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.

Gallbladder polyps (GPs) are protrusions of the gallbladder wall into the lumen, and are commonly detected during ultrasound examinations. Traditional management of multiple GPs (MGPs) has been conservative, including lifestyle interventions, regular monitoring, and surgical intervention in certain cases, but this approach poses risks of polyps enlargement and increase of number, as well as patients’ psychological burdens. Danning Tablets, a traditional Chinese medicine, have emerged as a potential non-surgical treatment for GPs, showing promise in reducing polyp size and alleviating symptoms, backed by their anti-inflammatory and antitumor properties demonstrated in preclinical studies. This suggests the need for further research into Danning Tablets as an alternative treatment for MGPs.

The study is designed as a prospective, randomized, controlled, open-label trial. The study will be conducted across multiple centres specializing in gastroenterology and hepatology. Participants will be recruited from these centres, ensuring a diverse patient demographic. Adult patients diagnosed with MGPs, based on ultrasound findings, will be included. Exclusion criteria include patients with a history of gallbladder cancer, previous gallbladder surgery, or serious comorbid conditions. The control group will receive standard care, including dietary and lifestyle advice, while the intervention group will receive Danning Tablets and standard care. The dosage and administration of Danning Tablets will follow established clinical guidelines. The primary outcome will be the change in size of the largest gallbladder polyps on week 24 ± 1, measured by ultrasound. The secondary outcomes will include symptom improvement and recording of any adverse events. The study will span over a period of 6 months, with periodic assessments at baseline, 4, 8, 12, and 24 weeks.