Hepatobiliary Pancreat Dis Int

	2024 Vol. 23 No. 3
	Published: 2024-06-15


	Pages 221-330
	REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas LETTERS TO THE EDITOR VIEWPOINTS

REVIEW ARTICLES

	221	Gavriilidis P, Pawlik TM, Azoulay D
		Comprehensive review of hepatocellular carcinoma with portal vein tumor thrombus: State of art and future perspectives ^Hot!
		Background: Despite advances in the diagnosis of patients with hepatocellular carcinoma (HCC), 70%-80% of patients are diagnosed with advanced stage disease. Portal vein tumor thrombus (PVTT) is among the most ominous signs of advanced stage disease and has been associated with poor survival if untreated. Data sources: A systematic search of MEDLINE (PubMed), Embase, Cochrane Library and Database for Systematic Reviews (CDSR), Google Scholar, and National Institute for Health and Clinical Excellence (NICE) databases until December 2022 was conducted using free text and MeSH terms: hepatocellular carcinoma, portal vein tumor thrombus, portal vein thrombosis, vascular invasion, liver and/or hepatic resection, liver transplantation, and systematic review. Results: Centers of surgical excellence have reported promising results related to the individualized surgi- cal management of portal thrombus versus arterial chemoembolization or systemic chemotherapy. Critical elements to the individualized surgical management of HCC and portal thrombus include precise classification of the portal vein tumor thrombus, accurate identification of the subgroups of patients who may benefit from resection, as well as meticulous surgical technique. This review addressed five specific areas: (a) formation of PVTT; (b) classifications of PVTT; (c) controversies related to clinical guidelines; (d) surgical treatments versus non-surgical approaches; and (e) characterization of surgical techniques correlated with classifications of PVTT. Conclusions: Current evidence from Chinese and Japanese high-volume centers demonstrated that pa- tients with HCC and associated PVTT can be managed with surgical resection with acceptable results.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 221-227 . [Abstract] ( 228 ) [HTML 1KB] [PDF 0KB] ( 291 )

	228	Cheng SY, Jiang L, Wang Y, Cai W
		Emerging role of regulated cell death in intestinal failure-associated liver disease ^Hot!
		Intestinal failure-associated liver disease (IFALD) is a common complication of long-term parenteral nutrition that is associated with significant morbidity and mortality. It is mainly characterized by cholestasis in children and steatohepatitis in adults. Unfortunately, there is no effective approach to prevent or reverse the disease. Regulated cell death (RCD) represents a fundamental biological paradigm that determines the outcome of a variety of liver diseases. Nowadays cell death is reclassified into several types, based on the mechanisms and morphological phenotypes. Emerging evidence has linked different modes of RCD, such as apoptosis, necroptosis, ferroptosis, and pyroptosis to the pathogenesis of liver diseases. Recent studies have shown that different modes of RCD are present in animal models and patients with IFALD. Understanding the pathogenic roles of cell death may help uncover the underlying mechanisms and develop novel therapeutic strategies in IFALD. In this review, we discuss the current knowledge on how RCD may link to the pathogenesis of IFALD. We highlight examples of cell death-targeted interventions aiming to attenuate the disease, and provide perspectives for future basic and translational research in the field.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 228-233 . [Abstract] ( 126 ) [HTML 1KB] [PDF 0KB] ( 153 )

	234	Wu J, Cai SY, Chen XL, Chen ZT, Shi SH
		Mirizzi syndrome: Problems and strategies
		Mirizzi syndrome is a serious complication of gallstone disease. It is caused by the impacted stones in the gallbladder neck or cystic duct. One of the features of Mirizzi syndrome is severe inflammation or dense fibrosis at the Calot’s triangle. In our clinical practice, bile duct, branches of right hepatic artery and right portal vein clinging to gallbladder infundibulum are often observed due to gallbladder infundibulum adhered to right hepatic hilum. The intraoperative damage of branches of right hepatic artery occurs more easily than that of bile duct, all of which are hidden pitfalls for surgeons. Magnetic resonance cholangiopancreatography (MRCP) and endoscopic retrograde cholangiopancreatography (ERCP) are the preferable tools for the diagnosis of Mirizzi syndrome. Anterograde cholecystectomy in Mirizzi syndrome is easy to damage branches of right hepatic artery and bile duct due to gallbladder infundibulum adhered to right hepatic hilum. Subtotal cholecystectomy is an easy, safe and definitive approach to Mirizzi syndrome. When combined with the application of ERCP, a laparoscopic management of Mirizzi syndrome by well-trained surgeons is feasible and safe. The objective of this review was to highlight its existing problems: (1) low preoperative diagnostic rate, (2) easy to damage bile duct and branches of right hepatic artery, and (3) high concomitant gallbladder carcinoma. Meanwhile, the review aimed to discuss the possible therapeutic strategies: (1) to enhance its preoperative recognition by imaging findings, and (2) to avoid potential pitfalls during surgery.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 234-240 . [Abstract] ( 135 ) [HTML 1KB] [PDF 0KB] ( 101 )

ORIGINAL ARTICLES/Liver

	241	Sun C, Goh GB, Chow WC, Chan WK, Wong GL, Seto WK, Huang YH, Lin HC, Lee IC, Lee HW, Kim SU, Wong VW, Fan JG
		Prevalence and risk factors for impaired renal function among Asian patients with nonalcoholic fatty liver disease ^Hot!
		Background: Nonalcoholic fatty liver disease (NAFLD) is associated with impaired renal function, and both diseases often occur alongside other metabolic disorders. However, the prevalence and risk factors for impaired renal function in patients with NAFLD remain unclear. The objective of this study was to identify the prevalence and risk factors for renal impairment in NAFLD patients. Methods: All adults aged 18-70 years with ultrasound-diagnosed NAFLD and transient elastography ex- amination from eight Asian centers were enrolled in this prospective study. Liver fibrosis and cirrhosis were assessed by FibroScan-aspartate aminotransferase (FAST), Agile 3+ and Agile 4 scores. Impaired renal function and chronic kidney disease (CKD) were defined by an estimated glomerular filtration rate (eGFR) with value of < 90 mL/min/1.73 m2 and < 60 mL/min/1.73 m2 , respectively, as estimated by the CKD-Epidemiology Collaboration (CKD-EPI) equation. Results: Among 529 included NAFLD patients, the prevalence rates of impaired renal function and CKD were 37.4% and 4.9%, respectively. In multivariate analysis, a moderate-high risk of advanced liver fibrosis and cirrhosis according to Agile 3+ and Agile 4 scores were independent risk factors for CKD ( P < 0.05). Furthermore, increased fasting plasma glucose (FPG) and blood pressure were significantly associated with impaired renal function after controlling for the other components of metabolic syndrome ( P < 0.05). Compared with patients with normoglycemia, those with prediabetes [FPG ≥5.6 mmol/L or hemoglobin A1c (HbA1c) ≥5.7%] were more likely to have impaired renal function ( P < 0.05). Conclusions: Agile 3+ and Agile 4 are reliable for identifying NAFLD patients with high risk of CKD. Early glycemic control in the prediabetic stage might have a potential renoprotective role in these patients.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 241-248 . [Abstract] ( 123 ) [HTML 1KB] [PDF 0KB] ( 300 )

	249	Wang MD, Yuan C, Wang KC, Wang NY, Liang YJ, Zhu H, Tong XM, Yang T
		Efficacy of ginseng-based Renshenguben oral solution for cancer-related fatigue among patients with advanced-stage hepatocellular carcinoma: A prospective multicenter cohort study
		Background: Cancer-related fatigue (CRF) is a common and debilitating symptom experienced by patients with advanced-stage cancer, especially those undergoing antitumor therapy. This study aimed to evaluate the efficacy and safety of Renshenguben (RSGB) oral solution, a ginseng-based traditional Chinese medicine, in alleviating CRF in patients with advanced hepatocellular carcinoma (HCC) receiving antitumor treatment. Methods: In this prospective, open-label, controlled, multicenter study, patients with advanced HCC at BCLC stage C and a brief fatigue inventory (BFI) score of ≥4 were enrolled. Participants were assigned to the RSGB group (RSGB, 10 mL twice daily) or the control group (with supportive care). Primary and secondary endpoints were the change in multidimensional fatigue inventory (MFI) score, and BFI and functional assessment of cancer therapy-hepatobiliary (FACT-Hep) scores at weeks 4 and 8 after enrollment. Adverse events (AEs) and toxicities were assessed. Results: A total of 409 participants were enrolled, with 206 assigned to the RSGB group. At week 4, there was a trend towards improvement, but the differences were not statistically significant. At week 8, the RSGB group exhibited a significantly lower MFI score ( P < 0.05) compared to the control group, indicating improved fatigue levels. Additionally, the RSGB group showed significantly greater decrease in BFI and FACT-Hep scores at week 8 ( P < 0.05). Subgroup analyses among patients receiving various antitumor treatments showed similar results. Multivariate linear regression analyses revealed that the RSGB group experienced a significantly substantial decrease in MFI, BFI, and FACT-Hep scores at week 8. No serious drug-related AEs or toxicities were observed. Conclusions: RSGB oral solution effectively reduced CRF in patients with advanced HCC undergoing antitumor therapy over an eight-week period, with no discernible toxicities. These findings support the potential of RSGB oral solution as an adjunctive treatment for managing CRF in this patient population.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 249-256 . [Abstract] ( 108 ) [HTML 1KB] [PDF 0KB] ( 248 )

	257	Ng KT, Pang L, Wang JQ, She WH, Tsang SHY, Lo CM, Man K, Cheung TT
		Indications of pro-inflammatory cytokines in laparoscopic and open liver resection for early-stage hepatocellular carcinoma ^Hot!
		Background: Our clinical practice of laparoscopic liver resection (LLR) had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma (HCC) over open liver resection (OLR), but the underlying mechanisms are not clear. This study was to find out whether systemic inflammation plays an important role. Methods: A total of 103 patients with early-stage HCC under liver resection were enrolled (LLR group, n = 53; OLR group, n = 50). The expression of 9 inflammatory cytokines in patients at preoperation, postoperative day 1 (POD1) and POD7 was quantified by Luminex Multiplex assay. The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR. Results: Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels. Compared to OLR, the POD1 levels of granulocyte-macrophage colony-stimulating factor (GM-CSF), interleukin-6 (IL-6), IL-8, and monocyte chemoattractant protein-1 (MCP-1) in the LLR group were significantly lower. Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation. The levels of these cytokines were positively associated with postoperative liver injury, and the length of hospital stay. Importantly, a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection. Conclusions: Significantly lower level of GM-CSF, IL-6, IL-8, and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 257-264 . [Abstract] ( 131 ) [HTML 1KB] [PDF 0KB] ( 249 )

	265	Garancini M, Fogliati A, Scotti MA, Ciulli C, Carissimi F, Rovere A, Gianotti L, Romano F
		Non-anatomical liver resection for hepatocellular carcinoma: The SegSubTe classification to overcome the problem of heterogeneity
		Background: The superiority of anatomical resection (AR) vs. non-anatomical resection (NAR) in the surgical management of hepatocellular carcinoma (HCC) is debated. ARs are well-defined procedures, whereas the lack of NAR standardization results in heterogeneous outcomes. This study aimed to introduce the SegSubTe classification for NAR detailing the appropriateness of the level of surgical section of the Glissonean pedicles feeding the tumor. Methods: A single-center retrospective analysis of pre- and postoperative imaging of consecutive patients treated with NAR for single HCC between 2012 and 2020 was conducted. The quality of surgery was assessed classifying the type of vascular supply and the level of surgical section (segmental, subsegmental or terminal next to the tumor) of vascular pedicles feeding the HCCs; then, the population was divided in “SegSubTe-IN”or “SegSubTe-OUT”groups, and the tumor recurrence and survival were analyzed. Results: Ninety-seven patients who underwent NAR were included; 76% were SegSubTe-IN and 24% were SegSubTe-OUT. Total disease recurrence, local recurrence and cut-edge recurrence in the SegSubTe-IN vs. SegSubTe-OUT groups were 50% vs. 83% ( P = 0.006), 20% vs. 52% ( P = 0.003) and 16% vs. 39% ( P = 0.020), respectively. SegSubTe-OUT odds ratio for local recurrence was 4.1 at univariate regression analysis. One-, three-, and five-year disease-free survival rates in the SegSubTe-IN vs. SegSubTe-OUT groups were 81%, 58% and 35% vs. 46%, 21% and 11%, respectively ( P < 0.001). Conclusions: The SegSubTe classification is a useful tool to stratify and standardize NAR for HCC, aiming at improving long-term oncological outcomes and reducing the heterogeneity of quality of NAR for HCC.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 265-271 . [Abstract] ( 87 ) [HTML 1KB] [PDF 0KB] ( 100 )

	272	Zhang HY, Zhu JJ, Liu ZM, Zhang YX, Chen JJ, Chen KD
		A prognostic four-gene signature and a therapeutic strategy for hepatocellular carcinoma: Construction and analysis of a circRNA-me diate d competing endogenous RNA network
		Background: Hepatocellular carcinoma (HCC) has a poor long-term prognosis. The competition of circular RNAs (circRNAs) with endogenous RNA is a novel tool for predicting HCC prognosis. Based on the alterations of circRNA regulatory networks, the analysis of gene modules related to HCC is feasible. Methods: Multiple expression datasets and RNA element targeting prediction tools were used to construct a circRNA-microRNA-mRNA network in HCC. Gene function, pathway, and protein interaction analyses were performed for the differentially expressed genes (DEGs) in this regulatory network. In the protein- protein interaction network, hub genes were identified and subjected to regression analysis, producing an optimized four-gene signature for prognostic risk stratification in HCC patients. Anti-HCC drugs were excavated by assessing the DEGs between the low- and high-risk groups. A circRNA-microRNA-hub gene subnetwork was constructed, in which three hallmark genes, KIF4A, CCNA2, and PBK, were subjected to functional enrichment analysis. Results: A four-gene signature ( KIF4A, CCNA2, PBK , and ZWINT ) that effectively estimated the overall survival and aided in prognostic risk assessment in the The Cancer Genome Atlas (TCGA) cohort and International Cancer Genome Consortium (ICGC) cohort was developed. CDK inhibitors, PI3K inhibitors, HDAC inhibitors, and EGFR inhibitors were predicted as four potential mechanisms of drug action (MOA) in high-risk HCC patients. Subsequent analysis has revealed that PBK, CCNA2 , and KIF4A play a crucial role in regulating the tumor microenvironment by promoting immune cell invasion, regulating microsatellite instability (MSI), and exerting an impact on HCC progression. Conclusions: The present study highlights the role of the circRNA-related regulatory network, identifies a four-gene prognostic signature and biomarkers, and further identifies novel therapy for HCC.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 272-287 . [Abstract] ( 87 ) [HTML 1KB] [PDF 0KB] ( 91 )

ORIGINAL ARTICLES/Biliary

	288	Liu P, Chen YW, Liu C, Wu YT, Zhao WC, Zhu JY, An Y, Xia NX
		Development and validation of a nomogram model for predicting the risk of gallstone recurrence after gallbladder-preserving surgery
		Background: The high incidence of gallstone recurrence was a major concern for laparoscopic gallbladder-preserving surgery. This study aimed to investigate the risk factors for gallstone recurrence after gallbladder-preserving surgery and to establish an individualized nomogram model to predict the risk of gallstone recurrence. Methods: The clinicopathological and follow-up data of 183 patients who were initially diagnosed with gallstones and treated with gallbladder-preserving surgery at our hospital from January 2012 to January 2019 were retrospectively collected. The independent predictive factors for gallstone recurrence following gallbladder-preserving surgery were identified by multivariate logistic regression analysis. A nomogram model for the prediction of gallstone recurrence was constructed based on the selected variables. The C-index, receiver operating characteristic (ROC) curve and calibration curve were used to evaluate the predictive power of the nomogram model for gallstone recurrence. Results: During the follow-up period, a total of 65 patients experienced gallstone recurrence, and the recurrence rate was 35.5%. Multivariate logistic regression analysis revealed that the course of gallstones > 2 years [odds ratio (OR) = 2.567, 95% confidence interval (CI): 1.270-5.187, P = 0.009], symptomatic gallstones (OR = 2.589, 95% CI: 1.059-6.329, P = 0.037), multiple gallstones (OR = 2.436, 95% CI: 1.133- 5.237, P = 0.023), history of acute cholecystitis (OR = 2.778, 95% CI: 1.178-6.549, P = 0.020) and a greasy diet (OR = 2.319, 95% CI: 1.186-4.535, P = 0.014) were independent risk factors for gallstone recurrence after gallbladder-preserving surgery. A nomogram model for predicting the recurrence of gallstones was established based on the above five variables. The results showed that the C-index of the nomogram model was 0.692, suggesting it was valuable to predict gallstone recurrence. Moreover, the calibration curve showed good consistency between the predicted probability and actual probability. Conclusions: The nomogram model for the prediction of gallstone recurrence might help clinicians de- velop a proper treatment strategy for patients with gallstones. Gallbladder-preserving surgery should be cautiously considered for patients with high recurrence risks.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 288-292 . [Abstract] ( 90 ) [HTML 1KB] [PDF 0KB] ( 144 )

	293	Zhu RT, Li Y, Zhang CX, Wang WJ, Liang RP, Li J, Bai K, Sun YL
		Acute suppurative terminal cholangitis: Clinical characteristics of a new subtype of acute cholangitis
		Background: Acute suppurative terminal cholangitis (ASTC) is rarer than acute obstructive cholangitis and is not well studied. To explore this subtype of acute cholangitis, we described our clinical experience with ASTC. Methods: We performed a retrospective review of patients with ASTC admitted to our center from September 2014 to August 2020. We analyzed their clinical characteristics, including etiology, clinical manifestations, imaging features, treatment and prognosis. Results: A total of 32 ASTC patients were included in the analysis. The majority of the patients had a history of biliary operations, and clinical manifestations were occult and atypical. The positive rate of bacterial culture was 46.9%. All the patients had typical imaging features on computed tomography and magnetic resonance imaging. Treatment with effective antibiotics was provided as soon as diagnosis was established. After treatment, most patients had a good outcome. Elevated levels of total bilirubin, aspartate aminotransferase, procalcitonin and gamma-glutamyltransferase were the characteristics of critically ill patients and were associated with relatively poor prognosis. Conclusions: Our results demonstrated that ASTC should be recognized as a new subtype of acute cholangitis, and that earlier diagnosis and more personalized treatments are needed.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 293-299 . [Abstract] ( 87 ) [HTML 1KB] [PDF 0KB] ( 256 )

ORIGINAL ARTICLES/Pancreas

	300	Huang Q, Liu JW, Dong HB, Wei ZJ, Liu JZ, Ren YT, Jiang X, Jiang B
		Mesenteric adipose tissue B lymphocytes promote intestinal injury in severe acute pancreatitis by mediating enteric pyroptosis
		Background: Visceral adipose tissue (VAT) has been linked to the severe acute pancreatitis (SAP) prognosis, although the underlying mechanism remains unclear. It has been reported that pyroptosis worsens SAP. The present study aimed to verify whether mesenteric adipose tissue (MAT, a component of VAT) can cause secondary intestinal injury through the pyroptotic pathway. Methods: Thirty-six male Sprague Dawley (SD) rats were divided into six different groups. Twelve rats were randomly divided into the SAP and control groups. We monitored the changes of MAT and B lymphocytes infiltration in MAT of SAP rats. Twelve SAP rats were injected with MAT B lymphocytes or phosphate buffer solution (PBS). The remaining twelve SAP rats were first injected with MAT B lymphocytes, and then with MCC950 (NLRP3 inhibitor) or PBS. We collected blood and tissue samples from pancreas, gut and MAT for analysis. Results: Compared to the control rats, the SAP group showed inflammation in MAT, including higher expression of tumor necrosis factor (TNF-α) and interleukin-6 (IL-6), lower expression of IL-10, and histological changes. Flow cytometry analysis revealed B lymphocytes infiltration in MAT but not T lymphocytes and macrophages. The SAP rats also exhibited intestinal injury, characterized by lower expression of zonula occludens-1 (ZO-1) and occludin, higher levels of lipopolysaccharide and diamine oxidase, and pathological changes. The expression of NLRP3 and n-GSDMD, which are responsible for pyroptosis, was increased in the intestine of SAP rats. The injection of MAT B lymphocytes into SAP rats exacerbated the inflammation in MAT. The upregulation of pyroptosis reduced tight junction in the intestine, which contributed to the SAP progression, including higher inflammatory indicators and worse histological changes. The administration of MCC950 to SAP + MAT B rats downregulated pyroptosis, which subsequently im- proved the intestinal barrier and ameliorated inflammatory response of SAP. Conclusions: In SAP, MAT B lymphocytes aggravated local inflammation, and promoted the injury to the intestine through the enteric pyroptotic pathway.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 300-309 . [Abstract] ( 89 ) [HTML 1KB] [PDF 0KB] ( 257 )

VIEWPOINTS

	310	Jin SF, Pan Q, Zhou JP, Pan XP
		Mechanisms of liver injuries caused by traditional Chinese medicines
		Drug-induced liver injury (DILI) is a common adverse drug reaction, which can even result in liver failure [1,2]. The Chinese Medical Association issued the Guidelines for the Diagnosis and Treatment of DILI based on the Roussel Uclaf Causality Assessment Method (RUCAM) in 2015 [3]. A previous study reported that traditional Chinese medicines (TCMs), herbal and dietary supplements, and antituberculosis drugs were the main causes of DILI in China [4]. Herb-induced liver injury (HILI) refers to liver injury caused by TCMs, natural drugs, and their related preparations [5]. With much more widespread applications of Chinese herbal medicine and continuous improvements in adverse drug reaction monitoring systems, the number of cases of HILI is increasing, which has become an important factor leading to DILI [4,5].
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 310-312 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 117 )

	313	Luvira V
		Tri-modal death distribution towards personalized management of intraductal papillary neoplasm of the bile duct patients: Every story has its own conclusion
		The concept of intraductal papillary neoplasm of the bile duct (IPNB) has gained recognition as a discrete entity [1,2], possessing many features including multiplicity [3,4], mucin production [3], slow progression [3,5], various morphology [6,7], easy sloughing and seeding [8], and having unique risk factors [2,9-11]. We have previously proposed a morphologic classification [6] and a progression model of IPNB [12], aiming to facilitate comprehension of the underlying characteristics of IPNB, thereby enabling the development of tailored treatment plans for individual patients. Despite the numerous advancements in IPNB research, the improvement of treatment outcomes for these patients has been limited due to the significant heterogeneity shown in this condition. There is no universally applicable policy that can cater to the needs of all individuals.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 313-316 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 103 )

LETTERS TO THE EDITOR

	317	Parente P, Angerilli V, Zamboni G, Sparaneo A, Fiordelisi F, Di Candia L, Fassan M, Graziano P
		Nrf2 and Her3 co-expression in cholangiocarcinoma: Possible biological pathways for potential therapeutic approach
		Cholangiocarcinomas (CCAs) are heterogeneous group of malignancies, encompassing intrahepatic CCA (iCCA), and extrahepatic CCA (eCCA); they are also classified into common hepatic duct cholangiocarcinoma (CHDCCA), choledocus extrapancreatic cholangiocarcinoma (EPCCA) and choledocus intrapancreatic cholangiocarcinoma (IPCCA) and, finally, gallbladder carcinoma (GBCCA). CCAs are relatively uncommon but, over the past 15 years, the incidence has steadily increased worldwide. CCAs are highly aggressive neoplasms, characterized by poor clinical outcome. Since the majority of patients are diagnosed at advanced stages, only 10%-15% are suitable for potentially curative surgery [1].
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 317-321 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 242 )

	322	Cheung BHH, She WH, Ho SL, Chan ACY, Lo CM, Cheung TT
		Solitary extraovarian primary peritoneal carcinoma with direct invasion into the liver, diaphragm and lung without peritoneal dissemination or distant metastasis
		Extraovarian primary peritoneal carcinoma (EOPPC) is an uncommon malignancy with many similarities to epithelial ovarian carcinoma in histological, clinical, and etiological aspects [1]. This phenomenon is explained by their common embryonal origin, in which both develop from the coelomic epithelium in the early embryological stage. Despite their similarities, the incidence of EOPPC is significantly lower than that of epithelial ovarian carcinoma (6.78 cases per million vs. 120.5 cases per million) [1].
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 322-325 . [Abstract] ( 87 ) [HTML 1KB] [PDF 0KB] ( 107 )

	326	Zhu F, Wang YM, Ni M, Liang Y, Huang JH, Wang XH, Cheng F, Lu L
		Diagnosis and therapy of tacrolimus toxicity in a liver transplant recipient during COVID-19 treatment
		SARS-CoV-2, the pathogen responsible for the pandemic of coronavirus disease 2019 (COVID-19), has had profound impacts on human health, and its antagonist Paxlovid is a commonly used treatment option [1]. However, treatment selection for immunosuppressed patients, such as liver recipients, remains uncertain due to potential drug interactions and the risk of immunosuppressant dosage adjustment, which can cause liver injury [2]. Therefore, we retrospectively analyzed a case of liver recipient with COVID-19 who experienced deteriorating liver function during anti-COVID-19 therapy.
		Hepatobiliary Pancreat Dis Int. 2024; 23(3): 326-330 . [Abstract] ( 95 ) [HTML 1KB] [PDF 0KB] ( 269 )

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