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Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives
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Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Gastroenterology & Hepatopancreatobiliary Medicine".

Deadline for manuscript submissions: 25 September 2026 | Viewed by 5327

Special Issue Editors

Dr. Andrea Benedetti Cacciaguerra

E-Mail Website
Guest Editor
Division of HPB and Abdominal Transplant Surgery, Department of Experimental and Clinical Medicine, Polytechnic University of Marche, 60126 Ancona, Italy
Interests: laparoscopic and robotic hepatobiliary surgery; HPB surgery; hepatocellular carcinoma
Dr. Paolo Vincenzi

E-Mail Website
Guest Editor
Division of HPB and Abdominal Transplant Surgery, Department of Gastroenterology and Transplants, Azienda Ospedaliero-Universitaria delle Marche, 60126 Ancona, Italy
Interests: HPB surgery; liver and kidney transplants; living donor laparoscopic nephrectomy; living donor kidney transplant

Special Issue Information

Dear Colleagues,

Hepatobiliary and pancreatic (HPB) surgery is used to treat various diseases, ranging from benign conditions to primary and secondary neoplasms. In the last two decades, important advances in surgical care have led to significant reductions in peri-operative morbidity and mortality, with considerable benefits in this rapidly growing field of surgery. Considerable improvements in surgical techniques, mainly represented by the expansion of minimally invasive methods, particularly robotic-assisted approaches, and in the applications of novel technologies, such as the implementation of artificial intelligence and augmented reality, have led to promising results, providing HPB patients with optimal diagnostic, therapeutic and prognostic tools for achieving the best possible outcomes.

Other approaches that have been successfully adopted for many years with demonstrated important benefits have recently undergone relevant improvements, i.e., the use of indocyanine green during hepatobiliary surgery for the identification of bile ducts and subcapsular hepatic tumors or the precise demarcation of hepatic segments, increasing the accuracy and safety of open and minimally invasive hepatic resections.

We invite you to submit a paper to this Special Issue, which will explore the most recent progress regarding HPB surgery. Both clinical and technological evolutions will be considered with the option of including narrative and systematic reviews, meta-analysis, research articles and case reports of particular interest or exceptional didactical value.

“Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives” will give specialists involved in the care of HPB surgical patients the opportunity to share their experiences or points of view on several relevant topics, with the primary aim being improving global knowledge and patient outcomes.

We look forward to receiving your contributions.

Dr. Andrea Benedetti Cacciaguerra
Dr. Paolo Vincenzi
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 250 words) can be sent to the Editorial Office for assessment.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatobiliary and pancreatic surgery
  • laparoscopic surgery
  • robot-assisted surgery
  • artificial intelligence
  • augmented reality
  • indocyanine green
  • liver tumors
  • pancreatic tumors

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Published Papers (4 papers)

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Research

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11 pages, 222 KB  
Article
Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: Perioperative Outcomes in the Modern Minimally Invasive Era
by Byeong Gwan Noh, Young Mok Park, Myunghee Yoon, Hyung Il Seo, Myeong Hun Oh, Suk Kim and Seung Baek Hong
J. Clin. Med. 2026, 15(7), 2753; https://doi.org/10.3390/jcm15072753 - 5 Apr 2026
Viewed by 182
Abstract
Background: As life expectancy increases, a growing number of elderly patients are considered for curative hepatectomy for hepatocellular carcinoma (HCC). However, perioperative outcomes in elderly patients in the contemporary era of minimally invasive liver surgery remain incompletely defined. Methods: We retrospectively reviewed 277 [...] Read more.
Background: As life expectancy increases, a growing number of elderly patients are considered for curative hepatectomy for hepatocellular carcinoma (HCC). However, perioperative outcomes in elderly patients in the contemporary era of minimally invasive liver surgery remain incompletely defined. Methods: We retrospectively reviewed 277 consecutive patients who underwent elective curative hepatectomy for HCC between 2019 and 2023. Outcomes were compared using age thresholds of ≥75 and ≥80 years. The primary endpoints were 90-day mortality and major postoperative complications (Clavien–Dindo grade ≥ III). Multivariable logistic regression identified predictors of major complications. Results: Elderly patients had more comorbidities, whereas liver function, tumor characteristics, and extent of resection were comparable across age groups. Laparoscopic hepatectomy was performed more frequently in patients aged ≥80 years. Major complication rates and 90-day mortality were similar regardless of age, with no deaths among patients aged ≥75 or ≥80 years. Age ≥75 years, higher ALBI score, major comorbidities, and longer Pringle maneuver time were independently associated with major postoperative complications. Conclusions: Hepatectomy for hepatocellular carcinoma may be performed with acceptable short-term outcomes in carefully selected elderly patients, including octogenarians. Chronological age alone should not be considered an absolute contraindication to surgery, although findings should be interpreted with caution. Full article
(This article belongs to the Special Issue Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives)
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13 pages, 1272 KB  
Article
Bile Bacterial Colonization Increases Risk of Postoperative Pancreatic Fistula and Worsens Overall Survival Following Pancreatoduodenectomy
by Natalia Olszewska, Tomasz Guzel, Kaja Śmigielska, Piotr Paluszkiewicz, Agnieszka Milner, Edyta Podsiadły and Maciej Słodkowski
J. Clin. Med. 2026, 15(4), 1566; https://doi.org/10.3390/jcm15041566 - 16 Feb 2026
Viewed by 452
Abstract
Background: Postoperative pancreatic fistula (POPF) is a major source of morbidity following a pancreatoduodenectomy (PD), often delaying or precluding adjuvant chemotherapy and potentially compromising long-term oncologic outcomes. While established risk models focus on anatomical and biochemical factors, the role of biliary microbiota remains [...] Read more.
Background: Postoperative pancreatic fistula (POPF) is a major source of morbidity following a pancreatoduodenectomy (PD), often delaying or precluding adjuvant chemotherapy and potentially compromising long-term oncologic outcomes. While established risk models focus on anatomical and biochemical factors, the role of biliary microbiota remains underexplored. This study aimed to assess relationship between bacteriobilia and the incidence of POPF, as well as its impact on overall survival (OS) in patients undergoing a PD for pancreatic ductal adenocarcinoma (PDAC). Methods: We analyzed the medical histories of 725 patients with a pancreatic tumor who were qualified for surgery between 2017 and 2022. This retrospective cohort study included 138 patients who underwent a PD for histologically confirmed PDAC. Intraoperative bile cultures were obtained and analyzed for microbial presence and resistance patterns. Results: Bacteriobilia was detected in 76.8% of patients, including bacteria with resistance mechanisms (BRM) present in 12.3% of bile samples. Bacterial bile colonization conferred an increased odds of POPF grade B (OR 5.11; p = 0.088), whereas BRM were strongly predisposed to POPF grade C (OR 4.97; p = 0.026). Upon a multivariate analysis, bacteriobilia independently drove clinically relevant POPF and POPF grade B (OR 5.50; p = 0.034 and OR 8.04; p = 0.048, respectively), while BRM remained a key determinant of POPF grade C (OR 6.17; p = 0.047). Beyond morbidity, bile colonization markedly impaired overall survival irrespective of tumor stage (26.7 vs. 54.7 months; log-rank p = 0.009). Conclusions: Bacterial bile colonization may contribute not only to higher rates of POPF but to a significantly reduced OS in patients undergoing a PD for PDAC. Bacteriobilia should be considered as a prognostic factor for worse survival after a PD. Full article
(This article belongs to the Special Issue Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives)
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13 pages, 585 KB  
Article
A Decade of Innovation: Short-Term Outcomes of 150 Robotic Liver Resections
by Alessio Pasquale, Francesco A. Ciarleglio, Laura Marinelli, Giovanni Viel, Stefano Valcanover, Nick Salimian, Stefano Marcucci, Marco Brolese, Paolo Beltempo and Alberto Brolese
J. Clin. Med. 2025, 14(18), 6530; https://doi.org/10.3390/jcm14186530 - 17 Sep 2025
Cited by 2 | Viewed by 991
Abstract
Background: Robotic liver resection (RLR) has seen remarkable advancements in recent years, overcoming many limitations of laparoscopic liver resection (LLR). RLR has evolved to include increasingly complex procedures, offering enhanced precision, reduced blood loss, and lower complication rates. Materials and Methods: A total [...] Read more.
Background: Robotic liver resection (RLR) has seen remarkable advancements in recent years, overcoming many limitations of laparoscopic liver resection (LLR). RLR has evolved to include increasingly complex procedures, offering enhanced precision, reduced blood loss, and lower complication rates. Materials and Methods: A total of 150 consecutive RLRs, performed at the Department of General Surgery II and HPB Unit of Santa Chiara Hospital (Trento, Italy), between January 2013 and June 2024 were retrospectively reviewed. Collected data included demographics, disease etiology, operative parameters, oncologic margins, and perioperative outcomes. Results: Indications were malignant disease in 83% of cases while benign disease accounted for 17%. Minor resections accounted for 91%. Cirrhosis was present in 49% of patients (Child–Pugh A 91%; B 9%; mean MELD 9). According to the Iwate difficulty score, resections were low difficulty in 38% of cases, intermediate in 50%, advanced in 7%, expert in 5%. Conversion rate was 12%, mainly for bleeding or adhesions. Mean blood loss was 159 mL (66% <100 mL); Pringle maneuver was used in 3%; drains omitted in 45%; ICG fluorescence used in 81%. Mean operative time was 250 min (console time 184 min). Mean lesion size was 34 mm; R0 margin rate was 82%. Overall mortality was 1.3%; morbidity 24% (Clavien–Dindo ≥ III in 10%). Mean hospital stay was 7 days (median 5; range 2–46). Conclusions: RLR is a safe and effective alternative to laparoscopy, providing comparable or superior perioperative outcomes. Medium-volume centers can achieve high-quality results with RLR. Continued technological advancements will further expand its applications to increasingly complex liver procedures. Full article
(This article belongs to the Special Issue Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives)
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15 pages, 1275 KB  
Systematic Review
A Systematic Review of Closed-Incision Negative-Pressure Wound Therapy for Hepato-Pancreato-Biliary Surgery: Updated Evidence, Context, and Clinical Implications
by Catalin Vladut Ionut Feier, Vasile Gaborean, Ionut Flaviu Faur, Razvan Constantin Vonica, Alaviana Monique Faur, Vladut Iosif Rus, Beniamin Sorin Dragan and Calin Muntean
J. Clin. Med. 2025, 14(15), 5191; https://doi.org/10.3390/jcm14155191 - 22 Jul 2025
Cited by 4 | Viewed by 2884
Abstract
Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no [...] Read more.
Background and Objectives: Postoperative pancreatic fistula and post-hepatectomy liver failure remain significant complications after HPB surgery; however, superficial surgical site infection (SSI) is the most frequent wound-related complication. Closed-incision negative-pressure wound therapy (ciNPWT) has been proposed to reduce superficial contamination, yet no liver-focused quantitative synthesis exists. We aimed to evaluate the effectiveness and safety of prophylactic ciNPWT after hepatopancreatobiliary (HPB) surgery. Methods: MEDLINE, Embase, and PubMed were searched from inception to 30 April 2025. Randomized and comparative observational studies that compared ciNPWT with conventional dressings after elective liver transplantation, hepatectomy, pancreatoduodenectomy, and liver resections were eligible. Two reviewers independently screened, extracted data, and assessed risk of bias (RoB-2/ROBINS-I). A random-effects Mantel–Haenszel model generated pooled risk ratios (RRs) for superficial SSI; secondary outcomes were reported descriptively. Results: Twelve studies (seven RCTs, five cohorts) encompassing 15,212 patients (3561 ciNPWT; 11,651 control) met the inclusion criteria. Device application lasted three to seven days in all trials. The pooled analysis demonstrated a 29% relative reduction in superficial SSI with ciNPWT (RR 0.71, 95% CI 0.63–0.79; p < 0.001) with negligible heterogeneity (I2 0%). Absolute risk reduction ranged from 0% to 13%, correlating positively with the baseline control-group SSI rate. Deep/organ-space SSI (RR 0.93, 95% CI 0.79–1.09) and 90-day mortality (RR 0.94, 95% CI 0.69–1.28) were unaffected. Seven studies documented a 1- to 3-day shorter median length of stay; only two reached statistical significance. Device-related adverse events were rare (one seroma, no skin necrosis). Conclusions: Prophylactic ciNPWT safely reduces superficial SSI after high-risk HPB surgery, with the greatest absolute benefit when baseline SSI risk exceeds ≈10%. Its influence on deep infection and mortality is negligible. Full article
(This article belongs to the Special Issue Hepatobiliary and Pancreatic (HPB) Surgery: Current Status and Future Perspectives)
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