HBPSurG - EFISDS Joint Meeting
October 30-31 2025
Dear Colleagues,
It is our great pleasure to welcome you to the HBPSurG 2025 Meeting in the vibrant city of Lyon, France. This year’s gathering brings together leading experts, surgeons, oncologists, and young specialists in hepatobiliary and pancreatic (HBP) diseases for an exceptional interdisciplinary scientific program dedicated to Learning, Education, and Excellence.
We are thrilled to host you in Lyon, a city renowned for its rich history and contributions to medical innovation. The HBPSurG 2025 Meeting promises to be a dynamic platform for sharing cutting-edge research, state-of-the-art techniques, and transformative ideas in HBP surgery and oncology.
We are particularly excited to feature an excellent selection of outstanding speakers, whose expertise and insights will inspire and elevate our discussions. Through keynote lectures, and interactive sessions, we aim to foster collaboration, advance knowledge, and empower the next generation of HBP specialists.
We look forward to engaging sessions that will spark innovation and strengthen connections within our global community of healthcare professionals. Together, let us continue to push the boundaries of excellence in patient care and surgical practice.
Thank you for joining us, and we wish you an enriching and memorable experience at HBPSurG 2025!
Warm regards,
Prof M Adham
Chair of the HBPSurG 2025 Organizing Committee.
On behalf of the HBPSurG 2025 Team
Main Topics
Pre-habilitation & Enhanced Recovery
HBP Malignancies
Recent Advances
Technical Innovations
Sessions
HBPSurG Invited Lectures
Meet the Experts
State-of-the-Art
Free papers
Lyon
Lyon
Lausanne
Lyon
Lyon
Hamburg
Belgrade
Lyon
Lyon
Gdańsk
München
Lyon
Bruxelles
Alessandria
Lyon
Lyon
Lyon
Verona
Paris
Goslar
Alessandria
Pavia
Birmingham
Riyadh
Hamburg
Sassari
Lyon
Peschiera del Garda
Saint Petersburg
Cali
October 30, 2025 - 8h30 - 16h15
08h30 – Registration |
08h50 – Welcome – Prof M Adham |
09h00-10h30 – Meet the Experts Chairs – A Karamarkovic, JY Mabrut, L Marano |
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10h15-10h30 – Questions & Discussion |
10h30-11h00 Coffee break |
11h00-13h00 – Free papers Chairs – G Cassese, R L’Huillier, X Muller. |
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12h30-13h00 – Questions & Discussion |
13h00-14h00 Lunch break |
14h00-14h45 – HBPSurG Invited Lecture Advances in Liver Surgery for Colorectal Cancer Metastases Prof David Fuks Chair – L Gerard, JY Mabrut |
14h45-16h15 – State-of-the-Art Chairs – D Fuks, F Panaro, Y Vashist |
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Video |
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Short Oral Posters |
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16h00-16h15 Questions & Discussion |
October 31, 2025 - 8h00 - 16h30
08h00 – Registration |
08h30-09h45 – Meet the Experts Chairs – J Mayerle, R Salvia, A Durand |
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09h25-09h45 Questions & Discussion |
09h45-10h30 – HBPSurG Invited Lecture Pancreatic Ductal Adenocarcinoma : Early Detection Prof Julia Mayerle Chair – R Gincul, R Salvia |
10h30-11h00 Coffee break |
11h00-13h00 – State-of-the-Art Chairs – J Perinel, J Navez, T Ponchon |
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12h30-13h00 Questions & Discussion |
13h00- 14h00 Lunch break |
14h00-16h00 – Free papers Chairs – L Calavas, X Muller, Y Vashist, R Vella |
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Video |
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Short Oral Posters |
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15h40-16h00 Questions & Discussion |
16h00 – Rising Stars Award Ceremony |
Free Papers Abstract Book
The impact of tumor burden score on postoperative morbidity and survival in colorectal cancer patients with liver metastases
Authors & Institutions
Anton Burlaka, Volodymyr Bezverhnyi, Veronika Rozhkova, Vitalii Zvirych, Andriy Beznosenko, Serhii Zemskov
National Cancer Institute, Kyiv, Ukraine. O. Bogomolets National Medical University, Kyiv, Ukraine.
Background
Introduction. Surgical oncologists are increasingly interested in how to make the transition from technically to biologically guided surgery for colorectal cancer with liver metastases (mCRC). Taking into account the tumor burden score (TBS) has demonstrated its effectiveness and accuracy in predicting the risk of cancer-specific death in a number of studies.
Method
A retrospective analysis of patients with mCRC who underwent liver resection in the period from September 2002 to March 2024 at the clinic of the National Cancer Institute was performed. The selected cohort included 351 patients with synchronous and metachronous metastatic liver disease (cT1-4N0-2M0-1).
The tumor burden index was used as a combined indicator of the TBS, taking into account the maximum size of the metastasis and the number of foci was calculated according to the Sasaki et al. “Metro-ticket” mathematic model.
Results
The median and 5-year OS in these cohorts were 69.5 months, 60.3 months, and 23.1 months, and 56.3%. 49.7% and 7.4%, respectively (p<0.001).
The ability of the TBS to predict postoperative complications was analyzed using the ROC curve, which demonstrated high sensitivity with AUC = 0.822.
According to multivariate Cox analysis, TBS clusters had a significant negative impact on overall survival, in particular, cohorts with TBS 3.5-10 (HR: 0.43, 95% CI: 0.18 – 0.97, P = 0.04) and TBS ≥10 (HR: 1.4, 95% CI: 1.31 – 1.46, P = 0.005).
Conclusion
This study demonstrated that the tumor burden score can be applied to patients to national population-based cohort of colorectal cancer patients with liver metastases. The tumor burden score has a strong prognostic potential for overall survival and surgical complications.
Liver surgery legitimacy in patients with multiple liver metastasis: retrospective analysis
Authors & Institutions
Anton Burlaka(1,2), Serhii Zemskov(2), Volodymyr Skyba (2).
1 – Hepatopancreatobiliary Department of National Cancer Institute, Kyiv, Ukraine
2 – Bogomolets National Medical University National Medical University, Kyiv, Ukraine
Background
The aim of this study was to determine the oncologic feasibility of surgical treatment of patients with CRC with multiple metastases using the tumor burden score (TBS) in a Ukrainian population-based cohort.
Method
Five hundred twenty-one consecutive patients who underwent liver resections for CRC LM between January 2002 and January 2024 were identified from the National cancer institute (Kyiv, Ukraine) prospective database and analysed retrospectively.
Results
The median and 5-year overall survival in cohorts with TBS clusters ≤3, ≥3-9 and >9 was 116.2 months, 50.3 months and 29.7 months; and 75.7%, 42.4% and 41.6%, respectively (р<0.001). TBS index has been shown the high postoperative morbidity prognostic specificity and sensitivity with AUC 0.97 on the ROC curve. The multivariate Cox regression model has shown the TBS clusters had a significant negative impact on overall survival, in particular, cohorts with TBS ≥3-9 (HR: 0.43, 95% CI: 0.18 – 0.97, P = 0.04) and TBS ≥9 (HR: 1.4, 95% CI: 1.31 – 1.46, P = 0.005).
Conclusion
This study demonstrates the rationality of surgical treatment of patients with multiple bilobar colorectal cancer liver metastases in Ukrainian population-based cohort.
Comparative effectiveness of immune-targeted and interventional therapies in HCV/HBV-infected vs non-infected patients
Authors & Institutions
Saud Ahmad Saad – West China Hospital, Sichuan University
Background
To evaluate differences in treatment response and outcomes between HBV/HCV-infected and non-infected HCC patients receiving immune-targeted therapies and hepatic artery infusion chemotherapy (HAIC).
Method
We retrospectively analyzed 80 HCC patients divided into HBV/HCV-infected (n=40) and non-infected (n=40) groups. All patients received either immune checkpoint inhibitors plus targeted therapy or HAIC-based combinations. Primary endpoints were overall response rate (ORR), progression-free survival (PFS), and overall survival (OS), assessed across groups.
Results
Non-infected patients had a higher ORR (55%) than HBV/HCV-infected patients (42.5%). HAIC-based therapies showed greater PFS benefits in the infected group. Median OS favored non-infected patients overall, but outcomes were more comparable in the subgroup receiving both HAIC and immunotherapy.
Conclusion
HBV/HCV status influences response to immune-targeted and interventional therapies in HCC. Viral etiology should be considered when selecting treatment, and further prospective studies are needed to optimize strategies.
Optimizing Surgical Management in High-Risk Pancreatic Resections: Comparative Outcomes of Duct-to-Mucosa and Blumgart Pancreaticojejunostomy Versus Total Pancreatectomy for Postoperative Fistula Prevention
Authors & Institutions
Evgenia Charitaki1, Charina Triantopoulou2, Eva Mastrokosta3, Hara Nikolaou4, Vasiliki Kuriakou1, Vasilis Karambas1, Nikos Kokoroskos1, Miltiadis Papastamatiou1, Spiros Delis1
1. Konstantopouleio General Hospital, Surgical Department, Athens, Greece.
2. Konstantopouleio General Hospital, Radiology Department, Athens, Greece.
3. Konstantopouleio General Hospital, Anesthesiology Department, Athens, Greece.
4. Konstantopouleio General Hospital, ICU, Athens, Greece.
Background
Given the high morbidity associated with postoperative pancreatic fistula following pancreaticoduodenectomy, this study aims to compare surgical outcomes between duct-to-mucosa and Blumgart pancreaticojejunostomy, and to evaluate total pancreatectomy as a risk-adapted approach in high-risk cases.
Method
We retrospectively analyzed 60 patients undergoing pancreaticojejunostomy (30 DM, 30 BT) and 34 undergoing total pancreatectomy. All had soft pancreatic parenchyma, ducts <3 mm, and periampullary malignancies. Primary endpoints included POPF, DGE, and postoperative hemorrhage. Secondary measures were operative time and hospital stay. Outcomes were assessed to identify optimal strategies for high-risk cases.
Results
POPF occurred in 26% of DM cases and 10% of BT cases, with only grade A fistulas in BT. DGE was more common in DM (33%) than BT (10%). BT was associated with shorter operative time and median hospital stay (10 vs. 18 days). In the PD vs. TP cohort, 32 PD patients developed POPF; none occurred in TP. DGE was 29% in PD and 12% in TP. No postoperative hemorrhage was observed. TP had shorter hospital stay (6 vs. 10 days) with similar operative time.
Conclusion
Blumgart anastomosis showed superior outcomes over duct-to-mucosa in soft pancreas. Total pancreatectomy eliminated POPF and reduced morbidity and hospitalization in selected high-risk patients, despite endocrine and exocrine insufficiency. Technique selection should be risk-adapted.
Impact of ERAS Compliance on Postoperative Outcomes and Hospital Stay in Liver Surgery
Authors & Institutions
Nottberg, Valerie Isabel (1); Nottberg, Eleanor (1,2); van Rüth, Victoria (1); Brodersen, Freya (1); Ghadban, Tarik (1); Hackert, Thilo (1); Izbicki, Jakob (1); Heumann, Asmus (1).
(1) Department of General, Visceral, and Thoracic Surgery; University Medical Center Hamburg-Eppendorf
(2) Department of Urology; Medical Faculty and University Hospital Düsseldorf
Background
Enhanced Recovery After Surgery (ERAS) protocols aim to improve surgical outcomes through standardized perioperative care. However, the relative influence of individual ERAS components remains unclear. This study evaluates which ERAS factors significantly affect postoperative complications, morbidity, and hospital length of stay in patients undergoing liver surgery.
Method
A total of 637 patients who underwent liver surgery at the University Medical Center Hamburg-Eppendorf between January 2020 and December 2024 were retrospectively analyzed. Data were collected through the ERAS Interactive Audit System (EIAS). Perioperative compliance was calculated for each patient, and patients were stratified into high compliance (≥70%) and low/moderate compliance (<70%) groups.
Statistical analyses were performed in R Studio. Univariate analyses included Chi-square tests for categorical outcomes (e.g., complications, morbidity) and Welch’s t-tests for continuous variables (e.g., blood loss, operation duration). Odds ratios (OR) with 95% confidence intervals (CI) were calculated to estimate the association between compliance and outcomes. Subsequently, multivariate logistic and linear regression models were used to adjust for potential confounders.
Results
High perioperative compliance was associated with significantly fewer postoperative complications during the primary hospital stay (51.0% vs. 69.8%, p < 0.001; OR = 0.45, 95% CI: 0.30–0.67) and lower severe morbidity rates (Clavien-Dindo > IIIb: 87.2% vs. 96.4%, p = 0.002; OR = 0.25, 95% CI: 0.10–0.64). Additionally, patients in the high compliance group had a significantly shorter hospital stay (7.4 vs. 10.6 days; difference: −3.2 days, 95% CI: −4.7 to −1.7; p < 0.001).
In multivariate analyses, minimally invasive surgery and early mobilisation on the day of surgery were protective factors, while nasogastric tube usage and higher intraoperative fluid volume were significantly associated with increased risk for complications and longer hospital stay.
Conclusion
High adherence to ERAS protocols in liver surgery is associated with fewer complications, reduced severe morbidity, and shorter hospital stay. These findings emphasize the importance of consistent protocol implementation to improve postoperative outcomes in hepatic surgery.
The resection of the caudate lobe for the treatment of hilar cholangiocarcinoma: our experience
Authors & Institutions
Teresa Perra & Alberto Porcu, Azienda Ospedaliero Universitaria di Sassari, Italy
Background
The routine resection of the caudate lobe for the treatment of hilar cholangiocarcinoma is still a debated procedure, despite the promising results in scientific literature. The aim of our study was to evaluate the safety, technical feasibility and main outcomes of the resection of the caudate lobe in the surgical treatment of patients affected by hilar cholangiocarcinoma at our institution.
Method
All patients who underwent surgical treatment for hilar cholangiocarcinoma between January 2008 and October 2023 at our institution were included in the study. Patients were divided into two groups based on whether or not they underwent caudate lobe resection (RLC and NRLC). The resection of the caudate lobe was an isolated procedure or combined with hepatectomy. We indicated the resection of the caudate lobe for all Bismuth-Corlette types II-IV hilar cholangiocarcinoma and when the distance of the tumor from the confluence of the hepatic ducts was lower than 2cm.
Results
44 patients were included in the study (23 RLC and 21 NRLC). Our results show an increase in overall survival in the RLC group, although it was not statistically significant when comparing the Kaplan-Meier curves. However, the trend of deaths in the study population should be noted. There was no significant difference between the two groups regarding deaths at 30 days and 12 months (when mortality is most influenced by possible postoperative complications). There was instead a significant difference in deaths at 24 months (when mortality could be most influenced by oncological radicality).
Conclusion
The resection of the caudate lobe is emerging as a fundamental part of the surgical treatment of hilar cholangiocarcinoma. Our results seem to confirm the positive results of some recent systematic reviews and meta-analyses, although further research is still needed.
Management and outcome of late post-pancreatectomy haemorrhage after pancreatoduodenectomy: experience from a high-volume UK tertiary centre
Authors & Institutions
Dobrzycka M, Chatzizacharias N, Bisht H, Raza SS, Dasari BV, Bartlett DC, Marudanayagam R, Roberts KJ, Sutcliffe RP, Papamichail M. Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham, Mindelsohn Way, Birmingham B15 2GW. United Kingdom
Background
Delayed bleeding after pancreaticoduodenectomy (PD) is a serious complication with significant morbidity and mortality. The aims of the study were to evaluate the incidence, management and outcomes of late (>24 hours) post-pancreaticoduodenectomy haemorrhage (PPH) after PD in a high-volume tertiary referral centre.
Method
A retrospective analysis of a prospectively maintained database of 1184 patients who underwent PD between 2011 and 2023 was performed. Patients who developed late PPH were identified. Diagnostic investigations included CT angiography, invasive angiography and endoscopy. Interventions included endovascular treatment (embolisation and/or stent graft placement) and laparotomy.
Results
Twenty-three patients (1.94%) developed late PPH, at a median onset of 15.6 days after surgery. 62.5% of late PPH cases were associated with pancreatic fistula. Eighteen patients (78.3%) underwent endovascular therapy, whilst five patients (21.7 %) required surgery. The gastroduodenal artery (GDA) was the most common source of bleeding (43.5%). In-hospital mortality was 17.4%.
Conclusion
Late PPH after PD is a rare but serious complication with a high mortality rate. Early detection with CT angiography and endovascular treatment is effective in managing most cases, reducing morbidity and mortality. Surgery remains a secondary option for refractory bleeding.
Immediate results of laparoscopic spleen-preserving distal pancreatectomy: Kimura vs Warshaw operation.
Authors & Institutions
Vervekin I., Trushin A., Kursenko R., Zacharenko A.
Pavlov First Saint Petersburg State Medical University. L’va Tolstogo str. 6-8, Saint Petersburg, Russia, 197022
Background
Laparoscopic distal spleen-preserving pancreatectomy is the standard of care for benign tumors of the body and tail of the pancreas. There are currently two methods: the Kimura-type, when the splenic vessels are preserved, and the Warshaw-type, when the splenic artery and veins are resected with preservation of short gastric vessels.
Method
The retrospective analysis included 60 patients who underwent distal pancreatectomy from February 2020 to February 2024. All patients were divided into 2 groups: 1 – Kimura-type (n = 34); 2 – Warshaw-type (n = 26).
There were no statistically significant differences in the baseline clinical characteristics of patients between the groups. A statistically significant difference in tumor size was found: larger tumors were more common in the WT group than in the KT group (2.85 cm vs. 4.7 cm, p = 0.026).
Results
The average duration of surgery in the WT group was 197.27 ± 42.09 min (95% CI 184.36 – 240.64) compared to the KT group (269.06 ± 70.95 (95% CI 227.74 – 319.95)), p = 0.006. No statistically significant differences were found between the groups in the analysis of blood loss, length of hospital stay, frequency of laparotomy, splenectomy, and reoperation. When assessing the incidence of POPF depending on the type of surgery, it was not possible to establish statistically significant differences (p = 0.474).
Conclusion
Both the Warshaw and Kimura techniques are safe and effective surgical approaches that provide similar results. The Warshaw method may be more advantageous in terms of the use of limited surgical resources without compromising the immediate surgical results of treatment.
The role of neoadjuvant chemotherapy (nCT) in the treatment of patients with resectable pancreatic cancer.
Authors & Institutions
Vervekin I., Trushin A., Kursenko R., Zacharenko A.
Affiliation. Pavlov First Saint Petersburg State Medical University. L’va Tolstogo str. 6-8, Saint Petersburg, Russia, 197022.
Background
The aim of the study was to evaluate of the efficacy and safety of neoadjuvant chemotherapy (nCT) using the mFOLFIRINOX regimen in the treatment of patients with resectable pancreatic cancer.
Method
The presented study is a single-center, prospective clinical trial. The primary endpoint is desease-free survival (DFS). Secondary endpoints: overall survival (OS), complication rate (Clavien-Dinо), histological tumor stage ypTN, tumor response to treatment (CAP grading system), R0 resection rate, resectability. The study includes patients with pancreatic adenocarcinoma that meets the resectability criteria (according to NCCN 2025). Patients (n=64) are randomized in a 1:1 ratio either to the control group (radical surgery + aCT) or to the experimental group (nCT mFOLFIRINOX + radical surgery).
Results
The median DFS was 10.7 months (95% CI 6.9–13.7) in the control group and 14.9 months (95% CI 6.4–19.4) in the NAC group (p=0.035). The median OS was 16.9 months (95% CI 7.9–20.4) in the control group and 21.7 months (95% CI 12.4–24.4) in the nCT group (p=0.031). The surgical resection rate was 71.8% in the control group and 84.6% in the nCT group (p=0.017). The R0 resection rate was 57% in the control group and 81.2% in the nCT group (p=0.037). The frequency of vascular resection (portal vein) was 17.5% in the control group and 9% in the nCT group (p=0.04).
Conclusion
The study demonstrated statistically significant superiority in the nCT group in terms of survival, resectability and the rate of R0 resections. The rate of postoperative complications did not differ statistically between the groups. Thus, nCT for resectable pancreatic cancer is a promising method.
Machine Learning for Individualized Survival Prediction in Colorectal Liver Metastases
Authors & Institutions
Ottavia Cicerone(1), Simone Famularo(2), Federica Lucev(3), Alessandro Vanoli(4), Anna Pagani(5), Marcello Maestri(6)
1. University of Pavia, Fondazione IRCCS Policlinico San Matteo, Chirurgia Generale I
2. Hepatobiliary Surgery Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Catholic University of the Sacred Heart, Rome, Italy; IRCAD, Research Institute Against Cancer of the Digestive System, 1 Place de l’Hôpital, Strasbourg, 67091, France
3. Fondazione IRCCS Policlinico San Matteo, Radiologia, Pavia, Italy
4. Fondazione IRCCS Policlinico San Matteo, Anatomia Patologica, Pavia, Italy
5. Fondazione IRCCS Policlinico San Matteo, Oncologia, Pavia, Italy
6. Fondazione IRCCS Policlinico San Matteo, Chirurgia Generale I
Background
The aim of this study is to develop and validate “LiverMetsApp”, a machine learning-based interactive platform for predicting survival in patients undergoing liver resection for colorectal liver metastases (CRLM). By integrating key prognostic variables into a Cox proportional hazards model, the tool provides individualized, patient-specific survival estimates to support clinical decision-making.
Method
Data from 264 CRLM patients were analyzed. Categorical variables were transformed via one-hot encoding, and missing data were handled using an iterative imputation algorithm in Python. Feature selection was performed using LASSO regression with 5-fold cross-validation, and selected variables were entered into a Cox proportional hazards model. Model performance was assessed by concordance index, log-likelihood ratio test, and ROC analysis. The final model was implemented in “LiverMetsApp” for interactive survival curve generation.
Results
Significant predictors in the multivariate analysis included pre-colectomy chemotherapy (HR=0.60, p=0.04), synchronous metastases (HR=1.75, p<0.005), number (HR=1.78, p=0.01) and size (HR=1.53, p=0.02) of metastases, and post-metastasectomy chemotherapy (HR=0.68, p=0.02). The model demonstrated good performance (C-index = 0.68, log-likelihood ratio = 54.01, p < 0.005) and a ROC AUC of 0.73, confirming its discriminative ability. The web application was developed and is freely accessible(1).
1. Cicerone O. LiverMetsApp 2025 [ https://livermetsapp-semqscsfsf7yq94c6f3jpu.streamlit.app.]
Conclusion
“LiverMetsApp” integrates machine learning and Cox regression to deliver personalized survival predictions for CRLM patients. By enabling individualized prognostic simulations, it may enhance treatment planning, facilitate multidisciplinary discussion, and serve as a valuable educational resource.
Distal Splenopancreatectomy After Percutaneous Portal Recanalization in the setting of BD-IPMN and Pancreatic Adenocarcinoma Complicated by Portal Cavernoma: A Case Report
Authors & Institutions
Marin Federico Alberto Niccolo‘ (1,2), Guizzetti Michela (1), Bonaffini Pietro Andrea (1), Salvatore Greco (1), Costantino Daniela (1), Carbone Francesco Saverio (1), Pinelli Domenico (1,2)
(1) Ospedale Papa Giovanni XXIII (2) Università degli studi di Milano UNIMI
Background
The coexistence of a pancreatic branch-duct intraductal papillary mucinous neoplasm (BD-IPMN) and ductal adenocarcinoma of the pancreatic body-tail, complicated by portal cavernoma, requires complex management. Abdominal surgery in portal hypertension patients carries a risk of bleeding and liver failure. Splenectomy reduces hepatic venous return and raises the risk of mesenteric vein thrombosis.
Method
A 70 y.o. woman with hypertension and dyslipidemia, previously undergoing laparoscopic cholecystectomy converted to open surgery for bleeding, showed intraoperative vascular anomalies. CT revealed portal vein thrombosis, periportal varices, and main pancreatic duct dilation (39 mm) with a cystic mass and enhancing nodules near the splenic vein. EUS-FNA confirmed ductal adenocarcinoma. Platelets were 111,000/mm³, aPTTr 1.77; liver function and tumor markers were normal. Anticoagulation was initiated. MRI, EGD and CT showed chronic portal cavernoma and F1 esophageal varices, without metastases.
Results
To decompress portal circulation, a TIPS via transplenic/transjugular access was attempted but failed for early thrombosis. Angioplasty with stenting of the portal trunk–spleno-mesenteric confluence succeeded. One week later, distal splenopancreatectomy was performed. Postoperative course included grade A pancreatic fistula, bowel obstruction requiring relaparotomy, anemia with spontaneous hemoperitoneum and bacteremia. She was discharged on POD 51. Histology: intraductal tubulopapillary neoplasm with invasive carcinoma (pT1cN0). Follow-up imaging showed no recurrence, TIPS and stent patent.
Conclusion
In selected cases, portal cavernoma does not exclude the feasibility of curative distal splenopancreatectomy preceded by percutaneous portal recanalization. This strategy demands careful multidisciplinary management.
Transition from open to full robotic living donor left liver graft procurement for pediatric recipients-Experience from a western center
Authors & Institutions
Lucas Pflieger MD 1, Xavier Muller PhD 12, Guillaume Rossignol PhD123, , Mathias Ruiz MD4 , Remi Dubois MD3, Teresa Antonini, MD 25 , Kayvan Mohkam, PhD 123, Jean-Yves Mabrut, PhD12.
1 Department of General Surgery and Liver Transplantation, Croix-Rousse University Hospital, Hospices Civils de Lyon, France
2 Hepatology Institute of Lyon, UMR 1350 PaThLiv, IHU EVEREST
3 Department of Pediatric Surgery and Liver Transplantation, Femme Mere Enfant University Hospital, Lyon, France.
4 Department of Pediatric Hepatology, Gastroenterology and Nutrition, Femme Mere Enfant University Hospital, Lyon, France
5 Department of Hepatology Croix-Rousse University Hospital, Hospices Civils de Lyon, France.
Background
Today, the majority of minimally invasive living donor hepatectomies (LDH) are performed with a robotic approach and 41% of the centers performing R-LDH transitioned directly from open to the robotic approach. In this context, there is an urgent need to assess the safety of the transition from open to R-LDH.
Method
In this retrospective single-center study in a high volume tertiary hepatobiliary and liver transplant center from France, we report all consecutive LDH performed from September 2019 to March 2025 for pediatric recipients. This IDEAL Stage 2a study assesses the donor safety of R-LDH in comparison to open-LDH. The primary safety endpoint is the absence of major donor morbidity (Clavien-Dindo Grade>II) after 90 postoperative days.
Results
During the study period, 23 LDHs were performed, with 16 (70 %) open LDHs and 7 (30%) robotic LDHs. The majority of LDHs were G23 (n=21, 91%).
At 90 days, there were no CD>II complications in the R-LDH and open group.
The operative duration of robotic-LDH was significantly longer (356 min vs 243 min, p=0.026) but intraoperative blood loss was further reduced (50 ml vs 125 ml p<0.001) and no conversion was required.
After a median overall follow-up of 25 months, graft and recipient survival was 100% in both groups.
Conclusion
In conclusion, the transition from open to R-LDH in the setting of a low-volume LDH center can be achieved without compromising donor safety. An extensive experience in minimal-invasive HPB surgery contributes to a safe transition from open to R-LDH.
Laparoscopic versus open liver resection for huge hepatocellular carcinoma (≥ than 10 cm): a multicenter propensity score - matched analysis from Eastern and Western referral centers
Authors & Institutions
Gianluca CASSESE, Fabio GIANNONE, Federica CIPRIANI, Antonio CUBISINO, Bruno BRANCIFORTE, Alessandro TROPEA, Fabio BENEDETTI, Fabrizio ROMANO, Salvatore GRUTTADAURIA, Guido TORZILLI, Mickael LESURTEL, Patrick PESSAUX, Francesca RATTI, Ho-Seong HAN, Fabrizio PANARO.
Background
There is still poor evidence about the safety and feasibility of minimally invasive liver surgery (MILS) for huge (> 10 cm) hepatocellular carcinomas (HCC). The aim of this study was to assess the short- and long- term outcomes of MILS versus open liver resection (OLR) for patients with huge HCC.
Method
Data regarding all consecutive patients undergoing liver resection for huge HCC were retrospectively collected from Asian (South Korean) and European (Italian and French) referral HPB centers. The cases were propensity-score matched for age, center, extent of the resection, tumor size, tumor number.
Results
A total of 198 patients were included in the study. Before matching there were statistically significant differences in tumor size (p<0.01) and rates of major hepatectomies performed (p=0.03). After PSM two cohorts of 39 patients were obtained, with no statistically significant differences in all the compared preoperative characteristics. No significant differences were found in terms of major complications, in-hospital mortality and operative time, between the matched cohorts. The length of hospital stay was significantly lower after LLR (median 7 vs. 10 days, p < .01), as well as the intraoperative estimated blood loss (median 500ml vs 80 ml, respectively; p=0.02) and the rates of intraoperative transfusions (25.6% vs 48.7%, respectively; p= 0.03). After a median follow-up of 61 (±7) months, there were no significant differences between OLR and LLR in both median OS (69 vs. 59 months, p = .74, respectively) and median DFS (12 vs. 10 months, p = .48, respectively).
Conclusion
MILS for huge HCC can be safe and effective in selected cases in referral centers, being able to reduce intraoperative blood loss, and to shorten median hospital stay.
Efficacy and Safety of Low-Dose Tacrolimus Monotherapy in Liver Transplantation: Experience from a Level-IV Hospital in Latin America (Cali, Colombia)
Authors & Institutions
Juan Manuel Rico Juri¹†, Anabel Vanin Aguas¹, Felipe Castro Villegas¹, Michael Zapata Palomino¹, Ilich Andrei Zúñiga Gaitán², Jesús David Charfuelan Caicedo³, Carolina Téllez Fina³
¹Liver Transplant Unit, Clínica Imbanaco, Cali, Colombia – transplant surgeons, general surgeon.
²Universidad del Valle, Cali, Colombia – general surgery resident.
³Pontificia Universidad Javeriana Cali, Colombia – general practitioners.
†Dr. Juan Manuel Rico Juri is also a member of the Compagnons Hépato-Biliaires.
Background
The present study aims to address this knowledge gap by describing the experience of a level-IV hospital in Cali, Colombia, with the use of tacrolimus monotherapy at different plasma levels. The primary objective is to evaluate immunological efficacy, metabolic safety, and one-year patient and graft survival, comparing outcomes among patients with tacrolimus levels <5 ng/ml, 5–10 ng/ml, and >15 ng
Method
This was a retrospective observational study conducted at Clínica Imbanaco, a level IV hospital in Cali, Colombia (Latin America), between April 2018 and May 2024. A total of 119 liver transplant recipients were included and classified according to their immunosuppressive regimen: low-level tacrolimus monotherapy (<10 ng/ml) or dual therapy with mycophenolate. Clinical, surgical, and immunological variables were evaluated, including metabolic complications, acute rejection, liver function, infections, and one-year survival.
Results
Tacrolimus monotherapy was used in 86.6% of patients. Levels between 5 and 10 ng/ml were associated with lower rejection rates (8.7%), preserved liver function, and a low infection rate. Levels <5 ng/ml were linked to increased rejection (21.1%) and infections (13.5%), while levels >15 ng/ml were associated with liver dysfunction. Compared to dual therapy, monotherapy was associated with lower rates of renal insufficiency, hypertension, and de novo diabetes, without differences in patient or graft survival.
Conclusion
Tacrolimus monotherapy at 5–10 ng/ml is safe and effective in selected patients, reducing toxicity without affecting liver function, immunity, or survival. This large Latin American single-center experience shows its feasibility and value in resource-limited settings.
Robotic Deceased Donor Liver Transplantation: A Video of Technical Aspects
Authors & Institutions
Mariya Ekimova
Dieter Broreing Organ transplant Center of Excellence, King Faisal Specialist Hospital and Research centre.
Background
To demonstrate the feasibility and potential advantages of a fully robotic deceased donor liver transplantation (DDLT) performed at our institution.
Method
A fully robotic DDLT was performed using the Da Vinci Xi system in a patient with end-stage liver disease due to NASH cirrhosis and hepatocellular carcinoma (SEG 7, 3 cm) with a MELD score of 30. Total native liver hepatectomy and graft implantation were conducted through a Pfannenstiel incision.
Results
The operation lasted 6 hours with a warm ischemia time of 30 minutes. No intraoperative or postoperative complications occurred. Blood loss was minimal (300 mL). The patient was discharged on postoperative day 7.
Conclusion
Robotic DDLT allows precise dissection around the portal triad and retrohepatic inferior vena cava, minimizing blood loss and enhancing surgical accuracy. Preliminary data suggest benefits for both patient and surgeon. Further studies are needed to assess long-term outcomes and compare this approach.
Tumor response scoring systems for pancreatic ductal adenocarcinoma: A Systematic Review
Authors & Institutions
Roberta Vella, Elvira Adinolfi, Beatrice Belmonte, Gabriella Pittau, Alessandro Anastasi, Guido Martignoni, Stefano Crippa, Giovanni Butturini, Isabella Frigerio.
Background
This review aims to provide a comprehensive review of existing literature on Tumor response scoring (TRS) systems for Pancreatic ductal adenocarcinoma (PDAC), highlighting current limits of existing systems and shedding light into novel ancillary techniques that might guide patient stratification following induction therapies.
Method
We searched PubMed, Scopus and the Cochrane database for English-language studies evaluating the prognostic role of TRS systems and novel regression scoring systems for PDAC. Literature search was conducted and reported according to PRISMA 2020 guidelines, and risk of bias was assessed through the QUIPS Cochrane tool.
Results
Several TRS systems were identified, varying in grading criteria and complexity. Despite their widespread use, these systems lack reproducibility and prognostic accuracy, particularly in distinguishing true tumor regression from pre-existing stromal characteristics. Recent evidence supports combining histopathological evaluation with radiological, serological, and molecular biomarkers—such as CA 19.9, circulating tumor DNA (ctDNA), KRAS mutation profiles, transcriptomic subtypes, and perineural invasion scoring—to accurately predict pathological complete response and optimize patient therapy.
Conclusion
Current TRS provide useful prognostic information, their limitations underscore the need for integrated histopathological, molecular, and imaging-based criteria. A multiparametric TRS system will be essential for guiding personalized therapeutic decision-making in the era of precision oncology.
The Role of “Conservative” Resection Strategy after neoadjuvant treatment for borderline/locally advanced PDAC with arterial involvement: a single-centre retrospective observational study
Authors & Institutions
Roberta Vella, Elisa Bannone , Alessandro Giardino, Isabella Frigerio, Martina Guerra, Erica Pizzocaro, Laura Bignotto, Filippo Scopelliti, Paolo Regi, Camillo Aliberti, Guido Martignoni, Roberto Girelli, Marcello Lino, Paolo Pederzoli, Giovanni Butturini.
Background
Recent advances in multimodal therapies have increased the potential for resectability of borderline
resectable and locally advanced Pancreatic ductal adenocarcinoma (PDAC). We herein describe the
conservative resection strategy adopted at our Institution and the oncological outcomes of patients with
PDAC and arterial involvement.
Method
This retrospective single-centre study included patients diagnosed with PDAC and radiologic evidence of
arterial involvement who underwent surgical exploration between January 2014 and June 2024. All patients received induction chemotherapy (± radiotherapy). Survival outcomes were analysed using the Kaplan–Meier and Cox proportional hazards models. Logistic regression analyses were used to identify predictors of resectability and recurrence.
Results
76 patients were included; 59 underwent pancreatic resection with arterial divestment (AD) and 17 were deemed unresectable at laparotomy. Neoadjuvant FOLFIRINOX was significantly associated with increased odds of resection (HR = 3.23, 95% CI: 1.59–9.90, p = 0.040). Median OS from diagnosis was 33 months (29–39) in resected patients and 26 months (16–29) in non-resected patients (p = 0.0176). Surgical resection and Ca 19,9 normalization after induction therapy were associated with reduced mortality risk (HR = 0.38, 95% CI: 0.19–0.75, p = 0.005 and HR=0.56, 95% CI: 0.35-0.88, p=0.014).
Conclusion
These findings highlight the value of multimodal strategies in managing PDAC with arterial involvement. AD represents a valuable technique associated with acceptable outcomes in selected patients. Future interventional prospective studies are needed to optimize patient selection.
Early Laparoscopic Cholecystectomy Post Endoscopic Retrograde cholangiopancreatography in Patients of Cholelithiasis with Choledocholithiasis: An Observational Study
Authors & Institutions
Sajad Ahmad Khoja, Ankit Uppal, Sheikh Bisma Ramzan, Showkat Ahmad Kadla, Haris Bashir.
institution: GOVT. MEDICAL COLLEGE , SRINAGAR, kashmir India
Background
to study the safety and efficacy of early LC post-ERCP in terms of intraoperative parameters like, operative time, adhesions (NASSAR grading), calots triangle anatomy, conversion to open, and complications.
Method
A total of 50 patients of CL with choledocholithiasis (CDL), aged more than 18 years, were enrolled for the study,which took place over a period of 18 months. The said patients were subjected to pre-operative ERCP for biliary clearance and were taken upfor laparoscopic surgery within 72 hours of ERCP, wherein the difficulty of operation/operative time/conversion to open was decided accordingto NASSAR grade scale.
Results
Themajority of the enrolled patients were classified as NASSAR grade II(n = 24) with a mean operative time of 43.4 minutes, followed bygrade IV (n = 14), grade II (n = 10) and grade I (n = 2) with a meanoperative time of 91.3 minutes, 55.2 minutes, and 36 minutesrespectively (Table 2). One of the patients (2%) was converted toopen following dense adhesions and frozen anatomy. About 40patients (80%) underwent LC within 48–72 hours of ERCP while 10
patients (20%) before 48 hours only.
Conclusion
Our study shows that LC within 3 days of ERCP is safe, and cost-effective.
Critical View of Safety in Laparoscopic Cholecystectomy: A Prospective, Observational Study
Authors & Institutions
Sajad Nazir Malla, Waseem Ul Rahman Dar, Haris Bashir, Imtiyaz Ahmad Malik, Bilal Ahmad Lone.
institution: GOVT. MEDICAL COLLEGE , SRINAGAR, kashmir India
Background
To observe the percentage of patients in whom CVS was attained during laparoscopic cholecystectomy, percentage of patients where bailout procedures were needed and the type of bail out procedure adopted.
Method
conducted in the Department of Minimal Access and General Surgery, Govt. Medical College Srinagar at Kashmir, over a period of 6 months. A total of 55 patients of symptomatic cholelithiasis, aged >20 years were enrolled. Sample selection was done using a purposive sampling technique. Information regarding age, gender, clinical presentation, and etiological factors was collected through an interview-based questionnaire from the patients or their attendants.collected data as i) operative time;ii) GB wallthickness, 3, BDI, 4 complications, 5. LOS. F/U for 6wks post op.
Results
(52.73%) of thepatients were in the age group of 40-59 years, followed by (29.09%) in 20-39 years age group. male-female ratio was 1:5. Critical view of safety (CVS)was attained in 50 patients (90.9%), while 5 patients had difficulties: difficulty in dissection ofcalot’s triangle in 5 cases, dense adhesions were found in 3 cases and 1 had perforated llbladder.Significant differences were observed between two groups (CVS attained and not attained) interms of operative time, gallbladder wall thickness and total hospital stay p<0.001). Bail out proceduresopted-conversion to open, lap fundus first.
Conclusion
Attainment of CVS makesthe procedure easy and convenient. Variouspredictive factors that lead to difficult gall bladderincluded difficult Calot’s triangle dissection,dense adhesion and thickened gall bladder wall.All these factors play predictive role for variousbail-out procedures or conversion .
Lapro-cystoscopic clearance in OCH & Roux-en Y hepaticojejunostomy.
Authors & Institutions
Prof Iqbal Saleem, Dr Haris Bashir, Dr Mudasir, Dr Anyees
institution: GOVT. MEDICAL COLLEGE , SRINAGAR, kashmir India
Background
Achieving clearance of sectoral ducts in patients of OrientalCholangioHepatitis using laparoscopy and help of cystoscopy.
Method
Laparoscopy and cystoscopy in absence of choledocoscopy, for confirmation and clearance of sectoral ducts.
Results
cystoscopic guidance stands a good alternative for good visualization, guided removal of calculi, even in the higher up ducts of Right or left hemiliver.
Conclusion
in absence of choledochoscope, cystoscope whether rigid/flexible can be used effectively to treat sectoral/ tertiary duct calculi in OCH.
Impact of laparoscopic resection for access to the waiting list of a single regional transplant center in southern Italy: entry and dropout flows’ analysis
Authors & Institutions
Duilio Pagano, Roberta Vella, Fabrizio di Francesco, Sergio Li Petri, Pasquale Bonsignore, Sergio Calamia, Alessandro Tropea, Caterina Accardo, Ivan Vella, Noemi Di Lorenzo, Salvatore Gruttadauria
Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS-ISMETT-UPMC.
Background
The aim of this study was to analyse the impact of laparoscopic liver resection for access to the waiting list of a single regional center for liver transplantation in a region with a donor shortage in southern Italy.
Method
We retrospectively analyzed patients with early/intermediate HCC treated from 2016–2023. Patients were grouped as surgically treatable or resectable/transplantable based on age, liver function, and comorbidities. MWTA-treated patients were included as surgically treatable. Linear correlation assessed LLR vs. transplant list metrics. Cox regression analyzed recurrence risk post-resection. Competing risk analysis evaluated 1-year probabilities of dropout, death, and transplant for listed patients.
Results
From 2016–2023, 887 patients with HCC or ESLD were included; 563 had early/intermediate HCC, and 320 underwent resection or thermoablation. Of 243 listed for transplant, 91 potentially transplantable patients were resected. Hepatic and laparoscopic resections increased over time. An inverse correlation (ρ=-0.82, p=0.023) was found between LLRs and ITT dropout/enrollments. Tumor size and multifocality predicted recurrence. HCC patients had lower dropout and higher transplant rates than non-HCC patients at 3, 6, and 12 months.
Conclusion
Minimally invasive surgical therapies for HCC have a specific impact on the drop-out rate of the overall ITT population and the waiting time for transplantation for transplanted HCC patients.
Early Biliary Complications After Pancreaticoduodenectomy: A Ten-Year Single-Center Experience
Authors & Institutions
O.Usenko, O. Lytvyn, S.O. Motelchuk
State institution “National Scientific Center of surgery and transplantation named after O.O. Shalimov to National Academy of medical sciences of Ukraine”, 30, Akademika Shalimova str., Kyiv, Ukraine, 03126
Background
Method
Patients were divided into groups: without postoperative fistula, with pancreatic fistula, with biliary fistula, and with combined pancreatico-biliary fistula. Pancreatic fistula was defined according to international criteria as the presence of fluid with amylase activity exceeding three times the upper normal serum limit within the first three postoperative days. Biliary fistula was diagnosed by bile in the drainage fluid with bilirubin concentration more than three times the upper normal serum level after the third postoperative day, or based on imaging (percutaneous transhepatic cholangiography, drainage cholangiography, or intratubular cholangiography) confirming communication between the extrahepatic bile ducts and the peritoneal cavity. Patients with amylase-rich fluid but without signs of biliary leakage were excluded. Combined pancreatico-biliary fistulas were defined according to the same criteria as isolated biliary fistulas, with additional presence of amylase-rich fluid.
Results
We retrospectively analyzed data from 421 patients who underwent pancreaticoduodenectomy between November 2014 and December 2024 for malignant and benign periampullary tumors, as well as complicated chronic pancreatitis.
Indications:
– Adenocarcinoma — 45% (n=189)
– Intraductal papillary mucinous neoplasm (IPMN) — 21% (n=88)
– Neuroendocrine tumors — 10% (n=42)
– Ampullary carcinoma — 8% (n=34)
– Cholangiocarcinoma — 6% (n=25)
– Chronic pancreatitis — 4% (n=17)
– Duodenal carcinoma — 2% (n=8)
– Others — 4% (n=18)
Preoperative biliary drainage was performed in 31% (n=130), and positive bile cultures were found in 35% (n=147). At the time of surgery, jaundice was present in 49% (n=206). A common bile duct diameter ≤5 mm was observed in 24% (n=101).
Hepaticojejunostomy technique:
– Interrupted sutures — 41% (n=173)
– Continuous sutures — 11% (n=46)
– Combined technique — 48% (n=202)
Postoperative complications:
– Biliary fistula — 3% (n=10)
– Pancreatic fistula — 22% (n=92)
– Delayed gastric emptying (DGE) — 25% (n=105)
– Combined hepaticojejunostomy and pancreaticojejunostomy leakage — 0.5% (n=2)
– No anastomotic failure — 72% (n=303)
The mean age was 61±9.3 years; 52% male (n=219) and 48% female (n=202). Postoperative mortality was 4% (n=17): surgical complications 62% (n=11; ischemic 2, pancreatic fistula 4, hemorrhage 5), cardiopulmonary 23% (n=4), and other causes 15% (n=2).
Risk factors for early biliary complications: sex, tumor nature (benign/malignant), pylorus-preserving technique, bile duct diameter <5 mm, presence of pancreatic fistula, and the use of 6/0 suture material for biliary anastomosis. All hepaticojejunostomy strictures occurred in patients with a duct diameter <5 mm. Transient jaundice was significantly more frequent in patients with bile duct diameter <5 mm. Cholangitis was more common in tumors of the biliary and periampullary region.
Conclusion
Early biliary fistulas are relatively rare but their combination with pancreatic fistula significantly increases the risk of severe complications and mortality. The most important independent risk factor is a narrow bile duct diameter, highlighting the critical role of surgical technique. The use of 6/0 suture material may contribute to ischemic injury and stricture formation. Approximately 50% of biliary fistulas close spontaneously if intra-abdominal drainage is maintained, with zero mortality from isolated biliary fistulas. Minimally invasive management strategies are effective and help avoid reoperation.
Preoperative Endoscopic Biliary Drainage as a Risk Factor for Increased Postoperative Complications After Pancreaticoduodenectomy
Authors & Institutions
O.I. Lytvyn, S.O. Motelchuk
State institution “National Scientific Center of surgery and transplantation named after O.O. Shalimov to National Academy of medical sciences of Ukraine”, 30, Akademika Shalimova str., Kyiv, Ukraine, 03126
Background
Preoperative endoscopic biliary drainage (EBD) before pancreaticoduodenectomy (PD) is performed to improve liver function and correct coagulation abnormalities, which may affect postoperative recovery in patients with obstructive jaundice. The rationale behind EBD is to stabilize the patient’s condition and improve surgical outcomes. However, the increasing incidence of postoperative and infectious complications highlights the need to clearly define the indications for preoperative biliary decompression and to avoid its routine use.
Method
A retrospective analysis was conducted at the Shalimov National Scientific Center of Surgery and Transplantology (Kyiv, Ukraine). Between April and December 2024, PD was performed in 91 patients, of whom 49 underwent preoperative EBD. All patients were divided into two groups: with EBD and without EBD. Clinical characteristics and the incidence of postoperative complications were compared between the groups.
Results
The overall incidence of postoperative complications was significantly lower in the non-EBD group compared to the EBD group (23.8% vs. 53%, p < 0.05). The incidence of clinically significant postoperative pancreatic fistula was also lower in the non-EBD group (12.2% vs. 28.2%, p = 0.003). The rate of infectious complications was 9.5% in the non-EBD group compared to 20.4% in the EBD group (p < 0.05).
Conclusion
Preoperative EBD significantly increases the risk of postoperative and infectious complications in patients undergoing PD. The findings confirm that patients who undergo endoscopic retrograde biliary decompression before PD are at higher risk of developing external pancreatic fistulas and infectious complications.
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Hôpital Edouard Herriot
Maison des Professionnels
5 Place d'Arsonval, 69003 Lyon
Grange Blanche
Lyon
Lyon
Gdańsk
Goslar
