{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:56:32Z","timestamp":1790610992486,"version":"4.1.0"},"reference-count":16,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T00:00:00Z","timestamp":1790553600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Immunotherapy has revolutionized cancer treatment with remarkable outcomes, expanding treatment options and enabling new surgical opportunities for patients with previously unresectable disease. This descriptive study examines the impact of immunotherapy on the volume and nature of hepato-pancreato-biliary (HPB) surgeries in a large referral center and reviews the current literature.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Analysis included consecutive surgeries performed in a referral HPB unit between January 1, 2020, and June 1, 2025. Patients undergoing HPB surgery following immunotherapy-based treatment, in clinical scenarios historically infrequently considered for surgery, were identified. Surgical volume trends, indications, perioperative outcomes, and oncologic follow-up were assessed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Of 1,306 surgeries, 22 (1.6%) were performed in patients who received immunotherapy-based treatment prior to surgical consideration. The proportion of these patients increased from 0.71% in 2020 to over 4% in 2025. Surgical indications were divided into three main patterns; patients who were downstaged to resectability, those in whom the primary disease was controlled by immunotherapy and developed new resectable cancer, and those in whom surgery was used as an adjunct to immunotherapy. Notably, the proportion of complex procedures increased over the study period, reflecting growing surgical experience and confidence in the durability of immunotherapy responses.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>Immunotherapy is reshaping the role of HPB surgery by expanding the spectrum of clinical scenarios in which surgical intervention may be considered. These findings highlight the evolving integration of surgery within multidisciplinary cancer care in the immunotherapy era and the need for refined patient selection and clearer operative indications.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2026.1862622","type":"journal-article","created":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:13:05Z","timestamp":1790608385000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Evolving patterns of hepato-pancreato-biliary surgery in the immunotherapy era"],"prefix":"10.3389","volume":"17","author":[{"given":"Ya\u2019ara","family":"Gutman","sequence":"first","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ofer","family":"Margalit","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shira","family":"Golan","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ron","family":"Pery","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rony","family":"Eshkenazy","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Talia","family":"Golan","sequence":"additional","affiliation":[{"name":"Department of Oncology, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ido","family":"Nachmany","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Niv","family":"Pencovich","sequence":"additional","affiliation":[{"name":"Department of General Surgery and Transplantation, Sheba Medical Center, Tel-Hashomer, Gray Faculty of Medicine and Health Sciences, Tel-Aviv University","place":["Tel-Aviv, Israel"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,9,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1159\/000514313","article-title":"Downstaging and resection of initially unresectable hepatocellular carcinoma with tyrosine kinase inhibitor and anti-PD-1 antibody combinations","volume":"10","author":"Zhu","year":"2021","journal-title":"Liver Cancer"},{"key":"B2","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.1046584","article-title":"Lenvatinib plus anti-PD-1 therapy represents a feasible conversion resection strategy for patients with initially unresectable hepatocellular carcinoma: a retrospective study","volume":"12","author":"Yi","year":"2022","journal-title":"Front Oncol"},{"key":"B3","doi-asserted-by":"publisher","DOI":"10.1002\/cnr2.70244","article-title":"Emerging trends in neoadjuvant immunotherapy for hepatocellular carcinoma: a focus on liver transplant candidates","volume":"8","author":"Yu","year":"2025","journal-title":"Cancer Rep (Hoboken)"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1383978","article-title":"Frontiers and future of immunotherapy for pancreatic cancer: from molecular mechanisms to clinical application","volume":"15","author":"Zheng","year":"2024","journal-title":"Front Immunol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.1038\/s41698-024-00681-z","article-title":"Barriers and opportunities in pancreatic cancer immunotherapy","volume":"8","author":"Ju","year":"2024","journal-title":"NPJ Precis Oncol"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2026.1811918","article-title":"Perioperative immunotherapy for hepatocellular carcinoma: adjuvant, neoadjuvant, and biomarker-guided strategies","volume":"13","author":"Li","year":"2026","journal-title":"Front Med (Lausanne)"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.1097\/01.sla.0000133083.54934.ae","article-title":"Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey","volume":"240","author":"Dindo","year":"2004","journal-title":"Ann Surg"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.1038\/s41467-020-17670-y","article-title":"A decade of immune-checkpoint inhibitors in cancer therapy","volume":"11","author":"Robert","year":"2020","journal-title":"Nat Commun"},{"key":"B9","doi-asserted-by":"publisher","DOI":"10.26355\/eurrev_202308_33287","article-title":"Neoadjuvant immunotherapy for resectable hepatocellular carcinoma: a systematic review and meta-analysis","volume":"27","author":"Han","year":"2023","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"B10","doi-asserted-by":"publisher","DOI":"10.1007\/s12029-025-01237-5","article-title":"Neoadjuvant pembrolizumab enables successful downstaging and resection of borderline resectable MSI-H\/dMMR pancreatic ductal adenocarcinoma: a case report and literature review","volume":"56","author":"Zhao","year":"2025","journal-title":"J Gastrointest Cancer"},{"key":"B11","doi-asserted-by":"publisher","DOI":"10.3389\/fimmu.2024.1355812","article-title":"Neoadjuvant systemic therapy for hepatocellular carcinoma","volume":"15","author":"Chick","year":"2024","journal-title":"Front Immunol"},{"key":"B12","doi-asserted-by":"publisher","DOI":"10.1016\/S1470-2045(24)00457-1","article-title":"Pathological response following neoadjuvant immune checkpoint inhibitors in patients with hepatocellular carcinoma: a cross-trial, patient-level analysis","volume":"25","author":"D\u2019Alessio","year":"2024","journal-title":"Lancet Oncol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.1016\/j.hpb.2024.04.003","article-title":"Neoadjuvant therapy leads to objective response in intrahepatic cholangiocarcinoma","volume":"26","author":"Van Treeck","year":"2024","journal-title":"HPB"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1038\/s43018-025-00990-7","article-title":"The rapidly evolving paradigm of neoadjuvant immunotherapy across cancer types","volume":"6","author":"Awada","year":"2025","journal-title":"Nat Cancer"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.2147\/jhc.s340935","article-title":"Neoadjuvant immunotherapy for hepatocellular carcinoma","volume":"9","author":"Marron","year":"2022","journal-title":"J Hepatocell Carcinoma"},{"key":"B16","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2024.1367450","article-title":"FusionVAC22_01: a phase I clinical trial evaluating a DNAJB1-PRKACA fusion transcript-based peptide vaccine combined with immune checkpoint inhibition for fibrolamellar hepatocellular carcinoma and other tumor entities carrying the oncogenic driver fusion","volume":"14","author":"Hackenbruch","year":"2024","journal-title":"Front Oncol"}],"container-title":["Frontiers in Immunology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1862622\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T15:13:06Z","timestamp":1790608386000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fimmu.2026.1862622\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,9,28]]},"references-count":16,"alternative-id":["10.3389\/fimmu.2026.1862622"],"URL":"https:\/\/doi.org\/10.3389\/fimmu.2026.1862622","relation":{},"ISSN":["1664-3224"],"issn-type":[{"value":"1664-3224","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,28]]},"article-number":"1862622"}}