Bjørn von Gohren Edwin

• Kjæstad, Erik; Thiis-Evensen, Espen; Edwin, Bjørn von Gohren; Bakka, Arne Olav; Lilleaas, Anne Helene & Thorsen, Yngve [Vis alle 7 forfattere av denne artikkelen] (2026). Extended D3 Mesenterectomy in Small Bowel Cancer Treatment: Feasibility and Importance for Staging. First Results of a Prospective Clinical Trial. World Journal of Surgery. ISSN 0364-2313. s. 1–12. doi: 10.1002/wjs.70550.
• Adel, Soufyan El; Jaradat, Derar; Hoogteijling, Tijs J.; Koh, Ye Xin; Cacciaguerra, Andrea Benedetti & Conci, Simone [Vis alle 48 forfattere av denne artikkelen] (2026). Anatomical versus non-anatomical liver resection for hepatocellular carcinoma – an international multicenter propensity score-matched analysis of short- and long-term outcomes in an international multicenter cohort. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2026.05.002.
• Romandini, Elisa; Perri, Giampaolo; Maekawa, Aya; Bannone, Elisa; Sahakyan, Mushegh & Kleive, Dyre [Vis alle 17 forfattere av denne artikkelen] (2026). Postpancreatectomy acute pancreatitis after distal pancreatectomy: tri-institutional international cohort. BJS Open. 10(4). doi: 10.1093/bjsopen/zrag069. Fulltekst i vitenarkiv
• Syversveen, Trygve; Hansen, Ingrid Schrøder; Brabrand, Knut; Brudvik, Kristoffer Watten; Bjørk, Ida Torunn & Østergaard, Daniel [Vis alle 12 forfattere av denne artikkelen] (2026). Intra-procedural CT control versus ultrasound only in ultrasound-guided thermal ablation of colorectal liver metastases: a single-centre cohort study. Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-026-12912-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Local ablative treatment is increasingly used for small colorectal liver metastasis (CRLM). Adequate ablative margins are essential for achieving local control, yet reported rates of local tumour progression (LTP) vary widely. This study compared LTP rate after ultrasound (US)-guided ablation of CRLM performed with versus without intraoperative CT control. Methods All percutaneous US-guided ablations for CRLM performed in a single centre from 2018 to 2021 were reviewed for LTP. Procedures with intraprocedural CT (CT group), allowing immediate re-ablation for margin extension, were compared with procedures without intraprocedural CT control (OR group). Results A total of 152 procedures in 137 patients were analysed. In the CT group, 5 LTP events (8.0%) occurred after 62 procedures, affecting 5 of 111 CRLM (4.5%). In the OR group, 20 LTP events (22.2%) occurred after 90 procedures, affecting 22 of 132 CRLM (16.6%) (procedure-based and lesion-based p = 0.0035 and p = 0.0255), respectively. For CRLM ≤ 10 mm visualized with US, LTP occurred in 1/50 lesions (2%) in the CT group and 0/51 lesions (0%) in the OR group (p = 0.495). Most LTP occurred with synchronous recurrence elsewhere in the liver (CT group 3/5 [60%], OR group 16/22 [73%]). Only minor complications, Accordion grades 1–2, were observed with similar frequency (8% vs. 12% in CT group and OR group, respectively). Conclusion Intraprocedural CT control was associated with substantially lower LTP, suggesting that CT control should be considered standard when available. US-only ablation may remain appropriate for small, clearly visualized lesions.

• Kupcikevicius, Ignas; Boretto, Luca; Grünbeck, Inger Annett; Kumar, Rahul Prasanna; Nainamalai, Varatharajan & Akhavi, Seyed Mohammadmehdi Sadat [Vis alle 8 forfattere av denne artikkelen] (2026). AI-Enabled Vessels Segmentation Model for Real-Time Laparoscopic Ultrasound Imaging. Proceedings of Machine Learning Research (PMLR). 307. Fulltekst i vitenarkiv
• Hansen, Ingrid Schrøder; Aghayan, Davit; Pelanis, Egidijus; Røsok, Bård Ingvald; Brudvik, Kristoffer Watten & Yaqub, Sheraz [Vis alle 12 forfattere av denne artikkelen] (2026). Long-Term Oncological Outcomes After Laparoscopic Resection and Thermal Ablation of Colorectal Liver Metastases Within a Parenchyma-Sparing Strategy. Annals of Surgical Oncology. ISSN 1068-9265. doi: 10.1245/s10434-026-19621-1. Fulltekst i vitenarkiv Vis sammendrag

  Background Thermal ablation of colorectal liver metastases (CRLM) is traditionally reserved for patients who are not candidates for surgical resection, but it is increasingly applied as a parenchyma-sparing alternative. This study investigates long-term outcomes following laparoscopic resection and thermal ablation in a parenchyma-sparing treatment strategy. Methods Cohort study of patients with CRLM treated with laparoscopic resection or thermal ablation at Oslo University Hospital between 2007 and 2020, identified from two prospectively maintained databases. The primary endpoint was the average treatment effect on survival, estimated using inverse probability weighting to adjust for prognostic variables. Secondary endpoints included overall survival and progression-free survival. In case of recurrence of liver metastases after the study treatment, both ablation and resection were used. Results A total of 207 ablation procedures and 499 resection procedures were eligible for analysis. Five-year overall survival was 55.2% in the ablation group and 55.1% in the resection group. The estimated average treatment effect of ablation versus resection was − 0.34 months (95% confidence interval − 7.29 to 6.57; P = 0.919), indicating that treating all patients with ablation would yield an average survival of 0.34 months shorter than treating all patients with resection. Conclusions In a parenchymal-sparing paradigm, thermal ablation yields long-term survival comparable to resection for CRLM.

• Cunha, Gabriela Pilz da; Aghayan, Davit; Cipriani, Federica; Chua, Darren W.; Morrison-Jones, Victoria & Lanari, Jacopo [Vis alle 60 forfattere av denne artikkelen] (2026). Conversion in Minimally Invasive Liver Surgery: The Impact of Conversion Urgency and Surgical Approach. Annals of Surgical Oncology. ISSN 1068-9265. doi: 10.1245/s10434-026-19124-z. Fulltekst i vitenarkiv
• Drejian, Sarkis; Akhavi, Mehdi Sadat; Grzyb, Krzysztof; Kazarian, Airazat; Fretland, Åsmund Avdem & Edwin, Bjørn von Gohren [Vis alle 7 forfattere av denne artikkelen] (2026). Histopathologic growth patterns as prognostic factor for survival in patients with colorectal liver metastases. Radiology and Oncology. ISSN 1318-2099. doi: 10.2478/raon-2026-0002. Fulltekst i vitenarkiv Vis sammendrag

  Background Histopathologic growth patterns (HGPs) of colorectal liver metastases (CRLM) have emerged as potential prognostic biomarkers, though their clinical significance remains under investigation. The objective is to evaluate the prognostic value of HGPs on recurrence-free survival (RFS) and overall survival (OS) in patients undergoing liver resection for CRLM. Patients and methods This was a retrospective analysis of the OSLO-COMET randomized controlled trial, where 280 patients underwent laparoscopic or open parenchyma-sparing liver resection for CRLM between February 2012 and February 2016. Patients eligible for long-term analysis and with available histological material were included. HGPs were categorized as desmoplastic, pushing, replacement, or mixed, according to international consensus guidelines. Kaplan–Meier and Cox proportional hazards models were used to evaluate associations between HGPs and survival. Results A total of 239 patients were included. Desmoplastic HGP was present in 43.5% of patients and associated with significantly better outcomes. Median RFS was 31 months for desmoplastic versus 9, 10, and 11 months for replacement, pushing, and mixed groups, respectively (p = 0.002). Five-year OS was 62% for desmoplastic, 59% for replacement, 55% for mixed, and 39% for pushing HGP (p = 0.036). In multivariable analysis, HGP, lymph node status, and extrahepatic disease were independent predictors of RFS. Age, tumor size, ECOG score, and extrahepatic metastasis significantly impacted OS. Conclusions Replacement, pushing and mixed HGPs were associated with poor RFS, although replacement and mixed patterns showed better OS after treatment of recurrences. Desmoplastic HGP was independently associated with better RFS and OS following resection for CRLM.

• Bruna, Caro L.; Hilst, Jony van; Korrel, Maarten; Jones, Leia R.; Balzano, Gianpaolo & Björnsson, Bergthor [Vis alle 47 forfattere av denne artikkelen] (2025). Minimally Invasive vs Open Left Pancreatectomy for Resectable Pancreatic Cancer. JAMA Surgery. ISSN 2168-6254. 160(12), s. 1299–1307. doi: 10.1001/jamasurg.2025.4054. Fulltekst i vitenarkiv
• Olij, Bram; Fichtinger, Robert S.; Aldrighetti, Luca A.; Hilal, Mohammad Abu; Troisi, Roberto I. & Sutcliffe, Robert P. [Vis alle 33 forfattere av denne artikkelen] (2025). Health-related quality of life in patients undergoing laparoscopic versus open hemihepatectomy: a secondary analysis of the ORANGE II PLUS randomised controlled, phase 3, superiority trial. The Lancet Regional Health - Europe. 54. doi: 10.1016/j.lanepe.2025.101311. Fulltekst i vitenarkiv Vis sammendrag

  Background Health-related quality of life (HRQoL) has become a critical factor in determining the benefits of new surgical approaches on patients. The ORANGE II PLUS randomised trial compared laparoscopic (LH) and open (OH) hemihepatectomy in an international multicentre randomised controlled setting, with HRQoL as a secondary outcome. The aim of this study was to perform an in-depth analysis of the HRQoL outcomes. Methods Between October 2013 and January 2019, 352 patients scheduled for hemihepatectomy, were randomly assigned to either LH or OH in a 1:1-ratio in 16 European centres. HRQoL was assessed using the EORTC-QLQ-C30 and QLQ-LMC21 modules, at baseline, hospital discharge, and at 10-days, 3-, 6-, and 12-months after discharge. Differences in functioning- and five selected symptom scales were compared between LH and OH over the cumulative periods from discharge to 3 months as well as to 12 months using a multivariable adjusted linear mixed regression model. The study was registered at ClinicalTrials.gov (NCT01441856). Findings The modified intention-to-treat analysis included 332 patients (166 LH and 166 OH), with 40% female in LH and 42% female in OH. 1546 questionnaires (81% of maximum) were obtained. Cumulatively over the period from discharge to 3 months postoperatively, patients in the laparoscopic group reported better physical (difference 4.20 points; 95% CI 1.07–7.34) and social functioning (5.95 points; 95% CI 1.65–10.26), and lower pain (−6.41 points, 95% CI −10.01 to −2.82) and appetite loss (−7.29 points, 95% CI −11.59 to −2.99), compared to the OH group. Similar clinically relevant, but slightly attenuated, differences were reported over the cumulative period from discharge to 12 months after surgery. The largest difference was observed at 10 days after surgery. Interpretation In this international randomised trial evaluating HRQoL, LH demonstrated better physical and social functioning, and less pain and appetite loss, compared to OH. These findings support the preferential use of the laparoscopic approach for hemihepatectomy in experienced centres. Funding Maastricht University Medical Centre+, University Hospital RWTH Aachen, Cancer Research UK 12/048, European Association of Endoscopic Surgery, participating centres.

• Abbassi, Fariba; Pfister, Matthias; Braun, Julia; Angenete, Eva; Haglind, Eva & Onerup, Aron [Vis alle 21 forfattere av denne artikkelen] (2025). Beyond P Values. Annals of Surgery. ISSN 0003-4932. 282(5), s. 670–677. doi: 10.1097/SLA.0000000000006877. Fulltekst i vitenarkiv
• Bruna, Caro L.; Ramshorst, Tess van; Hilst, Jony van; Balduzzi, Alberto; Koerkamp, Bas Groot & Dokmak, Safi [Vis alle 78 forfattere av denne artikkelen] (2025). Robot-assisted and laparoscopic extended left pancreatectomy: a pan-European multicenter propensity-score matched analysis. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006812. Fulltekst i vitenarkiv
• Vestengen, Anders Grinden; Qadir, Hemin Ali; Fretland, Åsmund Avdem; Edwin, Bjørn von Gohren & Balasingham, Ilangko (2025). Advancing Survival Analysis with Large Language Models: A Solution to Data Scarcity and Missing Information in Healthcare. I Redaktørkomite (Red.), 2025 47th Annual International Conference of the IEEE Engineering in Medicine and Biology Society (EMBC). IEEE (Institute of Electrical and Electronics Engineers). ISSN 9798331586188. s. 1–7. doi: 10.1109/embc58623.2025.11254763. Fulltekst i vitenarkiv Vis sammendrag

  Survival analysis and patient risk evaluation are vital tasks in healthcare. Deep learning models promise personalized patient prognosis, but they require large amounts of training data for good results. In healthcare, this presents a particular challenge as most datasets, especially tabular data, are manually entered by clinicians during trials. Missing data poses another significant hurdle. While deleting incomplete rows might seem logical, this further reduces the already limited sample size. A popular alternative is data imputation— estimating missing values using the dataset’s distribution— but this requires several assumptions to be valid and useful. Healthcare data also frequently contains non-numerical covariates like text descriptors, which require careful conversion to avoid introducing bias and noise. We propose a novel approach that sidesteps these issues by using large language models (LLMs) to create comprehensive sentences containing all relevant subject information. This approach offers several key benefits: patient data can be added directly without conversion, missing data becomes a non-issue as descriptions can be as detailed as needed, and the natural variability of clinical documentation is simulated through random masking. We demonstrate this method’s effectiveness by creating a simple network trained on our synthetic data that achieves comparable results to previous survival analysis research on the FLCHAIN, METABRIC, and SUPPORT datasets. Importantly, our approach is inherently intuitive, presenting a prognostic model that can stratify risk groups using human-like sentences. C-index: 0.857, 0.690, 0.985, IBS: 0.108, 0.188, 0.213

• Vasic, Teodor; Stimec, Milena; Stimec, Bojan Vladimir; Edwin, Bjørn von Gohren & Ignjatovic, Dejan (2025). Lymphatic and vascular anatomy define surgical principles for radical treatment of distal duodenal and proximal jejunal tumors. Surgical Endoscopy. ISSN 0930-2794. 39(8), s. 5421–5429. doi: 10.1007/s00464-025-11909-9. Fulltekst i vitenarkiv Vis sammendrag

  Background The arterial ligation level and the lymphadenectomy extent for surgical treatment of distal duodenal/proximal jejunal tumors are not standardized. Aim To define morphometric and topographic specifics of the superior jejunal artery (SJA) and the superior jejunal vein (SJV), and the width of arterial lymphovascular bundles through lymphatic clearances. By extrapolating results from two methodologies, the goal is to determine the arterial ligation level and the lymphadenectomy extent for duodenojejunal tumor treatment. Material and Methods The first series included an analysis of preoperative 3D-CT vascular reconstructions from 97 patients. The second series included 11 dissected cadavers where the course of the proximal mesenteric lymphatics was followed. The SJA was defined as the uppermost jejunal artery (JA) counted from the ileocolic artery (ICA) origin. Results SJA proper was present in 72 cases (74.2%). The mean SJA caliber was 3.4 ± 1.2 mm. SJA originated 17.5 ± 16.8 mm cranial to the middle colic artery (MCA) origin and was found cranial to it in 84 cases. SJA originated caudal to the inferior pancreatic border in 80 cases (82.8%) and cranial in 17 (17.2%). SJV coursed anteriorly to the superior mesenteric artery in 29 cases (29.9%). The distances of the cranial and caudal lymphatics following SJA at the level of the arterial origin were 1.15 ± 0.53 mm and 0.6 ± 0.35 mm. Conclusions To achieve adequate lymphatic clearance, it is crucial to ligate the tumor-feeding SJA at its origin. The conical arrangement of the SJA lymphatics underscores the necessity of a mesenterectomy extending both cranially and caudally, including lymphadenectomy along the adjacent JA to the level of the first arcade. Trial registration “Surgery with Extended (D3) Mesenterectomy for Small Bowel Tumors” registered at https://classic.clinicaltrials.gov/ct2/show/NCT05670574 NCT05670574

• Røsok, Bård Ingvald; Ahmad, Somaya Habib; Fretland, Åsmund Avdem; Østergaard, Daniel; Edwin, Bjørn von Gohren & Brudvik, Kristoffer Watten [Vis alle 7 forfattere av denne artikkelen] (2025). Surgical resection of adrenal metastases: Single-center experience and narrative literature review with emphasis on colorectal metastases. Scandinavian Journal of Surgery. ISSN 1457-4969. 114(2), s. 142–146. doi: 10.1177/14574969251331341. Fulltekst i vitenarkiv Vis sammendrag

  Adrenal glands can host metastases from various malignancies. While surgical resection offers potential benefits in solitary- or oligometastatic cases, many patients have systemic disease unsuitable for surgery when adrenal metastases are diagnosed. Most adrenal metastases originate from malignancies in the lungs, kidneys, or liver. This review explores diagnostic and treatment strategies for adrenal metastases including data from a single center. In particular, it is shown that surgical resection of metastases from colorectal cancer to the adrenals may offer a potential survival benefit. Personalized treatment plans and further research are critical for improving outcomes for patients with adrenal metastases.

• Olij, Bram; Cunha, Gabriela Pilz da; Kimman, Merel; Ratti, Francesca; Hilal, Mohammad Abu & Troisi, Roberto I. [Vis alle 34 forfattere av denne artikkelen] (2025). Healthcare Utilization, Costs, and Cost-Effectiveness of Patients Undergoing Laparoscopic and Open Hemihepatectomy: A Secondary Analysis of the ORANGE II PLUS Randomized Controlled, Phase 3, Superiority Trial. Annals of Surgical Oncology. ISSN 1068-9265. doi: 10.1245/s10434-025-18779-4. Fulltekst i vitenarkiv Vis sammendrag

  Background Laparoscopic hemihepatectomy (LH) has favorable short-term outcomes compared with open hemihepatectomy (OH), including shorter hospital stay. An in-depth healthcare utilization and cost-effectiveness analysis of the international multicenter ORANGE II PLUS randomized controlled trial comparing LH and OH was performed. Patients and Methods Patients were randomly assigned to LH or OH in 16 European centers from October 2013 to January 2019. Costs were determined as a product of unit costs using patient-level, clinician-reported resource utilization up to 90 days. Item-specific resource use per country was presented. The measure of effect was quality-adjusted life year (QALY). Cost and effect differences were compared between treatment arms using nonparametric bootstrapping, from a Dutch healthcare cost perspective. A cost-effectiveness analysis was performed to establish the incremental cost-effectiveness ratio (ICER), i.e., costs per QALY gained, for LH compared with OH 1 year postoperatively. Results Among 332 patients randomized to LH (n = 166) and OH (n = 166), intraoperative costs were higher for LH (LH 13,208 € versus OH 9437 €), while postoperative costs were lower for LH (LH 5774 € versus OH 7703 €). Longer operative time and greater instrument use contributed to higher intraoperative costs, while shorter hospital stays contributed to lower postoperative costs. Mean overall costs per patient were higher in LH (LH 18,982 € versus OH 17,141 €). The QALYs gained over 1 year postoperative were mean (standard deviation [SD]) 0.834 (0.218) for LH and mean 0.795 (0.237) for OH. The ICER was 36,677 € per additional QALY gained, and uncertainty analyses showed that LH had a 77% probability of being cost-effective compared with OH at a willingness-to-pay (WTP) threshold of 80,000 €. Conclusions Although LH was more costly than OH, in a multicenter randomized trial, its clinical advantages translated into more QALYs gained over the first postoperative year and high probability of cost-effectiveness. These findings suggest that, where resources allow, LH may be preferred over OH for selected patients, offering both clinical benefits and acceptable economic value.

• Nainamalai, Varatharajan; Jenssen, Håvard; Boretto, Luca; Luthra, Nikhil André Kumar; Espinoza, Andreas & Pelanis, Egidijus [Vis alle 11 forfattere av denne artikkelen] (2025). Morphological changes on the human liver during minimally invasive surgery: Implications for image-guided interventions and surgical navigation. Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-025-12392-y. Fulltekst i vitenarkiv
• d’Albenzio, Gabriella; Meng, Ruoyan; Aghayan, Davit; Pelanis, Egidijus; Sakinis, Tomas & Solberg, Ole Vegard [Vis alle 11 forfattere av denne artikkelen] (2025). Patient-specific functional liver segments based on centerline classification of the hepatic and portal veins. Computer Assisted Surgery. 30(1). doi: 10.1080/24699322.2025.2580307. Fulltekst i vitenarkiv Vis sammendrag

  Purpose: Couinaud’s liver segment classification has been widely adopted for liver surgery planning, yet its rigid anatomical boundaries often fail to align precisely with individual patient anatomy. This study proposes a novel patient-specific liver segmentation method based on detailed classification of hepatic and portal veins to improve anatomical adherence and clinical relevance. Methods: Our proposed method involves two key stages: (1) surgeons annotate vascular endpoints on 3D models of hepatic and portal veins, from which vessel centerlines are computed; and (2) liver segments are calculated by assigning voxel labels based on proximity to these vascular centerlines. The accuracy and clinical applicability of our Hepatic and Portal Vein-based Classification (HPVC) were compared with conventional Plane-Based Classification (PBC), Portal Vein-Based Classification (PVC), and an automated deep learning method (nnU-Net) using volumetric measurements, Dice similarity scores, and expert evaluations. Results: HPVC demonstrated superior anatomical conformity compared to traditional methods, especially in complex segments like 5 and 8, providing segmentations more reflective of actual vascular territories. Volumetric analysis revealed significant discrepancies among the methods, particularly with nnU-Net generally producing larger segment volumes. HPVC consistently achieved higher surgeon-rated scores in patient-specific anatomical adherence, perfusion region assessment, and accuracy in surgical planning compared to PBC, PVC, and nnU-Net. Conclusion: The presented HPVC method offers substantial improvements in liver segmentation precision, especially relevant for surgical planning in anatomically complex cases. Its integration into clinical workflows via the open-source platform 3D Slicer significantly enhances its accessibility and usability.

• Hilal, Mohammad Abu; Hoogteijling, Tijs; Edwin, Bjørn von Gohren; Dagher, Ibrahim; D'Hondt, Mathieu & Marques, Hugo P [Vis alle 109 forfattere av denne artikkelen] (2025). The Brescia internationally validated European guidelines on minimally invasive liver surgery. British Journal of Surgery. ISSN 0007-1323. 112(6). doi: 10.1093/bjs/znaf113. Fulltekst i vitenarkiv
• Goh, Brian K. P.; Sucandy, Iswanto; Chua, Darren W.; Liu, Qu; Edwin, Bjørn von Gohren & Aghayan, Davit [Vis alle 157 forfattere av denne artikkelen] (2025). Defining Global Benchmarks for Robotic Liver Resections: An International Multicenter Study. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006852. Fulltekst i vitenarkiv
• Høye, Eirik; Kanduri, Chakravarthi; Kristensen, Annette Torgunrud; Lorenz, Susanne; Edwin, Bjørn von Gohren & Larsen, Stein Gunnar [Vis alle 10 forfattere av denne artikkelen] (2025). Enrichment of Cancer-Associated Fibroblasts, Macrophages, and Up-Regulated TNF-α Signaling in the Tumor Microenvironment of CMS4 Colorectal Peritoneal Metastasis. Cancer Medicine. 14(1). doi: 10.1002/cam4.70521. Fulltekst i vitenarkiv Vis sammendrag

  Background Metastatic colorectal cancer (mCRC) is the main cause of CRC mortality, with limited treatment options. Although immunotherapy has benefited some cancer patients, mCRC typically lacks the molecular features that respond to this treatment. However, recent studies indicate that the immune microenvironment of mCRC may be modified to enhance the effect of immune checkpoint inhibitors. This study aimed to explore the metastatic tumor microenvironment (TME) by comparing cell populations in colorectal liver (CLM), lung (mLu), and peritoneal (PM) metastases. Methods RNA isolated from 20 CLM, 15 mLu, and 35 PM samples was subjected to mRNA sequencing and explored through TME deconvolution tools, consensus molecular subtyping (CMS), and differential gene expression and gene set enrichment analysis, with respect to the metastatic sites. Clinical data and KRAS/BRAF hotspot mutation status were also obtained for all the cases. Results The cell type fractions in the TME were relatively similar between the metastatic sites, except for cancer-associated fibroblasts (CAFs), B cells, endothelial cells, and CD4+ T cells. Notably, PM showed enrichment for CAFs and endothelial cells, consistent with distinct pathways associated with metastatic growth and progression in the peritoneal cavity. PM with the mesenchymal subtype, CMS4, had increased CAFs, endothelial cells, and macrophages, along with up-regulated genes related to TNF-α signaling via NF-κB, EMT, and angiogenesis. Conclusions Tumor samples from different metastatic sites exhibited a broadly similar TME in terms of immune cell composition, with some intriguing differences. Targeting CAF-associated pathways, macrophages, and TNF-α signaling through NR4A could represent potential novel therapeutic approaches in CMS4 PM.

• Jenssen, Håvard; Nainamalai, Varatharajan; Pelanis, Egidijus; Kumar, Rahul Prasanna; Abildgaard, Andreas & Kolrud, Finn Kristian [Vis alle 11 forfattere av denne artikkelen] (2025). Challenges and artificial intelligence solutions for clinically optimal hepatic venous vessel segmentation. Biomedical Signal Processing and Control. ISSN 1746-8094. 106. doi: 10.1016/j.bspc.2025.107822. Fulltekst i vitenarkiv Vis sammendrag

  Background : Liver vessel identification is crucial for clinical disease assessment and treatment planning, especially concerning local treatment of liver tumors. As artificial intelligence (AI) develops in radiology, opportunities arise to craft models adept at hepatic venous vessel segmentation, opening possibilities for creating patient-specific models of the liver anatomy quickly, despite the diverse features of CT images encountered in clinical settings. Objective: This research evaluates the performance of AI models combined with various pre-processing filters for liver vessel segmentation, emphasizing clinically relevant results. A novel evaluation method was introduced to offer more anatomically accurate assessments, moving beyond traditional metrics like the Dice score. Methods: Using open-source and proprietary datasets, we implemented residual UNet and Dense UNet in combination with smoothness and vesselness filters. We used a clinical evaluation approach focused on major and minor liver vessels, thereby underscoring the precision of AI outcomes. Results: The Dense UNet model with a specific pre-processing filter produced an average Dice score of 0.8144 in our internal dataset. For the public test dataset, the score was 0.7859. Both scores were higher than those not using pre-processing filters, 0.8052 and 0.7765. Clinical assessments showed 85% of AI predictions accurately identified all wanted vessel structures, though segmentation beyond the vessel borders did occur in half the predictions. Conclusion: This study highlights the effectiveness of AI in liver vessel segmentation, with the Dense UNet model combined with pre-processing filters showing high Dice scores and clinical accuracy.

• Peng, Yufu; Liu, Fei; Li, Bo; Wei, Yonggang; Tan, Hwee-Leong & Syn, Nicholas L. [Vis alle 132 forfattere av denne artikkelen] (2025). Validation of the Iwate scoring system for the stratification of laparoscopic liver resections: An international multicenter study. European Journal of Surgical Oncology. ISSN 0748-7983. 51(6). doi: 10.1016/j.ejso.2025.109597. Fulltekst i vitenarkiv
• Yaqub, Sheraz; Longva, Anne Madsi; Angelsen, Jon-Helge; Brudvik, Kristoffer Watten; Carling, Johan Ulrik & Edwin, Bjørn von Gohren [Vis alle 15 forfattere av denne artikkelen] (2025). Multimodal treatment for colorectal liver metastases: A toolbox for clinicians. Scandinavian Journal of Surgery. ISSN 1457-4969. 114(2), s. 126–134. doi: 10.1177/14574969251333524. Fulltekst i vitenarkiv Vis sammendrag

  Colorectal cancer is the second most common cause of cancer-related death worldwide, and liver metastases are the leading cause of mortality in these patients. Surgical innovations combined with modern systemic chemotherapy have improved 5-year overall survival rates. This review aims to equip non-hepatobiliary surgeons with a comprehensive toolbox for the diagnosis and management of colorectal liver metastases. It covers the current landscape of diagnostic workup, including imaging modalities and biomarkers, and reviews the surgical and nonsurgical treatment options. This guide attempts to enhance multidisciplinary care for patients with colorectal liver metastases by integrating evidence-based practices with innovative strategies, which can improve outcomes and survival.

• Treider, Martin; Romandini, Elisa; Alavi, Dena Treider; Aghayan, Davit; Rasmussen, Margrethe Kallestad & Marchegiani, Giovanni [Vis alle 11 forfattere av denne artikkelen] (2025). Postoperative changes in body composition after laparoscopic and open resection of colorectal liver metastases: data from the randomized OSLO-COMET trial. Surgical Endoscopy. ISSN 0930-2794. 39, s. 2450–2457. doi: 10.1007/s00464-025-11613-8. Fulltekst i vitenarkiv Vis sammendrag

  Background Low muscle mass is negatively associated with survival in patients undergoing surgery for colorectal cancer. Current evidence is limited regarding whether the surgical approach for liver resection of colorectal metastasis impacts postoperative changes in body composition and whether preoperative body composition can impact complication rate and survival. Method This study included patients previously included in the randomized OSLO-COMET trail where patients was allocated to laparoscopic or open liver resection for colorectal liver metastasis. CT scans 0–3 months before and 2–6 months after liver resection were segmented with the artificial intelligence-based tool BodySegAI to measure skeletal muscle mass (SM), visceral adipose tissue (VAT), and inter- and intramuscular adipose tissue (IMAT). SM, VAT and IMAT was compared between the open and laparoscopic group and as predictors for 5-year survival and postoperative complications. Results This study included 216 patients, median age was 67, 127 (59%) were male, 91 (42%) had primary tumor in rectum and 86 (40%) had multiple liver metastasis. There was no significant difference in postoperative change in SM, VAT or IMAT between those undergoing laparoscopy or open surgery. In multivariate analysis, high preoperative IMAT was a predictor for increased risk of postoperative complications (HR (95% CI): 1.045 (CI 95%: 1.003–1.089), p = 0.034). Moreover, postoperative increase in IMAT was a negative predictor for 5-year survival (HR (95%CI):1.009 (1.003–1.016), p = 0.003). Conclusion Postoperative change in body composition did not differ between patients randomly assigned to open or laparoscopic liver resection for colorectal metastasis. High preoperative IMAT was associated with an increased risk of postoperative complications.

• Meng, Ruoyan; Aghayan, Davit; Pelanis, Egidijus; Edwin, Bjørn von Gohren; Cheikh, Faouzi Alaya & Avalos, Rafael Palomar (2025). Resectograms: Planning liver surgery with real-time occlusion-free visualization of virtual resections. Computer Methods and Programs in Biomedicine Update. 7. doi: 10.1016/j.cmpbup.2025.100186. Fulltekst i vitenarkiv Vis sammendrag

  Background and Objective: Visualization of virtual resections plays a central role in computer-assisted liver surgery planning. However, the intricate liver anatomical information often results in occlusions and visualization information clutter, which can lead to inaccuracies in virtual resections. To overcome these challenges, we introduce Resectograms, which are planar (2D) representations of virtual resections enabling the visualization of information associated with the surgical plan. Methods: Resectograms are computed in real-time and displayed as additional 2D views showing anatomical, functional, and risk-associated information extracted from the 3D virtual resection as this is modified during planning, offering surgeons an occlusion-free visualization of the virtual resection during surgery planning. To further improve functionality, we explored three flattening methods: fixed-shape, Least Squares Conformal Maps, and As-Rigid-As-Possible, to generate these 2D views. Additionally, we optimized GPU memory usage by downsampling texture objects, ensuring errors remain within acceptable limits as defined by surgeons. Results: We evaluated Resectograms with experienced surgeons (n = 4, 9-15 years) and assessed 2D flattening methods with computer and biomedical scientists (n = 11) through visual experiments. Surgeons found Resectograms valuable for enhancing surgical planning effectiveness and accuracy. Among flattening methods, Least Squares Conformal Maps and As-Rigid-As-Possible techniques demonstrated similarly low distortion levels, superior to the fixed-shape approach. Our analysis of texture object downsampling revealed effectiveness for liver and tumor segmentations, but less so for vessel segmentations. Conclusions: This paper presents Resectograms, a novel method for visualizing liver virtual resection plans in 2D, offering an intuitive, occlusion-free representation computable in real-time. Resectograms incorporate multiple information layers, providing comprehensive data for liver surgery planning. We enhanced the visualization through improved 3D-to-2D orientation mapping and distortion-minimizing parameterization algorithms. This research contributes to advancing liver surgery planning tools by offering a more accessible and informative visualization method. The code repository for this work is available at: https://github.com/ALive-research/Slicer-Liver.

• Perri, Giampaolo; Romandini, Elisa; Marchegiani, Giovanni; Ghorbani, Poya; Sahakyan, Mushegh & Holmberg, Marcus [Vis alle 17 forfattere av denne artikkelen] (2024). Postoperative Hyperamylasemia (POH) is an Early Predictor of Pancreatic Fistula Occurrence and Severity after Distal Pancreatectomy: Results from a European Multicentric Study. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006222. Fulltekst i vitenarkiv
• Butt, Khayam Ashraf; Jonas, Olav Salterød; Trichet, Laurent Olivier; Sjo, Ole Helmer; Edwin, Bjørn von Gohren & Hartvigsen, Gunnar [Vis alle 7 forfattere av denne artikkelen] (2024). Surgical telementoring as teaching tool in the operating room: trans-Nordic IDEAL stage 2a telementored series of a robotic ventral mesh rectopexy learning curve. British Journal of Surgery. ISSN 0007-1323. 111(6). doi: 10.1093/bjs/znae123. Fulltekst i vitenarkiv
• Saleh, Mansour; Pascual, Franco; Ghallab, Mohammed; Wu, Andrew G. R.; Chin, Ken-Min & Ratti, Francesca [Vis alle 105 forfattere av denne artikkelen] (2024). Factors Associated with and Impact of Open Conversion in Laparoscopic and Robotic Minor Liver Resections: An International Multicenter Study of 10,541 Patients. Annals of Surgical Oncology. ISSN 1068-9265. 31(9), s. 5615–5630. doi: 10.1245/s10434-024-15498-0. Fulltekst i vitenarkiv
• Emmen, Anouk M L H; Graaf, Nine de; Khatkov, I.E.; Busch, O.R.; Dokmak, S. & Boggi, Ugo [Vis alle 31 forfattere av denne artikkelen] (2024). Implementation and outcome of minimally invasive pancreatoduodenectomy in Europe: a registry-based retrospective study - a critical appraisal of the first 3 years of the E-MIPS registry. International Journal of Surgery (IJS). ISSN 1743-9191. 110(4), s. 2226–2233. doi: 10.1097/JS9.0000000000001121. Fulltekst i vitenarkiv Vis sammendrag

  Background: International multicenter audit-based studies focusing on the outcome of minimally invasive pancreatoduodenectomy (MIPD) are lacking. The European Registry for Minimally Invasive Pancreatic Surgery (E-MIPS) is the E-AHPBA endorsed registry aimed to monitor and safeguard the introduction of MIPD in Europe. Materials and Methods: A planned analysis of outcomes among consecutive patients after MIPD from 45 centers in 14 European countries in the E-MIPS registry (2019–2021). The main outcomes of interest were major morbidity (Clavien–Dindo grade ≥3) and 30-day/in-hospital mortality. Results: Overall, 1336 patients after MIPD were included [835 robot-assisted (R-MIPD) and 501 laparoscopic MIPD (L-MIPD)]. Overall, 20 centers performed R-MIPD, 15 centers L-MIPD, and 10 centers both. Between 2019 and 2021, the rate of centers performing L-MIPD decreased from 46.9 to 25%, whereas for R-MIPD this increased from 46.9 to 65.6%. Overall, the rate of major morbidity was 41.2%, 30-day/in-hospital mortality 4.5%, conversion rate 9.7%, postoperative pancreatic fistula grade B/C 22.7%, and postpancreatectomy hemorrhage grade B/C 10.8%. Median length of hospital stay was 12 days (IQR 8–21). A lower rate of major morbidity, postoperative pancreatic fistula grade B/C, postpancreatectomy hemorrhage grade B/C, delayed gastric emptying grade B/C, percutaneous drainage, and readmission was found after L-MIPD. The number of centers meeting the Miami Guidelines volume cut-off of ≥20 MIPDs annually increased from 9 (28.1%) in 2019 to 12 (37.5%) in 2021 (P=0.424). Rates of conversion (7.4 vs. 14.8% P<0.001) and reoperation (8.9 vs. 15.1% P<0.001) were lower in centers, which fulfilled the Miami volume cut-off. Conclusion: During the first 3 years of the pan-European E-MIPS registry, morbidity and mortality rates after MIPD were acceptable. A shift is ongoing from L-MIPD to R-MIPD. Variations in outcomes between the two minimally invasive approaches and the impact of the volume cut-off should be further evaluated over a longer time period.

• Sijberden, Jasper P.; Hoogteijling, Tijs J.; Aghayan, Davit; Ratti, Francesca; Tan, Ek-Khoon & Morrison-Jones, Victoria [Vis alle 61 forfattere av denne artikkelen] (2024). Robotic Versus Laparoscopic Liver Resection in Various Settings: An International Multicenter Propensity Score Matched Study of 10.075 Patients. Annals of Surgery. ISSN 0003-4932. 280(1), s. 108–117. doi: 10.1097/SLA.0000000000006267. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To compare the perioperative outcomes of robotic liver surgery (RLS) and laparoscopic liver surgery (LLS) in various settings. Background: Clear advantages of RLS over LLS have rarely been demonstrated, and the associated costs of robotic surgery are generally higher than those of laparoscopic surgery. Therefore, the exact role of the robotic approach in minimally invasive liver surgery remains to be defined. Methods: In this international retrospective cohort study, the outcomes of patients who underwent RLS and LLS for all indications between 2009 and 2021 in 34 hepatobiliary referral centers were compared. Subgroup analyses were performed to compare both approaches across several types of procedures: (1) minor resections in the anterolateral (2, 3, 4b, 5, and 6) or (2) posterosuperior segments (1, 4a, 7, 8), and (3) major resections (≥3 contiguous segments). Propensity score matching was used to mitigate the influence of selection bias. The primary outcome was textbook outcome in liver surgery (TOLS), previously defined as the absence of intraoperative incidents ≥grade 2, postoperative bile leak ≥grade B, severe morbidity, readmission, and 90-day or in-hospital mortality with the presence of an R0 resection margin in case of malignancy. The absence of a prolonged length of stay was added to define TOLS+. Results: Among the 10.075 included patients, 1.507 underwent RLS and 8.568 LLS. After propensity score matching, both groups constituted 1.505 patients. RLS was associated with higher rates of TOLS (78.3% vs 71.8%, P < 0.001) and TOLS+ (55% vs 50.4%, P = 0.026), less Pringle usage (39.1% vs 47.1%, P < 0.001), blood loss (100 vs 200 milliliters, P < 0.001), transfusions (4.9% vs 7.9%, P = 0.003), conversions (2.7% vs 8.8%, P < 0.001), overall morbidity (19.3% vs 25.7%, P < 0.001), and microscopically irradical resection margins (10.1% vs. 13.8%, P = 0.015), and shorter operative times (190 vs 210 minutes, P = 0.015). In the subgroups, RLS tended to have higher TOLS rates, compared with LLS, for minor resections in the posterosuperior segments (n = 431 per group, 75.9% vs 71.2%, P = 0.184) and major resections (n = 321 per group, 72.9% vs 67.5%, P = 0.086), although these differences did not reach statistical significance. Conclusions: While both produce excellent outcomes, RLS might facilitate slightly higher TOLS rates than LLS.

• Bereska, Jacqueline; Zeeuw, Michiel; Wagenaar, Luuk; Jenssen, Håvard Bjørke; Wesdorp, Nina & Meulen, Delanie van der [Vis alle 50 forfattere av denne artikkelen] (2024). Development and external evaluation of a self-learning auto-segmentation model for Colorectal Cancer Liver Metastases Assessment (COALA). Insights into Imaging. 15(1). doi: 10.1186/s13244-024-01820-7. Fulltekst i vitenarkiv
• Hoogteijling, Tijs J.; Hilal, Mohammad Abu; Zimmitti, Giuseppe; Aghayan, Davit; Wu, Andrew G.R. & Cipriani, Federica [Vis alle 126 forfattere av denne artikkelen] (2024). Impact of neoadjuvant chemotherapy on short-term outcomes after simple and complex minimally invasive minor hepatectomy for colorectal liver metastases: A propensity-score matched and coarsened exact matched study. European Journal of Surgical Oncology. ISSN 0748-7983. 50(6). doi: 10.1016/j.ejso.2024.108309. Fulltekst i vitenarkiv
• Boretto, Luca; Pelanis, Egidijus; Regensburger, Alois; Petkov, Kaloian; Avalos, Rafael Palomar & Fretland, Åsmund Avdem [Vis alle 8 forfattere av denne artikkelen] (2024). Intraoperative patient-specific volumetric reconstruction and 3D visualization for laparoscopic liver surgery. Healthcare technology letters. 10(6), s. 374–383. doi: 10.1049/htl2.12106. Fulltekst i vitenarkiv Vis sammendrag

  Despite the benefits of minimally invasive surgery, interventions such as laparoscopic liver surgery present unique challenges, like the significant anatomical differences between preoperative images and intraoperative scenes due to pneumoperitoneum, patient pose, and organ manipulation by surgical instruments. To address these challenges, a method for intraoperative three-dimensional reconstruction of the surgical scene, including vessels and tumors, without altering the surgical workflow, is proposed. The technique combines neural radiance field reconstructions from tracked laparoscopic videos with ultrasound three-dimensional compounding. The accuracy of our reconstructions on a clinical laparoscopic liver ablation dataset, consisting of laparoscope and patient reference posed from optical tracking, laparoscopic and ultrasound videos, as well as preoperative and intraoperative computed tomographies, is evaluated. The authors propose a solution to compensate for liver deformations due to pressure applied during ultrasound acquisitions, improving the overall accuracy of the three-dimensional reconstructions compared to the ground truth intraoperative computed tomography with pneumoperitoneum. A unified neural radiance field from the ultrasound and laparoscope data, which allows real-time view synthesis providing surgeons with comprehensive intraoperative visual information for laparoscopic liver surgery, is trained.

• Kuemmerli, Christoph; Sijberden, Jasper P.; Cipriani, Federica; Osei-Bordom, Daniel; Aghayan, Davit & Lanari, Jacopo [Vis alle 40 forfattere av denne artikkelen] (2024). Is prolonged operative time associated with postoperative complications in liver surgery? An international multicentre cohort study of 5424 patients. Surgical Endoscopy. ISSN 0930-2794. 38, s. 7118–7130. doi: 10.1007/s00464-024-11276-x. Fulltekst i vitenarkiv
• Vallevik, Vibeke Binz; Babic, Aleksandar; Marshall, Serena; Elvatun, Severin; Brøgger, Helga Maria & Alagaratnam, Sharmini [Vis alle 10 forfattere av denne artikkelen] (2024). Can I trust my fake data – A comprehensive quality assessment framework for synthetic tabular data in healthcare. International Journal of Medical Informatics. ISSN 1386-5056. 185. doi: 10.1016/j.ijmedinf.2024.105413. Fulltekst i vitenarkiv
• Ghamarnejad, Omid; Sahan, Laura-Ann; Kardassis, Dimitrios; Widyaningsih, Rizky; Edwin, Bjørn von Gohren & Stavrou, Gregor Alexander (2024). Technical aspects and learning curve of complex laparoscopic hepatectomy: how we do it. Surgical Endoscopy. ISSN 0930-2794. 38(8), s. 4583–4593. doi: 10.1007/s00464-024-11002-7. Fulltekst i vitenarkiv
• Bodegraven, Eduard A. van; Ramshorst, Tess M E van; Bratlie, Svein O.; Kokkola, Arto; Sparrelid, Ernesto & Björnsson, Bergthor [Vis alle 43 forfattere av denne artikkelen] (2024). Minimally invasive robot-assisted and laparoscopic distal pancreatectomy in a pan-European registry a retrospective cohort study. International Journal of Surgery (IJS). ISSN 1743-9191. 110(6), s. 3554–3561. doi: 10.1097/JS9.0000000000001315. Fulltekst i vitenarkiv Vis sammendrag

  Background: International guidelines recommend monitoring the use and outcome of minimally invasive pancreatic surgery (MIPS). However, data from prospective international audits on minimally invasive distal pancreatectomy (MIDP) are lacking. This study examined the use and outcome of robot-assisted (RDP) and laparoscopic (LDP) distal pancreatectomy in the E-MIPS registry. Patients and methods: Post-hoc analysis in a prospective audit on MIPS, including consecutive patients undergoing MIDP in 83 centers from 19 European countries (01-01-2019/31-12-2021). Primary outcomes included intraoperative events (grade 1: excessive blood loss, grade 2: conversion/change in operation, grade 3: intraoperative death), major morbidity, and in-hospital/30-day mortality. Multivariable logistic regression analyses identified high-risk groups for intraoperative events. RDP and LDP were compared in the total cohort and high-risk groups. Results: Overall, 1672 patients undergoing MIDP were included; 606 (36.2%) RDP and 1066 (63.8%) LDP. The annual use of RDP increased from 30.5% to 42.6% (P<0.001). RDP was associated with fewer grade 2 intraoperative events compared with LDP (9.6% vs. 16.8%, P<0.001), with longer operating time (238 vs. 201 min, P<0.001). No significant differences were observed between RDP and LDP regarding major morbidity (23.4% vs. 25.9%, P=0.264) and in-hospital/30-day mortality (0.3% vs. 0.8%, P=0.344). Three high-risk groups were identified; BMI greater than 25 kg/m2, previous abdominal surgery, and vascular involvement. In each group, RDP was associated with fewer conversions and longer operative times. Conclusion: This European registry-based study demonstrated favorable outcomes for MIDP, with mortality rates below 1%. LDP remains the predominant approach, whereas the use of RDP is increasing. RDP was associated with fewer conversions and longer operative time, including in high-risk subgroups. Future randomized trials should confirm these findings and assess cost differences.

• Ramshorst, Tess M.E. van; Hilst, Jony van; Boggi, Ugo; Dokmak, Safi; Edwin, Bjørn von Gohren & Keck, Tobias [Vis alle 81 forfattere av denne artikkelen] (2024). Standardizing definitions and terminology of left-sided pancreatic resections through an international Delphi consensus. British Journal of Surgery. ISSN 0007-1323. 111(4). doi: 10.1093/bjs/znae039. Fulltekst i vitenarkiv
• Zheng, Junhao; Liang, Xiao; Wu, Andrew G.R.; Kabir, Tousif; Scatton, Olivier & Lim, Chetana [Vis alle 124 forfattere av denne artikkelen] (2024). Impact of liver cirrhosis, severity of cirrhosis and portal hypertension on the difficulty of laparoscopic and robotic minor liver resections for primary liver malignancies in the anterolateral segments. European Journal of Surgical Oncology. ISSN 0748-7983. 50(1). doi: 10.1016/j.ejso.2023.107252. Fulltekst i vitenarkiv Vis sammendrag

  Introduction We performed this study in order to investigate the impact of liver cirrhosis (LC) on the difficulty of minimally invasive liver resection (MILR), focusing on minor resections in anterolateral (AL) segments for primary liver malignancies. Methods This was an international multicenter retrospective study of 3675 patients who underwent MILR across 60 centers from 2004 to 2021. Results 1312 (35.7%) patients had no cirrhosis, 2118 (57.9%) had Child A cirrhosis and 245 (6.7%) had Child B cirrhosis. After propensity score matching (PSM), patients in Child A cirrhosis group had higher rates of open conversion (p = 0.024), blood loss >500 mls (p = 0.001), blood transfusion (p < 0.001), postoperative morbidity (p = 0.004), and in-hospital mortality (p = 0.041). After coarsened exact matching (CEM), Child A cirrhotic patients had higher open conversion rate (p = 0.05), greater median blood loss (p = 0.014) and increased postoperative morbidity (p = 0.001). Compared to Child A cirrhosis, Child B cirrhosis

• Zhao, Jianping; Lu, Yuanxiang; Zhang, Wanguang; Chua, Darren W.; Liu, Qu & Liu, Rong [Vis alle 66 forfattere av denne artikkelen] (2024). Defining Global Benchmarks for Laparoscopic Right Posterior Sectionectomy/H67 An International Multicenter Study. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006418. Fulltekst i vitenarkiv
• Kjeseth, Trond; Hagen, Rolf Eikeland; Edwin, Bjørn von Gohren; Lai, Xiaoran; Røsok, Bård Ingvald & Tholfsen, Tore [Vis alle 8 forfattere av denne artikkelen] (2024). Impact of pancreas transection site on incidence of pancreatic fistula after distal pancreatectomy: a propensity score matched study. HPB. ISSN 1365-182X. 26(9), s. 1164–1171. doi: 10.1016/j.hpb.2024.05.012. Fulltekst i vitenarkiv Vis sammendrag

  Background Distal pancreatectomy (DP) is performed for lesions in the body and tail of the pancreas. The morbidity profile is considerable, mainly due to clinically relevant postoperative pancreatic fistula (CR-POPF). This study aims to investigate potential differences in CR-POPF related to transection site. Methods An observational cohort study from a prospectively maintained database was performed. Subtotal distal pancreatectomy (SDP) was defined as transection over the superior mesenteric vein, and DP was defined as transection lateral to this point. Propensity score matching (PSM) in 1:1 fashion was applied based on demographical and perioperative variables. Results Six hundred and six patients were included in the analysis (1997–2020). Four hundred twenty (69.3%) underwent DP, while 186 (30.7%) underwent SDP. The rate of CR-POPF was 19.3% after DP and 20.4% after SDP (p = 0.74). SDP was associated with older age (63.1 vs 60.1 years, p = 0.016), higher occurrence of ductal adenocarcinoma (37.1 vs 17.6%, p = 0.001) and more frequent use of neoadjuvant chemotherapy (3.8 vs 0.7%, p = 0.012). After PSM, 155 patients were left in each group. The difference in CR-POPF between DP and SDP remained statistically non-significant (20.6 vs 18.7%, p = 0.67). Conclusion This study found no difference in CR-POPF related to transection site during distal pancreatectomy.

• Bozkurt, Emre; Sijberden, Jasper P.; Langella, Serena; Cipriani, Federica; Collado-Roura, Francesc & Morrison-Jones, Victoria [Vis alle 29 forfattere av denne artikkelen] (2024). Laparoscopic versus open right hepatectomy for colorectal liver metastases after portal vein embolization: international multicentre study. British Journal of Surgery. ISSN 0007-1323. 111(8). doi: 10.1093/bjs/znae181. Fulltekst i vitenarkiv Vis sammendrag

  Background Laparoscopic liver surgery is increasingly used for more challenging procedures. The aim of this study was to assess the feasibility and oncological safety of laparoscopic right hepatectomy for colorectal liver metastases after portal vein embolization. Methods This was an international retrospective multicentre study of patients with colorectal liver metastases who underwent open or laparoscopic right and extended right hepatectomy after portal vein embolization between 2004 and 2020. The perioperative and oncological outcomes for patients who underwent laparoscopic and open approaches were compared using propensity score matching. Results Of 338 patients, 84 patients underwent a laparoscopic procedure and 254 patients underwent an open procedure. Patients in the laparoscopic group less often underwent extended right hepatectomy (18% versus 34.6% (P = 0.004)), procedures in the setting of a two-stage hepatectomy (42% versus 65% (P < 0.001)), and major concurrent procedures (4% versus 16.1% (P = 0.003)). After propensity score matching, 78 patients remained in each group. The laparoscopic approach was associated with longer operating and Pringle times (330 versus 258.5 min (P < 0.001) and 65 versus 30 min (P = 0.001) respectively) and a shorter length of stay (7 versus 8 days (P = 0.011)). The R0 resection rate was not different (71% for the laparoscopic approach versus 60% for the open approach (P = 0.230)). The median disease-free survival was 12 (95% c.i. 10 to 20) months for the laparoscopic approach versus 20 (95% c.i. 13 to 31) months for the open approach (P = 0.145). The median overall survival was 28 (95% c.i. 22 to 48) months for the laparoscopic approach versus 42 (95% c.i. 35 to 52) months for the open approach (P = 0.614). Conclusion The advantages of a laparoscopic over an open approach for (extended) right hepatectomy for colorectal liver metastases after portal vein embolization are limited.

• Boretto, Luca; Pelanis, Egidijus; Regensburger, Alois; Fretland, Åsmund Avdem; Edwin, Bjørn von Gohren & Elle, Ole Jakob (2024). Hybrid optical-vision tracking in laparoscopy: accuracy of navigation and ultrasound reconstruction. MITAT. Minimally invasive therapy & allied technologies. ISSN 1364-5706. 33(3), s. 176–183. doi: 10.1080/13645706.2024.2313032. Fulltekst i vitenarkiv Vis sammendrag

  Introduction The use of laparoscopic and robotic liver surgery is increasing. However, it presents challenges such as limited field of view and organ deformations. Surgeons rely on laparoscopic ultrasound (LUS) for guidance, but mentally correlating ultrasound images with pre-operative volumes can be difficult. In this direction, surgical navigation systems are being developed to assist with intra-operative understanding. One approach is performing intra-operative ultrasound 3D reconstructions. The accuracy of these reconstructions depends on tracking the LUS probe. Material and methods This study evaluates the accuracy of LUS probe tracking and ultrasound 3D reconstruction using a hybrid tracking approach. The LUS probe is tracked from laparoscope images, while an optical tracker tracks the laparoscope. The accuracy of hybrid tracking is compared to full optical tracking using a dual-modality tool. Ultrasound 3D reconstruction accuracy is assessed on an abdominal phantom with CT transformed into the optical tracker’s coordinate system. Results Hybrid tracking achieves a tracking error < 2 mm within 10 cm between the laparoscope and the LUS probe. The ultrasound reconstruction accuracy is approximately 2 mm. Conclusion Hybrid tracking shows promising results that can meet the required navigation accuracy for laparoscopic liver surgery.

• Fichtinger, Robert S.; Aldrighetti, Luca A.; Hilal, Mohammed Abu; Troisi, Roberto I.; Sutcliffe, Robert P. & Besselink, Marc G. [Vis alle 35 forfattere av denne artikkelen] (2024). Laparoscopic Versus Open Hemihepatectomy: The ORANGE II PLUS Multicenter Randomized Controlled Trial. Journal of Clinical Oncology. ISSN 0732-183X. 42(15), s. 1799–1809. doi: 10.1200/JCO.23.01019. Fulltekst i vitenarkiv Vis sammendrag

  Purpose To compare outcomes after laparoscopic versus open major liver resection (hemihepatectomy) mainly for primary or metastatic cancer. The primary outcome measure was time to functional recovery. Secondary outcomes included morbidity, quality of life (QoL), and for those with cancer, resection margin status and time to adjuvant systemic therapy. Patients and Methods This was a multicenter, randomized controlled, patient-blinded, superiority trial on adult patients undergoing hemihepatectomy. Patients were recruited from 16 hospitals in Europe between November 2013 and December 2018. Results Of the 352 randomly assigned patients, 332 patients (94.3%) underwent surgery (laparoscopic, n = 166 and open, n = 166) and comprised the analysis population. The median time to functional recovery was 4 days (IQR, 3-5; range, 1-30) for laparoscopic hemihepatectomy versus 5 days (IQR, 4-6; range, 1-33) for open hemihepatectomy (difference, –17.5% [96% CI, –25.6 to –8.4]; P < .001). There was no difference in major complications (laparoscopic 24/166 [14.5%] v open 28/166 [16.9%]; odds ratio [OR], 0.84; P = .58). Regarding QoL, both global health status (difference, 3.2 points; P < .001) and body image (difference, 0.9 points; P < .001) scored significantly higher in the laparoscopic group. For the 281 (84.6%) patients with cancer, R0 resection margin status was similar (laparoscopic 106 [77.9%] v open 122 patients [84.1%], OR, 0.60; P = .14) with a shorter time to adjuvant systemic therapy in the laparoscopic group (46.5 days v 62.8 days, hazard ratio, 2.20; P = .009). Conclusion Among patients undergoing hemihepatectomy, the laparoscopic approach resulted in a shorter time to functional recovery compared with open surgery. In addition, it was associated with a better QoL, and in patients with cancer, a shorter time to adjuvant systemic therapy with no adverse impact on cancer outcomes observed.

• Mahootiha, Maryamalsadat; Qadir, Hemin Ali; Aghayan, Davit; Fretland, Åsmund Avdem; Edwin, Bjørn von Gohren & Balasingham, Ilangko (2024). Deep learning-assisted survival prognosis in renal cancer: A CT scan-based personalized approach. Heliyon. 10(2). doi: 10.1016/j.heliyon.2024.e24374. Fulltekst i vitenarkiv Vis sammendrag

  This paper presents a deep learning (DL) approach for predicting survival probabilities of renal cancer patients based solely on preoperative CT imaging. The proposed approach consists of two networks: a classifier- and a survival- network. The classifier attempts to extract features from 3D CT scans to predict the ISUP grade of Renal cell carcinoma (RCC) tumors, as defined by the International Society of Urological Pathology (ISUP). Our classifier is a 3D convolutional neural network to avoid losing crucial information on the interconnection of slides in 3D images. We employ multiple procedures, including image augmentation, preprocessing, and concatenation, to improve the performance of the classifier. Given the strong correlation between ISUP grading and renal cancer prognosis in the clinical context, we use the ISUP grading features extracted by the classifier as the input to the survival network. By leveraging this clinical association and the classifier network, we are able to model our survival analysis using a simple DL-based network. We adopt a discrete LogisticHazard-based loss to extract intrinsic survival characteristics of RCC tumors from CT images. This allows us to build a completely parametric survival model that varies with patients' tumor characteristics and predicts non-proportional survival probability curves for different patients. Our results demonstrated that the proposed method could predict the future course of renal cancer with reasonable accuracy from the CT scans. The proposed method obtained an average concordance index of 0.72, an integrated Brier score of 0.15, and an area under the curve value of 0.71 on the test cohorts.

• Sijberden, Jasper P.; Fiorentini, Guido; Lanari, Jacopo; Aghayan, Davit; Osei-Bordom, Daniel & Russolillo, Nadia [Vis alle 31 forfattere av denne artikkelen] (2024). The differential benefit of laparoscopic over open minor liver resection for lesions situated in the anterolateral or posterosuperior segments. Hepatobiliary surgery and nutrition. ISSN 2304-3881. 13(4). doi: 10.21037/hbsn-23-494. Fulltekst i vitenarkiv Vis sammendrag

  Background: It is well known that laparoscopic liver surgery can offer advantages over open liver surgery in selected patients. However, what type of procedures can benefit most from a laparoscopic approach has been investigated poorly thus far. The aim of this study is thus to define the extent of advantages of laparoscopic over open liver surgery for lesions in the anterolateral (AL) and posterosuperior (PS) segments. Methods: In this international multicentre retrospective cohort study, laparoscopic and open minor liver resections for lesions in the AL and PS segments were compared after propensity score matching. The differential benefit of laparoscopy over open liver surgery, calculated using bootstrap sampling, was compared between AL and PS resections and expressed as a Delta of the differences. Results: After matching, 3,040 AL and 2,336 PS resections were compared, encompassing open and laparoscopic procedures in a 1:1 ratio. AL and PS laparoscopic liver resections were more advantageous in comparison to open in terms of blood loss, transfusion rate, complications, and length of stay. However, AL resections benefitted more from laparoscopy than PS in terms of overall and severe complications (D-difference were 4.8%, P=0.046 and 3%, P=0.046) and blood loss (D-difference was 195 mL, P<0.001). Similar results were observed in the subset for high-volume centres, while in recent years no significant differences were found in the differential benefit between AL and PS segments. Conclusions: The advantage of laparoscopic over open liver surgery is greater in the AL segments than in the PS segments.

• Hu, Jie; Guo, Yuxin; Wang, Xiaoying; Yeow, Marcus; Wu, Andrew G.R. & Fuks, David [Vis alle 77 forfattere av denne artikkelen] (2024). Propensity score-matched analysis comparing robotic versus laparoscopic minor liver resections of the anterolateral segments: an international multi-center study of 10,517 cases. Annals of Surgery. ISSN 0003-4932. doi: 10.1097/SLA.0000000000006523. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To compare the outcomes of robotic minor liver resections (RMLR) versus laparoscopic (L) MLR of the anterolateral segments. Background: Robotic liver surgery has been gaining prominence over the years with increasing usage for a myriad of hepatic resections. Robotic liver resections(RLR) has demonstrated non-inferiority to laparoscopic(L)LR while illustrating advantages over conventional laparoscopy especially for technically difficult and major LR. However, the advantage of RMLR for the anterolateral(AL) (segments II, III, IVb, V and VI) segments, has not been clearly demonstrated. Methods: Between 2008 to 2022, 15,356 of 29,861 patients from 68 international centres underwent robotic(R) or laparoscopic minor liver resections (LMLR) for the AL segments Propensity score matching (PSM) analysis was performed for matched analysis. Results: 10,517 patients met the study criteria of which 1,481 underwent RMLR and 9,036 underwent LMLR. A PSM cohort of 1,401 patients in each group were identified for analysis. Compared to the LMLR cohort, the RMLR cohort demonstrated significantly lower median blood loss (75ml vs. 100ml, P<0.001), decreased blood transfusion (3.1% vs. 5.4%, P=0.003), lower incidence of major morbidity (2.5% vs. 4.6%, P=0.004), lower proportion of open conversion (1.2% vs. 4.5%, P<0.001), shorter post operative stay (4 days vs. 5 days, P<0.001), but higher rate of 30-day readmission (3.5% vs. 2.1%, P=0.042). These results were then validated by a 1:2 PSM analysis. In the subset analysis for 3,614 patients with cirrhosis, RMLR showed lower median blood loss, decreased blood transfusion, lower open conversion and shorter post operative stay than LMLR. Conclusion: RMLR demonstrated statistically significant advantages over LMLR even for resections in the AL segments although most of the observed clinical differences were minimal.

• Nainamalai, Varatharajan; Qadir, Hemin Ali; Pelanis, Egidijus; Jenssen, Håvard Bjørke; Fretland, Åsmund Avdem & Edwin, Bjørn von Gohren [Vis alle 8 forfattere av denne artikkelen] (2024). Automated algorithm for medical data structuring, and segmentation using artificial intelligence within secured environment for dataset creation. European Journal of Radiology Open (EJR Open). 13. doi: 10.1016/j.ejro.2024.100582. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Routinely collected electronic health records using artificial intelligence (AI)-based systems bring out enormous benefits for patients, healthcare centers, and its industries. Artificial intelligence models can be used to structure a wide variety of unstructured data. Methods: We present a semi-automatic workflow for medical dataset management, including data structuring, research extraction, AI-ground truth creation, and updates. The algorithm creates directories based on keywords in new file names. Results: Our work focuses on organizing computed tomography (CT), magnetic resonance (MR) images, patient clinical data, and segmented annotations. In addition, an AI model is used to generate different initial labels that can be edited manually to create ground truth labels. The manually verified ground truth labels are later included in the structured dataset using an automated algorithm for future research. Conclusion: This is a workflow with an AI model trained on local hospital medical data with output based/adapted to the users and their preferences. The automated algorithms and AI model could be implemented inside a secondary secure environment in the hospital to produce inferences.

• Sijberden, Jasper P.; Zimmitti, Giuseppe; Conci, Simone; Russolillo, Nadia; Masetti, Michele & Cipriani, Federica [Vis alle 32 forfattere av denne artikkelen] (2023). Simultaneous resection of colorectal cancer and synchronous liver metastases: what determines the risk of unfavorable outcomes? An international multicenter retrospective cohort study. International Journal of Surgery (IJS). ISSN 1743-9191. 109(3), s. 244–254. doi: 10.1097/JS9.0000000000000068. Fulltekst i vitenarkiv Vis sammendrag

  Background: The use of a simultaneous resection (SIMR) in patients with synchronous colorectal liver metastases (sCRLM) has increased over the past decades. However, it remains unclear when a SIMR is beneficial and when it should be avoided. The aim of this retrospective cohort study was therefore to compare the outcomes of a SIMR for sCRLM in different settings, and to assess which factors are independently associated with unfavorable outcomes. Methods: To perform this retrospective cohort study, patients with sCRLM undergoing SIMR (2004–2019) were extracted from an international multicenter database, and their outcomes were compared after stratification according to the type of liver and colorectal resection performed. Factors associated with unfavorable outcomes were identified through multivariable logistic regression. Results: Overall, 766 patients were included, encompassing colorectal resections combined with a major liver resection (n=122), minor liver resection in the anterolateral (n=407), or posterosuperior segments (‘Technically major’, n=237). Minor and technically major resections, compared to major resections, were more often combined with a rectal resection (29.2 and 36.7 vs. 20.5%, respectively, both P=0.003) and performed fully laparoscopic (22.9 and 23.2 vs. 6.6%, respectively, both P = 0.003). Major and technically major resections, compared to minor resections, were more often associated with intraoperative transfusions (42.9 and 38.8 vs. 20%, respectively, both P = 0.003) and unfavorable incidents (9.6 and 9.8 vs. 3.3%, respectively, both P≤0.063). Major resections were associated, compared to minor and technically major resections, with a higher overall morbidity rate (64.8 vs. 50.4 and 49.4%, respectively, both P≤0.024) and a longer length of stay (12 vs. 10 days, both P≤0.042). American Society of Anesthesiologists grades ≥3 [adjusted odds ratio (aOR): 1.671, P=0.015] and undergoing a major liver resection (aOR: 1.788, P=0.047) were independently associated with an increased risk of severe morbidity, while undergoing a left-sided colectomy was associated with a decreased risk (aOR: 0.574, P=0.013). Conclusions: SIMR should primarily be reserved for sCRLM patients in whom a minor or technically major liver resection would suffice and those requiring a left-sided colectomy. These findings should be confirmed by randomized studies comparing SIMR with staged resections.

• Kwak, Bong Jun; Lee, Jae Hoon; Chin, Ken Min; Syn, Nicholas L.; Choi, Sung Hoon & Cheung, Tan To [Vis alle 42 forfattere av denne artikkelen] (2023). Robotic versus laparoscopic liver resections for hepatolithiasis: an international multicenter propensity score matched analysis. Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-023-10051-8. Fulltekst i vitenarkiv
• Ramshorst, Tess M E van; Edwin, Bjørn von Gohren; Han, Ho-Seong; Nakamura, Masafumi; Yoon, Yoo-Seok & Ohtsuka, Takao [Vis alle 9 forfattere av denne artikkelen] (2023). Learning curves in laparoscopic distal pancreatectomy: a different experience for each generation. International Journal of Surgery (IJS). ISSN 1743-9191. 109(6), s. 1648–1655. doi: 10.1097/JS9.0000000000000408. Fulltekst i vitenarkiv Vis sammendrag

  Background: Learning curves of laparoscopic distal pancreatectomy (LDP) are mostly based on ‘self-taught’ surgeons who acquired sufficient proficiency largely through self-teaching. No learning curves have been investigated for ‘trained’ surgeons who received training and built on the experience of the ‘self-taught’ surgeons. This study compared the learning curves and outcome of LDP between ‘self-taught’ and ‘trained’ surgeons in terms of feasibility and proficiency using short-term outcomes. Materials and methods: Data of consecutive patients with benign or malignant disease of the left pancreas who underwent LDP by four ‘self-taught’ and four ‘trained’ surgeons between 1997 and 2019 were collected, starting from the first patient operated by a contributing surgeon. Risk-adjusted cumulative sum (RA-CUSUM) analyses were performed to determine phase-1 feasibility (operative time) and phase-2 proficiency (major complications) learning curves. Outcomes were compared based on the inflection points of the learning curves. Results: The inflection points for the feasibility and proficiency learning curves were 24 and 36 procedures for ‘trained’ surgeons compared to 64 and 85 procedures for ‘self-taught’ surgeons, respectively. In ‘trained’ surgeons, operative time was reduced after completion of the learning curves (230.5–203 min, P=0.028). In ‘self-taught’ surgeons, operative time (240–195 min, P≤0.001), major complications (20.6–7.8%, P=0.008), and length of hospital stay (9–5 days, P≤0.001) reduced after completion of the learning curves. Conclusion: This retrospective international cohort study showed that the feasibility and proficiency learning curves for LDP of ‘trained’ surgeons were at least halved as compared to ‘self-taught’ surgeons.

• Sayegh, Aref S.; Eppler, Michael; Sholklapper, Tamir; Goldenberg, Mitchell G.; Perez, Laura C. & Riva, Anibal La [Vis alle 17 forfattere av denne artikkelen] (2023). Severity Grading Systems for Intraoperative Adverse Events. A Systematic Review of the Literature and Citation Analysis. Annals of Surgery. ISSN 0003-4932. 278(5), s. e973–e980. doi: 10.1097/SLA.0000000000005883. Fulltekst i vitenarkiv
• Sijberden, Jasper P.; Zimmitti, Giuseppe; Cipriani, Federica; Furumaya, Alicia; Lanari, Jacopo & Suhool, Amal [Vis alle 32 forfattere av denne artikkelen] (2023). Trends in the characteristics and perioperative outcomes of patients undergoing laparoscopic and open resections for benign liver lesions: An international multicenter retrospective cohort study of 845 patients. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2023.10.016. Fulltekst i vitenarkiv Vis sammendrag

  Background Solid benign liver lesions (BLL) are increasingly discovered, but clear indications for surgical treatment are often lacking. Concomitantly, laparoscopic liver surgery is increasingly performed. The aim of this study was to assess if the availability of laparoscopic surgery has had an impact on the characteristics and perioperative outcomes of patients with BLL. Methods This is a retrospective international multicenter cohort study, including patients undergoing a laparoscopic or open liver resection for BLL from 19 centers in eight countries. Patients were divided according to the time period in which they underwent surgery (2008–2013, 2014–2016, and 2017–2019). Unadjusted and risk-adjusted (using logistic regression) time-trend analyses were performed. The primary outcome was textbook outcome (TOLS), defined as the absence of intraoperative incidents ≥ grade 2, bile leak ≥ grade B, severe complications, readmission and 90-day or in-hospital mortality, with the absence of a prolonged length of stay added to define TOLS+. Results In the complete dataset comprised of patients that underwent liver surgery for all indications, the proportion of patients undergoing liver surgery for benign disease remained stable (12.6% in the first time period, 11.9% in the second time period and 12.1% in the last time period, p = 0.454). Overall, 845 patients undergoing a liver resection for BLL in the first (n = 374), second (n = 258) or third time period (n = 213) were included. The rates of ASA-scores≥3 (9.9%–16%,p < 0.001), laparoscopic surgery (57.8%–77%,p < 0.001), and Pringle maneuver use (33.2%–47.2%,p = 0.001) increased, whereas the length of stay decreased (5 to 4 days,p < 0.001). There were no significant changes in the TOLS rate (86.6%–81.3%,p = 0.151), while the TOLS + rate increased from 41.7% to 58.7% (p < 0.001). The latter result was confirmed in the risk-adjusted analyses (aOR 1.849,p = 0.004). Conclusion The surgical treatment of BLL has evolved with an increased implementation of the laparoscopic approach and a decreased length of stay. This evolution was paralleled by stable TOLS rates above 80% and an increase in the TOLS + rate.

• Lim, Chetana; Scatton, Olivier; Wu, Andrew G.R.; Zhang, Wanguang; Hasegawa, Kiyoshi & Cipriani, Federica [Vis alle 123 forfattere av denne artikkelen] (2023). Impact of liver cirrhosis and portal hypertension on minimally invasive limited liver resection for primary liver malignancies in the posterosuperior segments: An international multicenter study. European Journal of Surgical Oncology. ISSN 0748-7983. 49(10). doi: 10.1016/j.ejso.2023.106997. Fulltekst i vitenarkiv
• Chen, Jeffrey W.; Ramshorst, Tess M E van; Lof, Sanne; Al-Sarireh, Bilal; Bjornsson, Bergthor & Boggi, Ugo [Vis alle 38 forfattere av denne artikkelen] (2023). ASO Visual Abstract: Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer-An International Retrospective Cohort Study. Annals of Surgical Oncology. ISSN 1068-9265. 30(5), s. 3035–3037. doi: 10.1245/s10434-023-13161-8. Fulltekst i vitenarkiv
• Ghotbi, Jacob; Aghayan, Davit; Fretland, Åsmund Avdem; Edwin, Bjørn von Gohren; Syn, Nicholas L. & Cipriani, Federica [Vis alle 116 forfattere av denne artikkelen] (2023). Impact of neoadjuvant chemotherapy on the difficulty and outcomes of laparoscopic and robotic major liver resections for colorectal liver metastases: A propensity-score and coarsened exact-matched controlled study. European Journal of Surgical Oncology. ISSN 0748-7983. 49(7), s. 1209–1216. doi: 10.1016/j.ejso.2023.01.014. Fulltekst i vitenarkiv
• Coelho, Fabricio Ferreira; Herman, Paulo; Kruger, Jaime A.P.; Wu, Andrew G.R.; Chin, Ken-Min & Hasegawa, Kiyoshi [Vis alle 68 forfattere av denne artikkelen] (2023). Impact of liver cirrhosis, the severity of cirrhosis, and portal hypertension on the outcomes of minimally invasive left lateral sectionectomies for primary liver malignancies. Surgery. ISSN 0039-6060. 174(3), s. 581–592. doi: 10.1016/j.surg.2023.04.057. Fulltekst i vitenarkiv
• Berardi, Giammauro; Kingham, T. Peter; Zhang, Wanguang; Syn, Nicholas L.; Koh, Ye-Xin & Jaber, Bashar [Vis alle 78 forfattere av denne artikkelen] (2023). Impact of body mass index on perioperative outcomes of laparoscopic major hepatectomies. Surgery. ISSN 0039-6060. 174(2), s. 259–267. doi: 10.1016/j.surg.2023.04.016. Fulltekst i vitenarkiv
• Kjeseth, Trond; Yakub, Sheraz; Edwin, Bjørn von Gohren; Kleive, Dyre & Sahakyan, Mushegh (2023). Peri-firing compression in prevention of pancreatic fistula after distal pancreatectomy: A systematic review and a cohort study. Scandinavian Journal of Surgery. ISSN 1457-4969. doi: 10.1177/14574969231211084. Fulltekst i vitenarkiv Vis sammendrag

  Background/Aims: Clinically relevant postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) occurs in 20%–40% of patients and remains a leading cause of morbidity and increased healthcare cost in this patient group. Recently, several studies suggested decreased risk of CR-POPF with the use of peri-firing compression (PFC) technique. The aim of this report was to conduct a systematic review to get an overview of the current knowledge on the use of PFC in DP. In addition, our experience with PFC was presented. Methods: The systematic literature review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Also, 19 patients undergoing DP with the use of PFC at Oslo University Hospital were studied. The primary endpoint was incidence of CR-POPF. Results: Seven articles reporting a total of 771 patients were ultimately included in the systematic review. Only two of these were case–control studies examining outcomes in patients with and without PFC, while the rest were case series. These were heterogeneous in terms of staplers used, cartridge selection policy, and PFC technique. Both case–control studies reported significantly reduced CR- POPF incidence with PFC. Eight (21%) of our patients developed CR-POPF after DP with PFC. Only one patient developed CR-POPF among those with pancreatic transection site thickness ⩽1.5 cm. Conclusion: Evidence on potential benefits of PFC in DP is limited in quantity and quality. Our findings suggest that the use of PFC does not lead to reduction in the incidence of CR-POPF. Yet, there might be a benefit from PFC when dealing with a thin pancreas.

• Heijde, Nicky van der; Görgec, Burak; Beane, Joal D.; Ratti, Francesca; Belli, Giulio & Cacciaguerra, Andrea Benedetti [Vis alle 23 forfattere av denne artikkelen] (2023). Transatlantic registries for minimally invasive liver surgery: towards harmonization. Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-022-09765-y. Fulltekst i vitenarkiv
• Liu, Qu; Zhang, Wanguang; Zhao, Joseph J.; Syn, Nicholas L.; Cipriani, Federica & Alzoubi, Mohammad [Vis alle 119 forfattere av denne artikkelen] (2023). Propensity-score matched and coarsened-exact matched analysis comparing robotic and laparoscopic major hepatectomies: an international multicenter study of 4822 cases. Annals of Surgery. ISSN 0003-4932. 278(6), s. 969–975. doi: 10.1097/SLA.0000000000005855. Fulltekst i vitenarkiv
• Ruzzenente, Andrea; Valle, Bernardo Dalla; Poletto, Edoardo; Syn, Nicholas L.; Kabir, Tousif & Sugioka, Atsushi [Vis alle 54 forfattere av denne artikkelen] (2023). Sub-classification of laparoscopic left hepatectomy based on hierarchic interaction of tumor location and size with perioperative outcomes. Journal of Hepato-Biliary-Pancreatic Sciences. ISSN 1868-6974. doi: 10.1002/jhbp.1323. Fulltekst i vitenarkiv
• Cipriani, Federica; Aldrighetti, Luca; Ratti, Francesca; Wu, Andrew G. R.; Kabir, Tousif & Scatton, Olivier [Vis alle 71 forfattere av denne artikkelen] (2023). Impact of Liver Cirrhosis, Severity of Cirrhosis, and Portal Hypertension on the Difficulty and Outcomes of Laparoscopic and Robotic Major Liver Resections for Primary Liver Malignancies. Annals of Surgical Oncology. ISSN 1068-9265. 31, s. 97–114. doi: 10.1245/s10434-023-14376-5. Fulltekst i vitenarkiv
• Hilal, Mohammad Abu; Ramshorst, Tess M.E. Van; Boggi, Ugo; Dokmak, Safi; Edwin, Bjørn von Gohren & Keck, Tobias [Vis alle 82 forfattere av denne artikkelen] (2023). The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS). Annals of Surgery. ISSN 0003-4932. 279(1), s. 45–57. doi: 10.1097/SLA.0000000000006006. Fulltekst i vitenarkiv Vis sammendrag

  Objective: To develop and update evidence-based and consensus-based guidelines on laparoscopic and robotic pancreatic surgery. Summary Background Data: Minimally invasive pancreatic surgery (MIPS), including laparoscopic and robotic surgery, is complex and technically demanding. Minimizing the risk for patients requires stringent, evidence-based guidelines. Since the International Miami Guidelines on MIPS in 2019, new developments and key publications have been reported, necessitating an update. Methods: Evidence-based guidelines on 22 topics in 8 domains were proposed: terminology, indications, patients, procedures, surgical techniques and instrumentation, assessment tools, implementation and training, and artificial intelligence. The Brescia Internationally Validated European Guidelines on Minimally Invasive Pancreatic Surgery (EGUMIPS, September 2022) used the Scottish Intercollegiate Guidelines Network (SIGN) methodology to assess the evidence and develop guideline recommendations, the Delphi method to establish consensus on the recommendations among the Expert Committee, and the AGREE II-GRS tool for guideline quality assessment and external validation by a Validation Committee. Results: Overall, 27 European experts, 6 international experts, 22 international Validation Committee members, 11 Jury Committee members, 18 Research Committee members, and 121 registered attendees of the 2-day meeting were involved in the development and validation of the guidelines. In total, 98 recommendations were developed, including 33 on laparoscopic, 34 on robotic, and 31 on general MIPS, covering 22 topics in 8 domains. Out of 98 recommendations, 97 reached at least 80% consensus among the experts and congress attendees, and all recommendations were externally validated by the Validation Committee. Conclusions: The EGUMIPS evidence-based guidelines on laparoscopic and robotic MIPS can be applied in current clinical practice to provide guidance to patients, surgeons, policy-makers, and medical societies.

• Montalti, Roberto; Giglio, Mariano Cesare; Wu, Andrew G. R.; Cipriani, Federica; D’Silva, Mizelle & Suhool, Amal [Vis alle 61 forfattere av denne artikkelen] (2023). Risk Factors and Outcomes of Open Conversion During Minimally Invasive Major Hepatectomies: An International Multicenter Study on 3880 Procedures Comparing the Laparoscopic and Robotic Approaches. Annals of Surgical Oncology. ISSN 1068-9265. 30, s. 4783–4796. doi: 10.1245/s10434-023-13525-0. Fulltekst i vitenarkiv
• Cheung, Tan-To; Liu, Rong; Cipriani, Federica; Wang, Xiaoying; Efanov, Mikhail & Fuks, David [Vis alle 45 forfattere av denne artikkelen] (2023). Robotic versus laparoscopic liver resection for huge (≥10 cm) liver tumors: an international multicenter propensity-score matched cohort study of 799 cases. Hepatobiliary surgery and nutrition. ISSN 2304-3881. 12(2). doi: 10.21037/hbsn-22-283. Fulltekst i vitenarkiv Vis sammendrag

  Background: The use of laparoscopic (LLR) and robotic liver resections (RLR) has been safely performed in many institutions for liver tumours. A large scale international multicenter study would provide stronger evidence and insight into application of these techniques for huge liver tumours ≥10 cm. Methods: This was a retrospective review of 971 patients who underwent LLR and RLR for huge (≥10 cm) tumors at 42 international centers between 2002–2020. Results: One hundred RLR and 699 LLR which met study criteria were included. The comparison between the 2 approaches for patients with huge tumors were performed using 1:3 propensity-score matching (PSM) (73 vs. 219). Before PSM, LLR was associated with significantly increased frequency of previous abdominal surgery, malignant pathology, liver cirrhosis and increased median blood. After PSM, RLR and LLR was associated with no significant difference in key perioperative outcomes including media operation time (242 vs. 290 min, P=0.286), transfusion rate rate (19.2% vs. 16.9%, P=0.652), median blood loss (200 vs. 300 mL, P=0.694), open conversion rate (8.2% vs. 11.0%, P=0.519), morbidity (28.8% vs. 21.9%, P=0.221), major morbidity (4.1% vs. 9.6%, P=0.152), mortality and postoperative length of stay (6 vs. 6 days, P=0.435). Conclusions: RLR and LLR can be performed safely for selected patients with huge liver tumours with excellent outcomes. There was no significant difference in perioperative outcomes after RLR or LLR.

• Coppola, Alessandro; Vaccara, Vincenzo La; Farolfi, Tommaso; Asbun, Horacio J; Boggi, Ugo & Conlon, Kevin [Vis alle 37 forfattere av denne artikkelen] (2023). Preoperative carbohydrate antigen 19.9 level predicts lymph node metastasis in resectable adenocarcinoma of the head of the pancreas: a further plea for biological resectability criteria. International Journal of Surgery (IJS). ISSN 1743-9191. 110(10), s. 6092–6099. doi: 10.1097/JS9.0000000000000773. Fulltekst i vitenarkiv
• Kato, Yutaro; Sugioka, Atsushi; Kojima, Masayuki; Syn, Nicholas L.; Zhongkai, Wang & Liu, Rong [Vis alle 67 forfattere av denne artikkelen] (2023). Impact of Tumor Size on the Difficulty of Laparoscopic Major Hepatectomies: An International Multicenter Study. Annals of Surgical Oncology. ISSN 1068-9265. 30(11), s. 6628–6636. doi: 10.1245/s10434-023-13863-z. Fulltekst i vitenarkiv
• Krenzien, Feliz; Schmelzle, Moritz; Pratschke, Johann; Feldbrügge, Linda; Liu, Rong & Liu, Qu [Vis alle 83 forfattere av denne artikkelen] (2023). Propensity Score-Matching Analysis Comparing Robotic Versus Laparoscopic Limited Liver Resections of the Posterosuperior Segments: An International Multicenter Study. Annals of Surgery. ISSN 0003-4932. 279(2), s. 297–305. doi: 10.1097/SLA.0000000000006027. Fulltekst i vitenarkiv
• Meng, Ruoyan; Aghayan, Davit; Pelanis, Egidijus; Edwin, Bjørn von Gohren; Cheikh, Faouzi Alaya & Avalos, Rafael Palomar (2023). Resectograms: Real-Time 2D Visualization of Liver Virtual Resections. Eurographics Workshop on Visual Computing for Biomedicine. ISSN 2070-5778. doi: 10.2312/vcbm.20231209. Fulltekst i vitenarkiv Vis sammendrag

  Visualization of virtual resections plays a central role in computer-assisted liver surgery planning. The complexity of the liver's internal structures often leads to difficulties in its proper visualization during the positioning of virtual resections. Occlusions by vessels and tumors are common problems leading to non-preservation of resection margin, incorrect intersection with vessels, and resections. To overcome these challenges, we introduce Resectograms: a visualization approach based on 2D representations of virtual resections, which enable the visualization of information associated with surgical planning. These representations are presented as an additional 2D view displaying anatomical, functional, and risk-associated information extracted from the virtual resection in real-time. This view offers surgeons a simple and occlusion-free visualization of the virtual resection during surgical planning. Our pilot experiment with clinicians shows that the use of this visualization tool provides more information while planning virtual resections and has the potential to enhance confidence in accurate resection. The code repository and supplementary materials for this work is available at: https://github.com/ALive-research/Slicer-Liver

• Ramshorst, Tess M.E. van; Hilst, Jony van; Bannone, Elisa; Pulvirenti, Alessandra; Asbun, Horacio J. & Boggi, Ugo [Vis alle 24 forfattere av denne artikkelen] (2023). International survey on opinions and use of robot-assisted and laparoscopic minimally invasive pancreatic surgery: 5-year follow up. HPB. ISSN 1365-182X. doi: 10.1016/j.hpb.2023.09.004. Fulltekst i vitenarkiv Vis sammendrag

  Background Evidence on the value of minimally invasive pancreatic surgery (MIPS) has been increasing but it is unclear how this has influenced the view of pancreatic surgeons on MIPS. Methods An anonymous survey was sent to members of eight international Hepato-Pancreato-Biliary Associations. Outcomes were compared with the 2016 international survey. Results Overall, 315 surgeons from 47 countries participated. The median volume of pancreatic resections per center was 70 (IQR 40–120). Most surgeons considered minimally invasive distal pancreatectomy (MIDP) superior to open (ODP) (94.6%) and open pancreatoduodenectomy (OPD) superior to minimally invasive (MIPD) (67.9%). Since 2016, there has been an increase in the number of surgeons performing both MIDP (79%–85.7%, p = 0.024) and MIPD (29%–45.7%, p < 0.001), and an increase in the use of the robot-assisted approach for both MIDP (16%–45.6%, p < 0.001) and MIPD (23%–47.9%, p < 0.001). The use of laparoscopy remained stable for MIDP (91% vs. 88.1%, p = 0.245) and decreased for MIPD (51%–36.8%, p = 0.024). Conclusion This survey showed considerable changes of MIPS since 2016 with most surgeons considering MIDP superior to ODP and an increased use of robot-assisted MIPS. Surgeons prefer OPD and therefore the value of MIPD remains to be determined in randomized trials.

• Lof, Sanne; Claassen, Linda; Hannink, Gerjon; Al-Sarireh, Bilal; Björnsson, Bergthor & Boggi, Ugo [Vis alle 42 forfattere av denne artikkelen] (2023). Learning Curves of Minimally Invasive Distal Pancreatectomy in Experienced Pancreatic Centers. JAMA Surgery. ISSN 2168-6254. 158(9), s. 927–933. doi: 10.1001/jamasurg.2023.2279. Fulltekst i vitenarkiv
• Nygaard, Vigdis; Ree, Anne Hansen; Dagenborg, Vegar Johansen; Børresen-Dale, Anne-Lise; Edwin, Bjørn von Gohren & Fretland, Åsmund Avdem [Vis alle 10 forfattere av denne artikkelen] (2023). A PRRX1 Signature Identifies TIM-3 and VISTA as Potential Immune Checkpoint Targets in a Subgroup of Microsatellite Stable Colorectal Cancer Liver Metastases. Cancer Research Communications. 3(2), s. 235–244. doi: 10.1158/2767-9764.CRC-22-0295. Fulltekst i vitenarkiv Vis sammendrag

  Disease recurrence and drug resistance are major challenges in the clinical management of patients with colorectal cancer liver metastases (CLM), and because tumors are generally microsatellite stable (MSS), responses to immune therapies are poor. The mesenchymal phenotype is overrepresented in treatment-resistant cancers and is associated with an immunosuppressed microenvironment. The aim of this work was to molecularly identify and characterize a mesenchymal subgroup of MSS CLM to identify novel therapeutic approaches. We here generated a mesenchymal gene expression signature by analysis of resection specimens from 38 patients with CLM using ranked expression level of the epithelial-to-mesenchymal transition–related transcription factor PRRX1. Downstream pathway analysis based on the resulting gene signature was performed and independent, publicly available datasets were used to validate the findings. A subgroup comprising 16% of the analyzed CLM samples were classified as mesenchymal, or belonging to the PRRX1high group. Analysis of the PRRX1 signature genes revealed a distinct immunosuppressive phenotype with high expression of immune checkpoints HAVCR2/TIM-3 and VISTA, in addition to the M2 macrophage marker CD163. The findings were convincingly validated in datasets from three external CLM cohorts. Upregulation of immune checkpoints HAVCR2/TIM-3 and VISTA in the PRRX1high subgroup is a novel finding, and suggests immune evasion beyond the PD-1/PD-L1 axis, which may contribute to poor response to PD-1/PD-L1–directed immune therapy in MSS colorectal cancer. Importantly, these checkpoints represent potential novel opportunities for immune-based therapy approaches in a subset of MSS CLM. Significance: CLM is an important cause of colorectal cancer mortality where the majority of patients have yet to benefit from immunotherapies. In this study of gene expression profiling analyses, we uncovered novel immune checkpoint targets in a subgroup of patients with MSS CLMs harboring a mesenchymal phenotype.

• Korrel, Maarten; Lof, Sanne; Sarireh, Bilal Al; Björnsson, Bergthor; Boggi, Ugo & Butturini, Giovanni [Vis alle 32 forfattere av denne artikkelen] (2023). Short-term Outcomes after Spleen-preserving Minimally Invasive Distal Pancreatectomy with or Without Preservation of Splenic Vessels: A Pan-European Retrospective Study in High-volume Centers. Annals of Surgery. ISSN 0003-4932. 277(1), s. E119–E125. doi: 10.1097/SLA.0000000000004963. Fulltekst i vitenarkiv
• Gholinejad, Maryam; Edwin, Bjørn von Gohren; Elle, Ole Jakob; Dankelman, Jenny & Loeve, Arjo J. (2023). Process model analysis of parenchyma sparing laparoscopic liver surgery to recognize surgical steps and predict impact of new technologies. Surgical Endoscopy. ISSN 0930-2794. 37, s. 7083–7099. doi: 10.1007/s00464-023-10166-y. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Surgical process model (SPM) analysis is a great means to predict the surgical steps in a procedure as well as to predict the potential impact of new technologies. Especially in complicated and high-volume treatments, such as parenchyma sparing laparoscopic liver resection (LLR), profound process knowledge is essential for enabling improving surgical quality and efficiency. Methods Videos of thirteen parenchyma sparing LLR were analyzed to extract the duration and sequence of surgical steps according to the process model. The videos were categorized into three groups, based on the tumor locations. Next, a detailed discrete events simulation model (DESM) of LLR was built, based on the process model and the process data obtained from the endoscopic videos. Furthermore, the impact of using a navigation platform on the total duration of the LLR was studied with the simulation model by assessing three different scenarios: (i) no navigation platform, (ii) conservative positive effect, and (iii) optimistic positive effect. Results The possible variations of sequences of surgical steps in performing parenchyma sparing depending on the tumor locations were established. The statistically most probable chain of surgical steps was predicted, which could be used to improve parenchyma sparing surgeries. In all three categories (i–iii) the treatment phase covered the major part (~ 40%) of the total procedure duration (bottleneck). The simulation results predict that a navigation platform could decrease the total surgery duration by up to 30%. Conclusion This study showed a DESM based on the analysis of steps during surgical procedures can be used to predict the impact of new technology. SPMs can be used to detect, e.g., the most probable workflow paths which enables predicting next surgical steps, improving surgical training systems, and analyzing surgical performance. Moreover, it provides insight into the points for improvement and bottlenecks in the surgical process.

• Chen, Jeffrey W.; Ramshorst, Tess M. E. van; Lof, Sanne; Al-Sarireh, Bilal; Bjornsson, Bergthor & Boggi, Ugo [Vis alle 45 forfattere av denne artikkelen] (2023). Robot-Assisted Versus Laparoscopic Distal Pancreatectomy in Patients with Resectable Pancreatic Cancer: An International, Retrospective, Cohort Study. Annals of Surgical Oncology. ISSN 1068-9265. 30(5), s. 3023–3032. doi: 10.1245/s10434-022-13054-2. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Robot-assisted distal pancreatectomy (RDP) is increasingly used as an alternative to laparoscopic distal pancreatectomy (LDP) in patients with resectable pancreatic cancer but comparative multicenter studies confirming the safety and efficacy of RDP are lacking. Methods An international, multicenter, retrospective, cohort study, including consecutive patients undergoing RDP and LDP for resectable pancreatic cancer in 33 experienced centers from 11 countries (2010–2019). The primary outcome was R0-resection. Secondary outcomes included lymph node yield, major complications, conversion rate, and overall survival. Results In total, 542 patients after minimally invasive distal pancreatectomy were included: 103 RDP (19%) and 439 LDP (81%). The R0-resection rate was comparable (75.7% RDP vs. 69.3% LDP, p = 0.404). RDP was associated with longer operative time (290 vs. 240 min, p &lt; 0.001), more vascular resections (7.6% vs. 2.7%, p = 0.030), lower conversion rate (4.9% vs. 17.3%, p = 0.001), more major complications (26.2% vs. 16.3%, p = 0.019), improved lymph node yield (18 vs. 16, p = 0.021), and longer hospital stay (10 vs. 8 days, p = 0.001). The 90-day mortality (1.9% vs. 0.7%, p = 0.268) and overall survival (median 28 vs. 31 months, p = 0.599) did not differ significantly between RDP and LDP, respectively. Conclusions In selected patients with resectable pancreatic cancer, RDP and LDP provide a comparable R0-resection rate and overall survival in experienced centers. Although the lymph node yield and conversion rate appeared favorable after RDP, LDP was associated with shorter operating time, less major complications, and shorter hospital stay. The specific benefits associated with each approach should be confirmed by multicenter, randomized trials.

• Singh, Banipal Gurpreet; Stimec, Bojan Vladimir; Andersen, Solveig Norheim; Edwin, Bjørn von Gohren; Næsgaard, Jens Marius & Benth, Jurate Saltyte [Vis alle 7 forfattere av denne artikkelen] (2023). Are Metastatic Central Lymph Nodes (D3 volume) in right-sided Colon Cancer a Sign of Systemic Disease? A sub-group Analysis of an Ongoing Multicenter Trial. Annals of Surgery. ISSN 0003-4932. 279(4), s. 648–656. doi: 10.1097/SLA.0000000000006099. Fulltekst i vitenarkiv Vis sammendrag

  Objective: Assess outcomes of patients with right-sided colon cancer with metastases in the D3 volume after personalized surgery. Background: Patients with central lymph node metastasis (D3-PNG) are considered to have a systemic disease with a poor prognosis. A 3-dimensional definition of the dissection volume allows the removal of all central nodes. Methods: D3-PNG includes consecutive patients from an ongoing clinical trial. Patients were stratified into residual disease negative (D3-RDN) and residual disease positive (D3-RDP) groups. D3-RDN was further stratified into four periods to identify a learning curve. A personalized D3 volume (defined through arterial origins and venous confluences) was removed "en bloc" through medial-to-lateral dissection, and the D3 volume of the specimen was analyzed separately. Results: D3-PNG contained 42(26 females, 63.1SD9.9 y) patients, D3-RDN:29(17 females, 63.4SD10.1 y), and D3-RDP:13(9 females, 62.2SD9.7 y). Mean overall survival (OS) days D3-PNG:1230, D3-RDN:1610, D3-RDP:460. Mean disease-free survival (DFS) was D3-PNG:1023, D3-RDN:1461, D3-RDP:74 days. The probability of OS/ DFS in D3-PNG:52.1%/50.2%, D3-RDN:72.9%/73.1%, D3-RDP: 7.7%/0%. There is a significant change in OS/DFS in the D3-RDN from 2011-2013 to 2020-2022(both P=0.046) and from 2014-2016 to 2020-2022 (P=0.028 and P=0.005,respectively). Conclusion: Our results indicate that surgery can achieve survival in most patients with central lymph node metastases by removing a personalized and anatomically defined D3 volume. The extent of mesenterectomy and the quality of surgery are paramount since a learning curve has demonstrated significantly improved survival over time, despite the low number of patients. These results imply a place for the centralization of this patient group, where feasible.

• Chen, Zewei; Yin, Mengqiu; Fu, Junhao; Yu, Shian; Syn, Nicholas L. & Chua, Darren W. [Vis alle 121 forfattere av denne artikkelen] (2023). Impact of body mass index on the difficulty and outcomes of laparoscopic left lateral sectionectomy. European Journal of Surgical Oncology. ISSN 0748-7983. 49(8), s. 1466–1473. doi: 10.1016/j.ejso.2023.03.235. Fulltekst i vitenarkiv
• Høye, Eirik; Dagenborg, Vegar Johansen; Kristensen, Annette Torgunrud; Lund-Andersen, Christin; Fretland, Åsmund Avdem & Lorenz, Susanne [Vis alle 13 forfattere av denne artikkelen] (2023). T cell receptor repertoire sequencing reveals chemotherapy-driven clonal expansion in colorectal liver metastases. GigaScience. 12. doi: 10.1093/gigascience/giad032. Fulltekst i vitenarkiv Vis sammendrag

  Background - Colorectal liver metastasis (CLM) is a leading cause of colorectal cancer mortality, and the response to immune checkpoint inhibition (ICI) in microsatellite-stable CRC has been disappointing. Administration of cytotoxic chemotherapy may cause increased density of tumor-infiltrating T cells, which has been associated with improved response to ICI. This study aimed to quantify and characterize T-cell infiltration in CLM using T-cell receptor (TCR) repertoire sequencing. Eighty-five resected CLMs from patients included in the Oslo CoMet study were subjected to TCR repertoire sequencing. Thirty-five and 15 patients had received neoadjuvant chemotherapy (NACT) within a short or long interval, respectively, prior to resection, while 35 patients had not been exposed to NACT. T-cell fractions were calculated, repertoire clonality was analyzed based on Hill evenness curves, and TCR sequence convergence was assessed using network analysis.<p> <p>Results - Increased T-cell fractions (10.6% vs. 6.3%) were detected in CLMs exposed to NACT within a short interval prior to resection, while modestly increased clonality was observed in NACT-exposed tumors independently of the timing of NACT administration and surgery. While private clones made up >90% of detected clones, network connectivity analysis revealed that public clones contributed the majority of TCR sequence convergence.<p> <p>Conclusions - TCR repertoire sequencing can be used to quantify T-cell infiltration and clonality in clinical samples. This study provides evidence to support chemotherapy-driven T-cell clonal expansion in CLM in a clinical context.

• Sahakyan, Mushegh; Brudvik, Kristoffer Watten; Angelsen, Jon-Helge; Dille, Rachel; Sandvik, Oddvar Mathias & Edwin, Bjørn von Gohren [Vis alle 8 forfattere av denne artikkelen] (2023). Preoperative Inflammatory Markers in Liver Resection for Colorectal Liver Metastases: A National Registry-Based Study. World Journal of Surgery. ISSN 0364-2313. 47(9), s. 2213–2220. doi: 10.1007/s00268-023-07035-z. Fulltekst i vitenarkiv Vis sammendrag

  Preoperative inflammatory markers were shown to be associated with prognosis following surgery for hepato-pancreato-biliary cancer. Yet little evidence exists about their role in patients with colorectal liver metastases (CRLM). This study aimed to examine the association between selected preoperative inflammatory markers and outcomes of liver resection for CRLM.

• Görgec, Burak; Hansen, Ingrid Schrøder; Kemmerich, Gunter; Syversveen, Trygve; Hilal, Mohammed Abu & Belt, Eric J T [Vis alle 43 forfattere av denne artikkelen] (2023). MRI in addition to CT in patients scheduled for local therapy of colorectal liver metastases (CAMINO): an international, multicentre, prospective, diagnostic accuracy trial. The Lancet Oncology. ISSN 1470-2045. 25(1), s. 137–146. doi: 10.1016/S1470-2045(23)00572-7. Fulltekst i vitenarkiv
• Korrel, Maarten; Jones, Leia R.; Hilst, Jony van; Balzano, Gianpaolo; Björnsson, Bergthor & Boggi, Ugo [Vis alle 50 forfattere av denne artikkelen] (2023). Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): an international randomised non-inferiority trial. The Lancet Regional Health - Europe. 31, s. 1–15. doi: 10.1016/j.lanepe.2023.100673. Fulltekst i vitenarkiv Vis sammendrag

  Background The oncological safety of minimally invasive surgery has been questioned for several abdominal cancers. Concerns also exist regarding the use of minimally invasive distal pancreatectomy (MIDP) in patients with resectable pancreatic cancer as randomised trials are lacking. Methods In this international randomised non-inferiority trial, we recruited adults with resectable pancreatic cancer from 35 centres in 12 countries. Patients were randomly assigned to either MIDP (laparoscopic or robotic) or open distal pancreatectomy (ODP). Both patients and pathologists were blinded to the assigned approach. Primary endpoint was radical resection (R0, ≥1 mm free margin) in patients who had ultimately undergone resection. Analyses for the primary endpoint were by modified intention-to-treat, excluding patients with missing data on primary endpoint. The pre-defined non-inferiority margin of −7% was compared with the lower limit of the two-sided 90% confidence interval (CI) of absolute difference in the primary endpoint. This trial is registered with the ISRCTN registry (ISRCTN44897265). Findings Between May 8, 2018 and May 7, 2021, 258 patients were randomly assigned to MIDP (131 patients) or ODP (127 patients). Modified intention-to-treat analysis included 114 patients in the MIDP group and 110 patients in the ODP group. An R0 resection occurred in 83 (73%) patients in the MIDP group and in 76 (69%) patients in the ODP group (difference 3.7%, 90% CI −6.2 to 13.6%; pnon-inferiority = 0.039). Median lymph node yield was comparable (22.0 [16.0–30.0] vs 23.0 [14.0–32.0] nodes, p = 0.86), as was the rate of intraperitoneal recurrence (41% vs 38%, p = 0.45). Median follow-up was 23.5 (interquartile range 17.0–30.0) months. Other postoperative outcomes were comparable, including median time to functional recovery (5 [95% CI 4.5–5.5] vs 5 [95% CI 4.7–5.3] days; p = 0.22) and overall survival (HR 0.99, 95% CI 0.67–1.46, p = 0.94). Serious adverse events were reported in 23 (18%) of 131 patients in the MIDP group vs 28 (22%) of 127 patients in the ODP group. Interpretation This trial provides evidence on the non-inferiority of MIDP compared to ODP regarding radical resection rates in patients with resectable pancreatic cancer. The present findings support the applicability of minimally invasive surgery in patients with resectable left-sided pancreatic cancer.

• Sahakyan, Mushegh; Kleive, Dyre; Dille, Rachel; Kjeseth, Trond; Waardal, Kim & Edwin, Bjørn von Gohren [Vis alle 8 forfattere av denne artikkelen] (2023). The Role of Preoperative Inflammatory Markers in Pancreatectomy: a Norwegian Nationwide Cohort Study. Journal of Gastrointestinal Surgery. ISSN 1091-255X. doi: 10.1007/s11605-023-05726-5. Fulltekst i vitenarkiv Vis sammendrag

  Background and purpose Preoperative inflammatory markers, such as Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio, were shown to be associated with prognosis in patients undergoing pancreatectomy for cancer. However, little is known about their predictive role in a Western population. Methods The Norwegian National Registry for Gastrointestinal Surgery (NORGAST) was used to capture all pancreatectomies performed within the study period (November 2015—April 2021). The association between the preoperative inflammatory markers and postoperative outcomes was studied. Their impact on survival was examined in patients operated for pancreatic ductal adenocarcinoma. Results A total of 1554 patients underwent pancreatectomy in this period. Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio were associated with severe complications (Accordion grade ≥ III) in the univariable but not in the multivariable analysis. C-reactive protein to albumin ratio, but not Glasgow prognostic score and modified Glasgow prognostic score, was linked to survival following pancreatectomy for ductal adenocarcinoma. In the multivariable model, age, neoadjuvant chemotherapy, ECOG score, C-reactive protein to albumin ratio and total pancreatectomy correlated with survival. Also, preoperative C-reactive protein to albumin ratio was significantly associated with survival after pancreatoduodenectomy. Conclusions Preoperative Glasgow prognostic score, modified Glasgow prognostic score and C-reactive protein to albumin ratio have no role in predicting the complications after pancreatectomy. C-reactive protein to albumin ratio is a significant predictor for survival in ductal adenocarcinoma, yet its clinical relevance should be explored in conjunction with the pathology parameters and adjuvant therapy.

• Fyhn, Thomas Johan; Kvello, Morten; Edwin, Bjørn von Gohren; Schistad, Ole; Pripp, Are Hugo & Emblem, Ragnhild [Vis alle 8 forfattere av denne artikkelen] (2022). Outcome a decade after laparoscopic and open Nissen fundoplication in children: results from a randomized controlled trial. Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-022-09458-6. Fulltekst i vitenarkiv Vis sammendrag

  Abstract Background Randomized controlled trials (RCT) comparing long-term outcome after laparoscopic (LF) and open fundoplication (OF) in children are lacking. Here we report recurrence rates and time to recurrence, frequency of re-interventions, use of antisecretory drugs, gastrointestinal symptoms, and patient/parental satisfaction a decade after children were randomized to LF or OF. Methods Cross-sectional long-term follow-up study of a two-center RCT that included patients during 2003–2009. Patients/parents were interviewed and medical charts reviewed for any events that might be related to the fundoplication. If suspicion of recurrence, further diagnostics were performed. Informed consent and ethical approval were obtained. Clinicaltrials.gov: NCT01551134. Results Eighty-eight children, 56 (64%) boys, were randomized (LF 44, OF 44) at median 4.4 [interquartile range (IQR) 2.0–8.9] years. 46 (52%) had neurological impairment. Three were lost to follow-up before first scheduled control. Recurrence was significantly more frequent after LF (24/43, 56%) than after OF (13/42, 31%, p  = 0.004). Median time to recurrence was 1.0 [IQR 0.3–2.2] and 5.1 [IQR 1.5–9.3] years after LF and OF, respectively. Eight (19%) underwent redo fundoplication after LF and three (7%) after OF ( p  = 0.094). Seventy patients/parents were interviewed median 11.9 [IQR 9.9–12.8] years postoperatively. Among these, use of anti-secretory drugs was significantly decreased from preoperatively after both LF (94% vs. 35%, p  &lt; 0.001) and OF (97% vs. 19%, p  &lt; 0.001). Regurgitation/vomiting were observed in 6% after LF and 3% after OF ( p  = 0.609), and heartburn in 14% after LF and 17% after OF ( p  = 1.000). Overall opinion of the surgical scars was good in both groups (LF: 95%, OF: 86%, p  = 0.610). Patient/parental satisfaction with outcome was high, independent of surgical approach (LF: 81%, OF: 88%, p  = 0.500). Conclusions The recurrence rate was higher and recurrence occurred earlier after LF than after OF. Patient/parental satisfaction with outcome after both LF and OF was equally high. Graphical abstract

• Andersen, Bjarte Tidemann; Kazaryan, Airazat M.; Stimec, Bojan V.; Edwin, Bjørn von Gohren; RANCINGER, PETER IVAN & Ignjatovic, Dejan (2022). Personalized surgery for the splenic flexure cancer: new frontiers. British Journal of Surgery. ISSN 0007-1323. 109(9), s. 880–881. doi: 10.1093/bjs/znac153. Fulltekst i vitenarkiv
• Sandri, Giovanni B. Levi; Hilal, Mohammed Abu; Dokmak, Safi; Edwin, Bjørn von Gohren; Hackert, Thilo & Keck, Tobias [Vis alle 9 forfattere av denne artikkelen] (2022). Figures do matter: A literature review of 4587 robotic pancreatic resections and their implications on training. Journal of Hepato-Biliary-Pancreatic Sciences. ISSN 1868-6974. doi: 10.1002/jhbp.1209. Fulltekst i vitenarkiv

Se alle arbeider i NVA

• Hansen, Ingrid Schrøder; Hårvig, Karina Roheim; Brudvik, Kristoffer Watten; Røsok, Bård Ingvald; Bjørk, Ida Torunn & Østergaard, Daniel [Vis alle 15 forfattere av denne artikkelen] (2025). A Randomized Controlled Trial of Resection Versus Thermal Ablation of Colorectal Cancer Liver Metastases (New Comet): Study Protocol. doi: 10.1245/s10434-025-17984-5. Fulltekst i vitenarkiv Vis sammendrag

  Background. The use of thermal ablation of liver tumors is rapidly increasing. This is despite a lack of high-level evidence of the oncologic efficacy of ablation. Ablation is most often used in cases where resection is not possible, but as the technique has improved it is increasingly used as a substitute for resection. Patients and Methods. New Comet is an international multicenter randomized controlled double-blinded, non inferiority trial comparing thermal ablation to resection of colorectal liver metastases. It will include 230 patients with colorectal liver metastases (up to 5 lesions, tumor size up to 3 cm) where thermal ablation and resection both are considered suitable treatment options for all lesions. The patients are randomized to either resection or ablation, and all lesions in each patient are treated with the same modaliity. Complete ablation will be verified with intraoperative computed tomography and ablation confirmation software. Conclusions. The primary endpoint is local tumor recurrence at 12 months. Secondary endpoints include overall survival, disease-free survival, time to surgical failure, health-related quality of life, complications, and cost-effectiveness (trial registration no.: NCT05129787).

• Kazaryan, Airazat M.; Hagve, Martin Iversen; Augestad, Knut Magne; Nordby, Tom; Edwin, Bjørn von Gohren & Ghanima, Waleed (2025). Academic writing in medicine and healthcare. Frontiers in Medicine. 12. doi: 10.3389/fmed.2025.1617752. Fulltekst i vitenarkiv Vis sammendrag

  The article highlights factors that can motivate doctors to do medical research. Various types of medical publications are presented. In addition, prerequisites that can contribute to successful publication are described. An overview of trends in research publication is given as well as an explanation of the terms discovery and innovation. The role and importance of research and scientific writing for progress in medicine and healthcare are discussed here. The connection between medical practice and research is also highlighted. Not least, the need for support from supervisors and management in the research and publication process is highlighted.

• Kazaryan, Airazat M.; Hagve, Martin Iversen; Mala, Tom; Augestad, Knut Magne; Nordby, Tom & Edwin, Bjørn von Gohren [Vis alle 7 forfattere av denne artikkelen] (2024). Forskning og vitenskaplig skriving 3. Formidling av forskningen i moderne tid – bedre tilgang, nye medier og fagfellerollen. Kirurgen. ISSN 1504-8888. 4, s. 238–240. Fulltekst i vitenarkiv Vis sammendrag

  Denne artikkelserien som består av tre kronikker belyser faktorer som kan motivere til medisinsk forskning. Ulike typer av medisinske publikasjoner framstilles. I tillegg beskrives forutsetninger som kan bidra til vellykket publisering. Det gis en oversikt over trender i forskningspublisering, samt forklaring av betegnelsene oppdagelse og innovasjon. Her drøftes også forskningen og den vitenskapelige skrivningens rolle og betydning for framgangen innen medisin og helsevesen, og videre belyses sammenhengen mellom medisinsk praksis og forskning. Ikke minst poengteres behov om støtte fra veileder og ledelse i forsknings- og publiseringsprosessen. Kronikk 3 omhandler tema «Formidling av forskningen»

• Kazaryan, Airazat M.; Mala, Tom; Hagve, Martin Iversen; Augestad, Knut Magne; Nordby, Tom & Ghanima, Waleed [Vis alle 7 forfattere av denne artikkelen] (2024). Forskning og vitenskaplig skriving 2. Fra ide til ferdig artikkel. Kirurgen. ISSN 1504-8888. 4, s. 234–237. Fulltekst i vitenarkiv Vis sammendrag

  Denne artikkelserien, som består av tre kronikker, belyser faktorer som kan motivere til medisinsk forskning. Ulike typer av medisinske publikasjoner framstilles. I tillegg beskrives forutsetninger som kan bidra til vellykket publisering. Det gis en oversikt over trender i forskningspublisering samt forklaring av betegnelsene oppdagelse og innovasjon. Her drøftes også forskningen og den vitenskapelige skrivningens rolle og betydning for framgangen innen medisin og helsevesen, og videre belyses sammenhengen mellom medisinsk praksis og forskning. Ikke minst poengteres behov om støtte fra veileder og ledelse i forsknings- og publiseringsprosessen. Kronikk 2 inkluderer tema «Fra idé til ferdig artikkel»

• Kazarian, Airazat; Mala, Tom; Hagve, Martin Iversen; Augestad, Knut Magne; Nordby, Tom & Edwin, Bjørn von Gohren [Vis alle 7 forfattere av denne artikkelen] (2024). Forskning og vitenskaplig skriving 1. Hvordan komme igang ? Kirurgen. ISSN 1504-8888. Fulltekst i vitenarkiv
• Sijberden, Jasper; Hoogteijling, Tijs J.; Edwin, Bjørn von Gohren; Aldrighetti, Luca A.; Goh, Brian K.P. & Primrose, John N. [Vis alle 20 forfattere av denne artikkelen] (2024). Assessment of textbook outcome of robotic versus laparoscopic liver resection in various settings: an international multicenter propensity score matched study of 9676 patients. European Journal of Surgical Oncology. ISSN 0748-7983. doi: 10.1016/j.ejso.2023.107349. Fulltekst i vitenarkiv
• Hoogteijling, Tijs J.; Sijberden, Jasper; Aldrighetti, Luca; Cillo, Umberto; Vivarelli, Marco & Besselink, Marc [Vis alle 18 forfattere av denne artikkelen] (2024). Laparoscopic vs. Open Hepatectomy for Giant Hepatocellular Carcinoma: A Propensity Score Matched Retrospective Analysis of Short- and Long-term Outcomes. European Journal of Surgical Oncology. ISSN 0748-7983. doi: 10.1016/j.ejso.2023.107763. Fulltekst i vitenarkiv
• Yakub, Sheraz; Edwin, Bjørn von Gohren; Hammoud, Zane; Herrera-Almario, Gabriel; Jabir, Buthaina & Lassen, Kristoffer [Vis alle 23 forfattere av denne artikkelen] (2024). Gaza War: Too many citizens being killed. British Journal of Surgery. ISSN 0007-1323. 111(4). doi: 10.1093/bjs/znae094. Fulltekst i vitenarkiv
• Butt, Khayam Ashraf; Thomassen, Niels; Christensen, Peter; Consten, Esther C. J.; Rautio, T. & Titu, Vasile-Liviu [Vis alle 15 forfattere av denne artikkelen] (2023). A Surgical Telementoring Curriculum for Robotic Ventral Mesh Rectopexy. Colorectal Disease. ISSN 1462-8910. 25, s. 147–147. doi: 10.1111/codi.16720. Fulltekst i vitenarkiv
• Aghayan, Davit; Kazarian, Airazat; Fretland, Åsmund Avdem & Edwin, Bjørn von Gohren (2023). Difficult procedures, better outcomes. Hepatobiliary surgery and nutrition. ISSN 2304-3881. doi: 10.21037/hbsn-23-302. Fulltekst i vitenarkiv
• Heijde, Nicky van der; Görgec, Burak; Beane, Joal D.; Ratti, Francesca; Belli, Giulio & Cacciaguerra, Andrea Benedetti [Vis alle 23 forfattere av denne artikkelen] (2023). Correction: Transatlantic registries for minimally invasive liver surgery: towards harmonization (Surgical Endoscopy, (2023), 10.1007/s00464-022-09765-y). Surgical Endoscopy. ISSN 0930-2794. doi: 10.1007/s00464-023-09887-x. Fulltekst i vitenarkiv
• Olij, Bram; Fichtinger, Robert S.; Kimman, Merel; Aldrighetti, Luca A.; Hilal, Mohammad Abu & Troisi, Roberto [Vis alle 20 forfattere av denne artikkelen] (2023). Removal notice to “Patient reported outcomes after laparoscopic versus open hemihepatectomy within an enhanced recovery program, the ORANGE–II–PLUS Randomized Clinical trial: A Quality of Life and Body image analysis” [European Journal of Surgical Oncology 49 (2) (February 2023) e33] (European Journal of Surgical Oncology (2023) 49(2) (e33), (S074879832200885X), (10.1016/j.ejso.2022.11.136)). European Journal of Surgical Oncology. ISSN 0748-7983. 49(10). doi: 10.1016/j.ejso.2023.107037. Fulltekst i vitenarkiv
• Meng, Ruoyan; Cheikh, Faouzi Alaya; Avalos, Rafael Palomar & Edwin, Bjørn von Gohren (2025). Analytics and Visualization for Computational Liver Surgery Planning. Norges teknisk-naturvitenskapelige universitet. ISSN 9788232694938. Fulltekst i vitenarkiv Vis sammendrag

  Liver cancer remains one of the leading causes of cancer-related mortality worldwide. While surgical resection offers the best chance for long-term survival, it demands precise preoperative planning to ensure complete tumor removal while preserving sufficient functional liver tissue. Given the liver’s intricate vascular architecture and individual anatomical variability, this planning process is both critical and challenging. This thesis builds upon the foundation of computer-assisted surgical planning by introducing novel methods to improve the visualization and analysis of liver anatomy, intending to enhance surgical precision and support personalized treatment strategies. This thesis introduces a set of novel methods to enhance computer-assisted liver surgery planning by improving the interpretation of virtual resections, refining liver segment classification, and enabling more flexible volumetric analysis. We propose Resectogram, an intuitive 2D visualization technique that overcomes occlusion challenges in 3D resection views, improving clarity in surgical decision making. A semi-automatic approach to liver segment classification is also presented, allowing personalized segmentation based on vascular anatomy and user defined landmarks. Additionally, we develop an interactive tool for liver volumetry that supports both standard and custom segment definitions, facilitating comparative analysis of complex resection scenarios. These contributions are integrated into Slicer-Liver, an open-source 3D Slicer extension, supporting broader adoption in research and clinical practice. In summary, the results presented in this thesis advance virtual liver surgery planning through improved visualization, segmentation, and analysis tools, contributing to safer, more informed, and patient-specific surgical strategies.

Se alle arbeider i NVA