Background: Postoperative liver injury remains a major challenge after curative-intended liver resection for hepatocellular carcinoma (HCC), impacting both early complications and long-term survival. The recently introduced SAAR (Sum of AST/ALT Ratios) score may serve as a novel marker for predicting postoperative outcomes. Methods: This retrospective single-center study included 213 patients undergoing liver resection for HCC between January 2007 and October 2024. The SAAR score was calculated using AST/ALT ratios on postoperative days 1 and 3 and correlated with post-hepatectomy liver failure (PHLF), disease-free survival (DFS), and overall survival (OS). The predictive performance of the SAAR score was compared with that of the combined APRI + ALBI score. Results: Patients with SAAR ≥ 2 showed significantly higher rates of PHLF (OR = 2.5, p = 0.019) and impaired long-term outcomes. Median DFS and OS were significantly reduced in the SAAR ≥ 2 group (7 vs. 24 months, p < 0.001; 12 vs. 32 months, p = 0.004, respectively). Multivariate Cox regression confirmed SAAR ≥ 2 as an independent predictor for DFS (HR = 2.1) and OS (HR = 1.9). The APRI + ALBI score also demonstrated strong preoperative predictive value for PHLF (AUC = 0.854) but not for long-term outcome.

Background.: Several viability tests, including lactate clearance and bile production, are used to evaluate livers during normothermic machine perfusion (NMP). However, specific cutoff values and therapeutic consequences vary significantly. The noninvasive ¹³ C-methacetin liver function breath test (LiMAx) was developed to measure the actual liver function capacity. This might also provide useful insights into graft function during NMP. Methods.: Therefore, we used an established porcine model of prolonged static cold storage (pSCS) and subsequent NMP for additional functional monitoring with the LiMAx test. Livers obtained from 9 pigs underwent NMP for 6 h directly after procurement (control group) or after 20 h of SCS (pSCS). After 6 h of NMP, the LiMAx test was performed using a liver weight-adjusted dose of ¹³ C-methacetin. Results.: After pSCS, transaminase and cholestasis parameters were found to be elevated in the perfusate and reduced lactate clearance was measured. Bile analyses further revealed reduced bile production and elevated glucose concentrations. In line with these results, the LiMAx test also showed significantly reduced values compared with the control group, with a mean value of 57.0 µg/kg/h compared with 182.0 µg/kg/h in the control group ( P = 0.032). Conclusions.: Therefore, we suggest the LiMAx test as a novel diagnostic tool for evaluating donor organs during NMP.

Background/Objectives: Early and complete (R0) surgical resection is essential for optimal outcomes in pancreatic cancer. Optical coherence tomography (OCT) combined with artificial intelligence (AI) may offer real-time intraoperative guidance, potentially reducing reliance on frozen sections. This ex vivo study evaluated convolutional neural networks (CNNs) for distinguishing pancreatic ductal adenocarcinoma (PDAC) from normal pancreatic tissue in OCT images obtained ex vivo. Methods: Between October 2020 and April 2021, OCT scans were obtained from resected pancreatic specimens of 27 adult patients. Tumor and adjacent normal tissue were imaged using a 1310 nm OCT system, followed by histopathological confirmation. A total of 25 PDAC and 30 non-malignant scans were preprocessed and analyzed using cross-validated CNN models (ResNet50, DenseNet121, and MobileNetV2) with both 2D and 3D inputs. Results: Using five-fold stratified cross-validation on 9040 2D and 3000 3D samples (224 px resolution), the 3D DenseNet121 model achieved the highest performance, with an F1-score of 0.74, sensitivity of 72%, and specificity of 81%. Other architectures demonstrated comparable results. Conclusions: AI-assisted OCT can accurately differentiate PDAC from normal pancreatic tissue ex vivo, supporting its potential as a rapid intraoperative diagnostic adjunct. Further studies are warranted to assess its in vivo performance and utility in evaluating resection margins.