PurposeThis study aims to provide a meta-analysis of relevant outcomes related to various sclerosant agents used in percutaneous lymphocele sclerotherapy.Materials and MethodsA systematic review, registered on PROSPERO (Record CRD420251180687), was performed using PubMed, Scopus, and Web of Science, including studies reporting any kind of postoperative lymphoceles treated with a sclerosant agent. Searches were updated to November 2025. Pooled success, recurrence, and complication rates were estimated for each sclerosant agent, and differences across agents were explored. The risk of bias was assessed using Methodological Index for Non-Randomized Studies, while the certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation.ResultsSixteen studies were included-fifteen retrospective and one prospective-reporting on different sclerosant agents: ethanol, povidone-iodine, OK-432, fibrin glue, polidocanol, and doxycycline. A total of 335 lymphoceles were studied. Ethanol showed the most consistent results, with high clinical success (97.4%, 95% CI 82.6-99.7%) and low recurrence rates across the studies (6.7%, 95% CI 3.1-14.2%). The other sclerosant agents yielded similar results but with a lower grade of evidence certainty. Minor complication rates were low (12.2%), consisting predominantly of mild and self-limiting adverse events; only two major complications were reported. Limitations were heterogeneity among studies and predominance of retrospective designs.ConclusionsPercutaneous sclerotherapy yielded favorable results with all agents; however, ethanol is the best-characterized agent, with consistent outcomes and moderate certainty of evidence. High-quality, prospective research is needed in order to choose the best sclerosant agent and standardize the procedure.Level of EvidenceLevel IV, systematic review of retrospective non-comparative studies.

Background:Transjugular intrahepatic portosystemic shunt (TIPS) is used to manage portal hypertension-related complications in patients awaiting liver transplantation. However, the role of pretransplant TIPS placement remains controversial. Methods:We conducted a retrospective, single-center cohort study to evaluate the impact of pretransplant TIPS on postoperative complications and in-hospital mortality. Results:We included 263 cirrhotic patients who underwent liver transplantation from deceased donors between 2015 and 2023. Twenty-three patients (8.7%) underwent pretransplant TIPS placement. All TIPS were placed using controlled-expansion stents, with a median diameter of 8 ± 1 mm. Stent migration was identified intraoperatively in 7 patients (30.4%) and was associated with increased surgical complexity. After propensity score weighting, pretransplant TIPS was not independently associated with operative time, use of venovenous bypass, transfusion requirements, length of intensive care unit (ICU) or hospital stay, comprehensive complication index, major complications (Clavien-Dindo ≥ III), or in-hospital mortality. Conversely, reoperation rates were higher in the TIPS group (17.4% vs. 8.0%, P = 0.003). In multivariable analysis, previous abdominal surgery was the only independent predictor of in-hospital mortality. Conclusions:Pretransplant TIPS may allow patients with severe portal hypertension to achieve postoperative outcomes comparable to those without TIPS, but should be reserved for guideline-supported indications, given the lack of demonstrated survival benefit.

Background: The role of transarterial chemoembolization (TACE) in hepatocellular carcinoma (HCC) management has evolved over recent years. Although it appears that the overall number of procedures is declining, international guidelines now endorse TACE beyond the Barcelona Clinic Liver Cancer (BCLC) intermediate stage, and multiple TACE platforms allow patient-tailored treatments. In this context, degradable starch microspheres TACE (DSM-TACE) may be valuable when the goal is to preserve liver function and spare healthy parenchyma. This study reports multicenter retrospective Italian data to assess the efficacy and safety of DSM-TACE with EmboCept® in patients with early-to advanced-stage HCC, and to evaluate whether procedural selectivity (superselective vs. lobar) influences outcomes. Methods: This retrospective multicenter study included 201 patients initially; after applying exclusion criteria, 187 patients (334 HCC nodules) treated across eight centers (2014-2024) were analyzed. Treatment indications were discussed in multidisciplinary tumor boards in all centers. Superselective DSM-TACE was performed in 48 patients (66 nodules, 19.8%), while 139 patients (268 nodules, 80.2%) underwent a lobar approach. Repeated sessions were performed on demand and recorded for lobar treatments. Tumor response was assessed using mRECIST criteria at 1, 3-6, 6-9, and 9-12 months; adverse events were classified according to the Common Terminology Criteria for Adverse Events (CTCAE). efficacy and safety outcomes were compared according to the DSM-TACE approach. Results: In terms of safety, analysis confirmed the overall good tolerability of DSM-TACE, with no grade ≥ 3 adverse events and no major complications or procedure-related deaths. No significant differences were observed in post-embolization syndrome (PES) rates between groups. With regard to efficacy, for the entire cohort, the overall response rate (ORR) was 70% at 1 month, 31.6% at 3-6 months, 20.5% at 6-9 months, and 13.5% at 9-12 months, while the disease control rate (DCR) was 91.4% at 1 month, 69% at 3-6 months, 38.6% at 6-9 months, and 27% at 9-12 months. At intermediate follow-up, superselective DSM-TACE achieved higher ORR than lobar treatment at 3-6 months (53.8% vs. 26.4%; p = 0.009) and 6-9 months (43.8% vs. 15.3%; p = 0.009). Per-nodule analysis confirmed this advantage at 3-6 months (ORR = 66.7% vs. 31.3%; p = 0.0008). Conclusions: DSM-TACE with EmboCept® provides favorable tumor control and a good safety profile in routine clinical practice. A superselective approach is associated with improved response at intermediate follow-up compared with lobar strategy, supporting DSM-TACE as a flexible therapeutic option for localized HCC.

Malignant Bowel Obstruction (MBO) is an often preterminal complication of gastrointestinal and gynecological cancers. We tried to identify clinical and radiological parameters suggesting early providing of End of Life (EOL) care protocols in this kind of patients at Emergency Department (ED) presentation. We retrospectively analyzed 60 ED patients admitted for MBO in a one-year period, identifying a Bad Prognosis Group (BPG) (died or transferred to EOL care centers) and a Good Prognosis Group (GPG) (prosecution of treatment with curative intent). Predictors of bad prognosis were: time of onset of symptoms, Eastern Cooperative Oncology Group performance status (ECOG), Charlson Comorbidity Index (CCI), past intestinal obstruction, previous abdominal surgery and therapeutic strategy adopted. Computed tomography scan studies were reviewed by expert radiologists. CCI ≥ 4 (p=0,030), ECOG score ≥ 2 (p=0,016), no large bowel occlusion (p=0,045), mesenteric infiltration retraction (p=0,047) and extraperitoneal metastases (p=0,049) confirmed independent predictive value of bad prognosis at multivariate analysis. Identifying clinical and radiological criteria at ED evaluation can be useful to better identification of those MBO patients who may benefit from early providing EOL care protocols.

BACKGROUND & AIMS:Conventional CT (CCT) is widely used to assess hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE), but its diagnostic performance is often limited by lipiodol-induced beam-hardening artifacts and poor contrast resolution. Dual-energy CT (DECT) with low-keV monochromatic imaging may improve detection of viable residual tumors, yet its clinical value remains to be fully established. This study compared diagnostic performance, image quality, spatial accuracy, and interobserver agreement of DECT versus CCT for identifying viable HCC post-TACE using MRI as the reference standard. MATERIALS AND METHODS:This retrospective, single-center study included 48 patients with 76 HCC lesions who underwent both DECT and MRI within 3 months after conventional TACE. Conventional CT (CCT) and 40-keV monoenergetic (MonoE40) images were reconstructed from DECT data. Diagnoses were independently assessed by radiologists blinded to MRI results. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), Dice similarity coefficient (DSC) for spatial agreement, and Fleiss' kappa for interobserver agreement were analyzed. RESULTS:Fifty-five lesions were viable per MRI. MonoE40 images showed significantly superior diagnostic performance compared to CCT (P < 0.05), especially for lesions with viable components < 2 cm (detection rates: 74.1 %-85.2 % vs. 25.9 %-48.1 %). MonoE40 also yielded higher diagnostic confidence, lesion conspicuity, and arterialphase CNR (P < 0.001). Dice coefficients for tumor delineation improved from 0.31 to 0.54 on CCT to 0.76-0.95 on MonoE40 (P < 0.05). Interobserver agreement at whole-lesion level was higher with MonoE40 (κ = 0.55) versus CCT (κ = 0.29), with the greatest improvement among less-experienced readers (κ from 0.35 to 0.59). CONCLUSION:DECT with 40-keV monochromatic reconstruction significantly improves detection of viable residual HCC after TACE, enhances tumor boundary delineation, and increases consistency among radiologists compared with CCT, especially benefiting less-experienced readers. These results support incorporating DECT into standard post-TACE imaging protocols.

To perform a systematic review and meta-analysis comparing efficacy and the safety profile of Degradable Starch Microspheres TACE (DSM-TACE) with conventional treatments (cTACE and DEB-TACE) in patients with Hepatocellular carcinoma (HCC). Comparative studies (including randomized controlled trials -RCTs- and observational studies) reporting at least one of the following outcomes were included and considered for statistical analysis: Tumor response according to mRECIST criteria, Overall Survival (OS), Adverse Events (AEs), increase of ALT and AST levels. Risk Ratios were calculated using random-effects models. Survival analyses and Hazard Ratios were derived using reconstructed individual patient data. 6/180 articles met inclusion criteria, including 1 RCT and 5 observational studies. Tumor response was comparable between DSM-TACE and control groups, without significant differences in the pooled analyses. DSM-TACE was not associated with a significant improvement in OS compared with conventional treatments (HR = 1.04; 95

BACKGROUND AND AIMS:Clinically significant portal hypertension (CSPH) is the main driver of hepatic decompensation, and its early identification allows timely initiation of preventive therapies. Hepatic Venous Pressure Gradient (HVPG) is the current gold standard for assessing portal hypertension (PH), but it may underestimate PH in conditions with a presinusoidal component. Endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) enables direct measurement of portal pressure and may overcome these limitations. We evaluated the prognostic performance of EUS-PPG compared with HVPG for predicting hepatic decompensation in patients with suspected CSPH. APPROACH AND RESULTS:This preliminary exploratory analysis of the ongoing prospective EVADIPP study included 90 patients who underwent paired HVPG and EUS-PPG measurements and were followed for decompensation. Mean EUS-PPG and HVPG values were 13.8 ± 5.8 mmHg and 8.9 ± 4.8 mmHg, respectively, with poor overall agreement (ICC 0.08, 95% CI -0.08 to 0.24). Agreement remained poor in porto-sinusoidal vascular disorder (PSVD), slight in metabolic dysfunction-associated steatotic liver disease, and substantial in alcohol- and viral-related liver disease. During follow-up, 28 patients (31%) developed decompensation; no events occurred among patients with EUS-PPG<10 mmHg, whereas 60.7% had HVPG <10 mmHg. In multivariable analysis, EUS-PPG (HR 1.19, 95% CI 1.10-1.30; p<0.001) and albumin were independently associated with decompensation. EUS-PPG demonstrated better discrimination than HVPG (C-index 0.78 vs 0.56), and time-dependent ROC analysis identified an optimal threshold of 12 mmHg. CONCLUSIONS:EUS-PPG is independently associated with hepatic decompensation and showed better prognostic discrimination than HVPG in this exploratory cohort.

This multisociety, multidisciplinary consensus—formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology—was developed to standardise the assessment of ablation margins in liver tumour thermal ablation. A modified Delphi process, consisting of two online surveys and a hybrid (online and in-person meeting in Innsbruk) consensus meeting of 72 experts from North America, South America, Europe, and Asia. Formal consensus was reached for 150 (75%) of 199 statements. Strong agreement was observed between interventional and surgical oncologists, with only 12 (6%) of 199 statements showing significantly different ratings. Participants agreed that ablation margins should be assessed and documented for every treated tumour. Margins should be assessed quantitatively in three dimensions, with contrast-enhanced CT or MRI, preferably intraprocedurally with ablation confirmation software. Ablation margins should be categorised as A0 (tumour completely covered with sufficient margin), A1 (tumour completely covered but insufficient margin), or A2 (portion of tumour remains unablated). This effort is, to our knowledge, the first international consensus initiative to define best-practice recommendations for margin assessment in liver tumour thermal ablation to standardise practices, aiming to improve and promote uniform outcomes.

Minimally invasive ablative therapies have emerged as effective and safe alternate approach for the management of renal cell carcinoma (RCC), particularly in patients who are ineligible for surgery due to comorbidities or high operative risk. Techniques such as radiofrequency ablation (RFA), microwave ablation (MWA), cryoablation (CA), and high-intensity focused ultrasound (HIFU) offer kidney-sparing treatment with reduced morbidity. Current evidence suggests that for cT1a tumors (<4 cm), thermal ablation achieves technical success rates exceeding 95%, with local recurrence rates ranging from 1% to 9% and major complication rates generally below 5–7%. RFA is particularly suitable for small peripheral tumors, MWA enables rapid and deeper heating for larger or more vascular lesions, and CA provides precise control near critical structures. HIFU remains largely experimental with limited clinical applicability. Overall, these strategies demonstrate favorable oncological outcomes, emphasizing the importance of careful patient selection, multidisciplinary evaluation, and further studies to refine technique-specific indications and integration with systemic therapies.

Introduction: Low bone mineral density (BMD) is an increasingly recognized marker of skeletal frailty, associated with higher fracture risk and mortality in cancer patients. In advanced hepatocellular carcinoma (HCC), however, the prognostic significance of baseline BMD remains unclear. This exploratory subanalysis of the SORAMIC trial evaluated whether CT-derived BMD predicts overall survival (OS) in patients with unresectable HCC. Methods: In this exploratory post hoc study, 342 patients with unresectable HCC and preserved liver function (Child-Pugh ≤B7) were enrolled in the palliative arm of the SORAMIC trial and randomized to receive either sorafenib monotherapy (n = 170) or selective internal radiation therapy (SIRT) plus sorafenib (n = 172). BMD (in Hounsfield units [HU]) was measured at the third lumbar vertebra on pre-treatment contrast-enhanced CT scans. Patients were stratified into low and high BMD groups using three definitions: the cohort median (139.5 HU for men, 130.0 HU for women), <160 HU for men and <175 HU for women (Meister criteria), and <160 HU (Jang criteria). Cox regression analyses assessed the impact of BMD on OS. Results: Median OS in the overall cohort was 11.1 months. No significant association between BMD and OS was observed in the entire cohort or within the sorafenib and SIRT/sorafenib subgroups. Similar nonsignificant results occurred in alcohol-, viral-, and metabolic dysfunction-associated steatohepatitis/metabolic dysfunction-associated steatotic liver disease-induced HCC subgroups. Conclusion: Baseline CT-derived BMD does not predict OS in advanced HCC patients, indicating it is not a robust prognostic biomarker in this setting. Low BMD does not affect a patient’s resilience to SIRT.

Background and aims: Clinically significant portal hypertension (CSPH) is the strongest predictor of hepatic decompensation. The hepatic venous pressure gradient (HVPG) is the gold standard for diagnosing CSPH, but it provides only an indirect estimate of portal pressure and may underestimate presinusoidal or mixed forms of portal hypertension (PH), particularly in porto-sinusoidal vascular disorder (PSVD) and metabolic-associated steatotic liver disease (MASLD). Endoscopic ultrasound (EUS)-guided portal pressure gradient (PPG) measurement enables direct recording of portal and hepatic vein pressures, potentially offering a more comprehensive hemodynamic assessment. This study evaluated the concordance between EUS-PPG and HVPG and assessed their prognostic value in predicting hepatic decompensation.Methods: In this prospective single-center study, consecutive patients with suspected CSPH of various etiologies underwent both EUS-PPG and HVPG measurement. Baseline demographic, biochemical, and clinical data were collected. EUS-PPG was obtained using the EchoTip Insight™ system, and HVPG was measured according to Baveno VII recommendations. Correlation between EUS-PPG and HVPG was assessed using Pearson’s coefficient, while agreement was evaluated with Bland–Altman analysis. Predictors of hepatic decompensation (ascites, variceal bleeding, or hepatic encephalopathy) were explored using univariate and multivariate logistic regression analyses.Results: Ninety patients were enrolled (45.6% male; mean age 60 years). Liver disease etiologies included PSVD (35.6%), MASLD (31.1%), autoimmune liver diseases (14.4%), metabolic/alcohol-related liver disease (7.8%), viral hepatitis (7.8%), and alcohol-related liver disease (3.3%). All procedures were technically successful without severe adverse events. Mean EUS-PPG and HVPG values were 14 ± 6 mmHg and 9 ± 5 mmHg, respectively. Seventy patients (77.8%) had PPG >10 mmHg, while only 41 (45.6%) had HVPG >10 mmHg. Concordance between methods was modest, with a mean PPG–HVPG difference of + 4.7 mmHg (95% LoA: −9.6 to +18.9 mmHg) and a weak linear correlation (r = 0.036, p = 0.73). During a median follow-up of 12 months, 17 patients (18.9%) developed hepatic decompensation. At univariate analysis, PPG (OR 1.27; 95% CI 1.11–1.44; p = 0.0003) and platelet count (OR 0.97; 95% CI 0.95–0.99; p = 0.001) were significantly associated with the occurrence of hepatic decompensation In the multivariate analysis including significant variables, EUS-PPG (OR 1.40; 95% CI 1.11–1.76; p = 0.004), together with platelet count (OR 0.97; 95% CI 0.95–1.00; p = 0.037) remained independent predictors of hepatic decompensation.Conclusions: EUS-PPG is a feasible, safe, and informative method for assessing portal hypertension across heterogeneous liver disease etiologies. It independently predicts hepatic decompensation, suggesting potential advantages over HVPG especially in presinusoidal or mixed forms of PH such as PSVD and MASLD.

Thermal ablation offers a safer, less invasive, and more cost-effective curative-intent treatment for selected patients with primary and metastatic liver tumours than surgery; when done with appropriate technique, ablation can deliver similar oncological outcomes. However, effectiveness in routine practice varies because structured training, planning, and procedural governance remain scarce. These international multidisciplinary, multi-society guidelines—formally endorsed by the European Society of Surgical Oncology, the Cardiovascular and Interventional Radiological Society of Europe, and the Society of Interventional Oncology—define key domains contributing to procedural difficulty and practice variation in liver tumour thermal ablation. A Delphi consensus initiative held in Innsbruck, Austria, engaged 72 experts across three iterative rounds of scoring across 135 statements grouped into five domains: credentialing, indications, approach, procedural factors, and safety measures. Consensus was achieved for 94 (70%) of 135 statements. The least invasive route—typically percutaneous—should be prioritised, and margin adequacy was reaffirmed as the principal technical goal. Procedural difficulty was considered context-dependent, shaped by tumour factors, institutional infrastructure, and operator experience. Organ displacement techniques were endorsed to maintain safety and expand treatable indications. Complex ablations should be done by experienced operators (more than 100 previous cases), with programmes underpinned by structured training, multidisciplinary team participation, and routine audit. Future efforts should develop and validate practical tools such as difficulty scoring systems, standardised procedural reporting templates, and comprehensive training curricula to improve consistency, standardisation, and clinical outcomes globally.

Transarterial chemoembolization (TACE) is a promising locoregional therapy for unresectable colorectal liver metastases, but patient selection remains challenging. We aimed to develop and validate prognostic radiomics-based machine learning models in a multicenter, prospectively collected drug-eluting microsphere TACE cohort. We retrospectively analyzed 76 patients (176 lesions) from the prospective CIREL registry trial. Radiomic features were extracted from each lesion. We tested three types of imaging markers: general radiomics, intensity-based features, and lesion volume. For each, we derived baseline and delta features, reflecting the difference in feature vector values between baseline and first follow-up. Using a center-based split, we trained genetic/evolutionary machine learning models to predict survival and lesion-level response. The median age of the final study population with baseline imaging was 66 years (IQR, 59–71), with 67.1

BACKGROUND & AIMS:HVPG is the gold standard for the diagnosis of clinically significant portal hypertension (CSPH), a condition associated with the risk of developing hepatic decompensation events. However, HVPG is an indirect method to measure portal pressure, and its application in the pre-sinusoidal form of portal hypertension (PH), as in porto-sinusoidal vascular disorder (PSVD), is hindered by low accuracy. Recently, endoscopic ultrasound-guided portal pressure gradient (EUS-PPG) measurement, which allows direct measurement of portal pressure, is emerging as a safe method and may overcome the limitation of HVPG. However, data in patients with CSPH and the pre-sinusoidal form of PH are still missing. This study aims to evaluate the safety and usefulness of EUS-PPG compared to HVPG in a cohort of patients with PSVD and CSPH. METHODS:In this prospective single center study, patients with a diagnosis of PSVD who presented a clinical suspicion of CSPH underwent HVPG and EUS-PPG baseline measurements. A second EUS-PPG measurement was performed in patients naïve to non-selective beta-blockers (NSBBs) to evaluate haemodynamic response to therapy. RESULTS:Twenty-six patients were enrolled and a total of 26 HVPG and 35 EUS-PPG measurements were performed, without any adverse events. Mean EUS-PPG was significantly higher than mean HVPG value (16.7 ± 5.5 mmHg versus 5.5 ± 2.8 mmHg). At logistic multivariate regression analysis, EUS-PPG value was the only variable associated with hepatic decompensation. CONCLUSIONS:EUS-PPG measurement is safe and might have a prognostic role in patients with PSVD and CSPH, outperforming HVPG. TRIAL REGISTRATION:ID5486.