Paweł Topolewski

Introduction: Bile leak (BL) remains one of the most common complications following liver resection, contributing to increased morbidity, prolonged hospitalisation and higher healthcare costs. Early intraoperative detection of open bile ducts is essential for minimising this risk. The intraoperative White test (WT), which involves retrograde injection of a lipid emulsion into the biliary tree, has been shown to enhance visualisation of BL and may reduce their incidence. However, the benefit of routine WT use across all types of liver resections has not been conclusively established. The Detection of Bile Leak in Elective Liver Resection (DELiveR) trial aims to evaluate the effectiveness and safety of routine intraoperative WT in elective liver surgery. Methods and analysis: This is a single-centre, prospective, parallel-group, participant-blinded and outcome assessor-blinded, superiority randomised clinical trial. Adult patients undergoing elective liver resection will be randomised in a 1:1 ratio to either routine WT using SMOFlipid 5% or standard intraoperative BL detection using visual inspection with white gauze. Final eligibility, including safe accessibility of an identifiable cystic duct or cystic duct stump for attempted cannulation, will be confirmed intraoperatively after completion of liver parenchymal transection and haemostasis. Eligible participants will then be randomised immediately before the assigned intraoperative BL assessment. The primary endpoint is the incidence of postoperative BL within 30 days, defined according to the International Study Group of Liver Surgery criteria. Permuted block randomisation will be used to allocate participants in a 1:1 ratio. The primary analysis will be conducted in the overall intention-to-treat population using logistic regression with treatment allocation as the independent variable. Secondary outcomes include severity of BL, postoperative morbidity and mortality, need for reinterventions, intensive care unit admission and length of hospital stay. A total of 270 patients will be enrolled. Ethics and dissemination: The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Ethical approval has been obtained from the Bioethics Committee of the Medical University of Warsaw. Written informed consent will be obtained from all participants. Study findings will be disseminated through peer-reviewed publications and presentations at national and international conferences. Trial registration number: NCT07511907 . Protocol version: DELiveR Trial Protocol, version 1.5, dated 28 August 2026.

In persistent HPS‐related hypoxemia after LT, prolonged VV‐ECMO can serve as a bridge to recovery when conventional oxygenation strategies fail. Serial contrast‐enhanced echocardiography and multidisciplinary management may support weaning decisions and the management of ECMO‐related complications.

Introduction: With the emergence of the global pandemic caused by SARS-CoV-2, health service providers were put to the test. The utilization of operating theatres is one of the prime indicators of the logistic and organizational efficacy of a hospital. We performed an analysis evaluating the impact of the COVID-19 pandemic on the fluidity of providing surgical care to a patient with severe comorbidities and the organizational efficacy of the operating theater in a university hospital in northern Poland. Methods: Casemix between the periods was tested and Fisher’s test was used to examine the significance of the association between (i) patient, (ii) workup, (iii) resource/facility, and (iv) bed-related causes of day-of-surgery cancellations in pre- and post-COVID-19 pandemic periods and early- and medium-COVID-19 pandemic periods. Results: In the study period, a total of 1,935 elective surgeries were booked, 2,219 elective and emergency surgeries were performed, and there were 203 (10.5%) cancellations. Patient-related cancellations increased significantly during the COVID-19 pandemic, accounting for 18.8% of cancellations, compared to 5.1% in pre- and post-pandemic periods (p = 0.0115). Resource/facility-related reasons remained the most frequent cause, contributing to 57.3% of cancellations during the pandemic. Conclusions: Patient-related causes were the most frequent reasons in the COVID-19 pandemic period. Furthermore, patient-related reasons may have contributed to a drop in demand for surgical care and a nonsignificant change in the correlation between demand and supply for surgical care. The further effects of the COVID-19 pandemic on surgical department work are yet to be observed and should be reported to find a solution for growing societies’ need for surgical care and find tools to minimize the “damage” caused by the next crisis in global healthcare.

Liver transplantation (LT) is one of the most effective treatments for hepatocellular carcinoma (HCC) in cirrhotic livers. Neoadjuvant bridging treatment in patients qualifying and listed for LT is advised but is still debatable owing to the low level of evidence. The aim of this study was to perform a systematic review to assess the prognostic value of bridging therapy, in terms of radiological and histopathological examination outcomes, for survival after LT. The systematic review was performed according to the PRISMA 2020 guidelines. The MEDLINE and Web of Science databases were searched. In total, five studies were included. An evaluation with the ROBINS-I resulted in studies classified as the following: moderate risk of bias (n = 1) and serious risk of bias (n = 4). The results of the analysis indicated that favorable LT outcomes were most common with complete response or partial radiological response. Poor radiological response or progressive disease during bridging treatment was generally associated with worse overall LT survival. There were not enough data to support the use of this approach to achieve a complete pathologic response. Radiological, pathological, histological, cellular, and molecular tumor features should be included in future LT qualification models.

Background: Liver transplantation (LT) is a method for treating hepatocellular carcinoma (HCC) with satisfactory outcomes. One of the novel methods for predicting LT outcomes is the Metroticket 2.0 model. The disease in patients initially within the Milan criteria (MC) may progress while on a transplantation waitlist; thus, various transplantation bridging therapy (BT) methods are proposed for patients to stay within the MC and optimize the LT outcome. Methods: We performed a retrospective analysis of patients who underwent LT for HCC at an oncological and transplantation center in northern Poland. Patients who underwent (n = 10) or did not undergo (n = 11) BT were included. The primary endpoints of the study were mortality among the patients, HCC recurrence, and Metroticket 2.0 scores based on LT qualification results and explant pathology outcomes. The median follow-up length was 44.03 months. Results: Patients who underwent BT had significantly lower Metroticket 2.0 scores and greater AFP concentrations at baseline. At LT, there was no significant difference in Metroticket 2.0 scores or AFP concentrations between the groups. Explant Metroticket 2.0 scores were significantly lower in patients who received BT. A complete pathologic response was achieved in 30.0% of patients who underwent BT. The recurrence-free survival rates were 100% and 90.91% in patients who underwent and did not undergo BT, respectively. Overall survival was 80.0% and 81.81% in patients who underwent and did not undergo BT, respectively. Conclusions: BT should be considered only as a means of remaining within the LT criteria. Routine BT does not appear to be justified for LT patients.

Background: Cholangiocarcinoma, the second most common primary liver cancer, is still a contraindication for performing liver transplantation in most patients. Despite various trials being performed in large clinical centers, the results are still not satisfactory. The aim of this study was to present cases from our own cohort and perform a systematic review of the results of liver transplantation in patients with incidental intrahepatic cholangiocarcinoma. Materials and methods: We retrospectively reviewed the records of all patients who underwent liver transplantation and identified two patients with incidental intrahepatic cholangiocarcinoma via histopathological examination of the explanted liver. The results of radiological and biochemical screening performed during liver transplantation, standardized histopathological examination and follow-up data are presented. Additionally, a systematic review of PubMed and Cochrane Reviews based on the PRISMA protocol was performed, yielding 413 similar cases. Results: We present two cases of incidental intrahepatic cholangiocarcinoma found after liver transplantation. The patients were managed according to a standard protocol with no consecutive modification of immunosuppression or chemotherapy. There was no recurrence or mortality. In this systematic review, the mean reported number of lesions ranged between 1 and 2 per patient. A total of 42 recurrences were reported. The percentage of recurrences ranged between 28.6% and 80%. Conclusions: Despite not being a frequent finding, follow-up and further treatment of patients with incidental iCCA should be reported and analyzed. Extra carefulness in screening is advised in patients who are already diagnosed with oncological disease of the liver. In long-term follow-up, recurrence of the disease is rather probable.

Background/Objectives: Primary vaginal melanoma (PVM) is a rare cancer representing five percent of vaginal cancers and less than one percent of all female vaginal melanomas, with an incidence rate of 0.46 per million women per year. The aim of this study was to present a case of combined therapy and conservative surgical treatment in a young patient with PVM and to perform a systematic review of the same subject. Methods: We performed a narrative review of the literature and presented a case report. Results: The review yielded a total of 43 articles. We presented treatment modalities and survival outcomes. The presented case involved a combination of surgical treatment with adjuvant therapy comprising nivolumab and ipilimumab. Conclusions: PVM is a disease with a poor prognosis; however, new treatment options are promising and have a great chance of significantly improving survival. The combination of the wide local excision of the primary lesion followed by adjuvant therapies results in the best outcomes in the treatment of PVM. Future clinical studies are warranted to provide new evidence for the treatment outcomes of nonsurgical, metastatic PVM and the adjuvant treatment of PVM.

Diabetic mastopathy is a rare breast condition that may occur in insulin-treated men and women of any age. The etiology is still unclear; however, the autoimmunological background of the disease is highly suspected. The changes in diabetic mastopathy may mimic breast cancer; therefore, its diagnostic process is demanding, and treatment options are not clear and limited. Lesions in DM are usually multiple; therefore, surgical removal is not fully effective. A well-done anamnesis with core-needle biopsy is essential and definitive in most cases. In this review, we summarize up-to-date knowledge of diagnostic methods and therapeutic options for diabetic mastopathy treatment and present three cases of diabetic mastopathy-type lesions in ultrasound and radiological examinations.