In patients with hepatic and pulmonary metastases from colorectal cancer selected according to strict inclusion criteria, surgical treatment performed in a specialized center is a safe option that offers prolonged survival.

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Introduction: Advancements in laparoscopic liver resection (LLR) has revolutionized the field of liver surgery. Currently, indocyanine green (ICG) fluorescent image technology is developed as intraoperative navigation tool to detect tumors and demarcation line in LLR. We assessed significance and surgical outcomes of ICG fluorescent surgery in LLR for navigation of demarcation line and intersegmental plane. Methods: We assessed 118 cases who had been performed LLR in our hospital. ICG fluorescent imaging was used with VECELA ELITE IIÒ (Olympus) or PINPOINTÒ (Stryker). Preoperative 3D simulation was performed and evaluated glissonian pedicle feeding the tumor. After clamping glissonian pedicle, we injected 2.5 mg of ICG intravenously. Then, demarcation line was assessed to decide transection line. During parenchymal transection, visualization of intersegmental plane was also assessed. In eight cases (S6: 3patients, S5: 1patient, S3: 4patients), we performed this technique and assessed intraoperative navigation of transection line and surgical outcomes. Results: In all cases, demarcation line could be detected by ICG navigation. New system of ICG fluorescent navigation could be detected intersegmental plane during parenchymal transection. In this series, surgical outcome was acceptable compared with other cases, and had no major complication and no mortality. However, it was difficult to recognize bleeding points from hepatic veins in ICG fluorescent mode of camera. To assure bleeding points, it is still needed to use normallight mode of laparoscopy system. Conclusion:The new system of ICG fluorescent navigation makes it possible to visualize not only superficial demarcation line but intersegmental plane during parenchymal transection in LLR.

Although CT-scans have a greater capacity to detect PMCRC, the F-FDG PET/CT could be useful in the detection of more pulmonary and extrapulmonary disease not identified by the CT-scan. Advances in knowledge: We tried to clarify the utility ofF-FDG PET/CT in the management of this subpopulation of patients.

Background Iatrogenic bile duct injury (IBDI) is a challenging surgical complication. IBDI management can be guided by artificial intelligence models. Our study identified the factors associated with successful initial repair of IBDI and predicted the success of definitive repair based on patient risk levels. Methods This is a retrospective multi-institution cohort of patients with IBDI after cholecystectomy conducted between 1990 and 2020. We implemented a decision tree analysis to determine the factors that contribute to successful initial repair and developed a risk-scoring model based on the Comprehensive Complication Index. Results We analyzed 748 patients across 22 hospitals. Our decision tree model was 82.8% accurate in predicting the success of the initial repair. Non-type E (p < 0.01), treatment in specialized centers (p < 0.01), and surgical repair (p < 0.001) were associated with better prognosis. The risk-scoring model was 82.3% (79.0–85.3%, 95% confidence interval [CI]) and 71.7% (63.8–78.7%, 95% CI) accurate in predicting success in the development and validation cohorts, respectively. Surgical repair, successful initial repair, and repair between 2 and 6 weeks were associated with better outcomes. Discussion Machine learning algorithms for IBDI are a novel tool may help to improve the decision-making process and guide management of these patients.

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Next-generation three-dimensional modelling software for personalized surgery allows spatially accurate depiction of the hepatic and vasculature anatomy based on the complexity and individual variation in each patient, and could facilitate decision-making about preoperative strategy in perihilar cholangiocarcinoma.