Background/objectives: Early detection of venous thromboembolism (VTE) is crucial to prevent disastrous outcomes after major abdominal surgery. This study aimed to investigate whether D-dimer testing can predict the incidence of VTE after major pancreatectomy. Methods: The medical records of patients who underwent major pancreatectomy between June 2018 and March 2021 at Kobe University Hospital were retrospectively reviewed. Plasma D-dimer levels were measured repeatedly after surgery. The ability of D-dimer to predict VTE was determined using receiver operating characteristic curve analysis. Results: Data from 234 patients (median age, 69 years) were analyzed. Twenty-two patients (9.4 %) were diagnosed with VTE (pulmonary embolism, 2.1 %; deep venous thrombosis [without concomitant pulmonary embolism], 3.4 %; portal venous thrombosis, 3.0 %). Age >70 years was an independent risk factor in multivariate analysis. Plasma D-dimer levels on postoperative days 0, 1, 3, 5, and 7 were significantly higher in patients with VTE than in those without VTE. Plasma D-dimer levels on postoperative days 3, 5, and 7 demonstrated good predictive ability to detect VTE (area under the curve: 0.77, 0.79, and 0.79, respectively) with cutoff values of 8.9 (sensitivity, 0.73; specificity, 0.77), 16.6 (sensitivity, 0.64; specificity, 0.85), and 14.2 (sensitivity, 0.77; specificity, 0.71) mu g/mL, respectively. Conclusions: Plasma D-dimer levels on postoperative days 3-7 may be useful in the early detection of VTE. (c) 2025 Asian Surgical Association and Taiwan Society of Coloproctology. Publishing services by Elsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/ by-nc-nd/4.0/).

Perihilar cholangiocarcinoma (PHCC) accounts for 50–60

Background :Relationship between timing of initiating adjuvant chemotherapy (AC) and clinical outcomes after surgery for pancreatic cancer remains controversial. Methods: In this ancillary analysis of the JASPAC 01 trial, 187 patients were classified according to the interval between surgery and chemotherapy initiation to Early (< 6 weeks, n = 45), Standard (6-8 weeks, n = 70), and Delayed (> 8 weeks, n = 72). Overall survival (OS) and relapse-free survival (RFS) were analyzed. Results: Baseline characteristics were comparable among three groups. The Standard group showed significantly longer OS than the Early group (median, 66 vs. 37 months; HR 0.61, 95% CI 0.38-0.99; p = 0.041), and relatively longer OS compared with the Delayed group (median, 45 months; HR 0.68, 95% CI 0.44-1.05; p = 0.077). RFS was longer in the Standard group (median, 46 months) compared with the Early group (20 months; HR 0.61, 95% CI 0.38-0.99; p = 0.040) and the Delayed group (20 months; HR 0.59, 95% CI 0.39-0.89; p = 0.011). Multivariate analysis identified operative procedure, R1 resection, lymph node metastasis, and nonstandard initiation (< 6 or > 8 weeks) as independent adverse prognostic factors. Conclusions: Initiation of S-1 AC at 6-8 weeks after pancreatectomy was associated with favorable survival outcomes.

BACKGROUND:The classification of oncological resectability for hepatocellular carcinoma (HCC) has been established, requiring validation of treatment outcomes for hepatectomy and systemic chemotherapy. METHODS:The study evaluated treatment outcomes in 978 patients who underwent hepatectomy and 222 patients with HCC who received first-line systemic chemotherapy (atezolizumab plus bevacizumab, lenvatinib, or durvalumab plus tremelimumab). RESULTS:Among three factors defining patients with borderline resectable 1 (BR1) and 2 (BR2), macrovascular invasion factor was associated with significantly worse prognosis in a hepatectomy group (BR1: 34.2 vs. 63.4 months, p = 0.04; BR2: 14.4 vs. 20.9 months, p = 0.004). In contrast, in the systemic chemotherapy group, none of the three factors affected prognosis in either BR1 or BR2 patients. In BR2 patients undergoing hepatectomy, those with a single risk factor had significantly better outcomes than those with 2-3 factors (20.1 vs. 12.6 months, p < 0.001). Similarly, in the entire systemic chemotherapy cohort, patients with a single risk factor had better outcomes than those with 2-3 (22.6 vs. 11.9 months, p = 0.001). However, among chemotherapy responders (per modified Response Evaluation Criteria in Solid Tumors), prognosis did not significantly differ between those with one factor and those with 2-3 factors (25.4 vs. 24.5 months, p = 0.502). CONCLUSION:Macrovascular invasion significantly impacted prognosis in patients undergoing hepatectomy, for both BR1 and BR2, whereas any of the tumor factors did not affect the prognosis of patients receiving systemic chemotherapy. Tumor burden correlated with prognosis in the entire cohort but not in chemotherapy responders, suggesting effective treatment may overcome poor prognostic indicators.

BACKGROUND/AIM:The prognostic impact of the timing of adjuvant chemotherapy initiation in patients with resected pancreatic cancer is unclear. Therefore, this study aimed to investigate whether delayed initiation of S-1 adjuvant chemotherapy affects the survival of patients with resectable pancreatic cancer. PATIENTS AND METHODS:Patients who received S-1 adjuvant chemotherapy after undergoing R0/R1 resection were grouped according to whether adjuvant chemotherapy was initiated <60 (n=36) or ≥60 days (n=27) after surgery. Correlations between the time to chemotherapy initiation, clinicopathological factors, and survival were analyzed. RESULTS:The median and mean times to chemotherapy initiation were 58 and 61 days, respectively. The delayed group had worse 2-year overall (57% vs. 80%, p=0.032) and recurrence-free survival (35% vs. 54%, p=0.044) rates than the early group. These results were similar in patients who completed S-1 adjuvant chemotherapy. In multivariate analysis, delayed initiation of chemotherapy, R1 resection, and tumor size (≥40 mm) were independent prognostic factors for poor overall survival. The delayed group had more patients with severe postoperative complications (Clavien-Dindo grade ≥III) (30% vs. 8%, p=0.028) and delayed recovery of serum albumin levels (postoperative days 7, 14, and 30: p=0.040, 0.004, and 0.003, respectively) than the early group. CONCLUSION:Delayed initiation of S-1 adjuvant chemotherapy had an adverse impact on survival and was correlated with severe postoperative complications and delayed recovery of postoperative nutritional status.

BACKGROUND:Portomesenteric vein (PMV) resection is performed for pancreatic ductal adenocarcinoma with venous invasion. However, positive transection margins may lead to local recurrence. This study aimed to evaluate whether routine intraoperative frozen section analysis (FSA) reduces positive PMV transection margins. METHODS:This retrospective study reviewed patients who underwent pancreatectomy with PMV resection at Kobe University Hospital from 2010 to 2020. Routine FSA of the PMV transection margin was introduced in 2017. Clinicopathological factors and the incidence of positive PMV transection margins were compared between patients who underwent FSA (PMV frozen [+]) and those who did not (PMV frozen [-]). Cox regression was used to assess the prognostic effect of margin status. RESULTS:A total of 115 patients were included (57 in the PMV frozen [+] group and 58 in the PMV frozen [-] group). The rate of positive PMV transection margins was significantly lower in the PMV frozen (+) group than in the PMV frozen (-) group (1.8% vs 17.2%, respectively; P =.003). Multivariate logistic regression analysis demonstrated that intraoperative FSA of the PMV transection margin was an independent factor associated with a reduced risk of positive PMV transection margins on final pathological diagnosis (odds ratio, 13.7 [95% CI, 1.61-116.7]; P =.017). However, the positive PMV transection margin was not associated with overall survival (hazard ratio, 0.96 [95% CI, 0.31-2.50; P =.937). CONCLUSION:Routine FSA of the PMV transection margin markedly reduces positive PMV transection margins after pancreatectomy. However, the prognostic effect of a positive PMV transection margin remains unclear. Larger prospective studies are needed to determine its prognostic relevance.

Background Technetium-99m-diethylenetriamine-penta-acetic acid-galactosyl human serum albumin (99mTc-GSA) scintigraphy is a useful method for assessing liver function and its heterogeneity. We evaluated its predictive usefulness for post-hepatectomy liver failure (PHLF) in liver resection for biliary tract cancer. Methods Between 2013 and 2024, 95 patients underwent major hepatectomy with bile duct resection for biliary tract cancer and had preoperative 99mTc-GSA scintigraphy. The GSA-K value was defined using established reduction formulas of indocyanine green plasma clearance rate (ICG-K) values based on LHL15 value (99mTc-GSA uptake ratio of the liver to the liver plus heart at 15 min) from 99mTc-GSA scintigraphy. Functional remnant liver volume (f-RLV) ratio was estimated by dividing scintillation counts of the future remnant liver by total counts of the whole liver. We compared volumetric (ICG-Krem: ICG-K x RLV ratio) and functional (GSA-Krem: GSA-K x f-RLV ratio) assessment methods of the future remnant liver for predicting PHLF. Results PHLF was observed in 34 patients (35.8%) and a receiver operating characteristic curve revealed cut-off values for predicting PHLF of 0.088 for ICG-Krem and 0.086 for GSA-Krem. Positive predictive values for PHLF were 53.2% (ICG-Krem) and 87.6% (GSA-Krem). In patients with portal vein embolization (PVE), GSA-Krem showed 89.1% of positive predictive value for PHLF, and ICG-Krem was very low (53.3%). The multivariate analysis identified GSA-Krem as one of independent predictors of PHLF. Conclusions GSA-Krem derived from 99mTc-GSA scintigraphy is a valuable predictor of PHLF.

The AirSeal® insufflation system (ASIS) provides stable pneumoperitoneum during minimally invasive pancreaticoduodenectomy (MIPD), but its impact on postoperative venous thromboembolism (VTE) remains unclear. We retrospectively analyzed 142 consecutive patients who underwent MIPD between May 2021 and January 2026. Patients were divided into an ASIS group and a standard insufflation system (StIS) group. In both groups, pneumoperitoneum pressure was maintained at 10 mmHg. The primary outcome was VTE, including deep vein thrombosis (DVT) and pulmonary embolism (PE), occurring within 14 days after surgery. Among 142 patients, 48 underwent MIPD with ASIS and 94 with StIS. VTE occurred in 12 patients (8.5

Laparoscopic liver resection is technically demanding for hepatocellular carcinoma (HCC) ≥10 cm in the right liver. In open liver resection, the anterior approach is established for large right-lobe tumors because it avoids parenchymal compression during mobilization.1, 2 However, its laparoscopic use remains limited,3 particularly in right posterior sectionectomy (RPS). This study describes the technique and perioperative outcomes of laparoscopic RPS using the anterior approach for huge HCCs. Among 799 minimally invasive liver resections performed between 2011 and 2025, four men (median age 72.5 years, range 60–84) with huge tumors (median diameter 11.5 cm, range 10–12) underwent laparoscopic (extended) RPS with an anterior approach. As the tumor bulk caused firm adhesion to the diaphragm and retroperitoneum, the right lobe was left in situ. Parenchymal transection was initiated caudally and progressed cranially along the right inferior vena cava. The specimen was detached only after the transection. Patients were placed in the left hemilateral decubitus position with French lithotomy, and clamp-crushing was used for transection. Two standard and two extended RPSs were completed. The median operative time was 524 minutes (range 418–603), and blood loss was 80 mL (range 10–550); no transfusions were required. The median weight was 753.5 g (range 450–934). No Clavien–Dindo ≥IIIa complications occurred. The median postoperative stay was 11 days (range 9–16). All margins were negative. Laparoscopic anterior-approach RPS is feasible and safe for huge right posterior HCCs, enabling secure transection without mobilization and yielding favorable short-term outcomes.

Laparoscopic anatomical segmentectomy is technically demanding due to the lack of visible surface landmarks identifying segmental borders. While indocyanine green (ICG) fluorescence imaging offers real-time navigation, its specific impact on anatomical orientation remains understudied. We evaluated the clinical impact of ICG fluorescence guidance on perioperative efficiency and outcomes in laparoscopic anatomical segmentectomy. We analyzed 78 consecutive patients (2017–2025) undergoing laparoscopic anatomical segmentectomy, stratified into ICG-guided (n = 51, negative staining) and conventional (n = 27) groups. Endpoints included perioperative outcomes (operative time, complications, and hospital stay), anatomical precision (RMSE between simulated volume and specimen weight), and long-term prognosis (RFS/OS) in a hepatocellular carcinoma (HCC) subgroup operated before 2023. While the non-ICG group included a higher proportion of high-difficulty cases according to the IWATE criteria (85.2 vs. 58.8

BACKGROUND/AIM:This study evaluated the clinical significance of baseline lymphocyte-to-monocyte ratio (LMR) and its early dynamic changes as an on-treatment biomarker in patients with advanced hepatocellular carcinoma (HCC) receiving atezolizumab plus bevacizumab (Ate/Bev), with stratification by alpha-fetoprotein (AFP) status. PATIENTS AND METHODS:We retrospectively reviewed 108 patients with advanced HCC treated with first-line Ate/Bev. Baseline LMR and LMR at six weeks (LMR 6w) were calculated. Patients were classified into high/low groups (cutoff: 3.69) and dynamic change groups [increased (Up) vs. decreased (Down)]. Overall survival (OS) and objective response rate (ORR) were assessed according to baseline AFP levels (cutoff: 20 ng/ml). RESULTS:High baseline LMR significantly correlated with longer OS (median not reached vs. 17.3 months, p<0.001). Notably, patients with increased LMR at six weeks (Up group) demonstrated significantly superior OS compared to the Down group (33.6 vs. 18.9 months, p=0.018) and a higher ORR (46.0% vs. 26.0%, p=0.037). The High+Up cohort achieved the most favorable prognosis. In stratified analyses, these prognostic and predictive values of early LMR dynamics were prominently observed in AFP-negative patients (p<0.05), but were attenuated in AFP-positive individuals. CONCLUSION:Early dynamic increase in LMR serves as a powerful, cost-effective on-treatment biomarker for Ate/Bev therapy in advanced HCC. Integrating systemic immune dynamics with tumor biology provides superior risk stratification, particularly for AFP-negative patients.

Pancreaticoduodenectomy (PD) is associated with a high incidence of surgical site infection (SSI), reported in 20–40

This study aimed to evaluate preoperative malnutrition using the Global Leadership Initiative on Malnutrition (GLIM) criteria and determine whether its prognostic impact after initial liver resection (LR) differs between older (≥70 years) and younger (<70 years) patients with hepatocellular carcinoma (HCC). This retrospective analysis included 330 patients with HCC who underwent LR between January 2011 and December 2019 at our institution. Overall survival (OS), recurrence-free survival (RFS), postoperative recurrence patterns, and treatment strategies for recurrence were compared between the two groups. Among the 330 patients with HCC, 150 and 180 were classified into younger and older groups, respectively. Preoperative severe malnutrition was independently associated with OS (p=0.001) and RFS (p=0.044) in older patients and with RFS (p=0.039), but not OS, in younger patients. Moreover, in older patients, preoperative malnutrition was associated with a lower rate of aggressive treatments for intrahepatic recurrence (p=0.018) and a higher rate of extrahepatic recurrence (p=0.023) after LR, which was not observed in younger patients. Severe malnutrition, as per the GLIM criteria, is a significant independent predictor of OS and RFS in older patients with HCC who underwent LR. Preoperative malnutrition was associated with the treatment strategies for intrahepatic recurrence and the rate of extrahepatic recurrence in this population.

Hepatectomy is a curative treatment for hepatocellular carcinoma (HCC) but deteriorating postoperative liver function can limit its benefits, especially for patients with borderline resectable (BR) HCC. We evaluated postoperative liver function trajectories and their impact on long-term survival. The subjects of this retrospective analysis were 790 patients who underwent initial curative hepatectomy, stratified by resectability (R, BR1, BR2) and modified albumin–bilirubin (mALBI) grade. Liver function was assessed via ALBI scores pre- and postoperatively. Deterioration was defined as an ALBI score ratio < 0.9. Median overall survival (OS) differed significantly, being 109.9, 54.4, and 40.4 months for the R, BR1, and BR2 groups, respectively (p < 0.001). While functional status at POD 90 influenced recurrence-free survival, deterioration at POD 180 was identified as a robust independent predictor of OS (HR 1.53, p = 0.005). Notably, no single preoperative or perioperative factor was a significant predictor of this long-term functional decline at POD 180. Postoperative recovery was heterogeneous, with 47.5

Background/Aim:Biliary tract cancers (BTCs) have poor prognoses, with limited curative options beyond surgical resection. Adjuvant S-1 chemotherapy has shown survival benefits in Japanese patients undergoing resection for BTC. However, prognostic factors influencing survival in these patients remain uncertain. In this study, we aimed to investigate the efficacy of preoperative nutritional status using the Global Leadership Initiative on Malnutrition (GLIM) criteria as a prognostic factor in patients receiving adjuvant S-1 chemotherapy for BTC. Patients and Methods:In this retrospective study, excluding intrahepatic cholangiocarcinoma, we evaluated 58 patients who underwent curative surgery for BTC at Kobe University from 2013 to 2022, followed by adjuvant S-1 chemotherapy. Nutritional status was classified by GLIM criteria into normal/moderate and severe malnutrition groups. Overall (OS) and recurrence-free (RFS) survival were analyzed using Kaplan-Meier and Cox proportional hazards models. Results:Of the 58 patients, 3.4% had no malnutrition, 72.5% had moderate malnutrition, and 24.1% had severe malnutrition. Patients with severe malnutrition had significantly worse 5-year OS (24.7% vs. 52.5%, p=0.0014) and RFS (34.3% vs. 52.0%, p=0.0066). Severe malnutrition was an independent prognostic factor for poorer OS (hazard ratio=3.40, 95% confidence interval=1.46-7.94; p=0.0047) and RFS (hazard ratio=2.48, 95% confidence interval=1.07-5.76; p=0.035). No significant difference in S-1 completion rates was observed. Conclusion:Severe malnutrition, as defined by GLIM criteria, is a poor prognostic factor in patients with BTCs undergoing adjuvant S-1 chemotherapy.

Aim: Laparoscopic liver resection (LLR) is increasingly used in the management of hepatocellular carcinoma (HCC), even among patients traditionally considered high risk due to advanced age or poor nutritional status. Malnutrition, assessed by the prognostic nutritional index (PNI), is known to negatively affect surgical outcomes; however, its impact in the context of LLR remains unclear. We aimed to clarify the effect of malnutrition, defined by the PNI, on short- and long-term outcomes following laparoscopic liver resection for HCC. Methods: We retrospectively analyzed 121 patients with HCC who underwent primary LLR between 2011 and 2019. Nutritional status was evaluated using the PNI, with a cutoff of < 40 indicating malnutrition. Short-term outcomes were assessed using the textbook outcome (TO), defined as meeting five criteria: no 30-day mortality, R0 resection, no major complications (Clavien–Dindo ≥ III), no unplanned readmission, and no prolonged hospitalization. Long-term outcomes included overall survival (OS) and recurrence-free survival (RFS). Results: Seventeen patients (14%) were classified as malnourished. TO achievement rates were similar between the malnutrition and normal-nutrition groups (70.6% vs. 74.0%, P = 0.771). No significant differences were observed in individual TO criteria. However, OS was significantly worse in the malnutrition group (median 40 vs. 107 months, P < 0.001), while RFS showed a non-significant trend (P = 0.085). In multivariate analysis, PNI-defined malnutrition was the only independent predictor of poorer OS. Conclusion: LLR yields acceptable short-term outcomes even in malnourished patients with HCC, as defined by the PNI. However, malnutrition remains a strong independent risk factor for decreased long-term survival. These findings underscore the importance of preoperative nutritional assessment and optimization in surgical candidates with HCC.

Introduction:Oncological resectability criteria for hepatocellular carcinoma have been defined (resectable [R]/borderline resectable 1 [BR1]/borderline resectable 2 [BR2]); however, their validation is necessary. Methods:A total of 1,469 patients who underwent hepatectomy and 525 patients who received systemic chemotherapy, including lenvatinib, atezolizumab plus bevacizumab, and durvalumab plus tremelimumab, as first-line treatment were analyzed. Results:In the BR1 group, the median survival times (MSTs) of patients who underwent hepatectomy and systemic chemotherapy were 52.7 and 34.6 months, respectively, without a significant difference (p = 0.075). In the propensity score matching (PSM) analysis of the BR1 group, the MSTs of hepatectomy and systemic chemotherapy were 42.4 and 35.1 months, respectively, without a significant difference (p = 0.772). Hepatitis virus infection, modified albumin-bilirubin (mALBI) grade 2b + 3, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas mALBI grade 2b + 3 was the only poor prognostic factor for systemic chemotherapy. In the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 19.5 months, respectively, with significantly better survival for hepatectomy than for systemic chemotherapy (p = 0.017). In the PSM analysis of the BR2 group, the MSTs of hepatectomy and systemic chemotherapy were 20.1 and 21.0 months, respectively, without a significant difference (p = 0.375). Serum alpha-fetoprotein levels≥100, intrahepatic tumor number ≥6, and the presence of extrahepatic metastasis were identified as poor prognostic factors for hepatectomy, whereas female, serum alpha-fetoprotein levels ≥100, mALBI grade 2b + 3, intrahepatic maximal tumor size >5 cm, and the presence of extrahepatic metastasis were identified as poor prognostic factors for systemic chemotherapy. Conclusion:In the PSM analysis, no significant differences were observed between the BR1 and BR2 groups for hepatectomy and systemic chemotherapy. The intrahepatic tumor number for hepatectomy and the intrahepatic maximal tumor size for systemic chemotherapy are significant risk factors for BR2 patients, highlighting the characteristics of each treatment and the potential for selecting the optimal modality.

BACKGROUND:Partial pancreatectomies for intraductal papillary mucinous neoplasms (IPMN) often leave a dilated main pancreatic duct (MPD). However, its impact on the development of remnant pancreatic lesions is unknown. METHODS:Medical records of consecutive patients who underwent partial pancreatectomy for noninvasive or microinvasive IPMN with dilated MPD on preoperative imaging between April 2007 and March 2023 at two tertiary referral centers in Japan were retrospectively reviewed. A dilated remnant MPD (DRM) was defined as an MPD diameter of the expected remnant pancreas of ≥5 mm. The clinically significant remnant pancreatic lesion (CSRPL) was defined as a remnant pancreatic lesion which requires intervention. RESULTS:A total of 172 patients (106 males and 66 females) were analyzed. Preoperatively, 132 patients (76.7 %) had mixed-type IPMN and 40 (23.1 %) had main duct IPMN. Among them, 16 patients (9.3 %) had CSRPL at 1569 days (median; range, 120-5503 days) after the initial surgery. In the preoperative imaging analysis, 104 patients (60.5 %) had DRM. The univariate analysis revealed that high-grade or micro-invasive pathology (p = 0.013) was significantly associated with CSRPL, whereas DRM was inversely associated with CSRPL (p = 0.021). The multivariate analysis revealed that the trends of DRM (p = 0.002) and high-grade/micro-invasive pathology (p = 0.003) remained significant. CONCLUSIONS:Leaving a dilated MPD did not increase but instead inversely associated with the incidence of CSRPL after IPMN resection. It was suggested that preserving the pancreas, including the dilated MPD, is oncologically safe if the lesion of interest can be resected.

Background Biliary tract cancers (BTCs) have poor prognoses, with limited curative options beyond surgical resection. Adjuvant S-1 chemotherapy has shown survival benefits in Japanese patients with resected BTCs. However, prognostic factors influencing survival in these patients remain uncertain. In this study, we aimed to investigate the efficacy of preoperative nutritional status using Global Leadership Initiative on Malnutrition (GLIM) criteria as a prognostic factor in patients receiving adjuvant S-1 chemotherapy for BTCs. Methods In this retrospective study, we evaluated 58 patients who underwent curative surgery for BTCs, excluding intrahepatic cholangiocarcinoma, at Kobe University from 2013 to 2022, followed by adjuvant S-1 chemotherapy. Nutritional status was classified by GLIM criteria into normal/moderate and severe malnutrition groups. Overall survival (OS) and recurrence-free survival (RFS) were analyzed using Kaplan–Meier and Cox proportional hazards models. Results Of the 58 patients, 3.4% had no malnutrition, 72.5% had moderate malnutrition, and 24.1% had severe malnutrition. Patients with severe malnutrition had significantly worse OS (24.7% vs 52.5%, p = 0.0014) and RFS (34.3% vs 52.0%, p = 0.0066). Severe malnutrition was an independent prognostic factor for both OS (hazard ratio [HR]: 3.40; 95% confidence interval [CI]: 1.46–7.94, p = 0.0047) and RFS (HR: 2.48; 95% CI: 1.07–5.76, p = 0.035). No significant difference in S-1 completion rates was observed. Conclusions Severe malnutrition, as defined by GLIM criteria, is a poor prognostic factor in patients with BTCs undergoing adjuvant S-1 chemotherapy.

We aimed to investigate the differences in surgical difficulty between laparoscopic partial liver resections of segments 7 and 8. We analyzed 173 patients who underwent partial liver resections of segments 7 or 8 between 2010 and 2022 at two institutions. We investigated differences in the surgical outcomes of each procedure using propensity score matching. We compared these outcomes with those of open partial liver resections for segments 7 and 8 to determine whether the differences were unique to the laparoscopic approach. Thirty and 54 patients underwent laparoscopic partial liver resections of segments 7 and 8. In the matched cohort (22 in each group), the operation time was significantly longer (377 vs. 278 min, P = 0.020) and the proportion of postoperative complications significantly higher in segment 7 (27