Hepatobiliary & Pancreatic Diseases International最新文献

英文中文

Three-dimensional visualization helps surgoens to make surgical decision: The 3D-ViDru trial - a randomized trial 三维可视化帮助外科医生做出手术决定：3D-ViDru试验-一项随机试验。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-02 DOI: 10.1016/j.hbpd.2025.12.003

Esther Giehl-Brown , Frederic Konrad , Steffen Löck , Johannes Schweipert , Felix Schön , Jens-Peter Kühn , Jürgen Weitz , Carina Riediger

Background

Successful liver resection in oncologic surgery depends on safety, precision, and efficacy, all of which require a thorough understanding of liver anatomy. Contrast-enhanced computed tomography (CT)-generated three-dimensional (3D) models have been proposed as a valuable tool to enhance this understanding. However, a systematic comparison of different display modalities across professional groups has not yet been performed.

Methods

In this prospective, monocentric randomized trial, we compared high-resolution two-dimensional (2D) CT images of liver malignancies with their corresponding standardized, non-colored 3D virtual and printed models in facilitating anatomical and spatial understanding as well as surgical decision-making. A total of 91 participants, including 40 surgeons, 10 radiologists, and 41 students, evaluated six clinical cases (three centrally and three peripherally located liver malignancies). Each participant assessed one central and one peripheral case per display modality, presented in a random order.

Results

Compared to 2D CT images, both 3D virtual and printed models significantly improved the identification of tumor location (P < 0.001), enhanced the comprehension of spatial relationships with adjacent liver and portal veins (P < 0.001 and P = 0.019, respectively), and facilitated clinical decision-making (P < 0.001). No significant difference was observed between virtual and printed models in terms of effectiveness. Within the different groups, surgeons and students, but not radiologists, more accurately identified tumor location and spatial relationships with adjacent liver and portal veins using 3D models. Subjectively, most surgeons and students preferred 3D printed models over virtual models and 2D CT images.

Conclusions

This study demonstrated that standardized, non-colored 3D virtual and printed models equally help preoperative anatomical understanding and decision-making, particularly for surgeons and students. By isolating the influence of display modality, our findings clarify prior inconsistent results and support the integration of cost-effective 3D visualization by applying virtual models into surgical planning and education. Preference for printed models despite comparable efficacy highlights the importance of user-centered implementation strategies.

背景：在肿瘤手术中成功的肝切除依赖于安全性、精确性和有效性，所有这些都需要对肝脏解剖有透彻的了解。对比增强计算机断层扫描（CT）生成的三维（3D）模型已被提出作为一种有价值的工具来加强这种理解。然而，不同的显示方式在专业团体之间的系统比较尚未进行。方法：在这项前瞻性、单中心随机试验中，我们将肝脏恶性肿瘤的高分辨率二维（2D） CT图像与其相应的标准化、非彩色3D虚拟和打印模型进行比较，以促进解剖和空间理解以及手术决策。共有91名参与者，包括40名外科医生，10名放射科医生和41名学生，评估了6例临床病例（3例中心和3例周围肝脏恶性肿瘤）。每个参与者评估一个中心和一个外围的情况下，每个显示模式，以随机顺序呈现。结果：与2D CT图像相比，3D虚拟模型和打印模型均显著提高了肿瘤位置的识别（P < 0.001），增强了对邻近肝脏和门静脉空间关系的理解（P < 0.001和P = 0.019），促进了临床决策（P < 0.001）。在有效性方面，虚拟模型和打印模型之间没有显著差异。在不同的小组中，外科医生和学生，而不是放射科医生，使用3D模型更准确地确定肿瘤的位置以及与邻近肝脏和门静脉的空间关系。主观上，大多数外科医生和学生更喜欢3D打印模型，而不是虚拟模型和2D CT图像。结论：本研究表明，标准化、非彩色3D虚拟和打印模型同样有助于术前解剖理解和决策，特别是对外科医生和学生。通过隔离显示方式的影响，我们的研究结果澄清了先前不一致的结果，并支持通过将虚拟模型应用于手术计划和教育中，将具有成本效益的3D可视化整合起来。尽管效果相当，但对打印模型的偏好突出了以用户为中心的实施策略的重要性。

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引用次数: 0

Machine learning model stratify hepatocellular carcinoma patients into high- and low-risk recurrence or death group post curative resection 机器学习模型将肝细胞癌患者在治愈切除后分为高、低复发或死亡风险组。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.09.001

Jun-Jun Jia , Yu-Yang Wang , Xin-Yue Tan , Yu Nie , Shu-Sen Zheng , Hang-Jin Jiang

Background

The high recurrence rate of hepatocellular carcinoma (HCC) following curative resection affects patient survival. The present study combined critical clinicopathological features and molecular markers to develop machine learning models to predict the risk of recurrence and mortality. We aimed to individualize risk stratification, post-surgical management strategies, and ultimately improve long-term prognosis for HCC patients with curative resections.

Methods

A total of 815 HCC patients undergoing surgical resection were divided randomly into a training cohort (n = 652) and a validation cohort (n = 163). To build a high-accuracy recurrent/death classifier using clinicopathological characteristics and molecular biomarkers, four different machine learning models, including the Cox proportional risk model, generalized linear model, extreme gradient boosting (XGBoost) model, and random survival forest (RSF) model, were developed and comprehensively compared. The outcomes were recurrence-free survival (RFS) and overall survival (OS).

Results

Factors including diabetes, albumin, tumor numbers, HCC diameter, portal vein tumor thrombus, blood loss, mismatch repair protein 2 (MSH2), and epithelial membrane antigen were significantly associated with RFS, while albumin, HCC diameter, MSH2, and Barcelona Clinic Liver Cancer (BCLC) stage were significantly associated with OS. The RSF model not only grouped HCC patients into high- and low-probability recurrence groups with significant differences in 5-year recurrence probability rate (training cohort: 87.3% vs. 51.5%, P < 0.0001; validation cohort: 75.9% vs. 64.8%, P < 0.0001), but also grouped HCC patients into high- and low-probability death groups with significant differences in 5-year death probability rate (training cohort: 56.0% vs. 15.3%, P < 0.0001; validation cohort: 50.0% vs. 23.1%, P < 0.0001).

Conclusions

The RSF model accurately stratified HCC patient into high- and low-risk recurrence or death groups, which guides the surgeons to plan adjuvant therapy after surgery.

背景：肝细胞癌根治性切除术后复发率高影响患者生存。目前的研究结合了关键的临床病理特征和分子标记来开发机器学习模型来预测复发和死亡的风险。我们的目的是个体化风险分层、术后管理策略，并最终改善肝细胞癌根治性切除患者的长期预后。方法：815例接受手术切除的HCC患者随机分为训练组（n = 652）和验证组（n = 163）。为了建立基于临床病理特征和分子生物标志物的高精度复发/死亡分类器，开发了四种不同的机器学习模型，包括Cox比例风险模型、广义线性模型、极端梯度增强（XGBoost）模型和随机生存森林（RSF）模型，并进行了全面比较。结果为无复发生存期（RFS）和总生存期（OS）。结果：糖尿病、白蛋白、肿瘤数量、肝癌直径、门静脉肿瘤血栓、出血量、错配修复蛋白2 （MSH2）、上皮膜抗原等因素与RFS显著相关，白蛋白、肝癌直径、MSH2、巴塞罗那临床肝癌分期与OS显著相关。RSF模型不仅分组HCC患者分为高-低概率复发组显著差异在5年复发概率率(训练队列:87.3%比51.5%,P < 0.0001;验证队列:75.9%比64.8%,P < 0.0001),而且分组HCC患者分为高和低概率死亡组显著差异在5年死亡概率率(训练队列:56.0%比15.3%,P < 0.0001;验证队列:50.0%比23.1%,P < 0.0001)。结论：RSF模型准确地将HCC患者分为高、低复发或死亡风险组，指导外科医生制定术后辅助治疗方案。

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引用次数: 0

Sarcopenia is risk factor for prognosis of patients with biliopancreatic diseases 肌少症是影响胆胰疾病患者预后的危险因素。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.09.005

Tomoya Emori , Reiko Ashida , Masayuki Kitano

The prevalence of sarcopenia tends to be high in patients with biliopancreatic disease. Sarcopenia is a risk factor of poor prognosis in patients with acute and chronic pancreatitis and biliary tract and pancreatic cancer. Several studies have suggested that sarcopenia may be a risk factor for perioperative complications and decreased recurrence-free or overall survival in patients with biliary tract and pancreatic cancer after surgery. Sarcopenia in biliary tract and pancreatic cancer may also increase chemotherapy-induced toxicities and worsen quality of life and survival in neoadjuvant or palliative chemotherapy. Moreover, sarcopenia is a risk factor for biliary stent occlusion in patients with malignant biliary obstruction, predictors of the efficacy of endoscopic ultrasound-guided celiac plexus neurolysis (EUS-CPN) for pain relief, EUS-guided drainage, and endoscopic necrosectomy for walled-off necrosis (WON). Diagnosis of sarcopenia prior to the treatment of biliopancreatic diseases and endoscopy may predict treatment efficacy, and appropriate nutritional and exercise therapy improve therapeutic outcomes of patients with biliopancreatic diseases.

胆道胰腺疾病患者中肌肉减少症的患病率往往较高。骨骼肌减少症是急慢性胰腺炎、胆道及胰腺癌患者预后不良的危险因素。一些研究表明，肌肉减少症可能是胆道和胰腺癌患者手术后围手术期并发症和减少无复发或总生存期的危险因素。胆道和胰腺癌的肌肉减少症也可能增加化疗引起的毒性，并使新辅助或姑息性化疗的生活质量和生存恶化。此外，肌少症是恶性胆道梗阻患者胆道支架闭塞的危险因素，是内镜下超声引导下腹腔丛神经松解术（EUS-CPN）缓解疼痛、eus引导下引流和内镜下坏死切除术治疗壁闭塞性坏死（WON）疗效的预测因素。胆道胰腺疾病治疗前的肌肉减少症诊断和内镜检查可以预测治疗效果，适当的营养和运动治疗可以改善胆道胰腺疾病患者的治疗效果。

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引用次数: 0

Meetings and Courses 会议及课程

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/S1499-3872(25)00189-4

引用次数: 0

Robotic duodenum-preserving pancreatic head resection in a 21-month-old infant with benign disease: Redefining the ‘‘minimum feasible age’’ for robotic surgery (with video) 21个月婴儿良性疾病的机器人保留十二指肠胰头切除术：重新定义机器人手术的“最小可行年龄”（附视频）。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.10.001

Guo-Dong Zhao , Yu-Hang Cheng , Xing-Ru Wang , Jun Feng , Jian-Yu Han , Pan Gao , Jia-Tong Xu , Hong Qin

引用次数: 0

A U-tube with balloon technique for transduodenal ampullectomy u型管球囊技术用于经十二指肠壶胃切除术。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.09.007

Zi-Man Zhu , Wei Zhao , Xin Jin , Li-Yuan Sun , Kai Jiang

引用次数: 0

Laparoscopic resection of a large primary pancreatic leiomyosarcoma (with video) 腹腔镜下巨大原发性胰腺良性肉瘤切除术（附视频）

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2024.08.006

Yu-Fu Ye , Wei-Chen Zhang , Wei Zheng , Song-Feng Yu , Jun Yu , Shu-Sen Zheng

引用次数: 0

Education and surgical recommendation improve therapeutic outcomes of laparoscopic cholecystectomy for biliary hyperkinesia 教育和手术推荐提高腹腔镜胆囊切除术治疗胆道运动亢进的疗效。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.09.002

Carolina Orsi , Mohamed Abdelgawad , Diana Wu , Rebecca Swindall , Carly Wadle , Alan Cook , Hishaam Ismael

引用次数: 0

Predictive factors of postoperative ascites after laparoscopic pancreaticoduodenectomy for periampullary carcinoma 腹腔镜胰十二指肠切除术治疗壶腹周围癌术后腹水的预测因素。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.08.002

Chuan-Zhi Tang , Zhong-Jun Wu , Da-Di Peng

Background

Laparoscopic pancreaticoduodenectomy (LPD) has gained growing acceptance for the resection of periampullary carcinoma. However, postoperative ascites (POA) frequently occurs after LPD, yet little is known about the underlying factors that promote POA under this laparoscopic approach. This study aimed to explore the clinical influence of POA after LPD and its potential predictors.

Methods

Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed. Patients were assigned to the two groups by whether daily abdominal drainage > 500 mL for at least three consecutive days, followed by subgroup analysis of pancreatic fistula (PF)-POA and non-PF-POA. Variables, including preoperative laboratory tests, past history, surgery-related factors, and incidence of complications, were compared. In addition, logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.

Results

A total of 38 patients (17.4%) developed POA, with 17 having PF-POA and 21 having non-PF-POA. Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection, and a longer hospital stay compared with other groups. Multivariate analysis demonstrated that prothrombin time > 14 s and main pancreatic duct diameter < 3 mm were independent risk factors for PF-POA. Moreover, male sex, total bilirubin > 34.2 μmol/L and platelet count < 100 × 10⁹/L were independent risk factors for non-PF-POA. The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA, respectively.

Conclusions

LPD recovery and postoperative complications are impacted by POA, where PF-POA is the most clinically relevant POA. Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA; male sex, elevated total bilirubin level, and decreased platelet count were independent risk factors for non-PF-POA.

背景：腹腔镜胰十二指肠切除术（LPD）越来越被接受为壶腹周围癌的切除术。然而，术后腹水（POA）经常发生在LPD后，但在腹腔镜下促进POA的潜在因素知之甚少。本研究旨在探讨LPD后POA的临床影响及其潜在的预测因素。方法：回顾2015年12月至2023年2月诊断为壶腹周围癌并行LPD的患者。根据患者是否连续3天每天腹腔引流> 500 mL分为两组，随后对胰瘘(PF)-POA和非PF-POA进行亚组分析。变量包括术前实验室检查、既往病史、手术相关因素和并发症发生率进行比较。此外，应用logistic回归分析揭示了PF-POA和非PF-POA的潜在独立危险因素。结果：38例（17.4%）患者发生POA，其中17例为PF-POA， 21例为非PF-POA。与其他组相比，B级PF-POA患者腹部感染发生率更高，住院时间更长。多因素分析显示凝血酶原时间> 14 s和主胰管直径< 3 mm是PF-POA的独立危险因素。男性、总胆红素> 34.2 μmol/L、血小板计数< 100 × 109/L为非pf - poa的独立危险因素。预测PF-POA和非PF-POA的受试者工作特征曲线下面积分别为0.682和0.786。结论：POA影响LPD恢复及术后并发症，其中PF-POA是临床上最相关的POA。凝血酶原时间延长和主胰管狭窄是PF-POA的独立危险因素；男性、总胆红素水平升高和血小板计数下降是非pf - poa的独立危险因素。

{"title":"Predictive factors of postoperative ascites after laparoscopic pancreaticoduodenectomy for periampullary carcinoma","authors":"Chuan-Zhi Tang , Zhong-Jun Wu , Da-Di Peng","doi":"10.1016/j.hbpd.2025.08.002","DOIUrl":"10.1016/j.hbpd.2025.08.002","url":null,"abstract":"<div><h3>Background</h3><div>Laparoscopic pancreaticoduodenectomy (LPD) has gained growing acceptance for the resection of periampullary carcinoma. However, postoperative ascites (POA) frequently occurs after LPD, yet little is known about the underlying factors that promote POA under this laparoscopic approach. This study aimed to explore the clinical influence of POA after LPD and its potential predictors.</div></div><div><h3>Methods</h3><div>Patients diagnosed with periampullary carcinoma who subsequently underwent LPD from December 2015 to February 2023 were reviewed. Patients were assigned to the two groups by whether daily abdominal drainage > 500 mL for at least three consecutive days, followed by subgroup analysis of pancreatic fistula (PF)-POA and non-PF-POA. Variables, including preoperative laboratory tests, past history, surgery-related factors, and incidence of complications, were compared. In addition, logistic regression analysis was applied to reveal the potential independent risk factors for PF-POA and non-PF-POA.</div></div><div><h3>Results</h3><div>A total of 38 patients (17.4%) developed POA, with 17 having PF-POA and 21 having non-PF-POA. Patients with grade B PF-POA experienced a higher incidence of intra-abdominal infection, and a longer hospital stay compared with other groups. Multivariate analysis demonstrated that prothrombin time > 14 s and main pancreatic duct diameter < 3 mm were independent risk factors for PF-POA. Moreover, male sex, total bilirubin > 34.2 μmol/L and platelet count < 100 × 10<sup>9</sup>/L were independent risk factors for non-PF-POA. The areas under the receiver operating characteristic curve were 0.682 and 0.786 for predicting PF-POA and non-PF-POA, respectively.</div></div><div><h3>Conclusions</h3><div>LPD recovery and postoperative complications are impacted by POA, where PF-POA is the most clinically relevant POA. Prolonged prothrombin time and narrowed main pancreatic duct were independent risk factors for PF-POA; male sex, elevated total bilirubin level, and decreased platelet count were independent risk factors for non-PF-POA.</div></div>","PeriodicalId":55059,"journal":{"name":"Hepatobiliary & Pancreatic Diseases International","volume":"24 6","pages":"Pages 684-691"},"PeriodicalIF":4.4,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144876829","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}

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Soluble TREM2 is a novel diagnostic and prognostic biomarker of acute-on-chronic liver failure in patients receiving liver transplantation 可溶性TREM2是肝移植患者急性-慢性肝衰竭的一种新的诊断和预后生物标志物。

IF 4.4 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hepatobiliary & Pancreatic Diseases International

Pub Date : 2025-12-01 DOI: 10.1016/j.hbpd.2025.06.009

Bo Peng , Kai Liu , Xu-Yu Xiang , Yu-Fei Zhang , Hao Li , Peng-Peng Zhang , Jun-Hui Li , Ying-Zi Ming

Background

Acute-on-chronic liver failure (ACLF) is a severe syndrome with high short-term mortality. Triggering receptor expressed on myeloid cells-2 (TREM2) is highly expressed in the livers of patients with ACLF, but the role of its soluble form, soluble TREM2 (sTREM2), in ACLF is not clear.

Methods

We enrolled 96 consecutive patients receiving liver transplantation (LT), including 40 ACLF patients and 56 non-ACLF patients, and collected plasma at pre-LT and day 3, 7 and 14 after LT. We also enrolled 22 healthy controls (HC). The plasma sTREM2 level was detected using the enzyme-linked immunosorbent assay. The expression of TREM2 in the livers was examined using quantitative polymerase chain reaction.

Results

The pre-LT sTREM2 of the ACLF group was significantly higher than that of the non-ACLF group (13.4 ng/mL vs. 2.6 ng/mL, P < 0.001) and the HC group (13.4 ng/mL vs. 0.57 ng/mL, P < 0.001), but sTREM2 did not correlate with the grades of ACLF. The level of sTREM2 was positively correlated with the expression of TREM2 in the livers and had tight correlations with liver function and liver failure-related scores. To diagnose ACLF, sTREM2 showed an area under the receiver operating characteristic curve (AUC) of 0.863 (P < 0.001). When the cut-off value was 6.5 ng/mL, the sensitivity was 74.3% and the specificity was 93.0%. sTREM2 levels tested at day 7 and 14 after LT were associated with mortality [hazard ratio (HR): 1.187 and 1.078, P < 0.001 and P = 0.043, respectively], and sTREM2 tested at day 3 after LT was a risk factor for early allograft dysfunction (EAD) [odds ratio (OR): 1.060, P = 0.023].

Conclusions

sTREM2 was a good biomarker for liver injury. Pre-LT sTREM2 could be used to diagnose ACLF and persistently high levels of sTREM2 after LT predicted poor survival and incidence of EAD.

背景：急性伴慢性肝衰竭（ACLF）是一种短期死亡率高的严重综合征。骨髓细胞上表达的触发受体-2 （TREM2）在ACLF患者的肝脏中高表达，但其可溶性形式可溶性TREM2 （sTREM2）在ACLF中的作用尚不清楚。方法：我们招募了96例连续接受肝移植（LT）的患者，包括40例ACLF患者和56例非ACLF患者，并在LT前和LT后第3、7和14天收集血浆。我们还招募了22名健康对照组（HC）。采用酶联免疫吸附法检测血浆sTREM2水平。采用定量聚合酶链反应检测肝脏中TREM2的表达。结果：ACLF组lt前sTREM2显著高于非ACLF组（13.4 ng/mL vs. 2.6 ng/mL, P < 0.001）和HC组（13.4 ng/mL vs. 0.57 ng/mL, P < 0.001），但sTREM2与ACLF分级无关。TREM2水平与肝脏中TREM2表达呈正相关，与肝功能及肝功能衰竭相关评分密切相关。sTREM2在诊断ACLF时，受试者工作特征曲线下面积（AUROC）为0.863 （P < 0.001）。截止值为6.5 ng/mL时，敏感性为74.3%，特异性为93.0%。移植后第7天和第14天检测的strem - 2水平与死亡率相关[危险比（HR）： 1.187和1.078,P < 0.001和P = 0.043]，移植后第3天检测的strem - 2是早期同种异体移植物功能障碍（EAD）的危险因素[优势比（OR）： 1.060, P = 0.023]。结论：sTREM2是肝损伤的良好生物标志物。LT前sTREM2可用于诊断ACLF， LT后持续高水平的sTREM2可预测生存率差和EAD发生率。

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