Background: The incidence of the highly morbid and potentially lethal gangrenous cholecystitis was reportedly increased during the COVID-19 pandemic. The aim of the ChoCO-W study was to compare the clinical findings and outcomes of acute cholecystitis in patients who had COVID-19 disease with those who did not. Methods: Data were prospectively collected over 6 months (October 1, 2020, to April 30, 2021) with 1-month follow-up. In October 2020, Delta variant of SARS CoV-2 was isolated for the first time. Demographic and clinical data were analyzed and reported according to the STROBE guidelines. Baseline characteristics and clinical outcomes of patients who had COVID-19 were compared with those who did not. Results: A total of 2893 patients, from 42 countries, 218 centers, involved, with a median age of 61.3 (SD: 17.39) years were prospectively enrolled in this study; 1481 (51%) patients were males. One hundred and eighty (6.9%) patients were COVID-19 positive, while 2412 (93.1%) were negative. Concomitant preexisting diseases including cardiovascular diseases (p < 0.0001), diabetes (p < 0.0001), and severe chronic obstructive airway disease (p = 0.005) were significantly more frequent in the COVID-19 group. Markers of sepsis severity including ARDS (p < 0.0001), PIPAS score (p < 0.0001), WSES sepsis score (p < 0.0001), qSOFA (p < 0.0001), and Tokyo classification of severity of acute cholecystitis (p < 0.0001) were significantly higher in the COVID-19 group. The COVID-19 group had significantly higher postoperative complications (32.2% compared with 11.7%, p < 0.0001), longer mean hospital stay (13.21 compared with 6.51 days, p < 0.0001), and mortality rate (13.4% compared with 1.7%, p < 0.0001). The incidence of gangrenous cholecystitis was doubled in the COVID-19 group (40.7% compared with 22.3%). The mean wall thickness of the gallbladder was significantly higher in the COVID-19 group [6.32 (SD: 2.44) mm compared with 5.4 (SD: 3.45) mm; p < 0.0001]. Conclusions: The incidence of gangrenous cholecystitis is higher in COVID patients compared with non-COVID patients admitted to the emergency department with acute cholecystitis. Gangrenous cholecystitis in COVID patients is associated with high-grade Clavien-Dindo postoperative complications, longer hospital stay and higher mortality rate. The open cholecystectomy rate is higher in COVID compared with non -COVID patients. It is recommended to delay the surgical treatment in COVID patients, when it is possible, to decrease morbidity and mortality rates. COVID-19 infection and gangrenous cholecystistis are not absolute contraindications to perform laparoscopic cholecystectomy, in a case by case evaluation, in expert hands. Graphical

Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy and a leading cause of cancer-related death in both the developed and developing world. Recurrent HCC (rHCC) develops in a significant proportion of patients even following curative-intent resection. In the absence of a structured treatment algorithm, a number of treatment options including repeat hepatectomy (RH) and radiofrequency ablation (RFA) have been utilized in select patients with rHCC. The aim of this systematic review and meta-analysis was to compare short- and long-term outcomes of patients undergoing RHR versus RFA for rHCC. Four electronic databases were screened until September 2022. A total of 17 studies were included in the meta-analysis. Overall and disease-free survival were comparable among the two groups. Patients undergoing RH were less likely to develop a second recurrence (RR 0.89, 95% C.I. 0.81 to 0.98, p = 0.02). Overall and major morbidity were significantly increased in the RH group (RR 3.01, 95% C.I. 1.98 to 4.56, p < 0.001 and RR 3.65, 95% C.I. 2.07 to 6.43, p < 0.001, respectively), while mortality was similar between RFA and RH. The data demonstrated that RFA is a safe and efficient alternative to RH for selected patients with rHCC. Nevertheless, despite higher morbidity associated with RH, repeat resection remains the preferred treatment option whenever feasible, as it allows for better local disease control.

Primary mesenteric tumors (PMTs) are rare, often presenting asymptomatically until large enough to compress adjacent structures. We present a case of a 36-year-old female with atypical post-cesarean abdominal pain. Imaging revealed an 11 × 10 cm mesenteric mass suggestive of sarcoma or desmoid tumor. Surgical exploration identified a mass involving the mesentery and ileum, necessitating resection of both, along with venous reconstruction of the superior mesenteric vein using a cadaveric graft. A postoperative complication due to venous stasis required a second operation with right colectomy and jejuno-transverse anastomosis. Final pathology confirmed desmoid-type mesenteric fibromatosis. The patient recovered well and remains disease-free and asymptomatic 12 months postoperatively. This case highlights the diagnostic and therapeutic challenges of PMTs, the importance of surgical expertise in vascular reconstruction, and the need for individualized treatment planning to achieve complete tumor resection while minimizing complications such as short bowel syndrome.

Background/Objectives: Liver metastasis develops in approximately 50% of patients with colorectal cancer. Invasion of the biliary tract from colorectal liver metastasis (CRLM) is rarely reported. Preoperative diagnosis remains elusive, prohibiting optimal surgical management. The objective of this systematic review was to summarize the clinical, radiological, pathological, and treatment characteristics of ibCRLM and describe the reported outcomes. Methods: A systematic literature search of the Medline, Embase, Web of Science, CENTRAL, and CINAHL databases was undertaken for studies reporting clinical outcomes of patients with ibCRLM, up to May 2026. An individual patient data analysis approach was utilized. Results: Thirty-eight case reports and 10 case-series, incorporating 228 patients with biliary involvement from CRLM, were identified. Mean age was 62.4 ± 10.9 years, with a male-to-female ratio of 3.2:1. The majority of metastatic lesions were metachronous in 71.1% and solitary in 59.1% of patients. Surgical treatment was implemented in 89.2% of patients. Major hepatectomy was the most common procedure, being performed in 46.2% of patients, followed by minor hepatectomy in 38.7% and pancreatoduodenectomy in 4.3%. After a median follow-up of 52.5 months (range 2–164 months), the survival rate was 60.5%. Non-survivors were found to have significantly more synchronous CRLM (50% versus 0, p = 0.008), while a single patient did not receive any curative-intent treatment and died 20 days following CRLM presentation. Conclusions: IbCRLM is a distinct clinicopathological presentation of CRLM with characteristic radiological and pathological features. The available evidence suggests that selected patients may achieve favorable long-term outcomes following complete surgical resection, although these findings should be interpreted with caution given the limitations of the available literature.

Primary hepatic perivascular epithelioid cell tumors (PEComas) are rare mesenchymal neoplasms that involve both melanocytic and smooth muscle differentiation. Primary hepatic PEComas remain a challenging condition for radiologists, pathologists, and surgeons. Our review provides an updated, clinically oriented synthesis of the available evidence on primary hepatic PEComas, integrating recent developments in diagnosis, imaging, histopathology, molecular biology, prognostic stratification, surgical and systemic treatment, and long-term surveillance. Although the majority of hepatic PEComas generally exhibit a slowly progressive clinical course, a small subgroup of them is characterized by aggressive biological behavior with an increased risk of recurrence, distant metastases, and disease-related mortality. As PEComas can resemble other hypervascular liver lesions such as hepatocellular carcinoma and hemangioma, preoperative diagnosis based on imaging techniques can be very difficult. Furthermore, the final diagnosis is usually made by histopathological examination of the surgical specimen, which reports characteristic expression of both smooth muscle markers and melanocytic markers such as HMB-45 and Melan-A. Although mTOR inhibitors have demonstrated antitumor activity in advanced PEComas, evidence specifically supporting their use in primary hepatic PEComas remains limited. Prognostic stratification, treatment selection, and long-term follow-up of primary hepatic PEComa remain major challenges. Further multicenter studies are needed to improve risk assessment and develop evidence-based guidelines for the management of these rare primary liver neoplasms.