fast, accurate graft volume estimation, reducing processing time and manual effort in LDLT.

Clinical trial registration: Not applicable.

Background: Although minimally invasive surgery is widely accepted across surgical disciplines, its role in pancreatic cancer continues to be debated. The objective of the São Paulo Consensus on Minimally Invasive Pancreatic Surgery (MIPS) was to establish consensus statements on the use of MIPS for pancreatic cancer, integrating contemporary evidence and recent advances.

Methods: A scoping literature review informed statement development across five thematic groups: (1) Left Pancreatectomy for Pancreatic Cancer, (2) Pancreatoduodenectomy and Total Pancreatectomy for Pancreatic Cancer, (3) Neuroendocrine Pancreatic Tumors, (4) Patient Evaluation and Surgical Technique, and (5) Implementation, Training, and Innovation. A three-round modified Delphi process was conducted with an international panel of 52 expert pancreas surgeons. Consensus was defined as ≥90 % agreement.

Results: From 2590 publications, 185 studies were selected for inclusion. Fifty-two hepatopancreatobiliary surgeons, with a median of 22 years of experience, achieved consensus through a three-round Delphi process. Ultimately, 22 of the initial 28 statements met the ≥90 % agreement threshold. The resulting recommendations provide evidence-based guidance on minimally invasive pancreas resection for cancer, including neuroendocrine tumors, patient evaluation, program implementation, and innovation.

Discussion: The São Paulo Consensus provides contemporary, evidence-based recommendations to guide the safe and judicious adoption, implementation, and practice of minimally invasive techniques.

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.

Background: Hepatocellular carcinoma (HCC) treatment is evolving rapidly with systemic/locoregional therapies which increase surgical options. This study explores whether neoadjuvant therapies affect early surgical outcomes.

Methods: National Surgical Quality Improvement Program (NSQIP) database was used to identify patients who underwent major hepatectomy for HCC from 2020 to 2023. We defined two groups; upfront hepatectomy and neoadjuvant therapy. Patient characteristics, preoperative and intraoperative factors, and postoperative outcomes were analyzed.

Results: Of 837 patients, 673 (80.4 %) had upfront hepatectomy, 164 (19.6 %) had neoadjuvant therapy. Neoadjuvant therapy patients were more likely to have preoperative albumin <3.5 gm/dL (23.1 vs 13.8 %, p = 0.004), pre-operative platelet count <150 10³/jL (17.2 vs 10.6 %, p = 0.016), transfusions (36.6 vs 23.2 %, p < 0.001), biliary reconstruction (9.8 vs 5.5 %, p = 0.04) and operative time >300 min (51.2 vs 34.7 %, p < 0.001). Length of stay and 30-day mortality were similar. Multivariate analysis showed intraarterial therapy and hepatitis B were more predictive of developing grade B/C liver failure.

Conclusions: While neoadjuvant therapy for HCC may increase surgical candidacy, patients may be sicker at resection and cases may be more challenging. Although early mortality is similar, neoadjuvant therapy may potentially affect liver function. More studies are needed to optimally select patients for conversion therapy.

Background: Hepatic cystic echinococcosis (HCE) appears more severe in human immunodeficiency virus (HIV) co-infected (HIV+) patients with a more complicated clinical presentation (larger, multifocal cysts, biliary obstruction, secondary infection, cyst rupture), often necessitating urgent treatment with higher post-operative complications. This case-cohort study compared HCE treatment outcomes in HIV+ and HIV negative (HIV-) patients.

Methods: Patients with known HIV status who underwent HCE surgery at our tertiary institution between 2011 and 2023 were assessed for pre-, intra-, and post-operative outcomes. Surgical complications were compared using the Accordion severity scores.

Results: The majority of the 87 operated patients were HIV+ (51.7 %). Complication rates were comparable between the HIV+ and HIV- groups with similar Accordion severity scores. Cholangitis was statistically less frequent in HIV+ (6.7 %) vs. HIV- patients (26.2 %), p = 0.019. Cyst infection rates were lower in HIV+ (20.0 %) than in HIV- (38.1 %) patients. Five HIV+ and three HIV- patients required re-operation. Mortality occurred in two HIV+ and five HIV- patients.

Conclusion: Although outcomes were similar, the disproportionately high number of HIV+ patients (51.7 %) compared to the general population HIV prevalence (12.7 %) suggests that HCE is less self-limiting with HIV co-infection, supporting a potential link between co-infection and severity of disease presentation.

Background: This study evaluated how lesion location affects treatment response and prognosis in hepatocellular carcinoma (HCC) patients treated with lenvatinib (LEN) or immune checkpoint inhibitors (ICIs; atezolizumab/bevacizumab or durvalumab/tremelimumab). Considering tumor microenvironment and heterogeneity, we analyzed lesion-specific responses to optimize therapy.

Methods: In this retrospective study, lesion-specific responses were assessed for intrahepatic lesions (IHLs), lung, lymph node, intra-abdominal, and other lesions; bone metastases were excluded due to evaluation limitations. Responses were measured using a modified size-based RECIST 1.1 method. Lesion-specific objective response rate (ORR) and disease control rate (DCR) were compared between LEN and ICI groups.

Results: ORR for IHLs was higher with ICIs than LEN (16.3 % vs. 3.5 %, P = 0.002). No significant differences were observed for lung, lymph node, or intra-abdominal lesions; adrenal metastases showed no response in either group. Subgroup analysis indicated better ORR and DCR for lung lesions treated with ICIs and lymph node lesions treated with LEN in patients without IHLs versus those with IHLs.

Conclusions: ICIs achieved higher ORR in IHLs than LEN, with no significant differences for metastatic lesions. The presence of IHLs may influence distant lesion response, and therapeutic efficacy varies with treatment regimen.

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.

Background: Repeat hepatectomy for recurrent colorectal liver metastasis (CRLM) is offered to selected patients but with limited data from population-derived cohorts related to outcomes.

Method: An observational cohort study of patients who underwent an index hepatectomy for CRLM within a population-defined region. Clinicopathological and molecular data were recorded. Overall and recurrence-free survival was calculated.

Results: 192 patients (245 hepatectomies) were included, of which 91 (47%) patients developed liver-recurrence after index hepatectomy, and 43 patients (47%) were offered a second repeat hepatectomy; 28 (64%) patients developed a further new liver-recurrence and 8 (29%) had a third re-hepatectomy. There was no clinicopathological difference between patients offered repeat hepatectomy and those that were not. Extrahepatic metastasis occurred more often in those with no repeat surgery (n = 30, 63%) than in the repeat hepatectomy group (n = 7, 16%; P < 0.001). Overall survival after first hepatectomy was 46 months (IQR 15-73). For patients offered hepatectomy, estimated median overall survival was 60 months (IQR 36-159). Median recurrence-free survival after repeat surgery was 6 months (IQR 3-22).

Conclusion: Repeat surgery for CRLM in a non-selected cohort offers favorable long-term overall survival, although recurrence free survival is short. Extrahepatic recurrence was the most prevalent factors negating further hepatectomy.

Background: Liver surgery carries a high risk of complications due to the interplay of patient-related factors, disease characteristics and liver function. This European consensus provides evidence-based guidance on selected aspects of perioperative care.

Methods: A modified Delphi process was used to achieve consensus, with a 70 % agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a nurse and physiotherapist. Systematic literature search was conducted in PubMed/Medline, EMBASE, Web of Science, and Cochrane databases. Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology.

Results: Six topics were addressed: (i) thromboprophylaxis, (ii) antibiotics, (iii) prehabilitation-nutrition-mobilisation, (iv) bile leaks, including bilio-enteric anastomosis, (v) post-hepatectomy haemorrhage, (vi) post-hepatectomy liver failure (PHLF). Screening yielded 204 included publications (initial 6514) and thirty-two statements were formulated (median evidence-level:2). Evidence strength varied by topic with lower evidence-levels in complex surgery settings and subcohorts. Study heterogeneity and specific inclusion criteria resulted in some topics in conditional recommendations despite high-level evidence. Weakest evidence was found for thromboprophylaxis and PHLF managment. Strong recommendations were formulated for prehabilitation, mobilisation, and avoidance of routine drainage. Several evidence gaps warranting multicentre studies were identified.

Conclusion: Optimising perioperative care after hepatectomy remains challenging. Standardising key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.