Background Fibrolamellar hepatocellular carcinoma (FL-HCC) is a rare disease and current efforts are focused on the prognosis and on the development of efficient and specific treatments. This study aimed to review the latest evidence regarding FL-HCC treatment and prognosis. Methods A systematic review of the literature over the past 10 years regarding FL-HCC, and meta-analysis of 1-, 3-, and 5-year overall survival (OS) comparing FL-HCC and conventional HCC were performed. Results Overall, 1567 articles were screened, of them 21 were selected for the systematic review, and 6 for meta-analysis. Twenty-one studies included a total of 2168 patients with FL-HCC, with a median age ranging from 11 to 56 years. The majority of patients underwent surgical resection or liver transplantation. After a median follow-up ranging from 24 to 58 months, 1-year OS was 67–100% and 5-year OS was 28–65%. A total of 743 patients with FL-HCC and 163,472 with conventional HCC were included in the meta-analysis. There was a significantly improved 1-, 3-, and 5-years OS in the FL-HCC group compared to the conventional HCC group, although high heterogeneity was found. When excluding population-based studies, and including 96 FL-HCC and 221 conventional HCC patients, the heterogeneity was low, and the meta-analysis showed a significantly longer 1-year OS in patients with FL-HCC than conventional HCC; however, there were no differences at 3- and 5-years OS. Conclusions Surgical resection for FL-HCC is currently the only curative treatment available. FL-HCC is plagued by high-recurrence rates and poor long-term outcomes which may be related to the absence of specific treatment for advanced and recurrent disease.

Background: In December 2019, an outbreak of pneumonia, caused by a new type of coronavirus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It quickly spread worldwide, resulting in a pandemic. The clinical manifestations of SARS-CoV-2 range from mild non-specific symptoms to severe pneumonia with organ function damage. In addition, up to 60% of patients have liver impairment or dysfunction, confirmed by several studies by the presence of SARS-CoV-2 in the liver tissue.Methods: We report two cases of symptomatic liver cyst requiring fenestration after recent SARS-CoV-2 infection. Both patients had hospital admission due to documented SARS-CoV-2 infection. Recently, after the infection, they developed symptoms caused by an enlarged hepatic cyst: one had abdominal pain, and the other had jaundice. They underwent surgery after two negative swab tests for SARS-CoV-2.Results: Cystic fluid was sent for microbiological test, and real-time fluorescence polymerase chain reaction COVID-19 nucleic-acid assay of the cyst fluid was found to be negative in both cases.Discussion: Although there are no current data that can document a viral contamination of cystic fluid, there are data that document a hepatotropism of COVID-19 virus. Herein we report that after viral clearance at pharyngeal and nasal swab, there is no evidence of viral load in such potential viral reservoir.

No abstract

Despite a growing number of women choosing to pursue surgical specialties, surgery is still perceived as a woman-unfriendly career. The difficulties of conciliating a demanding career with the requirements of both personal and family life for women surgeons have been investigated by several authors. The current study aims to summarize existing evidence on the issue of work-life balance for women surgeons, particularly focusing on possible strategies to improve it. Artificial intelligence (AI) has been investigated as a possible means to close the gender gap, acting as an equalizer for women surgeons. Female surgeons have been reported to be unmarried or to have married later in life at a higher rate than their male colleagues; many of them also choose not to have children or to have fewer and to have them later in life. These disparities are partly due to the issues connected to invisible work (e.g. household management), the difficulties of managing pregnancy during surgical residency, the challenges women face when returning to work following maternity leave, and the lack of a supportive environment. Flexible work schedules, implementation of childcare facilities, introduction and encouragement of paternity leave for surgeons, and enforcement of mentorship and sponsorship for female surgeons are some of the proposed solutions for building a fair and equitable work culture for all surgeons and overthrowing old, conventional ideas concerning gender roles. Moreover, technology has been advocated as a possible solution to gender discrimination in surgical departments; technology could facilitate an objective assessment of surgical performances and advanced training for surgeons unable to attend in-person education. A healthy, thriving, organized, supportive, and culturally transformed work environment could benefit surgeon and staff productivity and ultimately improve patient care.