Patients with chronic liver disease (CLD) present with cholangiocarcinoma (CCA) at earlier stages and experience improved survival rates compared to non-CLD patients.

• CLD patients had a higher frequency of early-stage disease (57% localized vs. 43% in non-CLD) and more often qualified for curative-intent surgery (60% vs. 48%).
• Median overall survival was longer for CLD patients (12.2 months vs. 11.1 months, HR 0.88).

Surgeons should consider implementing structured surveillance for high-risk CLD patients to facilitate earlier diagnosis and potentially improve surgical outcomes.

The left posterior approach to the superior mesenteric artery during robotic pancreaticoduodenectomy offers excellent outcomes, including a high rate of R0 resection and manageable complication rates.

• In a series of 27 patients, median operative time was 582 minutes with 100 mL of median blood loss.
• The approach resulted in an R0 resection rate of 89% and grade IIIa complications in only 7.4% of cases.
• Key factors for success include understanding 3D mesojejunal anatomy and maintaining precise resection planes.

Robotic hepatectomy in IWATE expert-level liver resections results in less blood loss and a shorter hospital stay compared to open surgery, without increasing major complications or mortality.

• In a matched cohort of 68 patients, robotic surgery had a median operative time of 240 minutes versus 206 minutes for open surgery (p = 0.002), lower estimated blood loss (100 ml vs. 200 ml; p = 0.038), and shorter postoperative stay (6 days vs. 9 days; p < 0.001).
• Major complications occurred in 13.2% of robotic cases compared to 19.1% for open cases (p = 0.480), with no significant differences in 90-day mortality.

These findings suggest that robotic techniques may offer logistical benefits in skilled hands for complex liver resections without compromising patient safety.

In patients with advanced hepatocellular carcinoma who responded to systemic therapy, surgical resection significantly prolongs time to treatment failure compared to maintenance therapy.

• Median time to treatment failure was 20.4 months with surgery versus 11.8 months with maintenance therapy (hazard ratio 0.60; p=0.015).
• Adverse events were higher in the surgery group (39%) versus maintenance (21%), with two treatment-related deaths linked to therapy.

Consider surgical resection for selected patients post-systemic therapy to enhance treatment duration before progression.