Journal of Hepato‐Biliary‐Pancreatic Sciences最新文献_第9页

Prognostic Impact of HER2 Overexpression in Intraductal Papillary Neoplasm of the Bile Duct HER2过表达对胆管内乳头状肿瘤预后的影响。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-25 DOI: 10.1002/jhbp.70000

Shunsuke Onoe, Takashi Mizuno, Nobuyuki Watanabe, Shoji Kawakatsu, Junpei Yamaguchi, Taisuke Baba, Ryusei Yamamoto, Yoshie Shimoyama, Toshio Kokuryo, Tomoki Ebata

Background

Overexpression of human epidermal growth factor receptor 2 (HER2) is a recognized prognostic marker and therapeutic target in oncology. However, its clinical significance in intraductal papillary neoplasm of the bile duct (IPNB) remains unclear.

Methods

This retrospective study reviewed patients who underwent resection for IPNB between 1998 and 2011. HER2 overexpression was evaluated by immunohistochemistry and semi-quantitatively categorized into four grades (score 0, 1+, 2+, 3+); the former two and the latter two grades defined HER2-negative and HER2-positive groups, respectively.

Results

A total of 184 IPNB cases were analyzed, of which 12 patients (6.5%) were diagnosed with HER2-positive disease. There were no significant differences between the groups in clinicopathologic characteristics such as tumor location, histologic type, or invasion depth, with the exception of superficial extension, which was significantly more frequent in the HER2-positive group. The HER2-positive group demonstrated significantly worse overall survival than the HER2-negative group (25% vs. 49% at 5 years, p = 0.030). In multivariable analysis, HER2 positivity, age ≥ 70, percutaneous transhepatic biliary drainage, nodal metastasis, and positive margin status were identified as independent prognostic factors.

Conclusion

HER2 overexpression is an independent biologic marker for unfavorable survival, though infrequent in IPNB.

背景：人表皮生长因子受体2 （HER2）的过表达是公认的肿瘤预后标志物和治疗靶点。然而，其在胆管内乳头状瘤（IPNB）中的临床意义尚不清楚。方法：本回顾性研究回顾了1998年至2011年间接受IPNB切除术的患者。免疫组化评价HER2过表达，半定量分为0、1+、2+、3+ 4个等级；前两个分级和后两个分级分别定义her2阴性组和her2阳性组。结果：共分析184例IPNB，其中12例（6.5%）诊断为her2阳性疾病。两组间在肿瘤位置、组织学类型、侵袭深度等临床病理特征上均无显著差异，但her2阳性组明显多发于浅表延伸。her2阳性组的总生存率明显低于her2阴性组（5年生存率为25% vs. 49%, p = 0.030）。在多变量分析中，HER2阳性，年龄≥70岁，经皮经肝胆道引流，淋巴结转移和阳性边缘状态被确定为独立的预后因素。结论：HER2过表达是不利生存的独立生物学标志物，尽管在IPNB中并不常见。

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引用次数: 0

Impact of New Portal Reconstruction Strategy on Portal Vein Growth and Outcomes in Living-Donor Liver Transplantation for Small Children With Biliary Atresia 新的门静脉重建策略对胆道闭锁儿童活体肝移植门静脉生长和预后的影响。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-24 DOI: 10.1002/jhbp.70003

Hikaru Aoki, Eri Ogawa, Takashi Ito, Elena Yukie Uebayashi, Shinya Okumura, Yuki Masano, Tatsuya Okamoto, Hironori Haga, Hideaki Okajima, Etsuro Hatano

Background/Purpose

We evaluated the outcomes of a new reconstruction method that we adopted in 2017 for small children with biliary atresia, involving aggressive resection of the sclerotic portal vein (PV), larger anastomotic orifice, and proactive vein graft interposition.

Methods

Data from 85 patients with biliary atresia (excluding one) aged < 3 years who underwent living-donor liver transplantation from January 2011 to December 2022 were retrospectively reviewed. Patients were categorized into former (“before 2017”) and latter (“after 2017”) groups, comprising 47 and 38 patients, respectively, according to their surgery time.

Results

The percentage of trunk reconstruction cases decreased from 51% to 26%, whereas that of vein graft interposition cases increased from 38% to 68% (p = 0.021). PV complication rates improved significantly from 19% to 3% (p = 0.035). Over 6 months postoperatively, the PV diameter was < 6 mm in 44% of cases in the former group but improved to 0% in the latter group (p < 0.01). Platelet counts at 1 year postoperatively were significantly higher in the latter group.

Conclusions

In living-donor liver transplantation for small children with biliary atresia, aggressive resection of the sclerotic PV, large anastomotic orifice, and proactive vein graft interposition may reduce PV complications and provide appropriate portal dilation for body growth.

背景/目的：我们评估了我们在2017年采用的一种新的胆道闭锁儿童重建方法的结果，包括积极切除硬化门静脉（PV）、扩大吻合口和主动静脉移植物介入。方法：85例老年胆道闭锁患者（不含1例）的资料。结果：胆道重建术的比例从51%下降到26%，静脉移植的比例从38%上升到68% （p = 0.021）。PV并发症发生率由19%显著改善至3% （p = 0.035）。结论：在胆道闭锁儿童活体肝移植中，积极切除硬化PV，扩大吻合口，主动静脉移植物介入可减少PV并发症，为机体生长提供适当的门静脉扩张。

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引用次数: 0

Novel Surgical Technique of Liver Parenchyma Transection During Robotic-Assisted Liver Resection: “Trac & Pac” 机器人辅助肝切除术中肝实质横断的新手术技术：“Trac & Pac”。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-22 DOI: 10.1002/jhbp.70006

Yuta Abe, Yutaka Nakano, Yosuke Uematsu, Minoru Kitago, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Taizo Hibi, Yuko Kitagawa

Background/Purpose

A standardized liver parenchymal transection method in robotic-assisted liver resection has not yet been established, and the techniques used vary among institutions. We developed a novel transection technique for robotic-assisted liver resection termed “Trac & Pac,” which uses maryland bipolar forceps with a gentle stroking motion and strategic traction to progressively expose and dissect the liver parenchyma.

Methods

We described the technical details of “Trac & Pac” and Evaluated its short-term outcomes (2022–2025), comparing them with those of conventional laparoscopic liver resection using the Cavitron Ultrasonic Surgical Aspirator (CUSA) (2018–2022).

Results

The robotic-assisted liver resection group included 26 patients who underwent robotic left or right hepatectomy with the “Trac & Pac” technique, whereas the laparoscopic liver resection group comprised 34 patients who underwent laparoscopic left or right hepatectomy using the CUSA. The robotic group had a longer time from pneumoperitoneum to the start of intra-abdominal manipulation than the laparoscopic group (p < 0.001). Both groups had similar parenchymal transection times, blood loss, and postoperative complications.

Conclusions

“Trac & Pac” is a safe and feasible robotic-assisted liver parenchymal transection technique that may provide a new solution for improving precision and exposure in minimally invasive liver surgery.

背景/目的：机器人辅助肝切除术中标准化的肝实质横断方法尚未建立，各机构使用的技术各不相同。我们开发了一种新的机器人辅助肝脏切除术的横断技术，称为“Trac & Pac”，它使用马里兰双极钳，轻柔的抚摸运动和策略牵引，逐步暴露和解剖肝实质。方法：我们描述了“Trac & Pac”的技术细节，评估了其短期疗效（2022-2025），并将其与传统腹腔镜下使用空腔超声手术吸引器（CUSA）的肝切除术（2018-2022）进行了比较。结果：机器人辅助肝切除术组包括26例采用“Trac & Pac”技术进行机器人左或右肝切除术的患者，而腹腔镜肝切除术组包括34例使用CUSA进行腹腔镜左或右肝切除术的患者。结论：“Trac & Pac”是一种安全可行的机器人辅助肝实质横断技术，可为提高微创肝脏手术的精度和曝光率提供新的解决方案。

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引用次数: 0

Successful Closure of an Enterocutaneous Fistula Associated With Surgical Site Infection After Pancreatoduodenectomy Using an Over-the-Scope Clip System 使用超镜夹系统成功关闭胰十二指肠切除术后与手术部位感染相关的肠皮瘘。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-20 DOI: 10.1002/jhbp.70005

Sho Hasegawa, Itaru Endo, Masato Yoneda

With accompanying video, Hasegawa and colleagues report the first successful closure of an enterocutaneous fistula following pancreatoduodenectomy using an over-the-scope clip system. A 75-year-old patient achieved complete and durable healing without recurrence, demonstrating that this minimally invasive approach is a safe and effective option for managing postoperative fistulas.

随附视频，Hasegawa和他的同事报道了胰十二指肠切除术后首次使用镜外夹系统成功关闭肠皮瘘。一名75岁的患者获得了完全和持久的愈合，没有复发，表明这种微创方法是治疗术后瘘管的安全有效的选择。

引用次数: 0

Comprehensive Analysis of Chyle Leak in Resected Pancreatic Head Cancer: Impact on Clinical, Oncologic, and Nutritional Outcomes 胰头癌切除术后乳糜漏的综合分析：对临床、肿瘤学和营养结果的影响。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-13 DOI: 10.1002/jhbp.12191

Jae Seung Kwak, Chang Moo Kang, Ho Kyoung Hwang, Sung Hyun Kim, Seung Soo Hong

Background

Chyle leak (CL) is a relevant complication of pancreatic surgery, but its incidence, risk factors, clinical and oncologic impacts, and nutritional relevance remain inconsistent and limited.

Methods

We retrospectively reviewed patients who underwent pancreaticoduodenectomy for pancreatic head cancer from 2007 to 2023 at a single institution. The clinical impact of CL was evaluated by prolonged hospital stays and immune-nutritional status, assessed using the Controlling Nutritional Status (CONUT) score at discharge. Oncologic impact included the administration of adjuvant chemotherapy, the surgery-to-chemotherapy interval, overall survival (OS), and recurrence-free survival (RFS). Predictors of CL were identified through multivariate analyses.

Results

CL occurred in 70 patients (13.8%) and was significantly associated with prolonged hospital stay (OR: 1.947, p = 0.045) and poor CONUT score at discharge (> 6; OR: 1.820, p = 0.036). CL did not significantly impact oncologic outcomes, including adjuvant chemotherapy (p = 0.732), surgery-to-chemotherapy interval (p = 0.235), 5-year OS (p = 0.978), or 5-year RFS (p = 0.919). Independent predictors of CL included hypertension, lymph node metastasis, delayed gastric emptying, minimally invasive surgery (MIS), and operative time.

Conclusions

CL is associated with prolonged hospital stay and poor nutritional status at discharge, but shows no significant impact on long-term oncologic outcomes.

背景：乳糜漏（CL）是胰腺手术的相关并发症，但其发病率、危险因素、临床和肿瘤学影响以及营养相关性仍然不一致和有限。方法：我们回顾性分析了2007年至2023年在同一医院接受胰十二指肠切除术治疗胰头癌的患者。通过延长住院时间和免疫营养状况来评估CL的临床影响，出院时使用控制营养状况（CONUT）评分进行评估。肿瘤学影响包括辅助化疗的管理、手术到化疗的间隔、总生存期（OS）和无复发生存期（RFS）。通过多变量分析确定CL的预测因素。结果：70例（13.8%）患者发生CL，与住院时间延长（OR: 1.947, p = 0.045）和出院时CONUT评分差(bb0.6；OR: 1.820, p = 0.036)。CL对肿瘤预后无显著影响，包括辅助化疗（p = 0.732）、手术至化疗间隔（p = 0.235）、5年OS （p = 0.978）或5年RFS （p = 0.919）。CL的独立预测因素包括高血压、淋巴结转移、胃排空延迟、微创手术（MIS）和手术时间。结论：CL与住院时间延长和出院时营养状况不良有关，但对长期肿瘤预后无显著影响。

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引用次数: 0

Response to the Letter to the Editor 对给编辑的信的回应。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-06 DOI: 10.1002/jhbp.12185

Kazumasa Nagai, Takao Itoi

引用次数: 0

Microbiological Characteristics of Pathogens Isolated From Blood Cultures of Patients With Acute Cholangitis: Insights From Patients With Biliary-Enteric Anastomosis 急性胆管炎患者血培养病原菌的微生物学特征：来自胆肠吻合患者的见解。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-02 DOI: 10.1002/jhbp.12193

Yuta Kuhara, Hiroki Kitagawa, Yuki Kaiki, Keitaro Omori, Norifumi Shigemoto, Tomoyuki Akita, Kenichiro Uemura, Shingo Fukuma, Shinya Takahashi, Hiroki Ohge

Background

We aimed to investigate the microbiological characteristics of pathogens isolated from blood cultures (BCs) of patients with acute cholangitis (AC) after biliary-enteric anastomosis and biliary intervention (BI).

Methods

A retrospective analysis was conducted on 366 patients with AC and bacteremia between 2015 and 2024 at Hiroshima University Hospital. Patients were categorized into three groups: post-biliary reconstruction-associated AC (PBR-AC), BI-associated AC (BI-AC), and common AC (C-AC). Patients' clinical and microbiological data were statistically analyzed in each group.

Results

The most frequently isolated pathogens were Escherichia coli and Klebsiella spp., accounting for > 50% of isolates in all groups. ESCPM spp. (Enterobacter spp., including Klebsiella aerogenes, Serratia marcescens, Citrobacter freundii complex, Providencia spp., and Morganella morganii) were significantly associated with PBR- and BI-AC compared with C-AC. No significant differences in the prevalence of anaerobic bacteria were observed among the groups.

Conclusions

The prevalence of ESCPM spp. isolated from BCs was significantly higher in the PBR- and BI-AC groups than in the C-AC group. The presence of biliary-enteric anastomosis or BI history should be checked when determining the treatment strategy for AC. Cefepime may be a better antibiotic option for PBR- and BI-AC, particularly in severe cases.

背景：研究急性胆管炎（AC）患者经胆肠吻合术及胆道干预治疗（BI）后血培养物（bc）病原菌的微生物学特征。方法：回顾性分析广岛大学医院2015 ~ 2024年收治的366例AC合并菌血症患者。患者分为三组：胆道重建相关AC (PBR-AC)， bi相关AC （BI-AC）和普通AC （C-AC）。统计分析各组患者的临床及微生物学资料。结果：分离最多的病原菌为大肠埃希菌和克雷伯氏菌，占各组分离菌总数的50%。与C-AC相比，ESCPM（肠杆菌，包括产气克雷伯氏菌、粘质沙雷氏菌、弗氏柠檬酸杆菌复合体、普罗维登氏菌和摩根氏菌）与PBR-和BI-AC显著相关。各组间厌氧菌患病率无显著差异。结论：PBR-和BI-AC组bc分离ESCPM的流行率明显高于C-AC组。在确定AC的治疗策略时，应检查是否存在胆肠吻合或BI病史。对于PBR和BI-AC，特别是在严重病例中，头孢吡肟可能是更好的抗生素选择。

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引用次数: 0

Outcomes of Patients With Unresectable Cholangiocarcinoma After Portal Vein Embolization: A Propensity Score-Matched Analysis 门静脉栓塞后不可切除胆管癌患者的预后：倾向评分匹配分析。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-08-01 DOI: 10.1002/jhbp.12192

Ho Seung Lee, Tae Jun Song, Sung Hyun Cho, Gunn Huh, Dongwook Oh, Jae Min Lee, Jae Hoon Lee, Dae Wook Hwang, Dong-Wan Seo

Background

This study aimed to evaluate the outcomes of patients with unresectable cholangiocarcinoma (CCA) who underwent portal vein embolization (PVE) with a focus on overall survival (OS) and the frequency of biliary drainage (BD).

Methods

In this retrospective analysis, we evaluated 255 patients with unresectable CCA; 56 patients underwent PVE but ultimately remained unresectable. Propensity score matching (PSM) was used to minimize the potential confounding factors. The primary outcome was the OS, while the secondary outcome was BD frequency.

Results

The PVE-unresectable group showed lower OS than that in the non-PVE-unresectable group both before and after PSM (median OS: 238.5 vs. 371.0 days, p = 0.006; 238.5 vs. 483.5 days, p = 0.002, respectively). Unresectable PVE status was a predictor of worse survival both before and after PSM (hazard ratio [HR] = 2.06, p < 0.001 and HR = 2.46, p < 0.001, respectively). Chemotherapy improved survival before and after PSM (HR = 0.45, p < 0.001 and HR = 0.41, p = 0.003, respectively). The BD frequency was higher in the PVE-unresectable group than in the non-PVE-unresectable group before and after PSM (0.693 vs. 0.470 procedures per month, p = 0.010).

Conclusions

Patients with unresectable CCA who underwent PVE had worse survival outcomes and required BD. Optimizing systemic therapy and BD strategies may improve the outcomes.

背景：本研究旨在评估不可切除胆管癌（CCA）患者行门静脉栓塞（PVE）的预后，重点关注总生存期（OS）和胆道引流（BD）频率。方法：回顾性分析255例不能切除的CCA患者；56例患者接受了PVE，但最终仍无法切除。倾向评分匹配（PSM）被用来最小化潜在的混杂因素。主要终点为OS，次要终点为BD频率。结果：pve -不可切除组在PSM前后的OS均低于非pve -不可切除组(中位OS: 238.5 vs. 371.0天，p = 0.006；238.5 vs 483.5天，p = 0.002)。不可切除的PVE状态是PSM前后较差生存的预测因子（危险比[HR] = 2.06, p）。结论：不可切除的CCA患者接受PVE后生存结果较差，需要BD治疗。优化全身治疗和BD策略可能改善预后。

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引用次数: 0

Artificial Intelligence-Enhanced Navigation for Early Detection of Inferior Vena Cava and Root of the Major Hepatic Veins During Robotic Hepatectomy 人工智能增强导航在机器人肝切除术中早期发现下腔静脉和肝大静脉根。

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-07-31 DOI: 10.1002/jhbp.12195

Yutaka Nakano, Yosuke Uematsu, Yuta Abe, Masashi Takeuchi, Minoru Kitago, Yasushi Hasegawa, Shutaro Hori, Masayuki Tanaka, Hirofumi Kawakubo, Yuko Kitagawa

Nakano and colleagues developed an artificial intelligence-enhanced navigation system for robotic hepatectomy, enabling early identification of the inferior vena cava and major hepatic vein roots. Using semantic segmentation on 1030 annotated images, the model showed reliable performance and may help reduce complications, enhance safety, and support minimally invasive liver surgery.

Nakano及其同事开发了一种用于机器人肝切除术的人工智能增强导航系统，可以早期识别下腔静脉和肝大静脉根。通过对1030张带注释的图像进行语义分割，该模型表现出可靠的性能，有助于减少并发症，提高安全性，并支持微创肝脏手术。

引用次数: 0

Lymph Node Metastasis Around the Common Hepatic Artery Is Associated With Dismal Prognosis in Patients Undergoing Resection of Extrahepatic Cholangiocarcinoma 肝外胆管癌切除术患者肝总动脉周围淋巴结转移与预后不良相关

IF 2.8 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Journal of Hepato‐Biliary‐Pancreatic Sciences

Pub Date : 2025-07-29 DOI: 10.1002/jhbp.12194

Sho Kiritani, Yoshikuni Kawaguchi, Yusuke Kazami, Kyoji Ito, Yujiro Nishioka, Yuichiro Mihara, Akihiko Ichida, Takeshi Takamoto, Nobuhisa Akamatsu, Kiyoshi Hasegawa

Background

Lymph node (LN) metastasis in extrahepatic cholangiocarcinoma (eCCA) is associated with poor prognosis, but the impact of specific metastatic sites is unclear. This study investigated the clinical significance of LN metastasis around the common hepatic artery (N [CHA]) in eCCA.

Methods

A total of 291 patients who underwent curative resection for eCCA between 2002 and 2022 were retrospectively reviewed. Patients were classified as N1 (CHA), N1 (other, regional LN metastasis without CHA), or N0. Clinical characteristics and long-term outcomes were compared. The short-to-long axis ratio (SLR) of CHA nodes on preoperative CT was evaluated for diagnostic value.

Results

Of 291 patients, 164 had perihilar and 127 had distal cholangiocarcinoma. The N1 (CHA), N1 (other), and N0 groups included 33, 103, and 155 patients, respectively. Five-year cancer-specific survival (CSS) rates were 6.9% (N1 [CHA]), 24.7% (N1 [other]), and 60.3% (N0). N1 (CHA) and N1 (other) had CSS hazard ratios of 3.34 and 1.86, respectively (p < 0.01). The area under the receiver operating characteristics curve for SLR in predicting N1 (CHA) was 0.779.

Conclusions

N1 (CHA) is a strong negative prognostic factor in eCCA. CHA node status may serve as a useful imaging-based marker of biological resectability.

背景：肝外胆管癌（eCCA）的淋巴结（LN）转移与预后不良有关，但具体转移部位的影响尚不清楚。本研究探讨肝总动脉（N [CHA]）周围淋巴结转移在eCCA中的临床意义。方法：回顾性分析2002年至2022年间291例eCCA根治性切除术患者的临床资料。患者分为N1 (CHA), N1（其他，无CHA的区域淋巴结转移）和N0。比较临床特征和远期结果。评估术前CT上CHA淋巴结的长短轴比（SLR）的诊断价值。结果：291例患者中，肝门周围胆管癌164例，远端胆管癌127例。N1 （CHA）组33例，N1（其他）组103例，N0组155例。5年癌症特异性生存率（CSS）分别为6.9% （N1 [CHA]）、24.7% （N1 [other]）和60.3% （N0）。N1 （CHA）和N1 （other）的CSS危险比分别为3.34和1.86 (p)。结论：N1 （CHA）是eCCA患者预后不良的重要因素。CHA节点状态可作为一种有用的基于成像的生物可切除性标记。

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引用次数: 0