{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T06:46:22Z","timestamp":1792737982008,"version":"4.5.0"},"reference-count":27,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:00:00Z","timestamp":1760140800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Cancers"],"abstract":"<jats:p>Background: Hepatopancreatobiliary (HPB) surgery is among the most complex domains in oncologic care, where decisions entail significant risk\u2013benefit considerations. Artificial intelligence (AI) has emerged as a promising tool for improving individualized decision-making through enhanced risk stratification, complication prediction, and survival modeling. However, its role in HPB oncologic surgery has not been comprehensively assessed. Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered with PROSPERO ID: CRD420251114173. A comprehensive search across six databases was performed through 30 May 2025. Eligible studies evaluated AI applications in risk\u2013benefit assessment in HPB cancer surgery. Inclusion criteria encompassed peer-reviewed, English-language studies involving human s ubjects. Two independent reviewers conducted study selection, data extraction, and quality appraisal. Results: Thirteen studies published between 2020 and 2024 met the inclusion criteria. Most studies employed retrospective designs with sample sizes ranging from small institutional cohorts to large national databases. AI models were developed for cancer risk prediction (n = 9), postoperative complication modeling (n = 4), and survival prediction (n = 3). Common algorithms included Random Forest, XGBoost, Decision Trees, Artificial Neural Networks, and Transformer-based models. While internal performance metrics were generally favorable, external validation was reported in only five studies, and calibration metrics were often lacking. Integration into clinical workflows was described in just two studies. No study addressed cost-effectiveness or patient perspectives. Overall risk of bias was moderate to high, primarily due to retrospective designs and incomplete reporting. Conclusions: AI demonstrates early promise in augmenting risk\u2013benefit assessment for HPB oncologic surgery, particularly in predictive modeling. However, its clinical utility remains limited by methodological weaknesses and a lack of real-world integration. Future research should focus on prospective, multicenter validation, standardized reporting, clinical implementation, cost-effectiveness analysis, and the incorporation of patient-centered outcomes.<\/jats:p>","DOI":"10.3390\/cancers17203292","type":"journal-article","created":{"date-parts":[[2025,10,14]],"date-time":"2025-10-14T07:51:28Z","timestamp":1760428288000},"page":"3292","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Artificial Intelligence for Risk\u2013Benefit Assessment in Hepatopancreatobiliary Oncologic Surgery: A Systematic Review of Current Applications and Future Directions on Behalf of TROGSS\u2014The Robotic Global Surgical Society"],"prefix":"10.3390","volume":"17","author":[{"given":"Aman","family":"Goyal","sequence":"first","affiliation":[{"name":"Department of General Surgery, Mahatma Gandhi Medical College and Research Institute, Sri Balaji Vidhyapeeth, Pondicherry-Cuddalore Rd., ECR, Pillayarkuppam 607402, Puducherry, India"},{"name":"Adesh Institute of Medical Sciences and Research, Bathinda 151109, Punjab, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michail","family":"Koutentakis","sequence":"additional","affiliation":[{"name":"Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, 02-927 Warsaw, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1291-1838","authenticated-orcid":false,"given":"Jason","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0481-8187","authenticated-orcid":false,"given":"Christian A.","family":"Macias","sequence":"additional","affiliation":[{"name":"Department of Health and Science, Hillsborough College, Tampa, FL 33614, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isaac","family":"Ballard","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77304, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2913-8682","authenticated-orcid":false,"given":"Shen Hong","family":"Law","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Hospital Seri Manjung, Perak 32040, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6015-3443","authenticated-orcid":false,"given":"Abhirami","family":"Babu","sequence":"additional","affiliation":[{"name":"School of Medicine, Our Lady of Fatima University, Manila 1440, Philippines"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ehlena Chien Ai","family":"Lau","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Manipal University College Malaysia, Melaka 75150, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-8866-886X","authenticated-orcid":false,"given":"Mathew","family":"Mendoza","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX 77021, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Susana V. J.","family":"Acosta","sequence":"additional","affiliation":[{"name":"Universidad Central de Venezuela, Caracas 1051, Venezuela"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3408-4540","authenticated-orcid":false,"given":"Adel","family":"Abou-Mrad","sequence":"additional","affiliation":[{"name":"Department of Surgery, Centre Hospitalier Universitaire d\u2019Orl\u00e9ans, 45100 Orl\u00e9ans, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9777-9588","authenticated-orcid":false,"given":"Luigi","family":"Marano","sequence":"additional","affiliation":[{"name":"Department of Medicine, Academy of Applied Medical and Social Sciences-AMiSNS, Akademia Medycznych I Spolecznych Nauk Stosowanych, 82-300 Elbl\u0105g, Poland"},{"name":"Department of General Surgery and Surgical Oncology, \u201cSaint Wojciech\u201d Hospital, \u201cNicolaus Copernicus\u201d Health Center, 80-462 Gda\u0144sk, Poland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3784-6555","authenticated-orcid":false,"given":"Rodolfo J.","family":"Oviedo","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sam Houston State University College of Osteopathic Medicine, Conroe, TX 77304, USA"},{"name":"Department of Surgery, University of Houston Tilman J. Fertitta Family College of Medicine, Houston, TX 77021, USA"},{"name":"Department of Surgery, Nacogdoches Medical Center, Nacogdoches, TX 75965, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,11]]},"reference":[{"key":"ref_1","first-page":"309","article-title":"Hepatopancreaticobiliary Surgical Outcomes at a Community Hospital","volume":"81","author":"Ehnstrom","year":"2022","journal-title":"Hawaii J. Health Soc. Welf."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.14701\/ahbps.2020.24.1.1","article-title":"Hepatobiliary and Pancreatic Surgery in the Elderly: Current Status","volume":"24","author":"Papis","year":"2020","journal-title":"Ann. Hepato-Biliary-Pancreat. Surg."},{"key":"ref_3","unstructured":"Hendrix, J.M., and Garmon, E.H. (2025). American Society of Anesthesiologists Physical Status Classification System. 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