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Background: To compare the outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC) with two methods. Methods: We retrospectively reviewed a data of 177 patients who underwent major liver resection for HCC (LLR; n = 67 vs. OLR; n = 110). We performed 1:1 propensity score matching (PSM) between two groups and matched 65 patients for both groups. Another comparison was done with already published article as a benchmark after applying similar inclusion and exclusion criteria (LLR; n = 30 vs. OLR; n = 34). Results: After PSM, there were no significant differences in blood loss (1,407.2 ± 2,322.7 vs. 1,071.5 ± 1,160.6 mL; p = 0.299), and transfusion rate (32.2% vs. 32.0%; p = 0.574) between two groups. The mean operative time was significantly longer in LLR than in the OLR group (418.7 ± 172 vs. 335.1 ± 121.6 min; p = 0.002). Complication rate (21.5% vs. 33.8%; p = 0.085) was similar and the mean hospital stay was shorter in the LLR than in the OLR group (11.4 ± 8.5 vs. 17.6 ± 21.4 days; p = 0.009). After benchmarking method, there were no significant differences in between two groups in terms of blood loss (780 ± 822 vs. 947 ± 660.5 mL; p = 0.382), transfusion rate (30.0 vs. 32.4%; p = 0.528), hospital stay (9 ± 3.7 vs. 10.4 ± 3.59 days; p = 0.119), and complication rate (10.0% vs. 20.6%; p = 0.208). Operation time (395 ± 166.6 vs. 296 ± 68.3 min; p = 0.002) was significantly longer in the LLR than in the OLR group. Benchmarking method showed significant loss of number of patients analysed, but results were quite similar to PSM method. Conclusions: Both methods showed that major LLR was safe compared to major OLR. Benchmarking method can be easily used to compare with data of other published article.

Background: Although various pathologic grading systems evaluating tumor response to neoadjuvant therapy (NAT) in pancreatic ductal adenocarcinoma (PDAC) exist, their prognostic value to predict recurrence after surgery has not been validated in. This study aimed to show that microscopic tumor mapping in post-NAT specimens could predict postoperative oncologic outcomes. Methods: Among patients who underwent pancreaticoduodenectomy after NAT for PDAC between 2019 and 2021, 44 pathological responders with College of American Pathologists (CAP) scores 1 or 2 were prospectively enrolled. Microscopic mapping was performed to identify residual tumor loci within the macroscopic tumor bed using 4 mm 2 -sized pixels. Patients were divided into large extent (LE, n = 22) and small extent (SE, n = 22) groups with a cutoff value of 300 mm 2 . Survival outcomes were compared between the two groups, and the diagnostic performance of microscopic tumor mapping was evaluated with receiver operating (ROC) curves. Results: Recurrence and cancer-related mortality rates were significantly higher in the LE group (18.2% vs. 50.0%, p = 0.026; 0 vs. 18.2%, p = 0.001). 1-year and 3-year disease-free survival rates were significantly lower in the LE group compared to the SE group (95.5% vs. 54.5% and 80.4% vs. 50.0%, respectively; p = 0.010). When ROC curves were compared, the area under curve (AUC) was 0.759 for pathologic response measured by microscopic tumor mapping, which was higher compared to the CAP score (AUC 0.586). Conclusions: Evaluation of residual tumor in post-NAT specimens by microscopic tumor mapping is a significant predictor for early recurrence after surgery, with better performance in predicting recurrence compared to the CAP score.

Lecture:Conversion to open surgery might nullify the benefits of laparoscopic surgery. Emergency conversion was associated with significant increases in the postoperative complication rates and length of stay and, more importantly, higher 30-and 90-day mortality rates. Because most of the indications for emergency conversion were related to bleeding or damage to the surrounding structures, conversion is associated with poor short-term outcomes after surgery. Nevertheless, the impact of conversion to open surgery on longterm outcomes remains controversial. Several studies have demonstrated that conversion to open surgery may be associated with adverse long-term oncologic outcomes in laparoscopic colorectal surgery. However, other studies have reported similar oncological outcomes after colectomy between converted and non-converted patients. To date, few studies have investigated the clinical impact of conversion to open surgery compared with LLR.The effects of unplanned conversion (UPC) to open surgery on the survival of patients with hepatocellular carcinoma (HCC) remain controversial. The aim of our study is i) to compare the surgical and oncological outcomes between patients who underwent laparoscopic liver resection (LLR) and those who underwent UPC during LLR for HCC located in posterosuperior (PS) segments. ii) to develop a predictive model for the possibility of UPC using the risk factor for conversion.

Background: High visceral to subcutaneous adipose tissue area ratio (VSR) has been reported to be a useful predictor of poor prognosis in various type of cancer. However, the clinical significant of high VSR in pancreatic ductal adenocarcinoma (PDAC) is less wellknown. This study aimed to evaluate the relationship between the high VSR and the prognosis of PDAC Methods: A total of 404 patients who underwent upfront surgery for PDAC from 2004 to 2020 were included in a single center, retrospective study. Visceral fat area (VFA) and subcutaneous fat area (SFA) were measured using the three-dimensional image analysis system. According to VSR (VFA/SFA) with a cut-off value of 0.5, the patients were divided into low VSR (n = 142) and high VSR (n = 262) groups. Perioperative outcomes and survival outcomes were compared between the two groups. Results: There are no significant differences in operative and pathological outcomes between low VSR and high VSR groups. The high VSR group had similar 5-year recurrence-free survival to the low VSR group (31.6% vs. 28.9%, p = 0.542), but had significantly lower 5-year overall survival than the low VSR group (35.3% vs. 21.0%, p = 0.004). In the high VSR group, a significant number of patients died from worsening of comorbidities rather than cancer progression. Conclusions: High VSR was associated with decreased survival related to worsening of comorbidities in patients with PDAC. Future studies should be conducted to investigate whether exercise and nutritional interventions for patients with high VSR can prolong the overall survival in patients with resected pancreatic cancer.