Management of adult congenital biliary dilatation (CBD) lacks standardized surgical guidance, particularly for complex intrahepatic and intrapancreatic involvement. Traditional anatomical classifications inadequately address modern surgical decision-making needs. This study aimed to develop and validate a surgery-oriented classification system that guides precise surgical approaches for adult CBD.

A classification system was developed based on anatomical characteristics, disease extent, and corresponding surgical approaches in 234 patients with CBD. Surgical procedures guided by the classification system included hepatectomy, biliary reconstruction, and liver transplantation. The long-term surgical outcomes and perioperative complications were analyzed.

The classification system categorized 234 patients with CBD into the following 4 types with 2 subtypes: Type A-peripheral intrahepatic (12 patients [5.1%]), Type B-central intrahepatic (5 [2.1%]), Type C-extrahepatic (45 [19.2%]), and Type D-combined intra- and extrahepatic (172 [73.5%]). Classification-guided surgery achieved excellent and good outcomes in 84.5% of cases. Major complications (Clavien–Dindo grade ≥ Ⅲ) occurred in 33 (14.1%) patients. Three-year disease-free survival was 71.4%, 100.0%, 89.3%, and 63.0% for Types A to D, respectively (p = 0.026). Type D2 patients, defined as having the most complex disease patterns, had the worst outcomes (3-year disease-free survival: 61.6%).

Our surgery-oriented classification effectively stratified adult CBD and guided the selection of surgical approaches. It shows particular value in managing complex disease patterns, although patients with combined intra- and extrahepatic involvement require careful consideration relative to the extent of surgical management. The standardized approach and validated outcomes of this classification suggest potential for widespread adoption in global surgical practice.

Hepatocellular carcinoma (HCC) is a leading cause of cancer death globally. Despite improved surgical techniques, early post-hepatectomy mortality remains a critical concern. Current staging systems and liver function classifications fail to estimate early mortality risk to guide surgical decision-making. We aimed to develop and validate an individualized online calculator to predict early post-hepatectomy mortality for HCC.

Patients undergoing curative-intent hepatectomy for HCC from 2011 to 2021 at 11 Chinese centers were included. The training cohort comprised nine centers, while the external validation cohort included two centers. Multivariable logistic regression identified predictors of postoperative 90-day mortality, which were incorporated into an online calculator. Discrimination was assessed using the concordance index (C-index) and calibration by graphical plots.

Among 4966 patients, 90-day mortality was 4.1%. Predictors of 90-day mortality included patient performance status, prothrombin time, albumin-bilirubin (ALBI) grade, aspartate aminotransferase to platelet ratio index (APRI), tumor burden score and gross vascular invasion. The model demonstrated excellent discrimination in training and validation (C-index 0.816 and 0.801) cohorts. The proposed model outperformed staging systems (American Joint Committee on Cancer AJCC and Barcelona Clinic Liver Cancer BCLC) and liver function classifications (Child-Pugh, APRI, ALBI, and Fibrosis-4 Index FIB4) (p < 0.001). Calibration was accurate in both cohorts. The calculator achieved sensitivity of 79.0% and specificity of 71.8% to identify high-risk patients. Decision curve analysis demonstrated that the model had superior net benefit compared with staging systems and liver function classifications.

An individualized online calculator was developed and validated to predict early post-hepatectomy mortality for HCC. By identifying high-risk patients, this tool may guide surgical decision-making.

Radiomic features extracted from preoperative contrast-enhanced computed tomography (CT) images have been shown to predict the prognosis of hepatocellular carcinoma (HCC). However, the prognostic role of radiomic features obtained from postoperative contrast-enhanced CT images of the remnant liver remains unclear. This study explored the prognostic value of radiomic features extracted from postoperative contrast-enhanced CT images in patients with HCC.

Robust radiomic features were obtained from postoperative contrast-enhanced CT images for 78 patients with primary HCC and used to construct a radiomics score. A clinical model and a combined model that integrated clinicopathological indicators and the radiomics score were established. The predictive performance of the model was assessed using the concordance index and net reclassification index.

The postoperative radiomics score for the remnant liver was an independent prognostic factor for disease-free survival (DFS) and overall survival (OS). The combined model was not inferior to the clinical model in predicting DFS but was superior in predicting OS. The net reclassification index confirmed that the combined model was more accurate and efficient in predicting OS and DFS. The radiomics score for DFS was significantly associated with tumor thrombus in the portal vein and the postoperative neutrophil-lymphocyte ratio. The radiomics score for OS was associated with multiple tumors, microvascular invasion, and tumor thrombus in the portal vein.

Postoperative contrast-enhanced CT radiomic features of the remnant liver were valuable prognostic indicators that could potentially reflect tumor burden and postoperative inflammatory status and provide more information for clinical decision-making.