Abstract:To further standardize and improve the management of colorectal liver metastases (CRLM) in China, the Chinese guidelines for the diagnosis and comprehensive treatment of colorectal cancer liver metastases (2025 edition) have been systematically updated based on previous versions and the latest international and domestic evidence. The updated guideline refines diagnostic pathways, strengthens multidisciplinary team collaboration, and comprehensively upgrades therapeutic strategies-including surgical resection, neoadjuvant and adjuvant treatments for patients eligible for no evidence of disease (NED) status, and systemic therapy for those who are not. It also expands the scope of genetic testing, incorporates innovative local ablative therapies, and emphasizes standardized follow-up and long-term management. The guideline aims to promote individualized and precision-based treatment, ultimately improving clinical outcomes and patient survival. It serves as a practical, evidence-based reference for healthcare providers managing CRLM across China.

Abstract:Most patients with biliary tract cancer are diagnosed at advanced stage and lose the opportunity for radical surgery resulting in dismal prognosis. In recent years, with advances in therapeutic approaches, conversion therapy has gradually been implemented in some cases of initially unresectable biliary tract cancer, enabling a subset of patients to achieve opportunities for radical surgery. To further standardize conversion therapy of biliary tract cancer and improve the overall efficacy, the Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association and Working Group of Biliary Surgeons, Chinese College of Surgeons, Chinese Medical Doctor Association, based on the latest evidence-based medical evidence and specific practices in the treatment of biliary tract cancer in China, organized discussion among experts in the field. Following the discussion, the "Expert consensus on conversion therapy of biliary tract cancer (2025)" was developed. This consensus aims to address key issues in the field of biliary tract cancer conversion therapy, standardize diagnostic and therapeutic procedures and protocols, and lay the foundation for further advancing research and practice in this area.

Abstract:Low anterior resection syndrome (LARS) is a common bowel dysfunction syndrome following sphincter-preserving surgery for rectal cancer, characterized by stool storage dysfunction and evacuatory dysfunction. It has become a critical factor adversely affecting patients' quality of life and long-term clinical outcomes. Currently, the pathogenic mechanisms of LARS remain incompletely elucidated, and high-quality evidence to guide clinical practice is still lacking. However, emerging evidence suggests that strategic optimization across the clinical management pathway—including precision oncology planning, surgical technique selection, multidimensional symptom profiling, proactive prevention protocols, and comprehensive symptom management—may effectively reduce LARS severity and improve survivorship outcomes. Given the absence of consensus guidelines for LARS management among clinicians across China, the Chinese Society of Coloproctology of Chinese Medical Doctor Association organized domestic experts in relevant fields. Through systematic review of global research findings, integration of international expertise and guidelines, and adaptation to domestic clinical realities, we developed the Chinese expert consensus on the diagnosis and treatment of low anterior resection syndrome (2025 edition). This consensus elaborates on key aspects including the definition, clinical manifestations, risk factors, pathophysiological mechanisms, symptom assessment, treatment modalities, and prevention strategies for LARS, aiming to standardize the diagnosis and management of LARS in China.

Abstract:Primary liver cancer (PLC) is a prevalent malignancy with high incidence and mortality rates globally. Hepatocellular carcinoma (HCC), primarily resulting from hepatitis B virus infections in Asia, constitutes most PLC cases. Despite advancements in targeted therapies and localized treatments, the 5-year survival rate remains low, indicating limited efficacy of current approaches. The advent of immunotherapy, particularly immune checkpoint inhibitors (ICIs), has brought new hope for patients with PLC. However, the liver's unique immune microenvironment presents significant challenges to the effectiveness of immunotherapy in HCC. This article reviews recent research developments in liver cancer immunotherapy, focusing on ICIs, combination therapies, emerging treatments, and prospective future directions.

Abstract:Magnetism possesses both "force" and "field" properties, enabling non-contact interactions. Hepatopancreatobiliary (HPB) surgery is a field characterized by continuous innovation. In 2015, our team first proposed the concept of "magnetic surgery," and subsequently advanced it from technical exploration to a disciplinary framework through organizing international conferences, founding a dedicated journal, and compiling textbooks. Many innovations originated in HPB practice: magnetic biliary and pancreatic anastomosis and magnetic recanalization for biliary strictures have significantly improved traditional approaches; magnetic vascular anastomosis has enabled rapid implantation of donor livers, supporting laparoscopic liver transplantation; and magnetic anchoring has provided multidimensional traction and exposure while reducing Trocar use and associated damage, thereby optimizing laparoscopic procedures. Looking ahead, multidisciplinary integration will drive the continued evolution of magnetic surgery, such as combining magnetic navigation with micro-nano surgical robots to achieve real-time tracking and guidance inside the body. These advances may overcome the limitations of conventional image guidance in applications like tumor ablation and catheter puncture. Ultimately, magnetic surgery is expected to evolve toward greater precision, minimal invasiveness, and intelligence, offering transformative solutions for HPB surgery and beyond.

Abstract:Perihilar cholangiocarcinoma (PHCC) has an insidious onset, is highly aggressive, and carries a poor prognosis. Radical surgical resection is crucial for improving patient survival. Due to the complex anatomy of the hepatic hilum, conventional laparoscopic surgery faces numerous challenges. In recent years, robotic surgery has shown significant potential in PHCC procedures, owing to its high-definition naked-eye 3D visualization, precise maneuvers, and superior dexterity. However, its widespread adoption remains limited by high costs, restricted intraoperative working space, and the absence of tactile feedback. Drawing on international research progress and our own clinical experience, this article analyzes optimization strategies including assessment of local tumor involvement, rational trocar placement, lymphatic and neural plexus dissection, determination of the extent of hepatectomy, vascular resection and reconstruction, bile duct reconstruction, and choledochojejunostomy. The aim is to explore approaches to overcoming these challenges and breaking through existing limitations, thereby providing new strategies and technical pathways for precise minimally invasive treatment of PHCC.

Abstract:Background and Aims Biliary tract cancers (BTCs) are highly aggressive malignancies with dismal prognosis, for which radical resection remains the only potentially curative treatment. Laparoscopic surgery has demonstrated superiority over open surgery in perioperative safety and recovery, yet it is technically limited in complex operations. Robot-assisted laparoscopy, with its high-definition three-dimensional vision and enhanced instrument dexterity, may overcome these limitations. However, comparative evidence balancing baseline differences between laparoscopic and robot-assisted laparoscopic radical resections for BTCs is still lacking. This study aimed to evaluate and compare their short-term safety using propensity score matching (PSM).Methods A total of 151 patients with biliary tract cancers who underwent radical resection were retrospectively enrolled from the Chinese Biliary Tract Tumor Collaborative Group database, including 128 in the laparoscopic group and 23 in the robotic-assisted laparoscopic group. To balance baseline differences, an initial 1∶1 PSM was performed, yielding 19 laparoscopic and 19 robotic cases. Subsequently, using the robotic group as the reference, a 1∶2 PSM was conducted, resulting in 36 laparoscopic and 18 robotic cases. Primary outcomes (conversion to open surgery, ICU admission, and postoperative complications) and secondary outcomes (operative time, intraoperative blood loss, transfusion, postoperative hospital stay, reoperation, readmission, and hospitalization costs) were compared between the two groups. Multivariate regression analyses were performed to explore factors associated with conversion to open surgery and postoperative hospital stay.Results After matching, baseline characteristics were well balanced between groups. For primary outcomes, the conversion rate to open surgery was significantly higher in the laparoscopic group than in the robotic group (41.7% vs. 0, P=0.001), while ICU admission, overall postoperative complications, and Clavien-Dindo graded complications showed no significant differences (all P>0.05). For secondary outcomes, the postoperative hospital stay was significantly more extended in the laparoscopic group compared with the robotic group (18.5 d vs. 8.0 d, P=0.005), whereas operative time, intraoperative blood loss, transfusion, reoperation, readmission, and hospitalization costs were comparable (all P>0.05). Logistic regression for conversion did not identify statistically significant predictors, but moderately differentiated tumors, elevated preoperative CA19-9, and higher harvested lymph node counts showed trends toward increased risk. Multivariate linear regression revealed that robotic-assisted surgery was an independent factor for reduced postoperative hospital stay (P=0.024), while preoperative total bilirubin (P=0.020), longer operative time (P=0.000), postoperative complications (P=0.006), and reoperation (P=0.005) were found to be associated with a prolonged hospital stay.Conclusion Robot-assisted laparoscopic radical resection for BTCs is not inferior to conventional laparoscopy in short-term safety and may further reduce conversion rates and hospital stay. Its technical advantages may be particularly valuable in anatomically complex or challenging cases. Nonetheless, cost-effectiveness and resource allocation should be considered for wider adoption.

Abstract:Background and Aims Complex biliary stones are often accompanied by hilar adhesions, distorted anatomy, biliary variations, or biliary-enteric fistulas. Conventional laparoscopic surgery is limited in such settings, with high conversion and complication rates. Robotic surgical systems provide high-definition 3D vision and enhanced dexterity, potentially improving surgical outcomes. This study compared the clinical efficacy of robotic vs. laparoscopic surgery for complex biliary stones.Methods A retrospective analysis was performed on 145 patients with complex biliary stones who underwent minimally invasive surgery at Fujian Provincial Hospital, Fuzhou University, from January 2023 to January 2025. Patients were divided into a robotic group (n=62) and a laparoscopic group (n=83). Intraoperative outcomes, postoperative complications, and recovery parameters were compared. Stone recurrence was assessed during follow-up.Results Baseline characteristics were comparable between groups (all P>0.05). The conversion rate was 0 in the robotic group vs. 7.2% in the laparoscopic group (P=0.038). The postoperative complication rate was significantly lower in the robotic group (1.6% vs. 10.7%, P=0.044). Time to first oral intake, first flatus, and postoperative hospital stay were all shorter in the robotic group (all P<0.05). No stone recurrence was observed in either group during follow-up until June 2025.Conclusion Robotic surgery is a safe and feasible approach for complex biliary stones, offering reduced conversion and complication rates and faster recovery compared with laparoscopy. It holds promise for wider clinical application in complex biliary disease.

Abstract:Background and Aims Perihilar cholangiocarcinoma (pCCA) is associated with poor prognosis. Radical resection remains the mainstay of treatment; however, high recurrence rates and limited overall survival (OS) after surgery. Metabolic syndrome (MetS) has been linked to unfavorable outcomes in various malignancies, but its impact on postoperative outcomes in pCCA is unclear. This study aimed to evaluate the influence of MetS on perioperative and long-term outcomes in patients undergoing radical resection for pCCA.Methods A retrospective analysis was conducted on 223 patients who underwent radical resection for pCCA at the First Affiliated Hospital of Army Medical University between January 2018 and December 2023. Patients were categorized into a MetS group (n=50) and a non-MetS group (n=173) according to diagnostic criteria. Perioperative complications, overall survival (OS), and recurrence-free survival (RFS) were compared between groups. Prognostic factors were identified using multivariate analysis.Results No significant differences were observed between the two groups regarding median hospital stay, overall complications, or severe complications (all P>0.05). The 1-, 3-, and 5-year OS rates in the MetS group were 62.3%, 22.3%, and 0, respectively, compared with 78.2%, 39.5%, and 22.0% in the non-MetS group. Corresponding RFS rates were 46.2%, 16.9%, and 0 in the MetS group vs. 63.8%, 29.6%, and 18.8% in the non-MetS group. Median OS and RFS were significantly shorter in the MetS group than in the non-MetS group (15.0 vs. 27.0 months; 12.0 vs. 21.0 months; P=0.021 and P=0.037, respectively). Multivariate analysis identified MetS and major vascular invasion as independent predictors of OS, while MetS, jaundice, R₀ resection, and major vascular invasion were independent predictors of RFS (all P<0.05).Conclusion MetS is significantly associated with worse long-term survival and higher recurrence risk after radical resection for pCCA. Incorporating MetS into preoperative assessment and postoperative management strategies may help improve patient outcomes.

Abstract:Background and Aims The incidence of intrahepatic cholangiocarcinoma (ICC) has been increasing in recent years. Due to its insidious onset and low rate of early diagnosis, radical resection remains the only potential curative treatment. Lymph node metastasis is a major adverse prognostic factor in ICC, but the scope and therapeutic value of lymphadenectomy remain controversial. Previous studies suggest that patients with central ICC may derive greater survival benefit from lymphadenectomy than those with peripheral ICC. Preoperative assessment of lymph node status mainly relies on imaging, but its accuracy is limited. This study aimed to investigate the prognostic impact of lymphadenectomy in ICC patients at different anatomical sites to inform surgical decision-making.Methods A retrospective analysis was conducted on 220 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA from May 2016 to May 2021. The cohort included 126 males and 94 females, with a mean age of (56.76±13.15) years. Patients were categorized into peripheral ICC (n=144) and central ICC (n=76) groups. Clinical characteristics, albumin-bilirubin (ALBI) grade, preoperative risk of lymph node metastasis, number of lymph nodes dissected, lymph node metastasis status, and postoperative survival outcomes were compared. Subgroup analyses were conducted to assess the prognostic value of the number of lymph nodes dissected under different risk stratifications.Results Significant differences were observed between peripheral and central ICC in ALBI grade (χ²=9.952, P=0.002), preoperative lymph node metastasis risk (χ²=6.166, P=0.014), number of lymph nodes dissected (χ²=4.167, P=0.042), and lymph node metastasis rate (χ²=7.331, P=0.007). The 3-year overall survival (OS) rate was higher in peripheral ICC (31.94%) than in central ICC (15.79%) (χ²=13.890, P<0.001). Among central ICC patients, those with ≥6 lymph nodes dissected had better 3-year OS than those with <6 (16.89% vs. 13.04%, χ²=3.894, P=0.048). In the high-risk subgroup of central ICC, ≥6 lymph nodes dissected was also associated with improved 3-year OS compared with <6 (15.62% vs. 11.11%, χ²=3.962, P=0.047). In contrast, the number of lymph node dissections had no significant prognostic impact in peripheral ICC or in patients classified as low risk.Conclusion Patients with peripheral ICC had a better prognosis than those with central ICC. Adequate lymphadenectomy (≥6 nodes) improved survival and enhanced staging accuracy in central ICC patients at high risk of lymph node metastasis, highlighting the importance of preoperative risk assessment for optimizing surgical strategies.

Abstract:Background and Aims Radical resection is the only potentially curative treatment for intrahepatic cholangiocarcinoma (ICC), yet the high recurrence rate results in poor prognosis. In recent years, "textbook outcome" (TO) has been proposed as a comprehensive quality metric, but its association with prognosis remains unclear. This study aimed to analyze the risk factors influencing the achievement of TO after radical resection of ICC and to explore the relationship between TO and survival.Methods A retrospective analysis was conducted on the clinical data of 180 ICC patients who underwent radical resection at the 904th Hospital of the Joint Logistic Support Force of the PLA between February 2018 and February 2023. Univariate and multivariate Logistic regression analyses were performed to identify risk factors associated with TO, and survival analysis was carried out using the Kaplan-Meier method and Log-rank test.Results Of the 180 patients, 66 achieved TO. Multivariate Logistic regression analysis indicated that preoperative total bilirubin >22 μmol/L, preoperative CA19-9 >35 U/mL, maximum tumor diameter >5 cm, poor tumor differentiation, microvascular invasion (MVI), and lymph node metastasis were independent risk factors for failing to achieve TO (all P<0.05). Survival analysis demonstrated that patients who achieved TO had a significantly longer median survival compared with those who did not (36 months vs. 16 months, P<0.001).Conclusion Preoperative total bilirubin >22 μmol/L, preoperative CA19-9>35 U/mL, maximum tumor diameter >5 cm, poor tumor differentiation, MVI, and lymph node metastasis are independent risk factors for not achieving TO after radical resection of ICC. Patients who achieved TO exhibited markedly longer survival, suggesting that TO not only reflects perioperative treatment quality but also serves as an important prognostic indicator. Greater attention to these risk factors and optimization of perioperative management may improve the likelihood of achieving TO and enhance long-term outcomes.

Abstract:Background and Aims Extrahepatic cholangiocarcinoma (ECCA) is a malignancy with insidious onset, strong invasiveness, and poor prognosis, characterized by a high postoperative recurrence rate and a 5-year overall survival of less than 20%. Most existing prognostic models are based on the Cox proportional hazards model, which is limited by the proportional hazards assumption and linearity constraints. The random survival forest (RSF) model, a novel machine learning algorithm, can capture complex interactions and nonlinear effects among variables; however, its application in ECCA remains scarce. Therefore, this study developed a prognostic model for ECCA patients after radical resection using the RSF algorithm, aiming to provide precise and individualized prognostic assessments and support clinical decision-making.Methods A total of 515 postoperative ECCA patients from the SEER database (2016-2021) were retrospectively enrolled and randomly divided into a training set (n=361) and a test set (n=154). Demographic and clinical variables were collected. Cox models were developed using univariate and multivariate regression, while RSF models were constructed using variable importance (VIMP) and minimal depth methods. Model performance was evaluated using the concordance index(C-index), time-dependent area under the curve(AUC), Brier scores, calibration plots, and decision curve analysis. Survival differences were assessed using Kaplan-Meier analysis, and interpretability was enhanced through the use of SurvSHAP and SurvLIME.Results Multivariate Cox regression identified seven independent prognostic factors: age, race, income, T stage, N stage, tumor size, and chemotherapy. The RSF model selected four key predictors: age, tumor size, lymph node positive rate, and chemotherapy. In the test cohort, the RSF model achieved a C-index of 0.751, outperforming the Cox model (0.711). The RSF model yielded AUCs of 0.843, 0.749, and 0.814 at 1, 2, and 3 years, respectively, with superior calibration, overall performance, and net clinical benefit. Nonlinear associations were observed for lymph node positive rate, age, and tumor size, while chemotherapy was associated with reduced mortality risk. Stratified survival curves indicated poorer prognosis in patients without chemotherapy, lymph node positive rate >0.1, age >70 years, or tumor size >20 mm.Conclusion The RSF model, based on only four readily available clinical variables, demonstrated superior predictive performance compared with the Cox model. It provides a reliable tool for individualized prognosis and postoperative management in ECCA patients. The integration of interpretability frameworks further enhances its clinical applicability, offering potential to improve survival outcomes and quality of life.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is one of the most common malignancies, with high incidence and mortality. The JAK/STAT signaling pathway plays a crucial role in regulating cell proliferation, apoptosis, and immune responses, and its persistent activation is closely associated with the development of HCC. This study aimed to investigate the effects of the JAK2 inhibitor AG490 and the STAT3-related inhibitor rapamycin (RPM) on the biological behaviors of HCC cells and their underlying molecular mechanisms.Methods Human hepatoma HepG2 cells were divided into four groups: blank control, AG490, RPM, and AG490+RPM. Cell proliferation, migration, and apoptosis were assessed by MTT assay, scratch test, and flow cytometry, respectively. ELISA and qRT-PCR were used to detect the protein and mRNA expression of Bax, Bcl-2, caspase-3, survivin, and c-Myc. A Western blot analysis was performed to examine the expression and phosphorylation levels of JAK2 and STAT3.Results Compared with the blank control group, the AG490, RPM, and AG490+RPM groups showed significantly decreased cell proliferation and migration abilities, as well as increased apoptosis, with the most pronounced effects observed in the AG490+RPM group (all P<0.05). Inhibitor-treated groups showed elevated expression of Bax and caspase-3, decreased expression of Bcl-2, survivin, and c-Myc, with the most significant changes in the AG490+RPM group (all P<0.05). In addition, the ratios of p-JAK2/JAK2 and p-STAT3/STAT3 were significantly reduced in all treated groups, with the lowest levels in the AG490+RPM group (all P<0.05).Conclusion Inhibitors targeting the JAK/STAT pathway significantly suppress proliferation and migration, and induce apoptosis in HCC cells, possibly by downregulating p-JAK2 and p-STAT3, as well as modulating genes related to apoptosis and proliferation. The combined use of AG490 and RPM exhibits superior antitumor effects, suggesting that multi-target blockade of the JAK/STAT pathway may represent a promising therapeutic strategy for HCC.

Abstract:Background and Aims Single-incision laparoscopic cholecystectomy (LC) has become increasingly popular due to its minimal invasiveness and cosmetic advantages, but challenges remain in biliary identification and limited operative space. Indocyanine green (ICG) fluorescence navigation enables real-time visualization of the biliary tract and may enhance surgical safety and efficiency. This study aimed to evaluate the clinical application value of ICG fluorescence navigation in single-incision LC.Methods A retrospective analysis was conducted on 59 patients with benign gallbladder diseases who underwent elective single-incision LC at Yixing Hospital affiliated to Jiangsu University from January 2023 to December 2024. Patients were divided into a fluorescence group (n=27) and a white-light group (n=32) according to whether ICG fluorescence navigation was applied. The two groups were compared in terms of Calot's triangle dissection time, operative time, intraoperative blood loss, surgeon satisfaction, hospital stay, and postoperative complications.Results No significant differences were observed in baseline clinical characteristics between the two groups (all P>0.05). In the fluorescence group, the cystic duct, common hepatic duct, and common bile duct were all successfully visualized. Compared with the white-light group, the fluorescence group had significantly shorter Calot's triangle dissection time [(25.56±3.49) min vs. (38.81±5.59) min], shorter operative time [(44.67±3.06) min vs. (61.31±4.96) min], and less intraoperative blood loss [(13.44±1.70) mL vs. (14.50±2.11) mL] (all P<0.05), with significantly higher surgeon satisfaction (P<0.05). No intraoperative bile duct injury, conversion to three-port surgery, or postoperative complications occurred in either group.Conclusion ICG fluorescence navigation can significantly improve biliary identification efficiency in single-incision LC, shorten operative time, reduce blood loss, and enhance surgeon satisfaction, demonstrating promising clinical application prospects.

Abstract:Background and Aims Centrally located breast cancer (CLBC), due to its proximity to the nipple-areolar complex, has long been treated primarily with mastectomy, while the oncologic safety of breast-conserving surgery (BCS) remains controversial. This study, based on a large-scale database combined with a real-world cohort, compared the survival outcomes of BCS and mastectomy to evaluate the feasibility and oncologic safety of BCS in CLBC patients.Methods Data of 10 325 female CLBC patients diagnosed between 2010 and 2015 were extracted from the SEER database, including 5 601 patients who underwent BCS and 4 724 who underwent mastectomy. Propensity score matching (PSM) yielded 1 951 matched pairs, and disease-specific survival (DSS) and overall survival (OS) were compared between groups. Cox regression analyses were performed to identify prognostic factors, and subgroup analyses were conducted. Additionally, an independent validation cohort from Xiangya Hospital, Central South University (2015-2016) included 221 BCS and 636 mastectomy patients, with OS and progression-free survival (PFS) assessed.Results After PSM, baseline characteristics between groups were well balanced. Kaplan-Meier analysis demonstrated no significant differences in DSS or OS between BCS and mastectomy, and 5-, 7-, and 10-year OS rates were comparable (all P>0.05). Subgroup analyses revealed equivalent outcomes for BCS and mastectomy in patients with T1/T2 disease, different HER2 statuses, and those receiving chemotherapy, while in patients receiving radiotherapy, BCS showed significantly better DSS and OS than mastectomy (both P<0.05). Multivariate Cox regression identified T, N, and M stage, histologic grade, molecular subtype, ER/PR status, and chemotherapy as independent prognostic factors (all P< 0.05), whereas surgical type was not (P>0.05). The validation cohort confirmed the SEER findings, with no significant differences in OS or PFS between the two groups (both P>0.05).Conclusions BCS provides DSS and OS comparable to mastectomy in CLBC patients and may confer additional survival benefits when combined with radiotherapy. These findings suggest that CLBC should not be considered a contraindication to BCS, supporting BCS as a feasible and safe surgical strategy that offers valuable evidence for individualized clinical decision-making and may help improve patients' quality of life.

Abstract:The 2025 American Society of Clinical Oncology (ASCO) Annual Meeting was held in Chicago from May 30 to June 3, 2025. As one of the largest and most influential academic events in global oncology, the ASCO meeting brought together numerous world-class oncology experts. It focused on the unmet clinical needs in gastrointestinal malignancies such as hepatocellular carcinoma, cholangiocarcinoma, and pancreatic cancer, and presented a wealth of cutting-edge research findings and therapeutic innovations. These advances provide important evidence-based support for the diagnosis and treatment of hepatobiliary and pancreatic cancers. Based on the latest achievements presented at ASCO 2025, this article discusses the hot topics and future directions in the management of hepatobiliary and pancreatic tumors.

Abstract:Biliary tract cancers (BTC), including intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, and gallbladder cancer, are relatively rare but carry a poor prognosis due to difficulties in diagnosis and limited therapeutic options. With the rapid advancement of artificial intelligence (AI), particularly machine learning and deep learning, its applications in clinical medicine have expanded substantially. This review summarizes the current progress of AI in BTC, focusing on its roles in diagnosis, prognostic evaluation, therapeutic decision-making, and recurrence prediction. The strengths and limitations of various AI models are discussed, alongside the challenges of clinical translation and potential future directions. The integration of AI into BTC management is expected to facilitate earlier detection, enhance personalized treatment strategies, and ultimately improve patient outcomes.

Abstract:Malignant obstructive jaundice is a severe pathophysiological disorder characterized primarily by hyperbilirubinemia secondary to biliary obstruction. To mitigate the adverse effects of hyperbilirubinemia and reduce postoperative complications, preoperative biliary drainage (PBD) has long been employed as a perioperative management strategy. Nevertheless, whether PBD confers definitive clinical benefits remains a subject of considerable debate. This review systematically summarizes the current literature, with particular emphasis on the indications, approaches, and clinical value of PBD in relation to obstruction at different anatomical sites, aiming to provide evidence-based guidance for surgical decision-making in patients with malignant obstructive jaundice.

Abstract:Donation after circulatory death liver transplantation (DCD-LT) remains a curative treatment for end-stage liver disease. Variant hepatic arteries are frequently encountered during transplantation, and inadequate management may result in localized ischemia and graft dysfunction. Precise handling of these variations remains a critical determinant of surgical success. This review summarizes anatomical classifications based on Michels' typology, highlights the value of imaging modalities in preoperative evaluation and intraoperative decision-making, and outlines current surgical approaches. Particular emphasis is placed on standardized strategies for arterial reconstruction in complex variations. Future research perspectives are also proposed, aiming to optimize assessment and management of variant hepatic arteries in DCD-LT.