Nicola Canitano

Background/Objectives: Salvage liver transplantation (SLT) is a well-established option for hepatocellular carcinoma (HCC) recurrence after liver resection. Laparoscopic microwave ablation (L-MWA) represents another curative strategy for early-stage HCC. However, its role within this therapeutic framework remains unexplored. Methods: Between 2014 and 2023, we treated 1341 patients with HCC using L-MWA. From this cohort, patients with Child-Pugh class A liver function, HCC within the Milan criteria, no contraindications to transplantation, and ≥12 months of follow-up were selected. SLT failure was defined as non-transplantable recurrence or death, resulting in the loss of a potentially curative therapeutic opportunity. The primary endpoint was overall survival (OS); secondary endpoints included predictors of survival and SLT failure. Results: A total of 341 patients met the inclusion criteria. Five-year OS was 62%. Independent predictors of poorer survival included the presence of cardiac disease or oesophageal varices, a Child-Pugh score of 6, tumour size, and elevated alpha-fetoprotein (AFP) levels. Treatment was successful in 255 patients (74.8%): 102 (29.9%) underwent SLT, 67 (19.6%) received alternative therapies, and 93 (27.3%) remained recurrence-free. Treatment failure occurred in 86 patients (25.2%) due to non-transplantable recurrence or death. Independent predictors of failure included older age, non-HBV aetiology, and elevated AFP levels. Five-year OS rates were 79% in the success group and 22% in the failure group (p < 0.001). Conclusions: A combined L-MWA and SLT strategy is safe and effective, yielding a 62% 5-year OS rate. This approach supports more efficient graft use with a consequent increase in the population transplant benefit. Improved selection may further reduce failure rates.

Background: Postpancreatectomy diarrhoea significantly impairs outcomes and patient’s quality of life. Its origin is multifactorial, extending beyond exocrine pancreatic insufficiency. Even with pancreatic enzyme replacement therapy, persistent postpancreatectomy diarrhoea can lead to malnutrition and inhibit adjuvant treatments. This study aimed to evaluate the incidence, risk factors, management, and impact of postpancreatectomy diarrhoea on quality of life. Methods: This prospective longitudinal study enrolled patients undergoing pancreatectomy at a single tertiary centre from 2023 to 2025. After surgery (at 7, 30, and 90 days), an adapted systemic therapy-induced diarrhoea assessment tool (STIDAT) questionnaire was used to assess for the presence of postpancreatectomy diarrhoea, patient-reported severity, frequency, medication use, associated symptoms, and quality of life. Results: A total of 237 patients were included (pancreatoduodenectomy 54%, distal pancreatectomy 35%, total pancreatectomy 11%). Overall, the incidence of postpancreatectomy diarrhoea was 32, 41, and 33% at 7, 30, and 90 days, respectively. Postpancreatectomy diarrhoea was most frequent and severe after total pancreatectomy and pancreatoduodenectomy (62 and 50% at 30 days) and least after distal pancreatectomy (22.0% at 30 days) (P < 0.001). The severity of postpancreatectomy diarrhoea correlated with worse quality of life and higher STIDAT scores at all time points. Most patients with postpancreatectomy diarrhoea required pancreatic enzyme replacement therapy, with a median dose of 85 000 lipase units per day by 90 days, and up to 37% also needed antidiarrhoeals. Common 30-day symptoms included urgency (52%), abdominal discomfort (69.4%), and incontinence (18.4%). In multivariable analysis, pancreatic ductal adenocarcinoma, vascular resection, and arterial divestment were independent predictors of moderate-to-severe postpancreatectomy diarrhoea, whereas distal pancreatectomy was protective. Conclusion: Postpancreatectomy diarrhoea is an impactful complication after pancreatectomy, affecting more than one-third of patients even after correct pancreatic enzyme replacement therapy. Patients undergoing vascular resection and arterial divestment are at higher risk of severe postpancreatectomy diarrhoea, and require tailored postoperative management to reduce its negative effects, which include impaired quality of life.