[Sex differences in hepatobiliary and transplantation surgery]. / Geschlechtsunterschiede in der hepatobiliären und Transplantationschirurgie.

Gender-specific differences in hepatobiliary and transplantation surgery are decisive for the diagnosis, treatment and long-term outcomes. Men exhibit a higher risk of late recurrences and cancer-specific death after liver cancer resection. The emphasis on screening recommendations and ensuring equal access to treatment options are vital to minimize disparities. In kidney and liver transplantations, women are less frequently listed and endure longer waiting times, while men dominate the waiting list. Gender-specific disparities in drug compatibility necessitate differentiated dosing. Further studies are needed to ensure equity in transplantation treatment. Individualized treatment considering these differences can enhance treatment outcomes and the quality of life of patients.

Perioperative outcome and long-term survival for intrahepatic cholangiocarcinoma after portal vein embolization and subsequent resection: A propensity-matched study.

INTRODUCTION: In view of the high therapeutic value of surgical resection for intrahepatic cholangiocarcinomas (ICC), our study addresses the question of clinical management and outcome in case of borderline resectability requiring hypertrophy induction of the future liver remnant prior to resection. METHODS: Clinical data was collected of all primary ICC cases receiving major liver resection with or without prior portal vein embolization (PVE) from a single high-volume center. PVE was performed via a percutaneous transhepatic access. Propensity score matching was performed. Perioperative morbidity was assessed as well as long-term survival with a minimum follow-up of 36 months. RESULTS: No significant difference in perioperative morbidity was seen between the PVE and the control group. For the PVE group, median OS was 28 months vs. 37 months for the control group (p = 0.418), median DFS 18 and 14 months (p = 0.703). Disease progression during hypertrophy was observed in 38% of cases. Here, OS and DFS was reduced to 18 months (p = 0.479) and 6 months (p = 0.013), respectively. In case of positive N-status or multifocal tumor (MF+) OS was also reduced (18 vs. 26 months, p = 0.033; MF+: 9 vs. 36months p = 0.013). CONCLUSION: Our results suggest that the surgical therapy in case of borderline resectability offers acceptable results with non-inferior OS rates compared to cases without preoperative hypertrophy induction and comparable oncological features. In the presence of additional risk factors (multifocal tumor, lymph node metastasis, PD during hypertrophy) the OS is notably reduced.

[Impact of the COVID-19 pandemic on hepato-pancreato-biliary surgery and organ transplantation]. / Auswirkung der COVID-19-Pandemie auf die hepatopankreatobiliäre Chirurgie und die Organtransplantation.

BACKGROUND AND OBJECTIVE: Due to the coronavirus disease 2019 (COVID-19) pandemic extensive reorganization and limitation of resources within the healthcare system became inevitable. This review highlights the direct and indirect impact of the COVID-19 pandemic on the fields of hepato-pancreato-biliary (HPB) surgery and organ transplantation incorporating the current literature and expert opinions published by national and international societies. Trends in surgical numbers were analyzed via the Eurotransplant Statistics Report Library and an in-center evaluation of HPB surgical procedures. RESULTS: For the fields of HPB surgery and organ transplantation a drastic decrease of procedures performed during the first wave of the pandemic was broadly reported. Interestingly, a compensatory increase of procedures was mostly not observed during the following months resulting in a slight overall decrease for 2020 compared to 2019. Whether this trend was due to increased mortality because of postponed surgeries and altered treatment regimens cannot be ruled out at this time. A severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is definitely associated with a complicated course, especially in the perioperative course and after transplantation. DISCUSSION: Due to the increased risk profile of the named patient groups, there is an increased risk for a severe COVID-19 course. This must be considered when weighing up the treatment alternatives, protection recommendations and prioritization for vaccinations.