Very Early Recurrence Following Liver Resection for Intrahepatic Cholangiocarcinoma: Is It Predictable by Clinical Preoperative Factors?

Background: Approximately one-quarter of patients undergoing resection for intrahepatic cholangiocarcinoma (ICC) experience very early recurrence (within 6 months after liver resection), which is associated with a poor prognosis. Identifying factors associated with very early recurrence may help optimize patient selection for surgery and avoid futile, high-risk hepatectomies. The aim of this study was to assess whether preoperative clinical factors alone can reliably predict very early recurrence following curative liver resection for ICC.

Liver hypertrophy techniques: a position paper from the Italian Group of Regenerative and Occlusive Worldwide-used techniques of hepatic Hypertrophy (I GROWtoH).

In candidates for hepatectomy, different techniques to induce liver hypertrophy and modulate the future liver remnant are available. However, their use in specific clinical scenarios is highly heterogeneous and there is no consensus about minimal safety standards needed to incorporate these strategies into routine clinical practice. The aim of this position paper was to summarize newly available evidence in the field and compare medical practice among different hepatobiliary surgical units to evaluate the transformative potential of liver hypertrophy techniques in surgical oncology.

From open to minimally invasive: evolving surgical approach for incidental gallbladder cancer (with video).

Background: Incidental gallbladder cancer (iGBC) presents unique management challenges. This retrospective single-center study evaluates perioperative and long-term outcomes following oncologic revisional resection (ORR) via open and minimally invasive surgery (MIS) over a 25-year period.

Methods: Patients diagnosed T1b-T3 iGBC undergone ORR (anatomical resection of liver segments 4b-5 and regional lymphadenectomy) from January 2000 through December 2024 were included.

International survey on the use of preoperative chemotherapy in the setting of multimodality management of intrahepatic cholangiocarcinoma.

Background: Indication to neoadjuvant chemotherapy and resectability of intrahepatic cholangiocarcinoma (iCCA) are not clearly defined. Aim of this survey was to assess practice patterns of iCCA treatment.

Methods: Data were collected from an online survey approved by the International Hepato-Pancreato-Biliary Association consisting of 33 questions.

Comprehensive management of synchronous colorectal liver metastases at a high-volume center: a propensity score-matched analysis.

The optimal management of synchronous colorectal liver metastases (CLM) remains debated, particularly regarding the role of centralized care. This study aimed to assess the impact of comprehensive management at a high-volume center on perioperative and long-term outcomes in patients undergoing curative-intent hepatectomy for synchronous CLM. We retrospectively analyzed 613 patients treated from 2010 to 2021 at a tertiary referral center.

MRI-based radiomics predicts the pathologic response of colorectal liver metastases to systemic therapy: A multicenter study.

Background: Tumor response to preoperative chemotherapy is a key prognostic factor for colorectal liver metastases (CRLM), but an accurate non-invasive assessment remains an unmet need.

Objective: To assess the contribution of radiomic analysis of preoperative, post-chemotherapy, gadoxetic acid (Gd-EOB-DTPA)-enhanced MRI to the non-invasive prediction of the pathologic response to systemic therapy of CRLM.

Methods: This retrospective bi-institutional study included all consecutive patients undergoing resection for CRLM (2018-2021) after preoperative oxaliplatin/irinotecan-based chemotherapy.

Minimally invasive hepatectomy thermoablation for single small (≤3 cm) hepatocellular carcinoma: A weighted real-life national comparison.

Background & Aims: For patients with single small (≤3 cm) hepatocellular carcinoma ablation is the first-line treatment, although a high rate of recurrence has been reported. The aim was to compare videolaparoscopic liver resection (laparoscopic resection group) percutaneous thermoablation (ablation group) in terms of overall survival, recurrence-free survival and early recurrence in a real-life national scenario.

Methods: The study is a retrospective collection with subsequent survival analysis.

Robotic vs laparoscopic resection for hepatocellular carcinoma: multicentric propensity-score matched analysis of surgical and oncologic outcomes in 647 patients.

Background And Objectives: Laparoscopic liver resection (LLR) for hepatocellular carcinoma (HCC) has been linked to several advantages compared to open approach, but the actual benefit of robotic liver resection (RLR) over LLR in HCC needs further investigation.

Methods: We performed a multicentric propensity-score matched (PSM) analysis comparing perioperative and oncologic outcomes of LLR vs. RLR for HCC.

Probability of Lymph Node Metastases in Patients Undergoing Adequate Lymphadenectomy during Surgery for Intrahepatic Cholangiocarcinoma: A Retrospective Multicenter Study.

Introduction: Nodal metastases (lymph node metastasis [LNM]) are one of the major determinants of prognosis following surgery for intrahepatic cholangiocarcinoma (ICC). Previous studies investigating the correlation between clinical-radiological features and the probability of LNM include patients undergoing inadequate nodal sampling. Aim of this study was to develop a model to predict the risk of LNM in patients undergoing adequate lymphadenectomy using preoperative clinical and radiological features.

Refinement of histologic subtypes and identification of biomarkers linked to unfavorable prognosis in cholangiocarcinoma: The ENSCCA registries' framework for digital twin advancement.

Background And Aims: Cholangiocarcinoma (CCA) displays remarkable anatomical and histological heterogeneity. Besides diagnosis confirmation, histology currently does not have a major role in the management of CCA. We aimed to study the clinical relevance of histological heterogeneity of CCA and putative tissue biomarkers by creating a multicentric digitalized European CCA Histology Registry.

Stratifying the risk in liver surgery: performance in an Italian cohort of 3.280 liver resection for HCC.

Background: Liver resection classifications have traditionally been based on the number of segments resected. However, with advancements in techniques and the diffusion of minimally invasive surgery (MiLS), these classifications may no longer adequately represent the complexities of modern liver surgery. This study evaluates five liver resection classifications using a multicenter Italian database of hepatocellular carcinoma resections with the main focus of catching surgical outcomes, rather than technical complexity.

Evolving surgical techniques for hepatolithiasis: A retrospective analysis of 164 liver resections at a Western center.

Objective: To assess the outcomes of liver resection for primary intrahepatic lithiasis in a Western population, emphasizing the evolution of surgical techniques, including minimally invasive surgery, and their impact on patient outcomes.

Methods: We performed a retrospective analysis of 164 patients who underwent liver resection for primary intrahepatic lithiasis at the Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy. Data included demographics, surgical techniques, complications, and long-term outcomes.

Minimally invasive versus open liver resection for nonmetastatic hepatocellular carcinoma staged BCLC - B and - C: an Italian multicentric analysis.

Background: Recent papers report significant survival gain after liver resection in BCLC-B and -C HCC patients. The results of minimally invasive liver surgery (MILS) in such patients have not been widely investigated so far.

Methods: Data regarding patients undergoing MILS or open liver resection (OLR) for HCC staged BCLC -B and -C were extracted from the HERCOLES database.

The Impact of a Multidisciplinary Tumor Board (MDTB) in the Management of Colorectal Cancer (CRC).

Background: The management of colorectal cancer (CRC) is a complex process. Defining the disease burden, assessing the radiological response and identifying the right time for surgery or other locoregional treatments are crucial factors which can require the involvement of a multidisciplinary tumor board (MDTB) comprising several specialists. This study investigates the impact of MDTB on management of CRC in our institution.

Laparoscopic versus open resection for hepatocellular carcinoma according to the procedure's complexity: real-world weighted data from a national register.

Background: Minimal access liver surgery (MALS) is considered superior to open liver resection (OLR) in reducing the perioperative risk in patients affected by hepatocellular carcinoma (HCC). No national-level comparisons exist based on procedure complexity. This study aims to compare postoperative complications, postoperative ascites (POA), and major complications (MC) between MALS and OLR.

Preoperative prediction of post hepatectomy liver failure after surgery for hepatocellular carcinoma on CT-scan by machine learning and radiomics analyses.

Introduction: No instruments are available to predict preoperatively the risk of posthepatectomy liver failure (PHLF) in HCC patients. The aim was to predict the occurrence of PHLF preoperatively by radiomics and clinical data through machine-learning algorithms.

Materials And Methods: Clinical data and 3-phases CT scans were retrospectively collected among 13 Italian centres between 2008 and 2022.

Integrating surgical complexity and nutritional parameters to enhance prediction of postoperative complications in liver resection.

Background: In patients undergoing liver resection, postoperative complications remain high. We hypothesized that the incidence of postoperative complications after liver resection would be predicted well by liver resection complexity and nutritional status.

Methods: We retrospectively assessed patients undergoing liver resection at The University of Tokyo Hospital from 2011 to 2021.

Single large hepatocellular carcinoma > 5 cm with surgical indication: is it mandatory a major hepatectomy? a propensity-score weighted analysis.

Purpose: Single large hepatocellular carcinoma >5cm (SLHCC) traditionally requires a major liver resection. Minor resections are often performed with the goal to reduce morbidity and mortality. Aim of the study was to establish if a major resection should be considered the best treatment for SLHCC or a more limited resection should be preferred.

Protective Effect of Minimally Invasive Approach on Postoperative Peak Transaminase Following Liver Resection: A Single-Center Propensity Score-Based Analysis.

Background: Postoperative serum ALT levels are one of the most frequently used marker to detect liver tissue damage following liver resection. The aim of this study was to evaluate if minimally invasive liver surgery (MILS) may result in less hepatic injury than open hepatectomy by assessing the differences of postoperative ALT levels.

Methods: Patients who underwent MILS between 2009 and 2019 at our unit were included and compared with open liver resections.

Robotic approach for the treatment of gynecological cancers recurrences: A ten-year single-institution experience.

Introduction: Although the management of gynecological cancers recurrences may be challenging, due to the heterogeneity of recurrent disease, the aim of this work is to present a descriptive analysis of gynecological malignancies recurrences in our institution treated by robotic approach.

Materials And Methods: We performed a retrospective review and analysis of data of patients who underwent robotic surgery for recurrent gynecological malignancies at Catholic University of the Sacred Hearth, Rome, from January 2013 to January 2024.

Results: A total of 54 patients underwent successful robotic cytoreductive surgery.

Emerging Prognostic Markers in Patients Undergoing Liver Resection for Hepatocellular Carcinoma: A Narrative Review.

In patients with hepatocellular carcinoma (HCC), liver resection is potentially curative. Nevertheless, post-operative recurrence is common, occurring in up to 70% of patients. Factors traditionally recognized to predict recurrence and survival after liver resection for HCC include pathologic factors (i.

Treatment of oligo-metastatic pancreatic ductal adenocarcinoma to the liver: is there a role for surgery? A narrative review.

Pancreatic ductal adenocarcinoma (PDAC) is a prognostically unfavorable malignancy that presents with distant metastases at the time of diagnosis in half of patients. Even if patients with metastatic PDAC have not been traditionally considered candidates for surgery, an increasing number of researchers have been investigating the efficacy of surgical treatment for patients with liver-only oligometastases from PDAC, showing promising results in extremely selected patients, mainly with metachronous metastases after perioperative chemotherapy. Nevertheless, a standardized definition of oligometastatic disease should be adopted and additional investigations focusing on the role of perioperative chemotherapy and tumor biology are warranted to reliably assess the role of resection for PDAC metastatic to the liver.