The Effectiveness and Safety of the Short-Course Therapy in Liver Transplant Recipients With Uncomplicated Gram-Negative Bacteremia: A Retrospective Study.

Introduction: The appropriate duration of therapy for uncomplicated gram-negative bloodstream infection (GN-BSI) in liver transplant (LTx) recipients remains unknown. This study aims to explore the effectiveness of a short-course antimicrobial therapy.

Methods: This retrospective study was performed in a single LTx center in Japan.

Original articles: step-by-step decision-making for achieving oncologically acceptable but avoiding over-invasive surgery for gallbladder cancer.

Background: Gallbladder cancer is a malignancy with a highly dismal prognosis, requiring optimal surgical strategies to achieve effective outcomes. We aimed to evaluate the outcomes of our algorithm-based decision-making approach based on image T-factors and intraoperative pathology of regional lymph node metastases and the bile duct stumps in patients undergoing gallbladder cancer resection.

Methods: A prospectively maintained database of patients who underwent gallbladder cancer resection between April 2001 and June 2022 was reviewed.

Simple Trocar Placement for Robotic Liver and Pancreatic Surgery: Multiple Access Devices at 5-cm Single Umbilicus Incision with 2 Robotic Ports.

Background: Robotic trocars are recommended to be placed 6-8 cm apart, and assistant trocars are placed 7 cm away from the horizontal line of the robotic trocar placement. However, adhering to these rules may be difficult, particularly in lean patients. This study aims to demonstrate our standardized simple trocar placement, 5-cm single umbilicus incision + 2 ports for robotic liver resection (RLR) and robotic pancreaticoduodenectomy (RPD).

c-Met inhibitor upregulates E-cadherin, which is lost in portal vein tumor thrombus of hepatocellular carcinoma.

Aim: Portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) is an essential therapeutic and prognostic factor. E-cadherin plays a crucial role in adhesive properties and intercellular interaction in various cancer tissues, including HCC, but the expression profile and functional contribution of E-cadherin in PVTT remain unknown. This study aimed to analyze the expression of E-cadherin in the main tumor tissue and PVTT tissue of HCC, and evaluate the functional roles of E-cadherin in PVTT formation.

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.

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.

The Role of Frequent Screening or Diagnostic Testing of Serum Cryptococcal Antigen in Liver Transplant Recipients: A Descriptive Epidemiology.

Background: Cryptococcosis is a notable infectious complication of liver transplantation. Currently, there is no recommendation for screening serum cryptococcal antigen (CrAg) levels in solid organ transplant recipients. We aimed to explore the role of serum CrAg in liver transplant recipients at an institution where posttransplant serum CrAg has been widely tested.

The Effect of Renin-Angiotensin System Inhibitors in Patients Undergoing Pancreatic Cancer Resection.

Objectives: The local renin-angiotensin system promotes angiogenesis and proliferation via vascular endothelial growth factor or epidermal growth factor receptor expression. In this study, we aimed to evaluate the impact of angiotensin system inhibitors (ASIs) on long-term outcomes in patients undergoing surgical resection of pancreatic ductal adenocarcinoma (PDAC).

Methods: A single institutional retrospective analysis was performed using the medical records of patients who underwent pancreatic resection with curative intent for PDAC between January 2005 and December 2018.

Metallic Stents for Hepatic Venous Outflow Obstruction After Living-Donor Liver Transplantation and their Therapeutic Effects.

Background: Living-donor liver transplantation (LDLT) is established as a standard therapy for end-stage liver disease; however, vessel reconstruction is more demanding due to the short length and small size of the available structures compared with deceased-donor whole liver transplantation. Interventional radiology (IR) has become the first-line treatment for vascular complications after LDLT. Hepatic venous outflow obstruction (HVOO) is a life-threatening complication after LDLT.

A data-informed timeline for hospital discharge with a reasonably low risk of unplanned readmission after open and minimally invasive liver resections.

Background: Postoperative complications following liver resection remain high, ranging from 20% to 50%. Patients are hospitalized for a certain period of time following liver resection because of the risk of postoperative complications. We hypothesized that the risk of complications decreases with each complication-free postoperative day after open and minimally invasive liver resections and can be stratified using a recently reported three-level complexity classification.

Conditional recurrence analysis of intrahepatic cholangiocarcinoma: Changes in recurrence rate and survival after recurrence resection by disease-free interval.

Aim: The prognosis of patients with resected intrahepatic cholangiocarcinoma (ICC) is still unsatisfactory, with a high recurrence rate. We aimed to evaluate risks of recurrence changing over time and the survival benefit of resection for recurrent ICC.

Methods: This study included patients who underwent hepatectomy for ICC during 1995-2020.

Lenvatinib recruits cytotoxic GZMK+CD8 T cells in hepatocellular carcinoma.

Background: Lenvatinib was expected to enhance the effect of immune checkpoint inhibitors (ICIs) for unresectable HCC; however, their combination therapy failed to show the synergy in the phase III clinical trial.

Methods: To elucidate lenvatinib-induced molecular modulation, we performed bulk RNA-sequencing and digital spatial profiling of 5 surgically resected human HCC specimens after lenvatinib treatment and 10 matched controls without any preceding therapy.

Findings: Besides its direct antitumor effects, lenvatinib recruited cytotoxic GZMK+CD8 T cells in intratumor stroma by CXCL9 from tumor-associated macrophages, suggesting that lenvatinib-treated HCC is in the so-called excluded condition that can diminish ICI efficacy.

Interventional treatment for portal vein complications utilizing a hybrid operating room after liver transplantation.

Background: Vascular complications after liver transplantation (LT) can be lethal and require immediate treatment to prevent graft failure. Nowadays, with interventional radiology (IR), approaches such as the percutaneous transhepatic (PTH) and transileocolic venous (TIC), have become major treatment options. We reviewed the safety and efficacy of a hybrid operating room (OR) for portal vein complications after LT.

Posthepatectomy but not prehepatectomy chemotherapy was associated with a longer time to recurrence in patients with resectable colorectal liver metastases: Inverse probability of treatment weighting analysis.

Background: Patients with resectable colorectal liver metastases (CLM) are treated with surgery alone, surgery and posthepatectomy chemotherapy, or prehepatectomy chemotherapy and surgery. The optimal approach in terms of survival is unclear. We compared survival in the three treatment groups using inverse probability of treatment weighting (IPTW) analysis.

Transient loss of consciousness immediately after total pancreatectomy for pancreatic metastases from renal cell carcinoma: a case report.

Background: Total pancreatectomy (TP) is often selected for treatment of various pancreatic diseases. However, the resultant lack of autoregulation of glycometabolism necessitates careful postoperative management.

Case Presentation: A 77-year-old man who had undergone right nephrectomy for renal cell carcinoma 11 years previously presented with multiple histologically diagnosed pancreatic metastases.

Liver Resection for Hepatocellular Carcinoma With Tumor Thrombus in the Inferior Vena Cava or Right Atrium: A Large-scale Multicenter Survey Conducted in Japan.

Objective: To clarify the short and long-term postoperative outcomes and surgical indications for patients accompanied by hepatocellular carcinoma with tumor thrombus (TT) in the inferior vena cava (IVC) or right atrium (RA).

Background: These patients are known to have an extremely poor prognosis; however, the postoperative outcomes have not been fully verified because of the rarity of this disease.

Methods: We contacted 211 specialized centers in Japan and collected data on liver resection for hepatocellular carcinoma with TT in the IVC or RA from centers with experience performing surgery for such patients.

Automated liver tumor detection in abdominal ultrasonography with a modified faster region-based convolutional neural networks (Faster R-CNN) architecture.

Background: Although diagnostic ultrasound can non-invasively capture the image of abdominal viscera, diagnosis of the continuous ultrasound liver images to detect a liver tumor effectively and to determine whether the detected is benign or malignant is nontrivial. In order to minimize the gaps in diagnostic accuracy depending on doctor's proficiency, we built an automated system to support the ultrasonography of liver tumors by employing deep learning technologies.

Methods: We constructed a neural network model for the automated detection of tumor tissues and blood vessels from the sequential liver ultrasound images.