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Considering increasingly ambitious pledges by countries and various forms of pressure from current international constellations, society, investors, and clients further up the supply chain, the question for companies is not so much whether to take decarbonisation action, but what action and by when. However, determining an ideal mix of measures to apply ‘decarbonisation efficiency’ requires more than knowledge of technically feasible measures and how to combine them to achieve the most economic outcome: In this paper, working in a ‘backcasting’ manner, the author describes seven aspects which heavily influence the composition of an ‘ideal mix’ that executive leadership needs to take a (strategic) position on. Contrary to previous studies, these aspects consider underlying motivations and span across (socio-)economic, technical, regulatory, strategic, corporate culture, and environmental factors and further underline the necessity of clarity of definitions. How these decisions influence the determination of the decarbonisation-efficient ideal mix of measures is further explored by providing concrete examples. Insights into the choices taken by German manufacturers regarding several of these aspects stem from about 850 responses to the ‘Energy Efficiency Index of German Industry’. Knowledge of the status quo, and clarity in definitions, objectives, time frames, and scope are key.

Intrahepatic cholangiocarcinoma (ICC) is the second most common malignancy arising from the liver. ICC makes up about 10% of all cholangiocarcinomas. It arises from the peripheral bile ducts within the liver parenchyma, proximal to the secondary biliary radicals. Histologically, the majority of ICCs are adenocarcinomas. Only a minority of patients (15%) present with resectable disease, with a median survival of less than 3 years. Multidisciplinary management of ICC is complicated by large differences in disease course for individual patients both across and within tumor stages. Risk models and nomograms have been developed to more accurately predict survival of individual patients based on clinical parameters. Predictive risk factors are necessary to improve patient selection for systemic treatments. Molecular differences between tumors, such as in the epidermal growth factor receptor status, are promising, but their clinical applicability should be validated. For patients with locally advanced disease, several treatment strategies are being evaluated. Both hepatic arterial infusion chemotherapy with floxuridine and yttrium-90 embolization aim to downstage locally advanced ICC. Selected patients have resectable disease after downstaging, and other patients might benefit because of postponing widespread dissemination and biliary obstruction.

What motivates industrial companies to decarbonise? While climate policy has intensified, the specific factors driving corporate decisions remain underexplored. This article addresses that gap through a mixed-methods study combining qualitative insights from a leading automotive supplier with quantitative data from over 800 manufacturing companies in Germany. The study distinguishes between internal motivators—such as risk reduction, future-proofing, and competitive positioning—and external drivers like regulation, supply chain pressure, and investor expectations. Results show that internal economic logic is the strongest trigger: companies act more ambitiously when decarbonisation aligns with their strategic interests. Positive motivators outperform external drivers in both influence and impact on ambition levels. For instance, long-term cost risks were rated more relevant than reputational gains or regulatory compliance. The analysis also reveals how company size, energy intensity, and supply chain position shape motivation patterns. The findings suggest a new framing for climate policy: rather than relying solely on mandates, policies should strengthen intrinsic motivators. Aligning business interests with societal goals is not only possible—it is a pathway to more ambitious, resilient, and timely decarbonisation. By turning external pressure into internal logic, companies can move from compliance to leadership in the climate transition.

The present study aimed to examine the association of the controlling nutritional status (CONUT) score with outcomes in patients undergoing esophagectomy for esophageal cancer (EC). A systematic literature review was carried out to investigate the impact of the CONUT score in EC. Next, meta-analysis of long-term outcomes was performed. The search found six eligible retrospective studies, and five studies with 952 patients were included in the meta-analysis. Meta-analysis found a significant association of the CONUT score with outcomes including overall survival [hazard ratio (HR)=2.51, 95% confidence interval (CI)=1.75-3.60, p<0.001], cancer-specific survival (HR=2.60, 95%CI=1.53-4.41, p<0.001), and recurrence free survival (HR=2.08, 95%CI=1.39-3.12, p<0.001). The CONUT score may be an independent predictor associated with prognosis in patients undergoing esophagectomy for EC. However, further studies are needed to clarify the association of the CONUT score with postoperative outcomes in EC patients.

Background Post-hepatectomy liver failure (PHLF) is a major source of morbidity and mortality in patients undergoing liver resection. The aim of this review is to summarize the recent literature available on PHLF including its definition, predictive factors, preoperative risk assessment, severity grading, preventative measures, and management strategies. Methods A systematic literature search was carried out with the search engines PubMed, Medline, and Cochrane Database using the keywords related to “liver failure”, “posthepatectomy”, and “hepatic resection”. Results Liver resection is a curative treatment of liver tumors. However, it leads to concurrent death and regeneration of the remaining hepatocytes. Factors related to the patient, liver parenchyma and the extent of surgery can inhibit regeneration leading to PHLF. Conclusion Given its resistance to treatment and the high postoperative mortality associated with PHLF, great effort has been put in to both accurately identify patients at high risk and to develop strategies that can help prevent its occurrence.

The industrial sector’s increasing electricity demand (direct and indirect), driven by the electrification of processes and the production of green hydrogen, poses significant challenges for achieving decarbonisation goals. While switching to renewable electricity and offsetting emissions appears straightforward, the gap between current generation capacities and projected demand remains substantial. This article analyses survey data from the Energy Efficiency Index of German Industry (EEI), revealing that manufacturing companies aim to reduce 22.1% of their 2019 emissions by 2025 and 27.3% by 2030, primarily through on-site measures. However, given the slow pace of renewable capacity expansion and the increasing electrification across sectors, it becomes evident that the envisaged green electricity share of 80% by 2030 will require far more capacity than currently planned. To address this challenge, the article introduces a decarbonisability factor to better assess on-site versus off-site measures, highlighting the need for a strategic sequencing of efficiency and renewable generation. To support decision-makers, the article calls for improved data collection and periodic reassessment to account for changing geopolitical and economic conditions.

Background The clinical value of the controlling nutritional status (CONUT) score in hepatocellular carcinoma (HCC) has increased. The aim of this meta-analysis was to systematically review the association between the CONUT score and outcomes in patients undergoing hepatectomy for HCC. Methods Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar were systematically searched. Random effects meta-analyses were conducted to examine the prognostic value of the CONUT score in HCC patients. Results A total of five studies including 4679 patients were found to be eligible and analyzed in the meta-analysis. The CONUT score was significantly associated with overall survival (HR 1.78, 95%CI = 1.20–2.64, P  = 0.004, I 2  = 79%), recurrence-free survival (HR 1.34, 95%CI = 1.17–1.53, P  < 0.001, I 2  = 16%) and postoperative major complications (OR 1.85, 95%CI: 1.19–2.87, P  = 0.006, I 2  = 72%) in HCC patients. Moreover, the CONUT score was associated with the Child–Pugh classification, liver cirrhosis, ICGR15, and tumor differentiation. However, it was not associated with tumor size, tumor number, and microvascular invasion. Conclusions The CONUT score is an independent prognostic indicator of the prognosis and is associated with postoperative major complications and hepatic functional reserve in HCC patients.

Background The optimal tumor-free margin width remains controversial and may be inappropriate to investigate without considering differences in the underlying tumor biology. Methods R1 resection was defined as margin clearance less than 1 mm. R0 resection was further divided into 3 groups: 1–4, 5–9, and ≥10 mm. The impact of margin width on overall survival (OS) relative to KRAS status [wild type (wt KRAS ) vs. mutated (mut KRAS )] was assessed. Results A total of 411 patients met inclusion criteria. Median patient age was 58 years (interquartile range, 49.7–66.7); most patients were male ( n  = 250; 60.8 %). With a median follow-up of 28.3 months, median and 5-year OS were 69.8 months and 55.1 %. Among patients with wt KRAS tumors, although margin clearance of 1–4 mm or more was associated with improved OS compared to R1 (all P  < 0.05), no difference in OS was observed when comparing margin clearance of 1–4 mm to the 5–9 mm and the ≥10 mm groups (all P  > 0.05). In contrast, among patients with mut KRAS tumors, all three groups of margin clearance (1–4, 5–9, and ≥10 mm) fared no better in terms of 5-year survival compared to R1 resection (all P  > 0.05). Conclusions While a 1–4 mm margin clearance in patients with wt KRAS tumors was associated with improved survival, wider resection width did not confer an additional survival benefit. In contrast, margin status—including a 1 cm margin—did not improve survival among patients with mut KRAS tumors.

Background Given the increasing number of elderly and comorbid patients undergoing surgery, there is increased interest in preoperatively identifying patients at high risk of morbidity and mortality following liver resection. We sought to develop and validate the use of a frailty index (FI) to predict poor postoperative outcomes following liver surgery. Methods Patients undergoing a liver resection were identified using the National Surgical Quality Improvement Program Hepatectomy-targeted database for 2014 and randomized into a training or validation cohort. Multivariable logistic regression analysis was performed to develop a revised frailty index (rFI) to predict adverse postoperative clinical outcomes. Leave one out cross-validation was performed to validate the proposed rFI. Results A total of 2714 patients were identified who met the inclusion criteria. Postoperatively, 826 patients (30.4%) developed a postoperative complication, while 39 patients died within 30 days of surgery. Five preoperative variables (ASA class, BMI, serum albumin, hematocrit, underlying pathology, and type of liver resection) were used to develop the rFI. The rFI demonstrated good discrimination (AUROC = 0.68) and outperformed the previously proposed modified frailty index (mFI; AUROC = 0.53, p  < 0.001) when evaluated among patients included in the training cohort. On validation, the rFI demonstrated good model discrimination (AUROC = 0.68) and was accurately able to risk-stratify patients within the validation cohort at risk for developing a postoperative complication, prolonged length-of-stay, and postoperative mortality (all p  < 0.05). Conclusion Frailty, as measured by the rFI, was predictive of increased risk of morbidity and mortality following liver surgery and can be used to guide patient decision-making.

Background Colorectal cancer is the third most common type of cancer in the world. We characterize a cohort of patients who survived up to 5 years without recurrence and identify factors predicting the probability of cure. Methods We analyzed data of patients who underwent curative intent surgery for stage I–III CRC between 2007 and 2012 and who had had been included in a large multicenter study in the Netherlands. Cure was defined as 5-year survival without recurrence. Survival data were retrieved from a national registry. Results Analysis of data of 754 patients revealed a cure rate of 65% ( n = 490). Patients with stage I disease and T1- and N0-tumor had the highest probability of cure (94%, 95% and 90%, respectively). Those with a T4-tumor or N2-tumor had the lowest probability of cure (62% and 50%, respectively). A peak in the mortality rate for older patients early in follow-up suggests early excess mortality as an explanation. Patients with stage III disease, poor tumor grade, postoperative complications, sarcopenia and R1 resections show a similar trend for decrease in CSS deaths over time. Conclusion In the studied cohort, the probability of cure for patients with stage I–III CRC ranged from 50 to 95%. Even though most patients will be cured from CRC with standard therapy, standard therapy is insufficient for those with poor prognostic factors, such as high T- and N-stage and poor differentiation grade.