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Background and Objectives: Laparoscopic liver resection (LLR) is now widely recognized as the primary surgical option for hepatocellular carcinomas (HCC) smaller than 3 cm located in the left lateral segment of the liver. Nevertheless, there is a scarcity of studies comparing laparoscopic liver resection with radiofrequency ablation (RFA) in these cases. Materials and Methods: We retrospectively compared the short- and long-term outcomes of Child–Pugh class A patients who underwent LLR (n = 36) or RFA (n = 40) for a newly diagnosed single small (≤3 cm) HCC located in the left lateral segment of the liver. Results: Overall survival (OS) was not significantly different between the LLR and RFA groups (94.4% vs. 80.0%, p = 0.075). However, disease-free survival (DFS) was better in the LLR group than in the RFA group (p < 0.001), with 1-, 3-, and 5-year DFS rates of 100%, 84.5%, and 74.4%, respectively, in the LLR group vs. 86.9%, 40.2%, and 33.4%, respectively, in the RFA group. The hospital stay was significantly shorter in the RFA group than in the LLR (2.4 vs. 4.9 days, p < 0.001). The overall complication rate was higher in the RFA group than in the LLR group (15% vs. 5.6%). In patients with an α-fetoprotein level of ≥20 ng/mL, the 5-year OS (93.8% vs. 50.0%, p = 0.031) and DFS (68.8% vs. 20.0%, p = 0.002) rates were greater in the LLR group. Conclusions: LLR showed superior OS and DFS compared to RFA in patients with a single small HCC situated in the left lateral segment of the liver. LLR can be considered for patients with an α-fetoprotein level of ≥20 ng/mL.

Objective: This study aimed to evaluate the effect of liver resection on the prognosis of T2 gallbladder cancer (GBC). Background: Although extended cholecystectomy [lymph node dissection (LND) + liver resection] is recommended for T2 GBC, recent studies have shown that liver resection does not improve survival outcomes relative to LND alone. Methods: Patients with pT2 GBC who underwent extended cholecystectomy as an initial procedure and did not reoperation after cholecystectomy at 3 tertiary referral hospitals between January 2010 and December 2020 were analyzed. Extended cholecystectomy was defined as either LND with liver resection (LND+L group) or LND only (LND group). We conducted 2:1 propensity score matching to compare the survival outcomes of the groups. Results: Of the 197 patients enrolled, 100 patients from the LND + L group and 50 from the LND group were successfully matched. The LND + L group experienced greater estimated blood loss (P < 0.001) and a longer postoperative hospital stay (P = 0.047). There was no significant difference in the 5-year disease-free survival (DFS) of the 2 groups (82.7% vs 77.9%, respectively, P = 0.376). A subgroup analysis showed that the 5-year DFS was similar in the 2 groups in both T substages (T2a: 77.8% vs 81.8%, respectively, P = 0.988; T2b: 88.1% vs 71.5%, respectively, P = 0.196). In a multivariable analysis, lymph node metastasis [hazard ratio (HR) 4.80, P = 0.006] and perineural invasion (HR 2.61, P = 0.047) were independent risk factors for DFS; liver resection was not a prognostic factor (HR 0.68, P = 0.381). Conclusions: Extended cholecystectomy including LND without liver resection may be a reasonable treatment option for selected T2 GBC patients.

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.

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.