Hepato-Pancreato-Biliary Surgery in the Era of Immunotherapy

Dear Colleagues,

Immunotherapy has reshaped oncology by harnessing the immune system to recognize and eliminate cancer cells. In hepatobiliary (HPB) malignancies, where treatment options have traditionally been limited, immune checkpoint inhibitors (ICIs) targeting PD-1/PD-L1—often combined with agents such as bevacizumab or tyrosine kinase inhibitors—are creating new therapeutic opportunities. A particularly striking development is the potential for conversion surgery. Tumor regression achieved with immunotherapy can allow patients with initially unresectable disease to undergo curative resection, a scenario rarely possible with older systemic therapies. Moreover, prolonged survival in patients responding to immunotherapy has introduced new clinical situations, such as the resection of additional, unrelated malignancies while metastatic disease remains controlled. These changes highlight an evolving role for surgery in the era of immunotherapy. Questions now arise regarding patient selection, timing of surgery, perioperative outcomes, and the long-term survival of these novel surgical candidates.

This special issue will bring together studies and expert perspectives to explore how immunotherapy is transforming HPB surgery. By examining indications, surgical outcomes, and emerging challenges, we aim to define the opportunities and future directions of surgery for HPB malignancies in the immunotherapy era.

Dr. Niv Pencovich
Guest Editor

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