Backgrounds/Aims:The optimal surgical approach for pathologic T1b gallbladder cancer (GBC) is debated, with conflicting data on whether extended cholecystectomy (EC) offers a survival advantage over simple cholecystectomy (SC). To address this, we performed a systematic review and meta-analysis comparing oncologic outcomes between EC and SC specifically in patients with pathologically confirmed T1b GBC. Methods:We searched MEDLINE, Embase, and the Cochrane database from their inception to July 2025. We included studies that compared EC to SC in pT1b GBC and reported overall survival (OS), disease-specific survival (DSS), or recurrence rate. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pool7ed using fixed- or random-effects models, depending on heterogeneity. The ROBINS-I tool was used to assess the risk of bias. This study is registered with PROSPERO (CRD42024498316). Results:Our analysis included 26 non-randomized comparative cohorts, comprising 1,316 patients. No study was deemed to have a low risk of bias (11 were moderate, 16 serious). EC was linked to significantly better 5-year OS compared to SC (HR 0.48; 95% CI 0.33-0.70; p = 0.0001; I2 = 53%), with consistent results across institutional and registry-based subgroups, as well as geographic regions. However, no statistically significant differences were found in 5-year DSS (HR 0.73; 95% CI 0.41-1.28; p = 0.27) or recurrence-free survival (RFS) (RR 0.75; 95% CI 0.57-1.00; p = 0.0504). Conclusions:While EC was associated with improved OS in pT1b GBC, it did not demonstrate a benefit for DSS or recurrence rate. Given the inherent limitations of the retrospective evidence, these findings advocate for a risk-adapted surgical strategy and highlight the critical need for prospective studies with standardized operative and pathologic definitions.
Backgrounds/Aims:Left-sided gallbladder (LSG) is a rare biliary anomaly where the gallbladder (GB) is situated to the left of the ligamentum teres, without situs inversus. Most cases are not preoperatively identified during routine evaluations, which tend to focus more on surgical pathology than detailed anatomical variations. This study investigated the clinical implications of LSG in patients undergoing cholecystectomy. Methods:We retrospectively reviewed 7,487 consecutive cholecystectomies performed at a single center between June 2014 and October 2025. LSG was confirmed by intraoperative findings and operative photographs/videos. The indication for surgery, operative time, GB perforation, drain insertion, and postoperative complications were assessed and compared with non-LSG cases. Results:LSG was identified in 23 patients (0.3%). Mean operative time was comparable between LSG and non-LSG groups (43.5 vs. 42.4 min, p = 0.845). GB perforation rates were similar (17.4% vs. 17.8%, p = 0.964). Drain insertion was less frequent in LSG patients, although this did not reach statistical significance (8.7% vs. 27.3%, p = 0.046; continuity-corrected p = 0.078). No intraoperative or postoperative complications, including bile duct injury, occurred in the LSG group. Preoperative imaging failed to diagnose any case of LSG. Conclusions:The incidence of LSG (0.3%) in our series was consistent with previous reports. Standard laparoscopic cholecystectomy can be performed in most LSG cases. Nonetheless, surgeons should remain alert to the possibility of associated biliary or vascular anomalies to ensure safe dissection.
Backgrounds/Aims:Recurrence rates in patients with resected pancreatic ductal adenocarcinoma (PDAC) remain high, posing a significant clinical challenge. Pre-operative neutrophil-to-lymphocyte ratio (NLR) has shown promise as a prognostic marker in various cancers. NLR's role in PDAC recurrence has not been widely explored. This study aims to investigate the effect of pre-operative NLR on post-operative PDAC recurrence. Methods:A retrospective analysis was performed on patients who underwent surgery with curative intent for PDAC between 2015 and 2024. Patients were divided into two groups (high and low) using an NLR threshold of 3. Primary outcome was disease recurrence. The predictive value of NLR was compared using receiver operating characteristic curves and univariable and multivariable Cox regression models. Results:125 Patients were included; high NLR group n = 53 and low NLR group n = 72. Both groups were well balanced across all baseline characteristics. NLR is a strong predictor of recurrence compared to platelet-to-lymphocyte ratio (PLR) (AUC: NLR 0.716 vs. PLR 0.593, p = 0.022). The high NLR group had a significantly greater recurrence rate compared to the low NLR group (62.3% vs. 31.9%, p = 0.002) and a significantly greater local recurrence rate (43.4% vs. 19.4%, p = 0.004). A high NLR remains a significant negative prognosticator for recurrence in univariable (hazard ratio [HR] 2.540, p < 0.001) and multivariable analysis (HR 2.817, p < 0.001). Conclusions:A high pre-operative NLR (> 3) was associated with significantly greater risk of recurrence, especially local recurrence. NLR may be used within risk stratification models to identify patients at risk of PDAC recurrence.
Venous reconstruction is increasingly required during complex abdominal and oncologic surgery. Autologous parietal peritoneum (PP) has emerged as a potential graft material due to its availability, biocompatibility, and low thrombogenic profile. This systematic review aimed to evaluate the safety and clinical outcomes of venous reconstruction using PP. A systematic search of MEDLINE (PubMed), ScienceDirect, Web of Science, and Embase was conducted from database inception to December 2025, in accordance with PRISMA guidelines. Studies reporting outcomes of venous reconstruction using PP were included. Data were extracted on patient characteristics, reconstruction site, technique, anticoagulation, imaging follow-up, and outcomes. The primary outcome was vascular complications (thrombosis and stenosis). Secondary outcomes included reintervention and 30-day mortality. Risk of bias was assessed using Joanna Briggs Institute tools. A narrative synthesis with pooled proportions was performed due to heterogeneity. Twenty studies, including 277 patients, were analyzed. The most common reconstruction sites were the inferior vena cava (45%), mesenterico-portal system (36%), and hepatic veins (19%). Patch repair was performed in 77% of cases. The pooled vascular complication rate was 15.1%, including thrombosis in 5.4% and stenosis in 8.3%. The pooled 30-day mortality rate was 1.4%. Follow-up ranged from 3 to 18 months, with variable anticoagulation and imaging protocols. Autologous PP is a feasible option for venous reconstruction with acceptable short-term outcomes. However, evidence is limited by heterogeneity and a lack of long-term data, warranting further prospective studies.
Backgrounds/Aims:Dual hepatic and portal vein embolization, also known as dual venous embolization (DVE), is a potentially superior alternative to portal vein embolization for enhancing liver regeneration prior to major hepatectomy. This study evaluates the impact of DVE on the kinetic growth rate (KGR), volume increase (VI), functional increase (FI), and the correlation between volume and functional changes in the future liver remnant (FLR). Methods:Patients who underwent DVE with pre- and post-procedure volume and functional assessments were included. Growth rates of FLR volume and function were assessed using Tc99-mebrofenate single-photon emission computed tomography-computed tomography (Tc99-m SPECT-CT) scans. Correlation coefficients (R) were calculated to evaluate the relationship between VI and FI. Results:Among the 37 patients included, 27 proceeded to definitive surgery. The median time between DVE and the functional scan was 33 days (interquartile range [IQR], 13-69). The median increase in FLR volume was 30% (IQR, 14-50), and FLR function increased by 75% (IQR, 25-122) (p = 0.004). Median KGR (volume) was 6% (IQR, 3%-12%), and KGR (function) was 15% (IQR, 7%-23%) (p = 0.001). Pearson's correlation coefficient between VI and FI was 0.179 (confidence interval, 0.15-0.48). Functional resectability was achieved in 35 patients. Conclusions:The increase in FLR function following DVE is significantly greater than the increase in volume. Earlier SPECT-CT scans may reduce delays to surgery and warrant further investigation.
Pseudomembranous colitis due to Clostridioides difficile infection (CDI) is a serious complication of antibiotic therapy and hospitalization that can progress to toxic megacolon, necessitating emergency colectomy. Patients undergoing pancreaticoduodenectomy (PD) are particularly at high risk due to biliary obstruction, recurrent cholangitis, broad-spectrum antibiotic exposure, and prolonged postoperative stays. We report the case of an elderly woman with multiple cardiovascular comorbidities and recent CDI who underwent PD for pancreatic ductal adenocarcinoma (PDAC). Prior to surgery, she had an endoscopic retrograde cholangiopancreatography (ERCP) with duodenobiliary (DB) stent placement due to obstructive jaundice, and biopsies confirmed PDAC. Intravenous cefotaxime was initiated because of signs of acute cholangitis. She subsequently developed CDI and completed treatment with oral vancomycin, which was discontinued only 11 days before the PD. Standard prophylaxis with cefazolin was administered prior to surgery. On postoperative day (POD) 1, empirical antibiotic therapy with cefotaxime was initiated. By POD 3, she developed profuse watery diarrhea, fever, and leukocytosis, with confirmed recurrent CDI. Despite prompt fidaxomicin therapy and intensive care, she rapidly deteriorated. Computed tomography (CT) revealed severe pancolitis and toxic megacolon. Emergency subtotal colectomy with end ileostomy was performed, and histopathological examination confirmed the diagnosis. She eventually stabilized but remained frail, and the tumor board recommended best supportive care instead of adjuvant chemotherapy due to the disease stage and the severe course of CDI. This case underscores the need for early CDI testing in postoperative diarrhea following PD and for cautious perioperative antibiotic strategies in patients with recent CDI, as broad-spectrum antibiotics may precipitate fulminant recurrence.
Backgrounds/Aims:Adrenal metastasis from hepatocellular carcinoma (HCC) is uncommon, and the role of surgical resection remains undefined. This study analyzed clinical outcomes and prognostic factors in patients who underwent adrenalectomy for adrenal metastasis from HCC at a single tertiary center. Methods:We retrospectively analyzed 31 patients who underwent adrenalectomy for adrenal metastasis from HCC (2002-2019), classified by initial HCC treatment: liver resection (n = 17), liver transplantation (n = 7), and non-surgical management (n = 7). Results:The median age of patients was 58 years; 93.5% were male, and 90.3% had hepatitis B virus infection. The median interval from HCC diagnosis to adrenal metastasis was 20.5 months. After adrenalectomy, the median recurrence-free survival was 7.5 months, and the median overall survival (OS) was 34.3 months. The 5- and 10-year survival rates were 42.3% and 32.6%, respectively. OS differed significantly across treatment groups (p = 0.008): median OS was 75.5 months in the liver resection group, compared to 33.8 months in the non-surgical group and 20.7 months in the liver transplantation group. On multivariate Cox regression, prior liver resection was independently associated with reduced mortality. Conclusions:Adrenalectomy was associated with prolonged OS in selected patients with adrenal metastasis from HCC, particularly those with prior liver resection. Given the high recurrence rate and the lack of a non-surgical comparator, these findings warrant cautious interpretation. Adrenalectomy may be considered within a multidisciplinary framework for carefully selected patients, pending confirmation by prospective multicenter studies.
Perioperative chemotherapy is frequently used for resectable colorectal liver metastases (CRLM), despite persistent uncertainty regarding the extent of its survival benefit. This perspective revisits the evidence supporting this practice and asks whether upfront liver-directed treatment should be more strongly considered in selected patients. A central paradox underpins this debate: although adjuvant chemotherapy improves OS in stage III colon cancer, randomized trials in resectable CRLM have consistently failed to demonstrate an OS advantage for perioperative or adjuvant systemic therapy. Instead, chemotherapy primarily appears to delay recurrence while exposing patients to potential harms. These harms include treatment-related hepatic injury, increased perioperative morbidity, and, in some cases, progression during induction therapy that may preclude curative resection. Several explanations may account for this discrepancy, including clonal selection of resistant disease, the influence of the hepatic metastatic microenvironment, and the availability of salvage local therapy at recurrence. Nevertheless, systemic therapy remains relevant in selected patients with technically or biologically complex disease, such as those requiring staged liver surgery, downsizing for resectability, or treatment sequencing in synchronous primary and liver disease. Additionally, thermal ablation is emerging as a valid early liver-directed option for carefully selected small-volume metastases. Looking forward, circulating tumor DNA and other molecular tools may better identify the subgroup most likely to benefit from perioperative treatment. Treatment sequencing in resectable CRLM should therefore be guided by anatomy, tumour biology, and emerging molecular markers of residual risk, with systemic therapy used selectively rather than as a universal default.
Backgrounds/Aims:The optimal surgical approach for middle-third extrahepatic cholangiocarcinoma (MCC)-bile duct segmental resection (BDSR) or pancreaticoduodenectomy (PD)-remains controversial. This study aimed to compare the short- and long-term outcomes of BDSR and PD in patients with MCC. Methods:We retrospectively analyzed 570 patients who underwent curative-intent surgery for MCC between January 2010 and December 2022. Clinicopathological characteristics, surgical outcomes, and oncologic outcomes (progression-free survival [PFS] and overall survival [OS]) were compared after 1:3 propensity score matching. Results:Among 570 patients, 112 underwent BDSR and 458 PD. After propensity score matching, BDSR showed shorter operative time and hospital stay (both p < 0.001), but fewer retrieved lymph nodes and higher local recurrence rates (both p < 0.001). PFS was inferior after BDSR (27.4 vs. 34.3 months, p = 0.004), whereas OS was comparable (36.7 vs. 55.5 months, p = 0.117). In patients with R0 resection, both PFS and OS were similar between groups. Conclusions:BDSR may offer perioperative advantages over PD, but is associated with inferior PFS, with no significant difference in OS. In patients who achieved R0 resection, the PFS and OS did not reach statistical significance. This suggests that BDSR should be considered only in highly selected patients in whom R0 resection is achievable.
Backgrounds/Aims:MicroRNAs (miRNAs) have emerged as biomarkers for cancer diagnosis and progression. This pilot study evaluated whether circulating miRNAs correlate with tumor tissue expression and clinicopathological parameters in periampullary carcinoma (PACA) patients. Methods:Thirty-nine PACA patients who underwent pancreatoduodenectomy (April 2021-March 2024) were enrolled. Total RNA from preoperative serum and tumor tissue was isolated using the miRNeasy kit (Qiagen). Quantitative reverse-transcription polymerase chain reaction was performed for 14 PACA-related miRNAs, with U6 small nuclear RNA as a reference (ΔCt = CtmiRNA - CtU6 for normalization); relative expression was calculated as ΔΔCt = ΔCtcases - ΔCtcontrols. Results:The study comprised 28 male patients with median age of 56 years (interquartile range 51-63). The predominant tumor location was ampulla (43.6%), followed by distal common bile duct (23.1%). Serum ΔCt analysis showed significant differences for miR‑199, miR‑31, miR‑329, and miR‑19, with downregulation of miR‑195 and miR‑375; after false discovery rate adjustment, miR‑199, miR‑31, miR‑329, miR‑195 and miR‑375 remained significant, whereas the serum miR‑19 difference was only nominal (p = 0.050). In tumor tissue, miR‑199, miR‑329, and miR‑19 were upregulated (ΔΔCt -2.75, -0.87, and -1.82, respectively), while miR‑31 was downregulated (ΔΔCt 2.27) compared with controls. Serum miR‑19 ΔCt showed a weak correlation with CA 19-9 (Spearman's ρ = 0.31, p = 0.049). Subgroup analyses revealed no significant differences in miRNA expression across histological subtypes or tumor stages. Conclusions:Serum miR‑199 and miR‑19 showed exploratory concordance between circulating and tumor tissue expression in PACA, but their clinical utility remains limited and requires validation in a larger cohort.
Backgrounds/Aims:To evaluate the combination of modified response evaluation criteria in solid tumors (mRECIST) with alpha-fetoprotein (AFP) in patients with intermediate-advanced hepatocellular carcinoma receiving combination therapy with a tyrosine kinase inhibitor (TKI) and a programmed cell death protein-1 (PD-1) inhibitor, focusing on stable disease (SD) patients with low AFP levels. Methods:We analyzed 79 patients who received TKI plus PD-1 inhibitor combination therapy from 2018 to 2021. Based on AFP at 8 weeks, patients were divided into Group A (AFP ≥200 ng/mL, n = 26) and Group B (AFP <200 ng/mL, n = 53). Kaplan-Meier and Cox models assessed overall survival (OS) and progression-free survival (PFS). Results:Only Barcelona Clinic Liver Cancer stage C independently predicted OS (hazard ratio [HR] 7.193, p < 0.001). For PFS, independent predictors included tumor diameter (HR 1.009, p = 0.025), mRECIST response (global likelihood-ratio p = 0.070), and AFP group (HR 0.474, p = 0.049). Virus type was excluded due to collinearity with antiviral therapy. Among SD patients, low AFP was associated with longer PFS than high AFP (24.0 vs. 3.0 months, p < 0.001). In Group B, low-AFP SD showed numerically longer PFS than partial response (24.0 vs. 15.0 months; HR 0.389; p = 0.116). Conclusions:This exploratory analysis suggests that the prognostic value of AFP is largely mediated by tumor burden. While mRECIST response predicted PFS but not OS, low-AFP SD patients exhibited favorable outcomes in both PFS and OS. These findings indicate that integrating mRECIST with AFP may enhance response stratification, though prospective validation is necessary.
Backgrounds/Aims:Minimally invasive hepatobiliary surgery has advanced considerably, with laparoscopic liver resection now widely adopted. The IWATE difficulty score is commonly used to classify the technical complexity of laparoscopic resections; however, its ability to predict postoperative morbidity across different surgical approaches remains uncertain. This study aimed to evaluate the association between the IWATE score and postoperative complications and revision surgery following anatomical liver resection (ALR), irrespective of surgical approach. Methods:We conducted a retrospective analysis of 168 patients who underwent ALR between 2014 and 2018 at a tertiary hepatobiliary center. Resections were stratified according to the IWATE score. For open procedures, the score was modified by subtracting one point to approximate the hand-assisted category, as an exploratory adjustment. Perioperative outcomes, including overall postoperative complications and revision surgery, were analyzed using univariate and multivariable logistic regression. Results:Higher IWATE difficulty was independently associated with increased postoperative complications (odds ratio [OR] 3.69, 95% confidence interval [CI] 1.58-8.64; p = 0.002) and revision surgery (OR 2.72, 95% CI 1.37-5.41; p = 0.004). Laparoscopic resections were associated with reduced blood loss, lower transfusion rates, and improved postoperative recovery. Receiver operating characteristic analysis demonstrated good predictive performance of the IWATE score (area under the curve 0.87 and 0.79). Conclusions:The IWATE score is independently associated with postoperative morbidity and revision surgery following ALR and may serve as a universal preoperative risk stratification tool across surgical approaches. Prospective validation is warranted.
Post-pancreatectomy chyle leak is a common complication typically managed conservatively. However, rare ISGPS grade C leaks that produce high output can lead to significant morbidity and often resist non-operative treatments. We report two cases of such refractory leaks successfully addressed through surgical intervention. We describe two complex cases of postoperative chyle leakage. The first case involves a 66-year-old female who underwent pylorus-preserving pancreaticoduodenectomy with portal vein resection. The second case is a 67-year-old female who underwent completion total pancreatectomy. Both patients experienced persistent, high-output chyle leakage that did not respond to conservative management and several interventional procedures. Ultimately, both were successfully treated with exploratory laparotomy and multiple lymphatic ligations after undergoing preoperative fat loading. Postoperative chyle leak is initially managed conservatively, with interventional options reserved for refractory cases, though these are often ineffective. When conservative measures fail, surgical management with fat loading, targeted or prophylactic lymphatic ligation, and adjunct sealants can provide lasting control. Surgical management presents a viable salvage strategy for refractory postoperative chyle leaks when nonoperative measures are ineffective. Preoperative fat loading aids in intraoperative localization. Timely surgical intervention can prevent malnutrition and preserve opportunities for adjuvant therapy.
Backgrounds/Aims:Pancreaticoduodenectomy (PD) is the standard treatment for periampullary tumors, but it is technically challenging. Evidence directly comparing open, laparoscopic, robotic, and hybrid approaches is limited. This study conducts a network meta-analysis (NMA) to compare the perioperative and oncologic outcomes of open PD (OPD), laparoscopic PD (LPD), robotic PD (RPD), and hybrid PD. Methods:We searched PubMed, EMBASE, and the Cochrane Library for studies published between January 1994 and August 2024. We included randomized controlled trials and comparative observational studies that evaluated at least two PD approaches. Perioperative outcomes were the primary endpoints, while oncologic safety served as a secondary endpoint. A random-effects NMA was performed, establishing treatment hierarchies through ranking probabilities (PROSPERO ID: CRD420250365864). Results:A total of 78 studies were included (5 randomized and 73 retrospective). RPD was associated with lower blood loss compared to OPD (mean difference [MD], -163.85 mL) and LPD (MD, -84.14 mL). Hospital stays were also shorter for RPD compared to OPD (MD, -2.50 days) and LPD (MD, -1.88 days). In contrast, OPD was the most time-efficient approach compared to LPD (MD, -77.61 minutes) and RPD (MD, -73.30 minutes). Mortality rates, severe complications, clinically relevant postoperative pancreatic fistula rates, and reoperation rates were comparable across all surgical approaches. In terms of oncologic safety, lymph node yield and R0 resection rates were similar for all modalities. Conclusions:While OPD is the most time-efficient approach, RPD provides significant advantages in reducing intraoperative blood loss and shortening hospital stays compared to both LPD and OPD.
Backgrounds/Aims:Preoperative biliary drainage (PBD) is commonly used prior to pancreatoduodenectomy (PD), but its histologic effects on the extrahepatic bile duct are not well understood in humans. This study aimed to prospectively measure pericholedochal fibrosis (PCF) in PD specimens after plastic biliary stenting to assess its extent and clinical significance. Methods:Consecutive patients undergoing PD were divided into two groups: those who received PBD (n = 22) and non-drained controls (n = 24). Patients who had neoadjuvant chemotherapy were excluded to focus on stent-related effects. Common bile duct (CBD) specimens were analyzed using standardized Masson's trichrome staining. Digital morphometry quantified CBD dimensions, collagen area, and collagen density. Histologic markers were correlated with stent dwell time and surgical outcomes. Results:PBD was linked to a substantial increase in PCF. Stented ducts showed significantly greater wall thickness (6,554 vs. 499 μm; p < 0.001), total collagen area (p < 0.001), and collagen density (p < 0.001) compared to controls. Fibrosis developed rapidly, becoming clearly evident by day 6, with no significant correlation between collagen burden and stent dwell time (median 10 days). Despite these pronounced histologic changes, operative time (230 vs. 230 minutes; p = 0.98) and postoperative complication rates did not differ significantly between the groups. Conclusions:Short-term PBD with plastic stents causes rapid, intense, and persistent PCF that stabilizes soon after stent placement. Although this fibrotic response did not negatively impact surgical outcomes at a high-volume center, the findings underscore the significant tissue remodeling triggered by stenting and advocate for the careful use of PBD.
Backgrounds/Aims:Left lateral sectionectomy (LLS) is a commonly performed liver resection. The Rex-recess technique, an extrahepatic Glissonian approach through the umbilical fissure, provides earlier extrahepatic vascular control, potentially resulting in safer and faster resections. However, comparative data between these approaches is limited. This study aims to compare the Rex-recess technique with the standard technique for LLS regarding operative parameters, intraoperative blood loss, and postoperative outcomes. Methods:This retrospective cohort study included 48 consecutive adult patients who underwent open LLS at a tertiary hepatobiliary centre between January 2021 and November 2025. Patients were categorized based on the surgical technique used: standard technique (n = 25) and Rex-recess technique (n = 23). Primary outcomes assessed included operative time, blood loss, transfusion requirements, and postoperative complications. Secondary outcomes focused on selected early postoperative recovery parameters. Results:Baseline demographics were comparable between groups. The Rex-recess technique significantly reduced operative time (90 ± 17.1 minutes vs. 162 ± 27.2 minutes; p < 0.0001) and intraoperative blood loss (80 ± 42.3 mL vs. 250 ± 67.2 mL; p < 0.0001).Other postoperative outcomes, including complication rates and length of hospital stay, were comparable between the two groups. Conclusions:The Rex-recess approach appears to be a feasible and anatomically sound technique for LLS, offering advantages in operative efficiency, such as reduced operative time and blood loss. However, due to the retrospective design and non-randomized allocation, these findings should be interpreted with caution. Further prospective studies are needed to validate these results.
Backgrounds/Aims: Patients with hepatocellular carcinoma (HCC) and histologically confirmed F4 cirrhosis often have limited hepatic reserve, making major hepatectomy difficult. Although laparoscopic liver resection is increasingly performed, its perioperative safety in this setting remains unclear. This study compared laparoscopic and open partial hepatectomy in these patients using propensity score matching (PSM). Methods: Among 298 patients who underwent hepatectomy for HCC between 2006 and 2023, 112 with histologically confirmed F4 cirrhosis who underwent partial hepatectomy were included (laparoscopic, n = 60; open, n = 52). PSM was performed using previous liver resection, difficulty score, tumor size, tumor number, and platelet count, yielding 32 matched pairs. Outcomes included operative time, blood loss, transfusion requirements, complications, hospital stay, posthepatectomy liver failure (PHLF), R0 resection rate, and 30-day mortality. Results: After matching, intraoperative blood loss was significantly lower in the laparoscopic group than in the open group (50 mL vs. 295 mL, p < 0.001). Operative time, transfusion rate, complication rate, R0 resection rate, and 30-day mortality were comparable between groups. Hospital stay was significantly shorter in the laparoscopic group (13 vs. 22 days, p < 0.001). Grade A PHLF occurred in one patient in the open group, with no significant between-group difference. Conclusions: In patients with HCC and histologically confirmed F4 cirrhosis, laparoscopic partial hepatectomy was associated with less blood loss and shorter hospital stay than open surgery, without increasing perioperative morbidity. It may be a safe option in carefully selected patients undergoing limited liver resection.
Backgrounds/Aims:The most common cause of morbidity following pancreatoduodenectomy (PD) is the clinically relevant postoperative pancreatic fistula (CR-POPF). There is currently no universally accepted technique for pancreato-enteric anastomosis. This study aims to compare the Blumgart technique (B-PJ) with the modified Blumgart technique (mB-PJ). Methods:This is a retrospective study involving patients who underwent PD between January 2011 and December 2021. The primary endpoint was to compare the incidence of CR-POPF. Secondary endpoints included major morbidity, length of postoperative stay, rates of reoperation, hospital readmission, postoperative mortality, and predictors of CR-POPF. Propensity score matching (PSM) was employed to minimize potential selection bias. Results:The study included 292 patients. After PSM, the incidence of CR-POPF was not significantly different between B-PJ and mB-PJ (18.9% vs. 15.8%, p = 0.566). No statistical differences were observed in the secondary endpoints. Independent predictors of CR-POPF included preoperative cholangitis (odds ratio [OR]: 4.906, 95% confidence interval [CI]: 1.440-16.713, p = 0.011), soft pancreas (OR: 4.259, 95% CI: 1.043-17.376, p = 0.043), and main pancreatic duct size ≤ 3 mm (OR: 5.229, 95% CI: 1.865-14.656, p = 0.002). Conclusions:This study did not demonstrate that mB-PJ is superior to B-PJ in reducing the incidence of CR-POPF. Factors such as soft pancreas, main pancreatic duct size, and preoperative cholangitis are identified as independent risk factors for CR-POPF.
Backgrounds/Aims: Three-dimensional (3D) modeling is increasingly used in hepatobiliary surgery to enhance anatomical understanding and operative planning. However, its impact on oncologic outcomes remains uncertain. This study evaluated whether preoperative 3D liver models influence resection margin status and survival after hepatectomy for malignant disease. Methods: In this retrospective case-control study, 59 patients undergoing hepatic resection for malignancy between May 2018 and May 2023 were included. Patients were managed either with patient-specific 3D models (n = 31) or conventional imaging (n = 28). Predictors of R0 resection were analyzed using logistic regression, and overall survival (OS) and disease-free survival (DFS) were assessed using Cox proportional hazards models. Results: R0 resection was achieved in 79.7% of patients, with no significant difference between groups (77.4% vs. 82.1%; p = 0.865). Bilobar tumor distribution (adjusted odds ratio [OR] 0.05, 95% confidence interval [CI] 0.00-0.76; p = 0.039) and a higher albumin-bilirubin score (adjusted OR 0.06, 95% CI 0.00-0.46; p = 0.029) were independently associated with lower odds of achieving R0 resection. In multivariable analysis, the use of 3D models was independently linked to improved 2-year DFS (adjusted hazard ratio 0.47, 95% CI 0.24-0.92; p = 0.028). Tumor type affected recurrence rates, with hepatocellular carcinoma and other tumors showing a lower risk of recurrence compared to colorectal liver metastases. No significant differences in OS were found. Conclusions: Preoperative 3D modeling was not associated with higher R0 resection rates but was independently associated with improved 2-year DFS. Given the retrospective design and potential residual confounding, these findings should be interpreted cautiously and considered hypothesis-generating pending prospective validation.
Backgrounds/Aims:Early liver graft regeneration after living donor liver transplantation (LDLT) is critical for patient outcomes, yet prospective volumetric data from Indian recipients remain limited. This study quantifies early graft regeneration and identifies predictors using computed tomography (CT) volumetry. Methods:In this prospective single-center study, 34 consecutive adult LDLT recipients underwent CT volumetry on postoperative days 7 and 30. Results:Mean baseline graft volume was 607.9 ± 137.9 cm3, increasing to 957.3 ± 175.7 cm3 at day 7 (+62%, p < 0.001) and 1,293.4 ± 247.0 cm3 at day 30 (+111%, p < 0.001), achieving 93% ± 22.7% of predicted standard liver volume (SLV). Multivariate analysis identified recipient body mass index (BMI) (β = 29.4 cm3/kg/m2, 95% CI 14.4-44.4, p < 0.001) and graft-to-recipient-weight ratio (GRWR) (β = 435.9 cm3 per unit, 95% CI 95-777, p = 0.015) as independent predictors of day-30 graft volume (adjusted R2 = 0.349). Left-lobe grafts showed higher proportional growth than right-lobe grafts (174% ± 41% vs. 103% ± 34%, p < 0.001) with comparable absolute volumes (p = 0.56). Younger recipients (19-41 years) demonstrated greater regeneration than older recipients (56-64 years; 160% ± 32% vs. 109% ± 38%, p = 0.01). Mild macrosteatosis (< 30%) did not impair regeneration. Conclusions:Liver graft regeneration in this Indian LDLT cohort was rapid, with near-complete SLV restoration by 30 days. BMI and GRWR independently predicted volumetric recovery, supporting personalized graft selection and the expanded use of left-lobe grafts.
