Objective: The clinical aim of this work is to predict intraoperative LRC from preoperative CT scans only. Summary of Background Data: Liver resection (LR) is the most prevalent curative treatment for primary liver cancer, yet overall mortality/morbidity rates remain elevated. The conventional definition and classification of LR complexity (LRC) lack inclusion of the disease-induced 3D anatomical surgery complexity. Methods: 3D models of the organ, tumors and blood vessels were generated from Deep Learning models trained on patients CT scans. The surgeons’ expertise on which anatomical factors lead to LRC was translated into a new anatomical frame of reference around the Hepatic Central Zone (HCZ). A fully automatic pipeline to generate the HCZ and quantify the tumors position relative to it was assessed. An AI model was then trained to predict LRC from a patient cohort for whom LRC was annotated at the end of each surgery. The AI-prediction was finally compared to prediction of surgeons that only saw the patient preoperative CT scan. Results: The 3D reconstructions are successfully evaluated on benchmark datasets. The HCZ is accurately generated for a variety of atypical vascular anatomies (dice score 82±4.6%). The automatic pipeline is successfully run on a 145 HCC patient cohort. The predicted LRC outperforms the surgeons’ individual and combined anticipated complexities (accuracy and AUC scores: 79.4±3.4% and 85.1±3.2% respectively). Conclusion: This automatic digital tool accurately predicts intraoperative LRC and paves the way for an innovative oncology surgery planning. This tool could help orient patients towards appropriate medical centers depending on the predicted LRC level.

Background: Biliary tract cancers (BTCs) have distinct tumor biology but share a poor prognosis, with a 5-year-survival-rate of 5–19%. Surgical resection is the only potential cure, but recurrences are common. The role of adjuvant radiotherapy (XRT) remains unclear. Methods: Using the National Cancer Database (2006–2018), we analyzed resected non-metastatic BTCs. Patients who survived beyond 90 days post-surgery were included, while those with R2 resections or neoadjuvant therapy were excluded. Propensity matching was performed based on predictors of adjuvant radiation, age, and sex. Survival outcomes were compared between no adjuvant therapy, chemotherapy alone, and XRT ± chemotherapy. Results: Among 21,275 patients, including 5308 intrahepatic cholangiocarcinoma (IHC), 2689 perihilar cholangiocarcinoma (PHC), 3092 distal cholangiocarcinoma (DCC), and 10,186 gallbladder cancer (GBC) cases, adjuvant XRT did not improve survival for IHC. For PHC and DCC, XRT improved survival over no adjuvant therapy (PHC: 31.2 vs. 26.3 months, p = 0.004; DCC: 33.7 vs. 27.0 months, p = 0.015) but not over chemotherapy alone. For GBC, XRT significantly improved survival compared to both no adjuvant therapy and chemotherapy (30.2 vs. 26.6 and 24.6 months; p = 0.05 and p = 0.001). Conclusions: XRT provides a survival benefit for GBC, especially in node-positive and R1-resected patients. For PHC and DCC, XRT improves outcomes compared to no therapy, but its benefit over chemotherapy is uncertain. No benefit was observed for IHC.

Background: While the clinical use of radiolabeled somatostatin analogs is well established in neuroendocrine tumors, there is growing interest in expanding their application to other somatostatin receptor 2 (SSTR2)-expressing cancers. This study investigates the potential utility of SSTR2-targeted theranostics in hepatocellular carcinoma (HCC). Methods: SSTR2 expression in HCC cell lines and clinical samples was evaluated using qRT-PCR, Western blot analysis, and a public dataset. ⁶⁷Ga-DOTATATE uptake was measured, ¹⁷⁷Lu-DOTATATE cytotoxicity was assessed, and ⁶⁸Ga-DOTATATE tumor targeting was evaluated in HCC animal models and a patient via PET/CT imaging. Results: SSTR2 expression was confirmed in HCC cell lines and clinical samples. Radioligand uptake studies demonstrated SSTR2-mediated ⁶⁷Ga-DOTATATE uptake. ¹⁷⁷Lu-DOTATATE treatment reduced cell proliferation and enhanced the anti-tumor efficacy of the multikinase inhibitor sorafenib. ⁶⁸Ga-DOTATATE PET/CT scans successfully identified tumors in HCC animal models and spinal metastases in a patient with HCC. Conclusion: These findings provide evidence that SSTR2-based theranostics could have significant implications for the detection and treatment of HCC.

(1) Background: Somatostatin receptor 2 (SSTR2), a G protein-coupled receptor, is overexpressed in multiple malignancies, including hepatocellular carcinoma (HCC). While SSTR2 has traditionally been viewed as an inhibitory receptor involved in suppressing hormone secretion and cell proliferation, emerging evidence suggests a more complex role in cancer biology. However, the functional implications of SSTR2 expression in HCC remain poorly understood. This study aimed to systematically investigate the molecular landscape associated with SSTR2 expression in HCC and evaluate its potential as a therapeutic target. (2) Methods: SSTR2 expression patterns across 22 tumor types were assessed using TNMplot, and its expression in HCC was further validated through The Human Protein Atlas. Integrative analysis of transcriptomic profiles, protein expression data, and somatic copy number alterations was performed using data from The Cancer Genome Atlas (TCGA) to stratify HCC patients by SSTR2 expression levels. Gene Ontology (GO) enrichment analysis was conducted via SRplot to uncover biological processes and signaling pathways associated with SSTR2. Kaplan–Meier survival analyses were performed using GEO datasets to determine the prognostic significance of SSTR2 expression. (3) Results: SSTR2 is moderately expressed in the majority of HCC tumors. Elevated SSTR2 expression correlates with significantly poorer overall and disease-specific survival. High SSTR2 levels are associated with activation of oncogenic signaling cascades related to cell proliferation, epithelial-to-mesenchymal transition (EMT), angiogenesis, and metastasis. Additionally, SSTR2 expression is positively correlated with several receptor tyrosine kinases and oncogenes implicated in HCC progression. (4) Conclusions: Our findings suggest that SSTR2 is not merely a passive biomarker but may contribute to HCC pathogenesis through modulation of oncogenic pathways. These data support the rationale for further development of SSTR2-directed therapeutic strategies to inhibit tumor growth and invasion in HCC patients.

Background: Single port (SP) robotic surgery is the latest innovation in robotic surgery. Published evidence is limited and few series are available for SP robotic hepatectomy. The aim of this study was to investigate early feasibility of SP robotic hepatectomy in Europe. Methods: Between February and June 2025, data on true SP and SP plus one robotic hepatectomies were systematically collected at three participating centres. The study focussed on the description of the cohort, feasibility, surgical outcome in terms of blood loss, postoperative complications according to Clavien–Dindo (C–D), specific posthepatectomy complications according to the International Study Group of Liver Surgery (ISGLS) definitions and length of hospital stay (LOS). Results: A total of 12 SP and SP plus one robotic hepatectomies were performed. The cohort comprises six females and six males with a median age of 62 (23.38–78.46) years and a body mass index of 25.9 (21.1–36.3) kg/m ² . The series included seven non-anatomical/subsegment hepatectomies, two left lateral sectionectomies, two right hepatectomies and one segmentectomy. The median length of incision was 3.5 (2.7–4.7) cm plus a Pfannenstiel incision for larger specimen retrieval in two cases. An additional port (10 mm) was used in six cases. No procedure was converted to open, the median blood loss was 100 (0–580) ml. The median LOS was 3.5 days (1–8). According to the C–D classification, complications were categorized as follows: two grade I, two grade II and one grade IIIa complication. None of these met the criteria for ISGLS posthepatectomy complications. Follow-up at 30 days was uneventful in all cases. Conclusion: SP robotic hepatectomy is feasible when performed by experienced hepatobiliary surgeons. Larger series are needed to clearly define safety and the role of SP robotic hepatectomy within the armamentarium of hepatobiliary surgery and support the concept of tailored robotic-assisted surgery (T-RAS).