{
  "abstract": "Background\n\nHepatobiliary oncology is at an inflection point. Parallel advances in surgical technique, locoregional therapy, systemic treatment, and understanding of tumour biology have expanded the boundaries of curative-intent care yet have also exposed a critical reality that technical resectability is not synonymous with oncologic resectability. Technically successful resection or liver transplantation may be futile when tumour biology is aggressive, leading to early recurrence and limited survival benefit. Modern hepatobiliary surgical and transplant oncology must therefore move beyond anatomy-driven decision-making towards biologically informed strategies that incorporate tumour behaviour, treatment response, and temporal disease stability.Summary\n\nThe Asia-Pacific Transplant Oncology Symposium (APTOS) 2024 examined how Eastern and Western paradigms intersect across hepatocellular carcinoma, cholangiocarcinoma, and colorectal liver metastases, identifying pathways towards integration. Eastern and Western programmes have historically approached hepatobiliary oncology through distinct and longstanding philosophies. Eastern centres, frequently operating within living donor liver transplantation-dominant systems characterized by organ scarcity and the ethical principle of double equipoise, have traditionally leveraged high operative volume and technical expertise in complex resections. These environments have favoured surgery-first approaches when resection appears technically feasible, alongside response-driven conversion strategies aimed at expanding operability. Western centres, shaped by deceased-donor allocation frameworks and trial-oriented oncology models, have more consistently prioritized biological selection and longitudinal validation of disease control before proceeding to curative-intent intervention, particularly in borderline-resectable disease. These differences are driven by infrastructural and ethical factors, including donor availability, transplant systems, and biomarker integration, rather than surgical capability. This article is an expert statement reflecting the opinion of an international multidisciplinary faculty of hepatobiliary surgeons, transplant surgeons, hepatologists, and medical and clinical oncologists from Eastern and Western centres. It is a narrative expert perspective and not a formal consensus or guideline.Key messages\n\nThis expert statement proposes that the next phase of hepatobiliary oncology requires harmonized, biology-driven definitions of resectability, transplantability, and futility. Comparative evaluation of regional strategies is essential to clarify how treatment sequencing affects recurrence and survival, an effort that is time-sensitive as advances in systemic therapy may soon obscure strategy-specific effects. Rather than competing models, Eastern procedural expertise and Western biology-centred frameworks should be viewed as complementary, supporting context-dependent or sequential approaches that integrate surgery with biology-guided systemic or locoregional therapy. Aligning these paradigms within ethical stewardship of donor organs can establish globally coherent, biology-driven standards that maximize durable survival while minimizing futile surgery and transplantation.",
  "abstract_shown": true,
  "affiliations": [
    "Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, University Surgical Cluster, National University Hospital, Singapore, Singapore.",
    "Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgery, Alexandra Hospital, Singapore, Singapore.",
    "National University Centre for Organ Transplantation, National University Hospital, Singapore, Singapore.",
    "Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.",
    "Department of Liver Surgery and Liver Transplant Centre, Organ Transplant Centre, West China Hospital of Sichuan University, Chengdu, China.",
    "Department of Gastroenterology and Hepatology, Kindai University, Higashiosaka, Japan.",
    "Department of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.",
    "Liver Transplant Program, UCSF, San Francisco, CA, USA.",
    "Division of Hepatology, HPB Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumouri, Milan, Italy.",
    "Department of Surgery and Cancer, Imperial College London, Faculty of Medicine, Hammersmith Hospital, London, UK.",
    "Department of Translational Medicine (DIMET), University of Piemonte Orientale \"A. Avogadro,\" Novara, Italy.",
    "Department of Haematology-Oncology, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore.",
    "Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.",
    "Department of Transplantation Medicine, University of Oslo, Oslo, Norway.",
    "Department of Clinical Oncology, Chinese University of Hong Kong, Hong Kong, Hong Kong SAR.",
    "Department of HPB and Transplant Surgery, Washington University in St. Louis, St. Louis, MO, USA.",
    "Medical Oncology Department, Hospital Clinic Barcelona, Translational Oncology in Upper Gastrointestinal Cancer Group, IDIBAPS, Barcelona, Spain.",
    "Department of Surgical Oncology, UT Southwestern Medical Centre, Dallas, TX, USA.",
    "Division of Gastroenterology and Hepatology, Toronto General Hospital, Toronto, ON, Canada.",
    "Medical Oncology, Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.",
    "Department of Gastroenterology, Hepatology, Infectious Diseases and Endocrinology, Hannover Medical School, Hannover, Germany.",
    "Department of HPB Surgery, Chiba University, Chiba, Japan.",
    "Department of Surgery, Nagoya University Hospital, Nagoya, Japan.",
    "Department of Liver Transplant Surgery, Ain Shams University, Cairo, Egypt.",
    "Department of Medical Oncology, St. Vincent's University Hospital, Dublin, Ireland.",
    "Department of HPB Surgery, Alexandria University, Alexandria, Egypt.",
    "Cancer Institute, University College London (UCL), UK, and Royal Free NHS Foundation Trust, London, UK.",
    "Department of Surgery, Seoul National University College of Medicine, Seoul, South Korea.",
    "Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.",
    "Department of Haematology and Oncology, UCLA, Los Angeles, CA, USA.",
    "Department of Surgery, The University of Hong Kong, Hong Kong, Hong Kong SAR.",
    "Department of Oncology and Haemato-Oncology, University of Milan, Milan, Italy.",
    "Department of Surgery, Korea University College of Medicine, Seoul, South Korea.",
    "Department of Hepatobiliary Surgery and Liver Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai, China.",
    "Hepatopancreatobiliary Centre, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China.",
    "Department of Paediatric Surgery and Transplantation, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan.",
    "Department of Abdominal, General Surgery and Liver Transplantation, Hospital Universitario Vall d'Hebron, Barcelona, Spain.",
    "Department of General Surgery and Transplantation University Health Network, University of Toronto, Toronto, ON, Canada."
  ],
  "article_type": "review article",
  "arxiv": null,
  "author_total": 35,
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      "name": "Tomoki Ebata"
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      "name": "Mahmoud El-Meteini"
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      "name": "Mohamed Fathy Abdelghafar"
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      "name": "Suk Kyun Hong",
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      "name": "Prashant Bhangui"
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      "name": "Albert C Y Chan"
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      "name": "Jiahong Dong"
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      "name": "Taizo Hibi",
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      "name": "Gonzalo Sapisochin"
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      "name": "Alfred Wei Chieh Kow"
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  "bibtex": "https://research.draconitic.com/paper/6rkaah4stxh0f.bib",
  "cited_by": 0,
  "doi": "10.1159/lic/admag012",
  "fulltext_url": "https://europepmc.org/articles/PMC13685653",
  "id": "6rkaah4stxh0f",
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  "language": "eng",
  "licence": "CC-BY-NC",
  "licence_label": "CC BY-NC",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
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  "native_subjects": [
    [
      "openalex",
      "2721|Hepatocellular Carcinoma Treatment and Prognosis"
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  "pdf_url": "https://europepmc.org/articles/PMC13685653?pdf=render",
  "pmcid": "PMC13685653",
  "pmid": "42910203",
  "published": "2026-09-05",
  "publisher": null,
  "ris": "https://research.draconitic.com/paper/6rkaah4stxh0f.ris",
  "sources": [
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      "first_seen": "2026-10-30T12:20:14Z",
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      "url": "https://europepmc.org/article/MED/42910203"
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  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2721|Hepatocellular Carcinoma Treatment and Prognosis",
      "subfield": "general"
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  ],
  "title": "Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology.",
  "title_text": "Asia-Pacific Transplant Oncology Symposium 2024: Expert Statements on the Current State and Future Direction of Hepatobiliary Surgical and Transplant Oncology.",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:20:14Z",
  "url": "https://research.draconitic.com/paper/6rkaah4stxh0f",
  "venue": "Liver cancer",
  "versions": []
}