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Intrahepatic cholangiocarcinoma (ICC) is the second most common primary liver tumor after hepatocellular carcinoma (HCC). Management depends on their resectability at the time of diagnosis. Two types can be distinguished by imaging: resectable ICCs amenable to surgery and locally advanced and/or metastatic ICCs, that are treated by chemotherapy, radiotherapy or loco-regional treatment (radioembolization, chemoembolization, intra-arterial chemotherapy and thermoablation). Over the last decade, the management strategy for these tumors has been modified by the appearance of loco-regional treatments as well as the introduction of immunotherapy that have shown their efficacy in the control of ICC. The aim of this review is to describe the current status of treatments for ICCs, as well as the different therapeutic strategies being assessed. [ABSTRACT FROM AUTHOR]

The impact of the SARS-CoV-2 pandemic on managing liver malignancies worldwide is unknown. This study aimed to determine the impact of lockdowns on patient clinical pathways and postoperative morbi-mortality. This study evaluated all adults' hospital stays for liver tumors between 2019 and 2021 from the national French discharge database. The primary outcome was the clinical pathway, especially surgical care and postoperative outcomes, between patients admitted during COVID-19 lockdown periods (lockdown group) and during the same periods of 2019 and 2021 (control groups). The overall population included 58,508 patients: 18,907 patients in the lockdown group, 20,045 in the 2019 control group, and 19,556 in the 2021 control group. Surgical activity decreased by 11.6% during lockdowns, with 1,514 (8.0%) of patients in the lockdown group treated by surgery, 1,514 (8.6%) in the 2019 control group (P <.001), and 1,466 (7.4%) in the 2021 control group. Chemotherapy was considered more during the lockdowns (P <.001). More patients were operated in small-volume centers during the lockdowns (34% vs 32% vs 32%, P =.034), and fewer were hospitalized in highly populated regions (P <.001). Postoperative morbidity (47% vs 47% vs 47%, P =.90) and mortality (3.3% vs 3.6% vs 3.1%, P =.80) were comparable in the 3 periods, with no influence of lockdowns on morbidity (risk ratio = 0.94, 95% confidence interval = 0.81–1.09, P =.40) or mortality (odds ratio = 1.12, 95% confidence interval = 0.72–1.74, P =.6). Postoperative pulmonary (17% vs 13%, P =.024) and septic complications (20% vs 15%, P =.022) were significantly higher during the first lockdown compared to the second. This study provides a French overview of liver malignancy management during the COVID-19 pandemic. Moreover, surgical activity decreased by 11.6% in high-volume centers, with no impact on postoperative morbidity and mortality. [ABSTRACT FROM AUTHOR]

To validate the Institut Mutualiste Montsouris classification as a difficulty scoring system applicable to laparoscopic repeat liver resections and identify risk-factors of unexpected difficulty. From a prospectively collected database between 2000 and 2019, patients undergoing laparoscopic repeat liver resections were classified according to the Institut Mutualiste Montsouris classification. Doubly robust estimators (weighted regressions) were used to assess the effect of factors on intra- and postoperative outcomes and allowed for strong adjustment on age, body mass index, American Society of Anesthesiologists, carcinoembryonic antigen, number, and size of lesions. Unexpected difficulty was defined as a composite indicator which included substantial blood loss and/or substantial operative time and/or conversion. Of 205 laparoscopic repeat liver resections patients, 87, 25, and 93 procedures were classified as grade 1, 2, and 3 laparoscopic repeat liver resections, respectively. After doubly robust adjustment, the IMM classification was associated with blood loss (Cohen f2 0.12; P = 0.001), operative time (Cohen f2 0.07; P =.001), and length of stay (Cohen f2 0.13; P =.001), as well as with the risk of both minor and severe complications (odd ratio = 2.94; 95% confidence interval: 2.06–4.20) and the chances of achieving textbook outcome (relative risk = 0.57; 95% confidence interval: 0.41–0.81). Independently from the Institut Mutualiste Montsouris classification, a first major hepatectomy (relative risk = 1.15, 95% confidence interval: 1.03–1.29) as well as sinusoidal obstruction syndrome (relative risk = 1.24, 95% confidence interval: 1.09–1.41) were independent risk factors of unexpected difficulty. A first major resection was associated with decreased chances of textbook outcome (relative risk = 0.53; 95% confidence interval: 0.33–0.85). The Institut Mutualiste Montsouris classification is a valuable difficulty scoring system for laparoscopic repeat liver resections procedures, while previous major resection and presence of sinusoidal obstruction syndrome are likely to jeopardize the outcomes. [ABSTRACT FROM AUTHOR]

The development of laparoscopic liver resection has led to the hypothesis that intraoperative blood loss may be a key indicator of surgical care quality. This study assessed short- and long-term results of patients according to three levels of intraoperative blood loss during laparoscopic liver resection for colorectal liver metastasis. All patients who underwent laparoscopic liver resection for colorectal liver metastasis between 2000 and 2018 were included. Difficulty of laparoscopic liver resection was defined according to the Institut Mutualiste Montsouris classification. Three levels of the extent of intraoperative blood loss were defined: massive (≥1,000 mL), substantial (≥75th percentile of intraoperative blood loss within each grade of difficulty), and normal intraoperative blood loss. During study period, 317 patients underwent laparoscopic liver resection for colorectal liver metastasis. Among them, 213 (67.2%), 80 (25.2%), and 24 (7.6%) patients had normal, substantial, and massive intraoperative blood loss, respectively. Twenty-six patients (8.2%) required transfusion. Massive intraoperative blood loss came from a major hepatic vein in 54% of cases and were managed by laparoscopy in 83% of the cases. Laparoscopic liver resection difficulty grade (odds ratio = 3.15; P =.053) and number of colorectal liver metastasis (odds ratio = 1.24; P =.020) were independently associated with massive intraoperative blood loss. Risks factors for substantial intraoperative blood loss were bi-lobar colorectal liver metastasis (odds ratio = 3.12; P =.033) and sinusoidal obstruction syndrome (odds ratio = 3.27; P =.004). The level of intraoperative blood loss was not associated with severe complications nor overall and disease-free survival. Requirement of transfusion was associated with severe complications (odds ratio = 7.27; P =.002) and decreased 1-, 3-, and 5-year overall survival (87%, 68%, and 61% vs 95%, 88%, and 79%; P =.042). The extent of intraoperative blood loss did not affect short- and long-term results of laparoscopic liver resection for colorectal liver metastasis. Massive intraoperative blood loss was often incidental and, 83% of the time, manageable by laparoscopy. Rather than intraoperative blood loss, transfusion is a better relevant indicator of laparoscopic liver resection surgical quality. [ABSTRACT FROM AUTHOR]

Two-stage hepatectomy (TSH) has increased the chance of surgical resections for bilobar colorectal liver metastases (CRLM). Nevertheless, drop-out between stages and early recurrence rates raise the question of surgical futility in some situations. This study aimed to identify factors of TSH oncological failure. Patients with bilobar CRLM eligible for TSH in three tertiary centers between 2010 and 2021 were included, and divided in Failure and Success groups. Oncological failure was defined as failure of the second stage hepatectomy for tumor progression or recurrence within 6 months after resection. Among 95 patients, 18 (18.9%) had hepatic progression between the two stages, and 7 (7.4%) failed to complete the second stage hepatectomy. After TSH, 31 (32.6%) patients experienced early recurrence. Overall, 38 (40.0%) patients experienced oncological failure (Failure group). The Failure group had lower median DFS (3 vs. 32 months, p < 0.001) and median OS (29 vs. 70 months, p = 0.045) than the Success group. On multivariable analysis, progression between the two stages in the future liver remnant (OR = 15.0 (3.22–113.0), p = 0.002), and maximal tumor size ≥40 mm in the future liver remnant (OR = 13.1 (2.12–117.0), p = 0.009) were independent factors of oncological failure. Recurrence between the two stages and maximal tumor size ≥40 mm in the future liver remnant were associated with TSH failure for patients with bilobar CRLM. • 40% of patients who underwent two stage hepatectomy for colorectal liver metastases will experience oncological failure. • Oncological failure significantly shorten disease-free and overall survival. • Recurrence between the two stages and maximal tumor size ≥40 mm in the future liver remnant are associated with two-stage hepatectomy failure. [ABSTRACT FROM AUTHOR]

After local or systemic treatment, a small number of patients with primarily unresectable intrahepatic cholangiocarcinoma (ICC) may benefit from secondary resection. This study aimed to analyze the oncological outcome of patients who underwent radical surgery after preoperative treatment. From 2000 to 2021, all patients who underwent curative-intent liver resection for ICC in three tertiary centers were selected. Patients were divided into two groups: upfront surgery (US) and preoperative treatment (POT). Oncologic data (preoperative treatment, histologic data, adjuvant chemotherapy, overall survival, and recurrence-free survival) were compared between the two groups. Among 198 included patients, 31 (15.7%) received POT including chemotherapy (74.2%), radioembolization (12.9%), chemoembolization (9.7%), or combined radiotherapy and chemotherapy (3.2%). Major resection was performed in 156 (78.8%) patients, and 53 (26.8%) had vascular and/or biliary reconstruction. Histological findings were similar between US and POT group and were not affected by the type of POT. After a median follow-up of 23 months, recurrence rate (58.1% POT vs. 55.1% US, p = 0.760) and type were similar between groups. Recurrence-free survival at 1 and 3 years (41.9% and 22.6% vs. 46.7 and 21.6% in the POT and US, respectively, p = 0.989) and overall survival at 1 and 3 years (77.4% and 32.3% vs. 69.5% and 34.7% in the POT and US respectively, p = 0.323) were similar and independent of the POT type. After POT, downstaged patients who underwent curative-intent resection for initially unresectable ICC have similar long-term outcomes as those undergoing upfront surgery. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the impact and predictors of an ideal surgical care following SLHCC resection. SLHCC patients who underwent LR in two tertiary hepatobiliary centers between 2000 and 2021 were retrieved from prospectively maintained databases. The quality of surgical care was measured by the textbook outcome (TO). Tumor burden was defined by the tumor burden score (TBS). Factors associated with TO were determined on multivariate analysis. The impact of TO on oncological outcomes was assessed using Cox regressions. Overall, 103 SLHCC patients were included. Laparoscopic approach was considered in 65 (63.1%) patients and 79 (76.7%) patients presented with moderate TBS. TO was achieved in 54 (52.4%) patients. Laparoscopic approach was independently associated with TO (OR 2.57; 95% CI 1.03–6.64; p = 0.045). Within 19 (6–38) months of median follow up, patients who achieved TO had better OS compared to non-TO patients (1-year OS: 91.7% vs. 66.9%; 5-year OS: 83.4% vs. 37.0%, p < 0.0001). On multivariate analysis, TO was independently associated with improved OS, especially in non-cirrhotic patients (HR 0.11; 95% CI 0.02–0.52, p = 0.005). TO achievement could be a relevant surrogate marker of improved oncological care following SLHCC resection in non-cirrhotic patients. [Display omitted] [ABSTRACT FROM AUTHOR]