The surgical burden score: a novel continuous metric to predict postoperative complications after hepatectomy for hepatocellular carcinoma.

Background: No validated model incorporates surgical parameters for complication risk in hepatocellular carcinoma (HCC) resection. We evaluated a novel Surgical Burden Score (SBS), integrating adjusted blood loss (aBL; mL/kg) and operative time (hours) via a Pythagorean formula, and developed an SBS-based model to predict complications.

Methods: Patients undergoing curative-intent hepatectomy for HCC(2000-2023) were identified from an international database.

Characteristics of "Very Early" Intrahepatic Cholangiocarcinoma Undergoing Liver Resection and Its Relationship With Carbohydrate Antigen 19-9.

Introduction: The concept of "very early" ICC ( ≤ 2 cm, single tumor) has been introduced in the context of LT. Due to the limited number of patients in this subset, the characteristics and long-term outcomes have been ill-defined. We sought to assess long-term outcomes of very early ICC patients undergoing liver resection using a large, multi-institutional database.

The Lipid Hydrolase ABHD6 is a Therapeutic Target in Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD)-Related Hepatocellular Carcinoma.

Unlabelled: Primary liver cancer accounts for approximately 700,000 deaths worldwide annually ranking third in cancer-related mortality, with hepatocellular carcinoma (HCC) comprising the majority of these tumors. Metabolic dysfunction-associated steatotic liver disease (MASLD) is currently a leading cause of HCC in the United States. We previously identified the lipid hydrolase alpha/beta hydrolase domain 6 (ABHD6) as a key mediator of the development of metabolic syndrome and intimately involved in cell signaling, making it a prime target for investigation in MASLD-related HCC.

A New Era of Decision-making in Liver Transplantation: A Prospective Validation and Cost-effectiveness Analysis of FMN-guided Liver Viability Assessment During Normothermic Machine Perfusion.

Objectives: Flavin mononucleotide (FMN), a marker of mitochondrial complex 1 injury, has not yet been validated for its predictive value of outcomes and economic impact.

Background: Normothermic machine perfusion (NMP) is the only ex situ perfusion technique currently approved for liver transplantation in the United States. Optimal graft viability assessment on this approach remains controversial.

International validation of a natural-killer-cell-based model to predict recurrence-free survival in hepatocellular carcinoma.

Background: Models estimating recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on clinical variables and often overlook tumor immunobiology. The Liver Immune Status Index (LISI), derived from BMI, albumin, and Fibrosis-4 (FIB-4), reflects liver-resident natural killer (NK) cell activity. We validated the HISCO-HCC score, combining LISI, tumor burden score (TBS), and alpha-fetoprotein (AFP), using an international cohort.

The Role of KRAS Status Among Patients Undergoing Staged Versus Simultaneous Resection for Synchronous Colorectal Liver Metastases.

Background: This study aimed to evaluate the impact of surgical timing-simultaneous versus staged resection-on outcomes of patients with colorectal liver metastases (CRLM) in relation to KRAS mutation status, which is a key factor affecting prognosis.

Methods: Patients who underwent curative-intent resection for synchronous CRLM (sCRLM) were identified from an international, multi-institutional database. The association between clinicopathologic factors, staged versus simultaneous approach and wild-type (wtKRAS) versus mutated (mtKRAS) KRAS with long-term outcomes was assessed.

Oncological Resectability Criteria for Intrahepatic Cholangiocarcinoma: A Preoperative Framework for Multidisciplinary Management.

Introduction: Recent advancements in systemic chemotherapy have fueled debates regarding the feasibility of combining systemic therapy with surgery for advanced intrahepatic cholangiocarcinoma (ICC). However, the absence of consensus on oncological resectability criteria has hindered discussions on optimal multidisciplinary management. This study sought to propose preoperative oncological resectability criteria for ICC.

Preoperative Systemic Immune-Inflammatory Index Predicts Occult Nodal Disease in Clinically Node-Negative Intrahepatic Cholangiocarcinoma.

Background: Accurate preoperative diagnosis of nodal status in intrahepatic cholangiocarcinoma (ICC) remains challenging. The objective of the current study was to determine if the systemic immune-inflammatory index (SII) was associated with occult nodal disease (OND) among cN0 patients undergoing resection for ICC.

Methods: Patients who underwent curative resection for ICC were identified from an international multi-institutional database.

Mechanisms and Management of Graft In- and Out-flow in Liver Transplantation: A Narrative Review of the Literature and Guide for Interventional Management.

Background And Aims: Management of the dual vascular supply of liver grafts in liver transplantation (LT) is increasingly recognized as crucial to achieving adequate graft function. We aim to review how the relationship between graft in-flow and out-flow affects graft function, and how surgeons can manage graft function within the context of liver hemodynamic autoregulation. This includes mechanisms of such autoregulation including the hepatic artery buffer response (HABR), and the impact of porto-systemic circulatory changes on graft inflow.

Circulating Tumor DNA in Primary and Secondary Liver Cancers: A Comprehensive Review.

Similar to many other cancer types, liver malignancies pose the common challenges of late detection of primary tumors and recurrences. Liquid biopsies, which assess the presence of circulating tumor DNA, have emerged as a novel, non-invasive clinical tool for diagnostic and surveillance purposes. This review represents an introductory and comprehensive overview of the current circulating tumor DNA (ctDNA) literature relevant to primary and secondary liver malignancies.

Nutritional status as a potential modulator of tumor morphology relative to disease-free survival: the role of Geriatric Nutritional Risk Index among patients with colorectal liver metastases.

Background: Malnutrition is highly prevalent among oncologic patients and can affect both survival and therapeutic responses. The Geriatric Nutritional Risk Index (GNRI) is a validated nutritional score used in elderly populations to predict morbidity and mortality. However, the relationship between GNRI and tumor burden remains unknown.

Recurrence After Gallbladder Cancer Resection: Prognostic Impact of CA19-9 and CEA Levels at Baseline and During Surveillance.

Introduction: Baseline serum carbohydrate antigen (CA) 19-9 and carcinoembryonic antigen (CEA) levels may predict prognosis among patients undergoing resection for gallbladder cancer (GBC), yet the prognostic utility of the combination of the two markers has not been well established. In addition, the prognostic significance of elevated preoperative CA19-9 levels that normalize after GBC resection is currently unknown.

Methods: Patients undergoing resection of GBC between 2002 and 2021 were identified using an international, multi-institutional database.

Distinct patterns of late recurrence in long-term hepatocellular carcinoma survivors.

Background: Among patients with hepatocellular carcinoma (HCC), late recurrence - defined as recurrence occurring ≥2 years after treatment - has often been treated as a singular, uniform event, despite being inherently heterogeneous and driven by diverse biologic mechanisms. This study aimed to identify prognostic factors associated with recurrence among long-term survivors of HCC after treatment, with particular emphasis on the role of underlying liver fibrosis and intrinsic tumor aggressiveness.

Methods: Patients who underwent hepatectomy for HCC between 2000 and 2021 were identified from an international database.

Unraveling the obesity paradox in hepatocellular carcinoma: relative role of elevated body mass index on detrimental effects of postoperative complications.

Background: The "obesity paradox" suggests higher body mass index (BMI) may correlate with better long-term outcomes in cancers. The impact of BMI on hepatocellular carcinoma (HCC) resection, regarding postoperative complications, remains unclear. We examined the interplay between BMI and complications on recurrence-free survival (RFS) among patients undergoing HCC resection.

Liver-Directed Therapies in Colorectal Cancer: Old Hats and New Tricks.

Resection of liver metastases is considered the only treatment with curative potential for patients with metastatic colorectal cancer to the liver (CRLM). However, only a minority of patients with CRLM are eligible for up-front resection of liver metastases. Despite advances in systemic chemotherapy, long-term survival is rare without resection of liver metastases.

Oncologic impact of perineural invasion in perihilar cholangiocarcinoma: an international multicenter study.

Background: We sought to evaluate the prognostic significance of perineural invasion (PNI) among patients undergoing curative-intent resection for perihilar cholangiocarcinoma (pCCA), with a specific focus on early-stage disease.

Methods: Data from patients who underwent curative-intent resection for pCCA were collected from eight high-volume international hepatobiliary centers. The association between PNI status, clinicopathological features, and long-term survival was analyzed in both the overall cohort and a subset of patients with early-stage pCCA.

Quantifying Flavin mononucleotide: an internationally validated methodological approach for enhanced decision making in organ transplantation.

Background: Increasing donor risk, particularly in liver transplantation, where organs are often marginal, has made dynamic organ preservation techniques and viability assessment essential to safely improve organ quality and increase utilisation. However, existing viability parameters are based on routine clinical assessment in patients with acute liver failure, trauma, or liver resections. These parameters often do not correlate with clinically relevant post-transplant outcomes.

Transforming Transplant Oversight: Enhancing Combined Cardiothoracic Surgery and Liver Transplantation With Normothermic Machine Perfusion.

Background: Simultaneous cardiothoracic surgery and liver transplantation (LT) is a high-risk procedure associated with high mortality and morbidity rates. The use of normothermic machine perfusion (NMP) allows graft quality enhancement, assessment of liver viability, and logistics optimization, expanding the donor pool and reducing organ discard rate. We share our institution's experience with simultaneous cardiothoracic surgery and LT, using NMP for liver graft preservation and viability assessment.

Textbook outcome in liver surgery after staged versus simultaneous resection for synchronous colorectal liver metastases.

Background: We sought to define the likelihood of textbook outcome in liver surgery (TOLS) among patients undergoing simultaneous versus staged resection for sCRLM.

Methods: Patients with sCRLM who underwent curative-intent resection between 2000-2022 were identified from an international multi-institutional database. TOLS was defined by the absence of intraoperative grade ≥2 events, R1 resection margin, post-hepatectomy liver failure, bile leakage, major postoperative complications, in-hospital/90-day mortality, and 90-day readmission.

Model of End-Stage Liver Disease-alpha-fetoprotein-tumor burden (MELD-AFP-TBS) score to stratify prognosis after liver resection for hepatocellular carcinoma.

Introduction: Morphologic criteria, such as the Barcelona Clinic Liver Cancer staging system often fail to accurately predict long-term survival among patients undergoing liver resection for hepatocellular carcinoma. We sought to develop a continuous risk score that incorporates established markers of tumor biology and liver function to improve the prediction of overall survival.

Methods: Data from a multi-institutional database were used to identify patients who underwent curative-intent hepatectomy for hepatocellular carcinoma.

Enhancing outcome prediction in patients with colorectal liver metastases undergoing hepatectomy: the synergistic impact of FIB-4 index and tumor burden score across KRAS profiles.

Background: The prognostic value of Fibrosis-4 (FIB-4) index, concerning KRAS status (wild-type [wtKRAS] vs. mutated [mutKRAS]) remains unclear in post-hepatectomy colorectal liver metastases (CRLM). We evaluated the combined impact of FIB-4 and Tumor Burden Score (TBS) on overall survival (OS)/recurrence-free survival (RFS), stratified by KRAS status.

Out of Sequence Allocation in Liver Transplantation: A Poorly Used Tool to Improve Organ Utilization.

Significance: We evaluated the impact of OOS on organ utilization and also what factors impact the decision to employ OOS.

Background: Deceased donor liver allocation typically follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) may deviate from liver transplant standardized allocation using "out-of-sequence" (OOS) matches.

Enhancing Recurrence-Free Survival Prediction in Hepatocellular Carcinoma: A Time-Updated Model Incorporating Tumor Burden and AFP Dynamics.

Background: Existing models to predict recurrence-free survival (RFS) after hepatectomy for hepatocellular carcinoma (HCC) rely on static preoperative factors such as alpha-fetoprotein (AFP) and tumor burden score (TBS). These models overlook dynamic postoperative AFP changes, which may reflect evolving recurrence risk. We sought to develop a dynamic, real-time model integrating time-updated AFP values with TBS for improved recurrence prediction.

Impact of Tumor Size on the Survival Benefit of Anatomic Versus Non-Anatomic Resection for Intrahepatic Cholangiocarcinoma.

Background: The role of anatomic resection (AR) versus non-anatomic resection (NAR) for intrahepatic cholangiocarcinoma (ICC) has not been thoroughly investigated. This study sought to define the impact of tumor size on the relative therapeutic benefit of AR versus NAR for ICC. Specifically, the study aimed to identify a threshold tumor size to define when AR rather than NAR may be warranted to achieve better survival outcomes for patients undergoing resection of ICC.