Hepatic venous plexuses on the right border of the caudate lobe against the right liver in a liver cast.

Identifying the right border of the caudate lobe against the right liver is clinically important; however, this remains challenging. As the paracaval portion (PC) of the caudate lobe is adjacent to segment 8 of the right liver, we dissected a liver cast made from epoxy resin and colored dye to define the right border of the PC against segment 8. On the right border of the PC, two major venous plexuses appearing as bouquet-shaped branches joined the inferior vena cava and the middle hepatic vein, forming short hepatic veins, whereas the venous plexuses in segment 8 joined the right hepatic and the vein inferior vena cava.

Anatomical study of the caudate lobe of the liver on hepatic casts and the dawn of isolated caudate lobectomy.

Surgical resection of the caudate lobe of the liver remains the final hurdle for liver surgeons, not only in open hepatectomy but also in recent minimally invasive hepatectomy. In the dawn of liver surgery, Prof. Kumon made hepatic casts and showed the anatomy of the caudate lobe of the liver based on the portal segmentation in the National Cancer Center Hospital, Tokyo.

Epigenetic evolution and clinicopathological implications of distinct DNA methylation profiles in pancreatic ductal adenocarcinoma.

Pancreatic ductal adenocarcinoma (PDAC) remains a lethal malignancy with poor prognosis. We investigated intratumoral deoxyribonucleic acid methylation heterogeneity by analyzing 44 tumor samples and 5 normal samples from 6 cases of PDAC by using high-resolution methylation arrays. Two distinct methylation profiles were identified: T1, which is similar to normal pancreatic tissue and is associated with well-differentiated histology, and T2, which is significantly different from normal tissue and is linked to poorly differentiated morphology and squamous features.

Prognostic Impact of Pancreatic Body/Tail Cancer Involving the Portal Vein: A Project Study of the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Background: Although portal vein (PV) contact ≤ 180° in pancreatic body/tail ductal adenocarcinoma (PbtCa) is a criterion for resectable, adequate evidence has not been established yet.

Methods: This retrospective study analyzed 1693 patients with PbtCa who underwent distal pancreatectomy across 31 institutions in Japan. Clinicopathological factors, survival, and recurrence pattern were compared among non-PV contact, PV contact, and celiac axis (CeA) contact groups.

Development and validation of a nomogram to predict the need for bailout procedure in laparoscopic cholecystectomy: A multicenter study of 1,898 cases.

Background: Laparoscopic cholecystectomy is the standard treatment for benign gallbladder disease. A bailout procedure is recommended for patients with severe inflammation. This study identified the preoperative factors that predict bailout procedures and developed a predictive nomogram.

Advantage of Postoperative Inflammatory Status after Laparoscopic Distal Pancreatectomy.

Introduction: Laparoscopic distal pancreatectomy (LDP) is a safe and effective procedure; however, its impact on perioperative inflammatory reactions compared with open distal pancreatectomy (ODP) remains unclear. This study aimed to assess short-term outcomes following LDP and ODP regarding inflammatory reactions.

Methods: This retrospective study of 77 consecutive patients who underwent distal pancreatectomy for low-grade malignancies between 2005 and 2022 compared white blood cell (WBC) count, C-reactive protein (CRP) level, serum albumin level, and CRP/albumin ratio (CAR) between LDP and ODP.

Association between the paracaval branches of the caudate lobe and the three major hepatic veins in liver casts: Locating the cranial boundary of the caudate lobe.

According to Couinaud's definition, the cranial boundary of the caudate lobe is delineated by the three major hepatic veins. However, many branches of the caudate lobe go through the ceiling that is composed of these hepatic veins. The cranial boundary of the caudate lobe should be determined by employing the portal segmentation.

Trends in the treatment of advanced pancreatic cancer.

Pancreatic cancer (PC) has the poorest prognosis among digestive cancers; only 15-20% of cases are resectable at diagnosis. This review explores multidisciplinary treatments for advanced PC, emphasizing resectability classification and treatment strategies. For locally advanced unresectable PC, systemic chemotherapy using modified FOLFIRINOX and gemcitabine with albumin-bound paclitaxel is standard, while the role of chemoradiation is debated.

Rescue of outflow block of the remnant left liver after extended right hemihepatectomy for resection of a tumor in the caudate lobe.

Outflow block of the liver is a life-threatening event after living donor liver transplantation. Herein, we rescued a patient suffering from the outflow block of the remnant left hemiliver caused by bending of the left hepatic vein (LHV) after right hemihepatectomy plus caudate lobectomy combined with resection of the middle hepatic vein (MHV). A metastatic tumor sized 6 cm in the caudate lobe of the liver involving the root of the MHV was found in a 50's year old patient after resection of a right breast cancer eight years ago.

Impact of biliary drainage method before pancreaticoduodenectomy on short- and long-term outcomes in patients with periampullary carcinoma and obstructive jaundice: A multicenter retrospective analysis.

Background: The optima preoperative biliary drainage before pancreaticoduodenectomy in patients with biliary tract and pancreatic cancer remains controversial.

Methods: A total of 898 patients who underwent preoperative biliary drainage via endoscopic retrograde biliary drainage, endoscopic transnasal biliary drainage, or percutaneous transhepatic biliary drainage before pancreaticoduodenectomy for biliary tract and pancreatic cancer were included. Perioperative and long-term outcomes were analyzed.

A Multicenter Phase 2 Trial Evaluating the Efficacy and Safety of Preoperative Lenvatinib Therapy for Patients with Advanced Hepatocellular Carcinoma (LENS-HCC Trial).

Introduction: The phase III REFLECT trial demonstrated that lenvatinib was superior to sorafenib in terms of progression-free survival (PFS), time to progression, and objective response rate (ORR) for patients with unresectable hepatocellular carcinoma (HCC). This study assessed the efficacy and safety of preoperative lenvatinib therapy for patients with oncologically or technically unresectable HCC.

Methods: In this multicenter single-arm phase II trial, patients with advanced HCC and factors suggestive of a poor prognosis (macroscopic vascular invasion, extrahepatic metastasis, or multinodular tumors) were enrolled.

Efficacy and safety of regorafenib in combination with immune checkpoint inhibitor therapy as second-line and third-line regimen for patients with advanced hepatocellular carcinoma: a retrospective study.

Background: Despite the emergence of immune checkpoint inhibitors (ICIs) as first-line treatment for advanced hepatocellular carcinoma (HCC), there is an unmet need regarding subsequent treatments in patients that fail ICI. Regorafenib is a vascular endothelial growth factor receptor (VEGFR) inhibitor, which could increase programmed death-ligand 1 (PD-L1) expression in tumors and increase intra-tumoral CD8 T-cell infiltration by normalizing the cancer vasculature and improving the efficacy of the programmed cell death protein 1 (PD-1) antibody. Thus, we evaluated the combination of regorafenib and a PD-1 inhibitor for advanced HCC patients that had failed combined tyrosine kinase inhibitors (TKIs) plus ICI.

Intragastric free cancer cells may be attached to automatic staplers during anastomosis in patients with gastric cancer.

Background: Automatic staplers are often used to reconstruct the digestive tract during surgeries for gastric cancer. Intragastric free cancer cells adhering to automatic staplers may come in contact with the laparoscopic port area and progress to port site recurrence. This study aimed to investigate the presence/absence of cancer cells adhering to automatic staplers during gastric cancer surgery using cytological examinations.

Right hemihepatectomy preserving the fluorescently visible paracaval portion of the caudate lobe.

The paracaval portion (PC) of the caudate lobe is a small area of the liver located in front of the inferior vena cava. Conventional right hemihepatectomy (RH) along the Rex-Cantlie line involves resection of not only the anterior and posterior sections but also the PC behind the middle hepatic vein (MHV). However, to preserve the future liver remnant volume as much as possible, PC-preserving RH may be beneficial in selected patients.

Physical frailty recovery is slower than mental frailty recovery after non-cardiac surgery in older adult patients.

Purpose: Frailty is characterized by fragility and decline in physical, mental, and social activities; it is commonly observed in older adults. No studies have reported frailty status changes between the preoperative and postoperative periods, including mental and cognitive factors. Therefore, this study investigated frailty factors, including mental and cognitive functions, that change after non-cardiac surgery in older adults.

A multicenter validation study for determining the condition of nonanatomical or minor anatomical hepatectomies satisfying technical difficulty of current high-level hepatectomy certificated by the Japanese Society of Hepato-Biliary-Pancreatic Surgery.

Background: The current high-level hepatectomy (HLH) is certified by the Japanese Society of Hepato-Biliary-Pancreatic Surgery (JSHBPS), comprising only anatomical hepatectomies above Couinaud's segmentectomy. This multicenter study aimed to identify the conditions of non-HLH that satisfy equivalent technical difficulties to HLH.

Methods: Between 2018 and 2021, 595 first open hepatectomies without biliary reconstruction (374 HLHs and 221 non-HLHs) were performed in the five institutions.