Sarcopenia is a skeletal muscle disorder characterized by reduced muscle mass, strength, and performance. Muscle ultrasound can be helpful in assessing muscle mass, quality, and architecture, and thus possibly useful for diagnosing or screening sarcopenia. The objective of this study was to evaluate the reliability of ultrasound assessment of tibialis anterior muscle in sarcopenia diagnosis. We included subjects undergoing total or partial hip replacement, comparing measures with a healthy control group. We measured the following parameters: tibialis anterior muscle thickness, echogenicity, architecture, stiffness, skeletal muscle index (SMI), hand grip strength, and sarcopenia related quality of life evaluated through the SarQoL questionnaire. We included 33 participants with a mean age of 54.97 ± 23.91 years. In the study group we found reduced tibialis anterior muscle thickness compared to the healthy control group (19.49 ± 4.92 vs. 28.94 ± 3.63 mm, p < 0.05) with significant correlation with SarQoL values (r = 0.80, p < 0.05), dynamometer hand strength (r = 0.72, p < 0.05) and SMI (r = 0.76, p < 0.05). Moreover, we found reduced stiffness (32.21 ± 12.31 vs. 27.07 ± 8.04 Kpa, p < 0.05). AUC measures of ROC curves were 0.89 predicting reduced muscle strength, and 0.97 predicting reduced SMI for tibialis anterior muscle thickness, while they were 0.73 and 0.85, respectively, for muscle stiffness. Our findings showed that ultrasound assessment of tibialis anterior muscle might be considered a reliable measurement tool to evaluate sarcopenia.

Perihilar cholangiocarcinomas (pCCA) are rare yet aggressive tumors originating from the bile ducts. While surgery remains the mainstay of treatment, only a minority of patients are amenable to curative resection, and the prognosis of unresectable patients is dismal. The introduction of liver transplantation (LT) after neoadjuvant chemoradiation for unresectable pCCA in 1993 represented a major breakthrough, and it has been associated with 5-year survival rates consistently >50%. Despite these encouraging results, pCCA has remained a niche indication for LT, which is most likely due to the need for stringent candidate selection and the challenges in preoperative and surgical management. Machine perfusion (MP) has recently been reintroduced as an alternative to static cold storage to improve liver preservation from extended criteria donors. Aside from being associated with superior graft preservation, MP technology allows for the safe extension of preservation time and the testing of liver viability prior to implantation, which are characteristics that may be especially useful in the setting of LT for pCCA. This review summarizes current surgical strategies for pCCA treatment, with a focus on unmet needs that have contributed to the limited spread of LT for pCCA and how MP could be used in this setting, with a particular emphasis on the possibility of expanding the donor pool and improving transplant logistics.

Background Traditional outcome assessment after liver surgery mainly relies on perioperative mor-bidity and mortality. However, these parameters fail to capture the multidimensional recovery experienced by patients after hepatic resection. This study aimed to evaluate perioperative quality of life (QoL) trajectories using Patient-Reported Outcome Measures (PROMs) and to identify predictors of impaired postoperative recovery. Methods A prospective observational study was conducted including 71 consecutive patients undergoing liver resection at a tertiary hepatobiliary referral center between May 2024 and May 2025. QoL was assessed preoperatively and three months after surgery using the EORTC QLQ-C30 and QLQ-LMC21 questionnaires. PROMs were correlated with de-mographic, clinical, operative, and postoperative variables. Univariable and multivar-iable analyses were performed to identify factors associated with worse postoperative QoL. Results Significant improvements in postoperative QoL were observed at three months compared with baseline for both the QLQ-C30 and QLQ-LMC21 questionnaires (both p < 0.001). Psychological domains also significantly improved after surgery. Patients with ASA score ≥3 (p = 0.044) and those requiring perioperative blood transfusion (p = 0.011) reported significantly worse postoperative quality-of-life scores. On multivariable regression analysis, Grade B bile leak was associated with impaired postoperative QLQ-C30 out-comes (95% CI 0.75–23.81; p = 0.038). Conclusions Liver resection was associated with significant improvement in patient-reported QoL three months after surgery. PROMs provide clinically relevant information beyond conventional surgical metrics and may help identify patients requiring tailored peri-operative support. The integration of PROMs into liver surgery pathways may contribute to the development of a more patient-centered model of surgical care.

Background: Traditional outcome assessment after liver surgery mainly relies on perioperative morbidity and mortality. However, these parameters fail to capture the multidimensional recovery experienced by patients after hepatic resection. This study aimed to evaluate changes in quality of life (QoL) between the preoperative and three-month postoperative assessments using Patient-Reported Outcome Measures (PROMs) and to identify factors associated with impaired postoperative recovery. Methods: A prospective observational study was conducted including 71 consecutive patients undergoing liver resection at a tertiary hepatobiliary referral center between May 2024 and May 2025. QoL was assessed preoperatively and three months after surgery using the EORTC QLQ-C30 and QLQ-LMC21 questionnaires. PROMs were correlated with demographic, clinical, operative, and postoperative variables. Univariable and multivariable analyses were performed to identify factors associated with worse postoperative QoL. Results: Significant improvements in postoperative QoL were observed at three months compared with baseline in both the QLQ-C30 and QLQ-LMC21 questionnaires (both p < 0.001). Psychological domains also significantly improved after surgery. Patients with ASA scores ≥ 3 (p = 0.044) and those requiring intraoperative blood transfusion (p = 0.011) reported significantly worse postoperative quality-of-life scores. On multivariable regression analysis, Grade B bile leak was associated with impaired postoperative QLQ-C30 outcomes (95% CI 0.75–23.81; p = 0.038). Conclusions: Liver resection was associated with improvement in patient-reported QoL three months after surgery. PROMs provide clinically relevant information beyond conventional surgical metrics and may help identify patients requiring tailored perioperative support. The integration of PROMs into liver surgery pathways may contribute to the development of a more patient-centered model of surgical care.