Hepatocellular carcinoma (HCC) usually develops in cirrhotic liver, with high recurrence rates. However, considering its increasing detection in non-cirrhotic liver, the choice of treatment assumes particular relevance. This study aimed to investigate outcomes of patients among BCLC stages and enrolled for surgical resection (SR) according to a more complex evaluation, to establish its safety and efficacy. A total of 186 selected HCC patients (median age 73.2 yrs), submitted to SR between January 2005 and January 2021, were retrospectively analyzed. Of which, 166 were staged 0, A, B according to the BCLC system, while 20 with a single large tumor (>5 cm) were classified as stage AB. No perioperative mortality was recorded; complications occurred in 48 (25.80%) patients, and all but two were Clavien–Dindo grade I–II. Median follow-up was 9.2 years. Subsequently, 162 recurrent patients (87,1%) were selected for new treatments. Comparable overall survival rates (OS) were observed at 1, 3, 5, and 10 years in 0, A, B and AB stages (p = 0.2). Eventually, the BCLC-B group was matched to 40 BCLC-B patients treated (2015-2021) with TACE. Significant differences in baseline characteristics (p <0.0001) and in OS were observed at 1 and 3 years (p <0.0001); a significant difference was also observed in oncological outcomes, in terms of the absence, residual, or relapse of disease (p <0.05). Surgery might be a valid treatment in HCC for patients affected by chronic liver disease in a condition of compensation, up to BCLC-B stage. Surgical indication for liver resection in case of HCC should be extensively revised.

Hepatocellular carcinoma (HCC) accounts for 75–85% of primary liver malignancies, and elderlies have the highest incidence rates. Direct-acting antiviral agents (DAAs) have shown satisfying results in terms of HCV sustained viral response (SVR). However, data regarding HCC risk post-DAA-SVR is still conflicting. This study aims to consider HCC onset in moderate underlying liver disease. We conducted a retrospective study on 227 chronically infected patients (cHCV), treated with DAAs. Patients were divided into three groups: “de novo occurrent HCC”, “recurrent HCC”, and “without HCC”. Fifty-six patients aged <65 years (yDAA) were studied separately. HCC patients aged ≥65 years (DAA-HCC) were compared to a historical group of 100 elderly HCC patients, treated with peginterferon (Peg-IFN) ± ribavirin antiviral agents, non-SVR (hHCC). The HCC prevalence in DAA patients was 32.75%: “de novo occurrent’’ 18.13% and “recurrent’’ 14.62%, despite 42.85% of them having no fibrosis to mild or moderate fibrosis (F0-F1-F2). yDAA showed 5.36% “de novo occurrent” HCC. Curative procedure rates were compared between DAA-HCC and hHCC at the first and at recurrent presentation (22 (39.29%) vs. 72 (72%); 17 (30.36%) vs. 70 (70%), respectively (p < 0.001)). No significant difference was found in 3-year OS (p = 0.6). However, in cause-specific mortality analysis, HCC-related death was higher in the DAA-treated group, whereas cirrhosis-related death was more common in the historical group (p = 0.0288), considering together the two causes of death. A more accurate patient stratification according to multifactorial and new diagnostic investigations identifying HCC risk might allow an improvement in management and access to curative therapies.

In this chapter we aim at presenting the state of the art in liver surgery. After a brief introduction about natural evolution of hepatocellular carcinoma (HCC) either in cirrhotic or non-cirrhotic patients, this manuscript will focus on planning and timing surgery: CT evaluation of the remnant liver; biopsy and ultrasonography (US) evaluation of liver disease; intraoperative US; surgical techniques, such as major and limited hepatectomies and two-stage hepatectomies, each of them in open or mini-invasive approach; and their possible complications. Follow-up and further interventions during expected recurrences will be highlighted. Our chapter will also treat topics such as patient’s quality of life, importance of multidisciplinary evaluation and the role of surgeon in it.

Background: With the advancement of AI-powered online tools, patients are increasingly turning to AI for guidance on healthcare-related issues. Methods: Acting as patients, we posed eight direct questions concerning a common clinical condition—liver cysts—to four AI chatbots: ChatGPT, Perplexity, Copilot, and Gemini. The responses were collected and compared both among the chatbots and with the current literature, including the most recent guidelines. Results: Overall, the responses from the four chatbots were generally consistent with the literature, with only a few inaccuracies noted. For questions addressing “grey areas” in clinical research, all chatbots provided generalized answers. ChatGPT, Copilot, and Gemini highlighted the lack of conclusive evidence in the literature, while Perplexity offered speculative correlations not supported by data. Importantly, all chatbots recommended consulting a healthcare professional. While Perplexity, Copilot, and Gemini included references in their responses, not all cited sources were academic or of medium/high evidence quality. An analysis of Flesch Readability Ease Scores and Estimated Reading Grade Levels indicated that ChatGPT and Gemini provided the most readable and comprehensible responses. Conclusions: The integration of chatbots into real-world healthcare scenarios requires thorough testing to prevent potentially serious consequences from misuse. While undeniably innovative, this technology presents significant risks if implemented improperly.

In recent decades, the landscape of abdominal oncologic surgery has undergone a transformative shift, largely propelled by remarkable advancements in surgical techniques and integrative treatment modalities

Background: Xanthogranulomatous cholecystitis (XGC) is a rare form of chronic cholecystitis characterized by progressive fibrosis of the gallbladder wall. Its clinical, laboratory, and radiological features often mimic gallbladder carcinoma (GC), making preoperative diagnosis challenging. A definitive diagnosis is usually established by histopathological examination. As XGC may occasionally coexist with malignancy, surgical resection is generally recommended. Case Presentation: A 66‐year‐old woman presented with weight loss, epigastric discomfort, and a palpable mass in the right upper quadrant. Imaging revealed diffuse gallbladder wall thickening and a 33‐mm vascularized mass in the gallbladder fundus, with suspected extension to the liver, transverse colon, and abdominal wall, strongly suggesting GC. Multiple hepatic cysts were also identified. Following multidisciplinary evaluation, laparoscopic exploration was performed. Hepatic and colonic infiltration, distortion of Calot’s triangle, regional lymphadenopathy, and diffuse millimetric liver lesions initially suggested GC with intrahepatic metastases. However, histological examination of biopsied lesions excluded malignancy. After a 4‐month recovery from COVID‐19, the patient experienced clinical improvement and weight gain. Follow‐up computed tomography (CT) showed regression of both the gallbladder mass and hepatic involvement, supporting a benign inflammatory process. During subsequent laparotomy, frozen‐section analysis of the colonic infiltration confirmed inflammatory tissue. Radical cholecystectomy with en bloc resection of the adjacent liver parenchyma was performed. Final histopathology revealed diffuse XGC associated with diffuse biliary hamartomatosis. Conclusion: This case highlights the diagnostic challenge of distinguishing XGC from GC, particularly in the presence of biliary hamartomatosis. A stepwise diagnostic approach and multidisciplinary decision‐making were essential to ensure accurate diagnosis and appropriate management.