Dear Colleagues,

Liver and biliary tract disorders have always drawn the interest of the scientific community due to their heterogeneity, high frequency, and different treatment possibilities.

Nowadays, we are witnessing a change in the profile of hepatobiliary pathologies thanks to diagnostic and therapeutic innovations in various medical fields.

Developments in the radiological field, with the introduction of new CT, MRI, and study of liver volumetry methods, allow us to obtain more significant structural and functional information on hepatobiliary anomalies and healthy liver tissue. Furthermore, interventional radiology has substantially expanded through new avenues of approach and more accurate technologies. Radiological procedures, such as TACE, TARE, and RFA, have given rise to practical therapeutic strategies in patients with a more significant clinical risk. Percutaneous procedures have also increased the frequency of liver tissue sampling.

Consequently, advancements have been achieved in the anatomopathological field in microscopic anatomy, immunohistochemistry, and molecular biology. Genomic sequencing through NGS is becoming increasingly relevant in early diagnosis and pharmacological and surgical treatment plans.

New pharmacological therapies have definitively made it possible to cure liver diseases considered intractable until a decade ago.

Furthermore, in the oncology field, classic antineoplastic drugs are now supported by many biological medicines that change the therapeutic history of hepatobiliary tumors.

Finally, artificial intelligence (AI) and machine learning will accelerate all ongoing evolutionary processes and will provide the possibility of opening new, as yet unknown, horizons.

In the surgical field, the minimally invasive approach allows the surgical treatment of patients who cannot clinically tolerate a laparotomy. Furthermore, laparoscopy and robotics allow high oncological radicality, reducing the rate of perioperative complications and the risks related to reoperation. Therefore, surgical treatment can be performed on more patients, even for a different number of times. In oncology, minimally invasive hepatobiliary surgery for oncological purposes has similar outcomes as other treatments, becoming an effective and repeatable step within the paradigm of integrated oncological therapies.

Liver transplantation has also undergone various innovations, thanks to new technologies for the preservation and extra-corporeal analysis of the liver graft through hypothermic and normothermic machine perfusions. The minimally invasive approach is also increasingly affecting the different phases of liver transplantation, which will lose its characteristic of being an invasive method by definition over the years. Living liver transplantation increasingly benefits from minimally invasive surgery, establishing itself as an increasingly feasible step in hepatobiliary oncology.

In the coming years, the advances listed in the various medical disciplines will lead to a change in the clinical–pathological characteristics and treatment plans in hepatobiliary surgery.

Therefore, the scientific community must be ready to feel the new panorama in the hepatobiliary field to describe the patient's status better and discuss the new paradigms to be reached and addressed in the surgical area.

This Special Issue aims to outline the new lines of research that will be followed in the coming decades in evaluating, diagnosing, and treating patients in hepatobiliary surgery.

Furthermore, the editors invite the scientific community to propose the most innovative and exciting challenges to outline the future of hepatobiliary surgery. Therefore, the aim of the Special Issue is to involve all healthcare branches in presenting their ideas in the context of the diagnosis and integrated treatment of patients with liver disease.

Dr. Marco Maria Pascale
Dr. Alfonso W. Avolio
Guest Editors

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• hepatobiliary surgery
• liver transplant
• minimally invasive surgery
• hepatocarcinoma
• cholangiocarcinoma
• hepatobiliary disorders
• benign hepatobiliary disease