Bingying Huang

Background and Objectives: Intrahepatic cholangiocarcinoma (iCCA) is a highly malignant biliary tumor associated with a poor prognosis. Here, we explored conversion therapy (CT) for the treatment of locally advanced iCCA (LA‐iCCA).Methods: We retrospectively enrolled 115 patients with LA‐iCCA at our single center from January 2019 to June 2024, with the final follow‐up conducted in January 2025. The primary outcome measured was overall survival (OS), while the secondary outcome focused on progression‐free survival (PFS). We utilized a propensity score matching (PSM) approach to adjust for potential confounders between the CT group and the systemic therapy (ST) group.Results: Before PSM, the median OS was 34.57 months (95% CI: 19.22–49.91), while the median PFS was 17.30 months (95% CI: 12.89–21.71) in the CT group. Both OS and PFS were significantly longer than those in the ST group (both p < 0.001). After PSM, both groups were successfully matched, resulting in 31 patients in each group. In the CT group, the median OS and PFS were 45.53 months (95% CI: 29.19–61.87) and 18.23 months (95% CI: 7.02–29.45), respectively. Both values were significantly higher than those in the ST group, with P values of less than 0.001 for OS and 0.002 for PFS. Furthermore, CT was identified as an independent factor associated with improved outcomes, both before and after PSM.Conclusions: CT was an effective approach for improving outcomes in patients with LA‐iCCA.

Background Laparoscopic cholecystectomy (LC) has been carried out as day-case surgery. Current guidelines do not mention the role of drainage after LC. In particular, data stay blank with no prospective study on drainage management when gallbladder perforation (GP) accidentally occurs intraoperatively. Methods A randomized controlled trial was conducted to compare clinical outcomes of drainage and no drainage after elective day-case LC. Intraoperative GP was recorded. The primary and secondary outcomes were major and minor complications, respectively. Results Two hundred patients were randomized. No major complications occurred in either group. In secondary outcomes, nausea/vomiting, pain, hospital stay, and cost were similar in the drainage group and no drainage group; postoperative fever, WBC, and CRP levels were significantly lower in the no drainage group. GP occurred in 32 patients. Male patients with higher BMI and CRP and abdominal pain within 1 month were more likely to occur GP. Subgroup analysis of GP, primary outcomes, and most secondary outcomes had no difference. Postoperative WBC and CRP were higher in the drainage group. Postoperative fever occurred in 63 patients. Univariate analysis of fever showed that blood loss, drainage, postoperative WBC, CRP, and hospital stay were significant. Multivariable logistic regression analysis demonstrated that drainage was an independent risk factor for fever after LC (OR 3.418, 95% CI 1.392–8.390; p = 0.007). Conclusions No drainage after elective day-case LC is safe and associated with fewer complications, even in intraoperative GP. The trial proves that drainage is an independent risk factor for postoperative fever. The use of a drain after LC may lead to an unsuccessful day-case procedure by causing fever, elevated CRP, and extended hospital stay (NCT03909360).