BACKGROUND:Hepatobiliary (HB) surgery is increasingly complex, requiring expertise beyond general surgery training. Structured fellowship programmes aim to ensure adequate operative training, academic growth, and global leadership, but their outcomes are not well studied. The Liverpool Hepatobiliary Fellowship has provided international HB training in a high-volume centre in the United Kingdom for over 18 years. METHODS:We performed a cross-sectional survey of all senior fellows who completed ≥6 months of the Liverpool fellowship (2007-2025). The questionnaire covered demographics, pre-fellowship experience, operative volume, academic productivity, and subjective fellowship evaluation. Fellows self-rated their confidence (1-10 scale) in performing a right hemihepatectomy with a junior assistant before and after the fellowship. Quantitative data were analysed descriptively, and pre-post confidence changes were tested. Qualitative responses were thematically analysed. RESULTS:Eighteen of 22 eligible fellows (82%) completed the survey. Fellows reported a significant increase in operative confidence, measured subjectively as their confidence in performing a right hemihepatectomy with a junior assistant (median improvement: 2.5/10 to 9/10). Median case volume included 65 liver resections. Minimally invasive surgery (MIS) exposure increased from 10 cases overall at the beginning of the programme to over 20 in the last 5 years. Over 80% of fellows published during or after the fellowship, and 83% were appointed to consultant roles within one year. Qualitative responses emphasized strong mentorship, high case volume, and career-defining experiences. Gaps identified included robotic surgery exposure and structured academic support. CONCLUSIONS:Dedicated HB fellowship programmes significantly enhance surgical competence, operative autonomy, academic output, and leadership development. The Liverpool programme exemplifies a successful international training model, combining high-volume hands-on practice with strong mentorship. The recent incorporation of robotic-assisted surgery addresses an identified key training gap, ensuring the fellowship's continued relevance in a technologically advancing field.

Hepatobiliary (HBI) surgery remains a complex procedure with associated morbidity, despite advancements in surgical techniques and postoperative care. Optimal patient outcomes depend not only on the surgery itself but also on comprehensive preoperative, intraoperative, and postoperative strategies to support patient recovery and mitigate risks. Preoperative optimization, including prehabilitation and lifestyle interventions, has gained attention for its potential to improve surgical outcomes and reduce complications. This review synthesizes the current evidence on different preoperative optimization strategies. Specifically, interventions such as smoking cessation, cardiovascular exercise and weight management as well as dietary and exercise prehabilitation were examined. We also highlight the role of hygienic precautions and infection management in enhancing outcomes. Through a thorough analysis of recent findings, this review aims to establish a comprehensive understanding of accessible and effective preoperative interventions. To different degrees, all preoperative interventions showed improved outcomes, including fewer complications, reduced hospital stays and enhanced postoperative quality of life. Preoperative patient optimization might improve outcomes after liver resection. Further research is essential to develop standardized protocols for prehabilitation and other optimization measures tailored to the unique needs of HBI patients.

BACKGROUND:Established clinical risk scores (CRSs) can estimate the prognosis of patients with colorectal liver metastases (CLM) after hepatic resection. However, their ability to predict outcome for patients undergoing neoadjuvant chemotherapy is limited, mainly because most included variables do not reflect a biologic response to neoadjuvant chemotherapy (NAC). This study aimed to evaluate the prognostic value of total metastases volume (TMV) and relative volume reduction (RVR) for patients with CLM undergoing perioperative chemotherapy and surgery. METHODS:Liver metastases volume was semi-automatically measured on computed tomography images in 69 patients before and after NAC and compared to established CRS regarding progression-free survival (PFS) and overall survival (OS). RESULTS:Patients with a TMV smaller than 29.5 ml before NAC and 7.5 ml after NAC showed a significantly longer PFS than those with a larger TMV (median, 31.0 vs. 13.7 months [p = 0.005] and 22.6 vs. 9.1 months [p = 0.013], respectively). An RVR after NAC of at least 73% was a positive predictor of PFS (median, 38.0 vs. 9.4 months; p = 0.004) and OS (mean, 59.5 vs. 92.5 months; p = 0.002). CONCLUSIONS:Total tumor volume and RVR of CLM seem to be superior to established CRS for patients undergoing neoadjuvant chemotherapy and surgery.

Colorectal liver metastases (CRLM) are the leading cause of colorectal cancer (CRC)-related mortality. Transfer RNA-derived fragments (tRFs), a novel class of small non-coding RNAs (sncRNA), regulate gene expression, stress response, and immune functions in cancer. While increasingly implicated in CRC progression, their prognostic significance in CRLM remains unknown. This study investigates the abundance and prognostic value of genomic (ge) and mitochondrial (mt) tRFs in CRLM. Tumor samples from CRLM patients who underwent curative liver resection between January 2012 and December 2015 were retrospectively analyzed. Small RNA sequencing (sRNA-seq) quantified ge- and mt-tRF expression in tumor tissue. Event-free survival (EFS) was the primary outcome. Associations between tRF expression and EFS were evaluated using Cox regression, spline modeling, and network analysis. Among 588 screened samples, 40 met eligibility criteria (18 females [45

BACKGROUND:Intraoperative microwave ablation (MWA) can be used simultaneously with liver resection in patients with colorectal liver metastases (CLM) with curative intent. It is uncertain whether this treatment concept is limited by the number of intraoperative MWAs or the number of CLMs. This study was performed to investigate whether the number of CLMs and intraoperative MWAs is associated with overall survival (OS) and recurrence-free survival (RFS). METHODS:Patients with CLM who underwent both liver resection and intraoperative MWA between 1.1.2010 and 1.9.2020 were examined. The influence of the number of MWAs and CLMs on OS and RFS was assessed. RESULTS:Seventy-five patients were examined. The sex ratio (m:f) was 48:27. The median age was 61 years (range 34-86). The number of MWAs and CLMs was not associated with OS or RFS. Only adjuvant chemotherapy was associated with OS (HR 0.14 (0.04, 0.45), P < 0.001). CONCLUSION:The number of intraoperative MWAs and CLMs did not influence clinical outcomes. Liver resection and intraoperative MWA can be recommended to all patients regardless of the number of MWAs and CLMs, based on the findings of this study. Adjuvant chemotherapy emerges as a critical component of this multidisciplinary treatment strategy.

PDF - 43KB, Plastin protein expression from plasma of stage II/III CRC patients. ELISA quantitated LCP1 and PLS3 protein level in USC cohort patients' serum. The significance in expression level was determined by the GraphPad Prism software. Data shown represent the mean ? standard deviation. P <0.05 was considered significant. Stage of colorectal cancer was classified according to TNM staging system. Supplementary figure 4 method: ELISA: Microtiter 96-well plates were coated with patient plasma samples in 50 mM carbonate buffer at a pH of 9.0 and incubated overnight. The quantification of PLS3 (A-8, SC-166223, 1μg/ml) and LCP1 (B-9, SC-133218, 1μg/ml) protein was determined using the protocol provided by Santa Cruz Technology. Standard 1000, 500, 250, 15, 62.5, 31.25, 15.625, 7.8125, 3.9, 1.95 ng/ml dilutions of PLS3 and LCP1 were prepared, and the corresponding optical density (OD) values were used to prepare a standard curve using the Origin 6.1 software.

PDF - 56KB, Time-to-tumor recurrence (TTR) by PLS3 rs6643869 in USC cohort (Training set) stage II/III CRC male patients treated with 5-fluorouracil (5-FU)-based chemotherapy.

PDF - 278KB, Time-to-tumor recurrence (TTR) by PLS3rs6643869 in female right sided CRC and female left sided CRC patients in USC cohort.

Kaplan Meier curves for KDR mRNA levels in CLM for RFS (complete response, CR)

Kaplan Meier curves for EPHB4 mRNA levels in CLM for RFS (complete response, CR)

Purpose: The liver is a central immunological organ that orchestrates a wide range of distinct immune responses with iron being a fundamental element for immune homeostasis and cell regeneration. As iron is mainly stored in the liver, liver resection (LR) might also have an indirect effect on the immune system. Furthermore, preoperative iron storage might be especially relevant for the outcome after LR.

PDF - 56KB, Time-to-tumor recurrence (TTR) by LCP111342 in USC cohort (Training set) stage II/III CRC male patients treated with 5-fluorouracil (5-FU)-based chemotherapy.

ROC curve stratified by combination of CK20 and Survivin gene expression: An optimal cutoff value of either 0.16 for CK20 or 0.15 for Survivin yields a sensitivity of 79.6% and specificity of 85%.

PDF - 85KB, Primer sequences and region of Plastin polymorphisms.

Kaplan Meier curves for ACVRL1 mRNA levels in CLM for OS (complete response, CR; standard error, SE)

This figure shows the signal pathway of TLR1, TLR2, and TLR6. TLR1 and TLR6, each of which forms a heterodimer with TLR2, initiate MAPK or NFκB pathway through TAK1. MyD88: myeloid differentiation factor88, TRAF: TNF receptor-associated factor, IRAK: 　IL-1R associated kinase, TAK: TGFβ-activated kinase, TAB: TAK1-binding protein, MAPK: mitogen-activated protein kinase.

Purpose: Intraoperative microwave ablation (MWA) is used in patients with colorectal liver metastases (CLM) who undergo liver resection in curative intent. It is unknown if this treatment concept is limited by the extent of intraoperative MWA or the number of CLM. This study was performed to investigate if the number of CLM and intraoperative MWA are associated with overall survival (OS). Method: Patients with CLM who underwent liver resection and intraoperative microwave ablation in curative intent between 2010 and 2020 were investigated. The number of CLM and MWA and their association with overall survival and recurrence free survival (RFS) were analyzed. Results: Seventy-five patients were enrolled. The sex ratio (m:f) was 48:27. The median age was 61 years (range 34-86). The number of MWA and CLM were not associated with OS and RFS. Only adjuvant chemotherapy was associated with OS (HR 0.14 (0.04, 0.45), P< 0.001). Conclusion: The number of intraoperative MWA and CLM were not associated with clinical outcome. This study shows that liver resection and intraoperative MWA can be offered to all patients independent of the number of MWA and CLM. Adjuvant chemotherapy is a crucial factor in this multidisciplinary treatment approach.

Background: Obesity and associated steatosis is an increasing health problem worldwide. Its influence on post-hepatectomy liver failure (PHLF) and after liver resection (LR) is still unclear.Methods: Patients who underwent LR were investigated and divided into three groups [normal weight: body mass index (BMI) 18.5-24.9 kg/m2, overweight: BMI 25.0-29.9 kg/m2, obese: BMI >= 30 kg/m2] in this retrospective study. Primary aim of this study was to assess the influence of BMI and nonalcoholic steatohepatitis (NASH) on PHLF and morbidity.Results: Of 888 included patients, 361 (40.7%) had normal weight, 360 (40.5%) were overweight, 167 (18.8%) were obese. Median age was 62.5 years (IQR, 54-69 years). The primary indication for LR was colorectal liver metastases (CLM) (n=366, 41.2%). NASH was present in 58 (16.1%) of normal weight, 84 (23.3%) of overweight and 69 (41.3%) of obese patients (P<0.001). PHLF occurred in 16.3% in normal weight, 15.3% in overweight and 11.4% in obese patients (P=0.32). NASH was not associated with PHLF. There was no association between patients' weight and the occurrence of postoperative complications (P=0.45). At multivariable analysis solely major LR (OR 2.7, 95% CI: 1.83-4.04; P<0.001) remained a significant predictor for PHLF.Conclusions: Postoperative complications and PHLF are comparable in normal weight, overweight and obese patients and LRs using modern techniques can be safely performed in these patients.