The European Society for Medical Oncology Asia Congress 2024 was held in Singapore from December 6 to 8,2024.The conference unveiled several groundbreaking studies in the field of hepatobiliary and pancreatic tumors,covering clinical applications related to neoadjuvant and adjuvant therapies,translational treatments,later-line therapies,and tumor biomarkers.These studies provide new insights into the clinical diagnosis and treatment of hepatobiliary and pancreatic malignancies and drive the development of related fields.This article focuses on the key topics in hepatobiliary and pancreatic malignancies presented at the conference,aiming to interpret the latest advances in the field and explore the hot issues and future directions for development in this area.

With the rapid development of artificial intelligence(AI)technology,especially deep learning,AI is playing an increasingly important role in the diagnosis and treatment of liver cancer.AI has shown great potential in improving diagnostic accuracy,reducing the workload of physicians,and providing personalized treatment plans.In imaging diagnosis of liver cancer,AI technology has been widely applied to ultrasound,CT,and MRI data,enabling automatic recognition and segmentation of liver lesions and differentiation between benign and malignant lesions.In some cases,its diagnostic accuracy can match or even surpass that of professional radiologists.In pathological diagnosis,AI assists pathologists in differential diagnosis and classification by analyzing whole slide image,improving diagnostic efficiency and accuracy.For treatment decision support,AI analyzes clinical,imaging,and pathological data to predict postoperative recurrence risk,evaluate the effectiveness of specific treatments,and identify biomarkers,providing new perspectives for precision medicine and assisting clinicians in designing personalized treatment plans.With the advancement of multimodal AI models that integrate imaging,pathology,and clinical data,it is possible to achieve a more comprehensive understanding of the biological behavior of liver cancer,thereby offering more precise diagnoses and treatments for patients.Despite its immense potential,AI in liver cancer diagnosis and treatment faces challenges such as data standardization,security,and privacy protection.The clinical translation of AI models requires further validation and refinement.With technological advancements and data accumulation,AI is expected to provide more precise and personalized medical services for liver cancer patients in the future.This article focuses on summarizing significant research advances in AI for liver cancer diagnosis and treatment,and briefly discusses its limitations and future directions.

In the 2010s,laparoscopic hepatectomy(LH)rapidly gained popularity in Japan as a minimally invasive approach for liver resections.It offers significant advantages,such as reduced postoperative pain and faster recovery.The Glissonean pedicle approach,employed during LH,enables precise anatomical resection,particularly for hepatocellular carcinoma and metastatic liver tumors.Innovations in training,including the use of animal models and the Japan Society for Endoscopic Surgery certification program,have been instrumental in improving surgical expertise.However,complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges.Robot-assisted hepatectomy(RAH)has shown great potential for improved precision and visualization,though its high costs and uncertain long-term benefits limit its widespread adoption.Further technological advancements,enhanced training programs,and large-scale comparative trials are necessary to evaluate the long-term efficacy of both LH and RAH.

Hilar cholangiocarcinoma(hCCA)is a malignant tumor originating from the epithelial cells of the bile duct,characterized by high malignancy,significant surgical challenges,high mortality,and poor prognosis,making it one of the most formidable challenges in the field of surgery.In recent years,advancements in surgical concepts and diagnostic and therapeutic techniques have led to improvements in the diagnosis and treatment of hCCA.However,standardizing the management of hCCA,enhancing treatment efficacy,and improving patient outcomes remain pressing issues.To confront these challenges,the Hepatobiliary Surgery Professional Committee of Hunan Medical Association,Hunan Provincial Clinical Research Center for the Prevention and Treatment of Biliary Diseases,Hunan Provincial Key Laboratory for the Prevention and Treatment of Biliary Diseases,Hunan Provincial Engineering Research Center for Digital Hepatobiliary Medicine,the Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association,the Hunan Alliance of Hepatobiliary and Pancreatic Surgery,the Hunan Alliance for the Diagnosis and Treatment of Malignant Biliary Tumors,and the Hepatopancreatobiliary Disease Research Center of Furong Laboratory,convened a multidisciplinary panel of experts to develop the Hunan expert consensus on comprehensive diagnosis and treatment of hilar cholangiocarcinoma.This consensus aims to standardize the diagnosis and multidisciplinary treatment approach for hCCA,enhance overall diagnostic and therapeutic standards,and ultimately improve the overall prognosis of the disease.

Hepatocellular carcinoma(HCC)is the most common primary liver cancer and the third leading cause of cancer-related deaths worldwide.Despite continuous advancements in diagnostic and therapeutic technologies in recent years,the overall treatment outcomes for HCC remain to be improved.With the advancement of artificial intelligence,radiomics has emerged as an innovative approach by extracting quantitative features from medical images imperceptible to the naked eye,enabling predictive modeling for the diagnosis,treatment decision-making,therapeutic evaluation,and prognostic prediction of HCC.This article systematically reviews the application of radiomics in the intelligent management of HCC,based on the latest research progress,aiming to enhance comprehensive treatment strategies.

Translational therapy for liver cancer,as an emerging treatment strategy,is driving advancements in the management of intermediate and advanced liver cancer.Through continuous exploration by experts nationwide,translational therapy for liver cancer has reached a consensus,providing valuable scientific guidance for clinical practice.However,as treatment methods continue to evolve,translational therapy still faces numerous urgent challenges,particularly in areas such as personalized treatment,efficacy evaluation,and combined therapeutic strategies.These issues have become contentious and hotly debated topics,creating a situation where"consensus and controversy coexist,and opportunities and challenges intersect."To address these challenges,experts in the field of liver cancer must strengthen collaboration and communication,promote high-quality basic and clinical research,and continuously refine treatment protocols in practice,ultimately offering patients more scientific and precise therapeutic options.

Primary liver cancer,particularly hepatocellular carcinoma,is one of the most common malignancies in China,and hepatectomy remains the primary curative treatment.However,the efficacy of hepatectomy is significantly limited due to the heterogeneity of liver cancer,its high recurrence rate,and the fact that most patients are diagnosed at advanced stages.In recent years,the development of precision medicine has brought new hope to liver cancer treatment,especially with notable advancements in preoperative assessment,systemic therapy,minimally invasive surgery,and personalized treatment strategies.Preoperative assessment,including imaging technologies such as three-dimensional visualization and molecular imaging,helps physicians accurately evaluate tumor characteristics and liver function,guiding the choice of treatment plan.The combined application of immunotherapy and targeted therapy has significantly improved survival rates for patients with advanced liver cancer.The strategy of combining systemic therapy with local treatment has provided new pathways for translational therapy,expanding the indications for hepatectomy.The optimal selection of patients based on tumor biological characteristics,especially molecular subtyping and liver function status,to maximize patient benefit still requires further exploration.The"seven-step"modular laparoscopic hepatectomy,by achieving scientific hepatectomy,demonstrates the clinical practice of maximizing patient benefit,further elucidating a multidisciplinary,personalized treatment model centered on surgical therapy.

The development of classical anatomical liver resection has been a topic of considerable debate,particularly regarding its oncological efficacy in treating hepatocellular carcinoma.With continuous advancements in surgical techniques and iterative improvements in minimally invasive surgical equipment,laparoscopic portal territory anatomical resection(LPTAR)has gradually been adopted in clinical practice.Unlike classical anatomical liver resection,which approximates liver segmentectomy based on Couinaud's segmentation,LPTAR integrates technologies such as preoperative 3D visualization and intraoperative indocyanine green fluorescence navigation to target the true portal venous territory.Its core principle lies in achieving"precise liver segmentectomy"of the tumor-bearing portal venous territory.Currently,LPTAR is undergoing rapid development but faces several technical challenges,including the precise identification and control of hepatic pedicles,effective staining of difficult liver segments,and management of anatomical variations.Establishing standardized and streamlined technical protocols is crucial to addressing these issues,as it will improve surgical completeness and safety while enhancing oncological outcomes.Precision liver resection has long been a pursuit of surgeons,and laparoscopic liver resection,led by LPTAR,is poised to make a lasting impact in the field of precision hepatic surgery.

Background and Aims:Hepatectomy is an important treatment option for hepatic hemangioma,and the approach has gradually shifted from traditional open surgery to laparoscopic and robotic-assisted surgery.However,there is still no consensus on whether robotic assistance provides better treatment outcomes than laparoscopic surgery for hepatic hemangioma.Therefore,this study was performed to evaluate and compare the clinical efficacy and safety of robotic-assisted and laparoscopic hepatectomy for the treatment of hepatic hemangioma.Methods:The clinical data of 184 patients who underwent minimally invasive hepatectomy for hepatic hemangioma in the Department of Hepatobiliary and Pancreatic Surgery,Second Affiliated Hospital of Kunming Medical University,between February 2021 and July 2024 were retrospectively collected.Among them,30 cases were in the robotic group,and 154 cases were in the laparoscopic group.Propensity score matching(PSM)was performed based on baseline data such as patient demographics,tumor characteristics,and surgical resection range,with a 1∶2 matching ratio.Intraoperative and postoperative outcomes were compared between the two groups after matching.Results:After 1∶2 PSM,24 patients were in the robotic group and 48 in the laparoscopic group.Preoperative variables were well balanced between the groups(area under the ROC curve was 0.588).The robotic group had significantly shorter operative time(138 min vs.168 min,P=0.024)and hepatic hilum blocking time(25 min vs.45 min,P＜0.001)compared to the laparoscopic group.Postoperative albumin levels on day 1 and day 3 were higher in the robotic group,while transaminase levels on postoperative day 1 and day 3 were lower(all P＜0.05).However,the hospitalization cost was higher in the robotic group than that in the laparoscopic group(74 746 yuan vs.49 644 yuan,P＜0.001).No significant differences were found between the groups in terms of intraoperative blood loss,intraoperative transfusion rate,open conversion rate,postoperative length of stay,and postoperative complication rates as well as complication severity(all P＞0.05).Conclusion:For suitable cases of hepatic hemangioma,robotic-assisted laparoscopic hepatectomy is a safe and feasible treatment option.Compared to traditional laparoscopic surgery,it reduces operative time and hepatic hilum blocking time,and minimizes the impact on postoperative liver function.However,the treatment cost is higher,and selection should be based on the patient's individual needs.

Background and Aims:Body mass index(BMI),an important indicator of nutrition and health,is closely associated with postoperative complications.This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis,aiming to provide preoperative guidance for clinicians,reduce the risk of postoperative complications,and ensure surgical safety and efficacy.Methods:The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected.Patients were classified into low BMI group(≤18.4 kg/m2),normal BMI group(18.5-24.9 kg/m2),and high BMI group(≥25.0 kg/m2)based on preoperative BMI.Baseline characteristics,overall complications,severe complications,and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group.Risk factors for severe complications after liver resection were analyzed.Results:Among the 484 patients,79(16.3％)were in the low BMI group,328(67.8％)in the normal BMI group,and 77(15.9％)in the high BMI group.The high BMI group had significantly higher ASA score,preoperative albumin level,and proportion of hypertension compared to the normal BMI group(all P＜0.05).Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group(all P＞0.05).The incidence rates of overall complications were not significantly among the three groups(P＞0.05).However,the high BMI group had significantly higher incidence rates of severe complications(Clavien-Dindo grade Ⅲ-Ⅳ),postoperative infections,liver failure,and bile leakage compared to the normal BMI group;the low BMI group had significantly higher rates of perioperative blood transfusion,postoperative infections,liver failure,and reoperation compared to the normal BMI group(all P＜0.05).Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 pmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis(both P＜0.05).Conclusion:Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis,with high BMI being an independent risk factor for severe complications.To mitigate the risk of severe complications,clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors