Hpb最新文献

Background: Although the prognosis for gallbladder cancer (GBCA) improves with early diagnosis and aggressive surgical treatment, the management of patients with muscle layer invasion (T1b) remains controversial. This study aimed to analyze the optimal surgical approach for these patients.

Methods: A database was queried for patients with early T1b GBCA treated at four Chilean hospitals. Patients were prospectively treated and registered by the same surgical team at each hospital. Clinical outcomes, including survival rates according to the type of surgery, were analyzed.

Results: Between 1988 and 2023, 129 Chilean patients were pathologically diagnosed with T1b GBCA. Simple cholecystectomy (SC) was performed in 86 patients (66.7 %), while extended cholecystectomy (EC) was performed in 43 patients. The overall 5-year survival rate was 83 %, with no significant difference between SC and EC patients.

Conclusion: Simple cholecystectomy demonstrated survival rates comparable to extended cholecystectomy for patients with T1b GBCA. More extensive resections did not improve the prognosis.

Background: Enhanced Recovery After Surgery (ERAS) protocols decrease postoperative complications, but data on their effect on diabetic patients undergoing pancreatectomy are scarce. This study assessed whether diabetes mellitus (DM) was a morbidity predictor after pancreatectomy within an ERAS program.

Methods: A cross-sectional study including all patients who underwent pancreatectomy (2012-2022) and followed an ERAS pathway was performed. Multivariable analysis was used to determine whether DM was a morbidity predictor. Association between ERAS compliance and morbidity rate was assessed.

Results: A total of 558 patients were included (266 women, median age 66, median body-mass index 25). Most patients underwent open pancreatoduodenectomy (n=369, 66%). In diabetic patients with overall ERAS compliance≤60 %, morbidity was 38/40 (95%), whereas in diabetic patients with overall ERAS compliance>60 %, it decreased to 37/50 (74%, p=0.008). DM was not found as an independent complication predictor (OR 0.7, 95%CI 0.4-1.2, p=0.186), while body-mass index>25 kg/m² and preoperative biliary stenting were preoperative morbidity predictors (OR 1.1, 95%CI 1.0-1.1, p=0.049; OR 1.7, 95%CI 1.0-2.5, p=0.044).

Conclusion: This study showed that DM was not associated with postoperative complications after pancreatectomy within an ERAS program. It highlighted the importance of a good ERAS compliance to decrease the risk of postoperative complications in DM patients.

Background: Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.

Methods: Data were retrieved from the Italian HE. RC.O.LE.S. registry. Patients were categorized into OLR or MALS groups and stratified by complexity grade (CP1, CP2, CP3). An inverse probability weighting (IPW) was performed to ensure balanced comparisons.

Results: From 2008 to 2021, 4738 patients were included: 1596 (33.7 %) underwent MALS, and 3142 (66.3 %) underwent OLR. CP1 procedures were conducted in 2522 cases (53.2 %), CP2 in 974 cases (20.5 %), and CP3 in 1242 cases (26.2 %). For CP1, MALS was associated with reduced POA (OR 0.356, 95%CI:0.29-0.43, p < 0.001), and MC (OR 0.738, 95%CI:0.59-0.91, p: 0.006). In CP2, MALS showed association with MC (OR 0.557, 95%CI:0.37-0.82, p:0.004), but not with POA. For CP3, MALS was associated with increased MC risk (OR 1.441, 95%CI:1.10-1.88, p:0.008). Low-volume centers had significantly higher MC risks after CP2 and CP3 procedures than medium or high-volume centers.

Conclusion: In CP1 and CP2 procedures, MALS was proven advantageous in reducing POA and MC. Among CP3, MALS increased the risk of MC, but not among high-volume centres.

Background: The two-stage surgical technique of associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) enables extensive liver resection and promotes future liver remnant regeneration (FLR), in part by inhibiting the Hippo signalling pathway. Its main effector, Yes-associated protein (YAP), has low intrinsic transcriptional activity and requires the transcription enhanced associated domain factor (TEAD) family members as cofactors for target gene transcription. We evaluated the intracellular localization and expression of TEAD1-4, hypothesized to regulate the activity of YAP and, consequently, liver regeneration.

Methods: The intracellular localization of TEAD1-4 was characterized in tumor-free liver (TFL) tissue samples from 44 ALPPS patients obtained during the two stages of ALPPS surgery. Expression levels were correlated with clinical and pathological data as well as liver regeneration metrics.

Results: TEAD family members are simultaneously expressed in individual hepatocytes and show relations with liver regeneration, clinical outcome and outcome parameters when comparing TFL tissue obtained at different stages of ALPPS surgery. Furthermore, differences in TEAD expression and localization within hepatocytes appeared to be independent of global factors.

Conclusion: TEAD1-4 expression correlates with liver regeneration outcomes. Specifically, cytoplasmic and nuclear expression scores of TEAD1 serve as predictive markers for clinical outcomes following ALPPS.

Background: Hepato-Pancreato-Biliary (HPB) surgery is a complex specialty and Artificial Intelligence (AI) applications have the potential to improve pre- intra- and postoperative outcomes of HPB surgery. While ethics guidelines have been developed for the use of AI in clinical surgery, the ethical implications and reliability of AI in HPB surgery remain specifically unexplored.

Methods: An online survey was developed by the Innovation Committee of the E-AHPBA to investigate the current perspectives on the ethical principles and trustworthiness of AI in HPB Surgery among E-AHPBA membership. The survey consisted of 22 questions, based on guidelines outlined by the Artificial Intelligence Surgery Journal Task Force on AI Ethics in clinical surgery and was disseminated via email to all E-AHPBA members.

Results: A total of 84 members of the E-AHPBA participated in the survey. Seventeen out of 22 questions achieved more than 80 % agreement, with nine of those exceeding 90 %. Five questions had agreement levels between 70 % and 80 %.

Conclusion: While HPB surgeons are aware of the need to regulate the use of AI devices, robots, and to protect patient data, consensus appears to be heterogeneous regarding AI's role in mitigating gender-related and minority biases, as well as ensuring fairness and equity.

Objective: We sought to develop a machine learning (ML) preoperative model to predict bile leak following hepatectomy for primary and secondary liver cancer.

Methods: An eXtreme Gradient Boosting (XGBoost) model was developed to predict post-hepatectomy bile leak using data from the ACS-NSQIP database. The model was externally validated using data from hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) multi-institutional databases.

Results: Overall, 20,570 and 2253 patients were identified from the ACS-NSQIP and multi-institutional databases, respectively. The incidence rates of bile leak were 7.0 %, 6.3 % and 10.2 % in the ACS-NSQIP, HCC and ICC databases, respectively. The XGBoost model achieved areas under receiver operating characteristic curves (AUROC) of 0.748, 0.719 and 0.711 in the training, testing and external validation cohorts, respectively. The SHAP algorithm demonstrated that the factors most strongly predictive of postoperative bile leak were serum alkaline phosphatase, surgical approach and cancer diagnosis. An online tool was developed for ease-of-use and clinical applicability (https://altaf-pawlik-bileleak-calculator.streamlit.app/).

Conclusion: A novel ML model demonstrated strong discrimination power to preoperatively identify patients at high risk of developing bile leak post-hepatectomy. The online calculator may be used as a clinical tool to inform preoperative surgical planning, intraoperative decision-making, and postoperative recovery protocols for patients undergoing hepatectomy.

Background: Cystic echinococcosis (CE) is a significant public health issue, primarily affecting the liver. While several management strategies exist, there is a lack of predictive tools to guide surgical decisions for hepatic CE. This study aimed to develop predictive models to support surgical decision-making in hepatic CE, enhancing the precision of patient allocation to surgical or non-surgical management pathways.

Methods: This retrospective analysis included 406 hepatic CE patients treated at our center (2009-2021). Clinical, imaging, and treatment data were used to develop a Cox regression and a decision tree model to identify factors influencing surgical intervention, with model performance validated using K-fold cross-validation, train/test split, bootstrapping.

Results: Imaging findings and symptomatology emerged as the most significant predictors. The Cox model demonstrated a concordance index of 0.94 and an AUC of 0.96, while the decision tree model identified imaging, cyst stage, and symptoms as critical factors, achieving strong performance across validation techniques (mean AUC 0.950; 95% CI: [0.889, 0.978]).

Conclusion: This study presents validated predictive models for assessing surgical risk in hepatic CE. Integrating these models into clinical practice offers a dynamic tool that surpasses static guidelines, optimizing patient allocation to surgical or non-surgical pathways and potentially improving outcomes.

Background: Most patients undergoing pancreaticoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC) develop recurrence. No previous studies have investigated predictors of local-only recurrence following PD for PDAC. Our study aimed to determine timing, pattern and predictors of any-site and local-only recurrence following PD for PDAC.

Methods: Patients who underwent PD for PDAC between June 2012 and May 2015 (29 centres, eight countries) were included. The primary outcome was recurrence pattern (none, local-only, distant-only or mixed local/distant). Data were collected on demographics, comorbidities, investigations, operation details, complications, histology, adjuvant therapies, recurrence and survival. Univariable tests and regression analysis investigated factors associated with any-site and local-only recurrence.

Results: Of 866 patients, 573 (66 %) developed recurrence: 170 (20 %) developed local-only recurrence, 164 (19 %) developed mixed local/distant recurrence, and 239 (28 %) developed distant-only recurrence. Local-only or lung-only recurrence had a more favourable prognosis than other recurrence patterns. Predictors of any-site recurrence were preoperative biliary stenting, venous resection and poorly-differentiated, node-positive tumours. Predictors of local-only recurrence were preoperative radiological lymphadenopathy, well-differentiated tumours, fewer than 15 resected lymph nodes and intraoperative blood transfusion.

Discussion: Ensuring radical resection and avoiding intraoperative blood transfusion may reduce the risk of local-only recurrence following PD for PDAC.