Background The extent of liver resection for tumours is limited by the expected functional reserve of the future liver remnant (FRL), so hypertrophy may be induced by portal vein embolization (PVE), taking 6 weeks or longer for growth. This study assessed the hypothesis that simultaneous embolization of portal and hepatic veins (PVE/HVE) accelerates hypertrophy and improves resectability. Methods All centres of the international DRAGON trials study collaborative were asked to provide data on patients who had PVE/HVE or PVE on 2016–2019 (more than 5 PVE/HVE procedures was a requirement). Liver volumetry was performed using OsiriX MD software. Multivariable analysis was performed for the endpoints of resectability rate, FLR hypertrophy and major complications using receiver operating characteristic (ROC) statistics, regression, and Kaplan–Meier analysis. Results In total, 39 patients had undergone PVE/HVE and 160 had PVE alone. The PVE/HVE group had better hypertrophy than the PVE group (59 versus 48 per cent respectively; P = 0.020) and resectability (90 versus 68 per cent; P = 0.007). Major complications (26 versus 34 per cent; P = 0.550) and 90-day mortality (3 versus 16 per cent respectively, P = 0.065) were comparable. Multivariable analysis confirmed that these effects were independent of confounders. Conclusion PVE/HVE achieved better FLR hypertrophy and resectability than PVE in this collaborative experience.

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Background Limited evidence exists to guide the management of patients with liver metastases from squamous cell carcinoma (SCC). The aim of this retrospective multicentre cohort study was to describe patterns of disease recurrence after liver resection/ablation for SCC liver metastases and factors associated with recurrence-free survival (RFS) and overall survival (OS). Method Members of the European–African Hepato-Pancreato-Biliary Association were invited to include all consecutive patients undergoing liver resection/ablation for SCC liver metastases between 2002 and 2019. Patient, tumour and perioperative characteristics were analysed with regard to RFS and OS. Results Among the 102 patients included from 24 European centres, 56 patients had anal cancer, and 46 patients had SCC from other origin. RFS in patients with anal cancer and non-anal cancer was 16 and 9 months, respectively (P = 0.134). A positive resection margin significantly influenced RFS for both anal cancer and non-anal cancer liver metastases (hazard ratio 6.82, 95 per cent c.i. 2.40 to 19.35, for the entire cohort). Median survival duration and 5-year OS rate among patients with anal cancer and non-anal cancer were 50 months and 45 per cent and 21 months and 25 per cent, respectively. For the entire cohort, only non-radical resection was associated with worse overall survival (hazard ratio 3.21, 95 per cent c.i. 1.24 to 8.30). Conclusion Liver resection/ablation of liver metastases from SCC can result in long-term survival. Survival was superior in treated patients with liver metastases from anal versus non-anal cancer. A negative resection margin is paramount for acceptable outcome.

categorical and continuous variable. Disease specific survival (DSS) and Recurrence free survival (RFS) were calculated. Results: 139 patients underwent pancreaticodudenectomy. Of 139 patients, 104 (74%) were alive at last follow-up. Forty-four (31.7%) patients developed recurrence. Median DSS and RFS were 74 and 72 months, respectively. Threeyear and 5-year DSS was 77% and 69%, while RFS were 67% and 55% respectively. Total number of retrieved lymph nodes (<12 or >12, <15 or >15) did not affect DSS or RFS. Univariate analysis showed that T-stage, lymph node positivity, LNR and perineural invasion significantly affected DSS and RFS. Multivariate analysis showed Lymph node positivity lost its significance for RFS and DSS. AUC for prediction of DSS and RFS by LNR was 0.66 (p = 0.005) and 0.7 (p < 0.001). The sensitivity and specificity of LNR for DSS was 57% and 76% and for RFS was 57% and 79% respectively. Conclusion: While Lymph node involvement loses significance on multivariate analysis, LNR remains a significant factor using categorical test for RFS only. It has low sensitivity, with AUC <70. Lymph node retrieval did not show any impact. Further studies would be required before one concludes that LNR is an important prognostic factor in periampullarytumours.

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