Current status of atezolizumab combined with bevacizumab in the treatment of hepatocellular carcinoma / 中华肝胆外科杂志

Hepatocellular carcinoma (HCC) has a hidden onset and rapid progress. Most of the patients have lost the opportunity of surgery at the onset, and the systemic treatment effect is not satisfactory. In recent years, immune checkpoint inhibitors combined with targeted therapy have brought hope to HCC patients. In particular, treatment with atezolizumab combined with bevacizumab has been recommended by many domestic and foreign guidelines as the first-line treatment for patients with unresectable HCC who have not previously received systematic treatment. In this review, the application status of atezolizumab plus bevacizumab, coping strategies for treatment failure, cost-benefit analysis and side effects were described in order to provide reference for clinical treatment.

Epidemiological characteristics, diagnosis, treatment and prognosis of gallbladder cancer in China: a report of 6 159 cases / 中华消化外科杂志

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Clinical effect of simultaneous surgical resection of hepatic and pancreatic lesions versus systemic chemotherapy in treatment of resectable pancreatic cancer with liver metastasis / 临床肝胆病杂志

Objective To investigate the clinical effect of simultaneous surgical resection of hepatic and pancreatic lesions versus systemic chemotherapy in treatment of resectable pancreatic cancer with liver metastasis (PCLM). Methods A retrospective analysis was performed for related data of the patients with PCLM who were admitted to Shengjing Hospital of China Medical University from January 2013 to May 2020, and the patients with resectable PCLM were screened out and then divided into surgery group and chemotherapy group. The propensity score matching (PSM) method was used to reduce the impact of data bias and confounding factors. The independent samples t -test or the Mann- Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate survival time, and the log-rank test was used for evaluation. The univariate and multivariate Cox regression models were used to investigate the independent risk factors for survival. Results A total of 56 patients with resectable PCLM were screened out, with 33 patients in the surgery group and 23 patients in the chemotherapy group, and there were 15 patients in each group after PSM. The surgery group had a significantly shorter median overall survival time than the chemotherapy group before PSM (6.6 months vs 10.4 months, χ 2 =4.476, P =0.034) and after PSM (6.4 months vs 10.5 months, χ 2 =4.309, P =0.038). The multivariate Cox regression analysis showed that poorly differentiated tumor (hazard ratio [ HR ]=4.945, 95% confidence interval [ CI ]: 1.980-12.348, P =0.001) and absence of postoperative chemotherapy ( HR =3.670, 95% CI : 1.437-9.376, P =0.007) were independent risk factors for poor prognosis in patients with PCLM. Conclusion Compared with chemotherapy, simultaneous surgical resection of hepatic and pancreatic lesions fails to prolong the overall survival time of patients with resectable PCLM. Patients with poorly differentiated tumor and those without postoperative chemotherapy tend to have poor prognosis.

Mechanism of liver regeneration after associating liver partition and portal vein ligation for staged hepatectomy / 临床肝胆病杂志

Insufficient volume of future liver remnant (FLR) often leads to the complications including liver failure and even death and thus remains a bottleneck for liver surgery. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a newly developed two-stage hepatectomy procedure which can promote rapid regeneration of FLR, but the related mechanism has not yet been elucidated. With reference to the recent research advances in China and foreign countries, this article reviews the hemodynamic and humoral factors for ALPPS in promoting liver regeneration, the effect of ALPPS on liver parenchymal cells, and the role of non-parenchymal liver cells (including hepatic stellate cells, natural killer cells, macrophages, and liver progenitor/stem cells) in regulating liver regeneration. It is pointed out that the interaction between non-parenchymal liver cells and parenchymal cells is a hotspot in the research on the mechanism of liver regeneration after ALPPS.

Influence of ischemia-reperfusion injury on liver cancer and related mechanism / 临床肝胆病杂志

In the process of the surgical treatment of liver cancer, blood flow occlusion at the porta hepatis is an important method to reduce intraoperative bleeding, and ischemia-reperfusion injury (IRI) resulting from such occlusion has an important effect on tumor cell. IRI can not only lead to tumor recurrence and metastasis, but also exert an inhibitory effect on tumor. Such influence is associated with various factors including free radicals, nitric oxide, inflammatory cytokines, and enzymes. An understanding of such effect and related mechanisms is of great importance to the research on the association between IRI and liver cancer and the selection of treatment methods for liver cancer.

Albumin-bilirubin score versus Child-Pugh score as predictors of posthepatectomy liver failure in hepatocellular carcinoma patients / 中华普通外科杂志

Objective To investigate the perioperative risk factors for posthepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC).Methods Data of 322 cases of liver resection for HCC were retrospectively analyzed from Sep 2013 to Sep 2018.Logistic regression was used to analyze the risk factors for PHLF.The receiver operating characteristic (ROC) curve was used to analyze the predictive power of the ALBI score and the Child-Pugh score for PHLF.Results Child-Pugh score,ALBI score,intraoperative bleeding amount,ICG R15 and liver fibrosis,peritoneal effusion were independent factors affecting PHLF of HCC patients(P ＜ 0.05).ROC analysis of Child-Pugh and ALBI scores predicting PHLF showed that area under the ROC was respectively 0.621 (95％ CI:0.531-0.712) in the Child-Pugh score and 0.729 (95％ CI:0.645-0.812)in the ALBI score.The best critical value,sensitivity and specificity of PHLF that were predicted by ALBI score were-2.74,71.7％ and 71.4％,respectively.Conclusions The prognostic power of the ALBI score was greater than that of the Child-Pugh score in predicting PHLF.

Current status of immunotherapy and targeted therapy for intrahepatic cholangiocarcinoma / 中国肿瘤临床

Intrahepatic cholangiocarcinoma (ICC) is the second most frequently occurring primary liver cancer. It has been reported that the causes of late diagnosis of ICC are a high degree of malignancy, early metastasis, and diffusion. Most patients visit the hospital because of jaundice or discomfort due to the surrounding compression. ICC commonly recurs after resection, and chemotherapy is not sensitive. Therefore, patients have a poor prognosis and a low survival rate. Currently, a multidisciplinary approach based on surgery is recommended for ICC patients who can undergo surgical excision, and local treatment combined with chemotherapy is the main com-prehensive treatment for patients with advanced ICC who cannot undergo surgical resection. In recent years, it has been found that immunotherapy can involve the autoimmune system to remove tumor cells, and molecular-targeted therapy can kill tumor cells by in-hibiting cell membrane surface molecules that promote tumorigenesis and development. At present, these two treatment modalities have become the research focus of ICC therapy, and progress has been made. The research status is reviewed in this paper.

Assessment of quality of life after surgery for patients with hepatic hemangioma / 中华消化外科杂志

Objective@#To evaluate the postoperative quality of life after surgery of patients with hepatic hemangioma.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent surgery for hepatic hemangioma at Shengjing Hospital of China Medical University from September 2011 to February 2017 were collected. There were 28 males and 76 females, aged (49±8)years, with a range of 27-78 years. Enucleation of hepatic hemangioma or hepatectomy was selected according to tumor location of patients. Observation indicators: (1) surgical and postoperative situations; (2) assessment of quality of life in patients; (3) assessment of quality of life in patients comorbid with other chronic digestive diseases. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Repeated data were analyzed using repeated ANOVA. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative situations: of 104 patients, 67 underwent enucleation of hepatic hemangioma, 37 underwent hepatectomy. The tumor diameter, volume of intraoperative blood loss, duration of postoperative hospital stay were (10±4)cm, 200 mL (range, 10-3 000 mL), (11±5)days. Seven patients had complications, including 5 of massive abdominal ascites, 1 of abdominal infection, and 1 of pulmanory obstruction. There was no death occurred. (2) Assessment of quality of life in patients with hepatic hemangioma: the total scores of Gastrointestinal-related Quality of Life Index (GIQLI), the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 121.0±8.3, 69.2±4.1, 18.5±2.6, 19.5±1.8, and 13.8±1.4 at preoperation. The above indices were 121.9±6.9, 71.2±3.8, 17.2±2.5, 19.6±2.3, and 13.8±1.3 of 104 patients with hepatic hemangioma at one month after surgery, respectively. The above indices were 127.8±6.2, 73.2±3.6, 19.8±2.5, 20.8±2.4, and 14.1±1.0 at 6 months after surgery. There were significant differences in changing trends of above indices (F=68.4, 64.6, 71.4, 17.8, 3.3, P<0.05). The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-5.780, 6.640, P<0.05), but the total scores of GIQLI, the scores of mental and psychological status, and social activities showed no difference (t=-1.569, -0.705, 0.240, P>0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and mental and psychological status at 6 months after surgery showed significant differences compared with those of preoperation (t=-8.897, -9.919, -5.375, -5.024, P<0.05), but the score of social activities showed no difference(t=-1.919, P>0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-10.835, -6.787, -12.277, -4.560, -2.476, P<0.05). (3) Assessment of quality of life in hepatic hemangioma patients comorbid with other chronic digestive diseases: 29 of 104 patients were comorbid with chronic gastritis, biliary diseases, and appendicitis. For the 29 patients comorbid with other chronic digestive diseases, the total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 117.5±7.5, 67.8±4.2, 17.4±2.2, 19.0±1.5, and 13.2±1.3 at preoperation. The above indices were 118.7±6.9, 69.5±4.5, 16.7±2.0, 19.2±1.9, and 13.2±1.3 at one month after surgery, respectively. The above indices were 124.6±6.5, 70.9±4.5, 19.8±2.1, 19.9±2.4, and 14.0±0.9 of 29 patients comorbid with other chronic digestive diseases at 6 months after surgery. There were significant differences in changing of the total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities (F=15.0, 9.0, 27.6, 7.5, P<0.05), except the score of mental and psychological status (F=1.6, P>0.05) . The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-2.612, 2.191, P<0.05), but the total scores of GIQLI, the scores of mental and psychological status, and social activities showed no difference (t=-1.128, -0.587, -0.157, P>0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and social activities at 6 months after surgery showed significant differences compared with those of preoperation (t=-4.002, -3.441, -4.604, -3.266, P<0.05), but the score of mental and psychologica status showed no difference (t=-1.522, P>0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-4.819, -2.313, -7.081, -3.172, P<0.05), but the score of mental and psychological status had no significant difference (t=-1.154, P>0.05).@*Conclusions@#The quality of life in patients with hepatic hemangioma can be improved by surgery. Surgical treatment is still effective for improvement of the total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities for those combined with other digestive diseases.

Current status and perspectives of the treatment of hepatocellular carcinoma with portal vein tumor thrombus / 临床肝胆病杂志

Portal vein tumor thrombus is one of the most common complications of advanced hepatocellular carcinoma and greatly affects the treatment and prognosis of such patients. With the development and advances in surgical treatment methods, local interventional treatment, radiation therapy, targeted drug therapy, and immunotherapy in recent years, advanced hepatocellular carcinoma with portal vein tumor thrombus is no longer a dilemma in clinical treatment. Both single and combined treatments have achieved good clinical effects. This article reviews the current status, difficulties, and future treatment methods for advanced liver cancer with portal vein tumor thrombus.

Assessment of quality of life after surgery for patients with hepatic hemangioma / 中华消化外科杂志

Objective To evaluate the postoperative quality of life after surgery of patients with hepatic hemangioma.Methods The retrospective and descriptive study was conducted.The clinical data of 104 patients who underwent surgery for hepatic hemangioma at Shengjing Hospital of China Medical University from September 2011 to February 2017 were collected.There were 28 males and 76 females,aged (49±8)years,with a range of 27-78 years.Enucleation of hepatic hemangioma or hepatectomy was selected according to tumor location of patients.Observation indicators:(1) surgical and postoperative situations;(2) assessment of quality of life in patients;(3)assessment of quality of life in patients comorbid with other chronic digestive diseases.Measurement data with normal distribution were represented as Mean±SD,and measurement data with skewed distribution were represented as M (range).Repeated data were analyzed using repeated ANOVA.Count data were represented as absolute numbers.Results (1) Surgical and postoperative situations:of 104 patients,67 underwent enucleation of hepatic hemangioma,37 underwent hepatectomy.The tumor diameter,volume of intraoperative blood loss,duration of postoperative hospital stay were (10±4)cm,200 mL (range,10-3 000 mL),(11±5)days.Seven patients had complications,including 5 of massive abdominal ascites,1 of abdominal infection,and 1 of pulmanory obstruction.There was no death occurred.(2) Assessment of quality of life in patients with hepatic hemangioma:the total scores of Gastrointestinal-related Quality of Life Index (GIQLI),the scores of subjective symptoms,physiological status,mental and psychological status,and social activities were 121.0±8.3,69.2±4.1,18.5±2.6,19.5± 1.8,and 13.8± 1.4 at preoperation.The above indices were 121.9±6.9,71.2±3.8,17.2±2.5,19.6±2.3,and 13.8± 1.3 of 104 patients with hepatic hemangioma at one month after surgery,respectively.The above indices were 127.8±6.2,73.2±3.6,19.8±2.5,20.8±2.4,and 14.1±1.0 at 6 months after surgery.There were significant differences in changing trends of above indices (F=68.4,64.6,71.4,17.8,3.3,P＜0.05).The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-5.780,6.640,P＜0.05),but the total scores of GIQLI,the scores of mental and psychological status,and social activities showed no difference (t =-1.569,-0.705,0.240,P＞0.05).The total scores of GIQLI,scores of subjective symptoms,physiological status,and mental and psychological status at 6 months after surgery showed significant differences compared with those of preoperation (t =-8.897,-9.919,-5.375,-5.024,P＜ 0.05),but the score of social activities showed no difference(t =-1.919,P＞0.05).The total scores of GIQLI,the scores of subjective symptoms,physiological status,mental and psychological status,and social activities at 6 months after surgery were significantly different from those at one month after surgery (t =-10.835,-6.787,-12.277,-4.560,-2.476,P＜0.05).(3) Assessment of quality of life in hepatic hemangioma patients comorbid with other chronic digestive diseases:29 of 104 patients were comorbid with chronic gastritis,biliary diseases,and appendicitis.For the 29 patients comorbid with other chronic digestive diseases,the total scores of GIQLI,the scores of subjective symptoms,physiological status,mental and psychological status,and social activities were 117.5±7.5,67.8±4.2,17.4±2.2,19.0±1.5,and 13.2±1.3 at preoperation.The above indices were 118.7±6.9,69.5±4.5,16.7±2.0,19.2±1.9,and 13.2±1.3 at one month after surgery,respectively.The above indices were 124.6±6.5,70.9±4.5,19.8±2.1,19.9±2.4,and 14.0±0.9 of 29 patients comorbid with other chronic digestive diseases at 6 months after surgery.There were significant differences in changing of the total scores of GIQLI,the scores of subjective symptoms,physiological status,and social activities (F=15.0,9.0,27.6,7.5,P＜0.05),except the score of mental and psychological status (F=1.6,P＞0.05).The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t =-2.612,2.191,P＜0.05),but the total scores of GIQLI,the scores of mental and psychological status,and social activities showed no difference (t =-1.128,-0.587,-0.157,P＞0.05).The total scores of GIQLI,scores of subjective symptoms,physiological status,and social activities at 6 months after surgery showed significant differences compared with those of preoperation (t =-4.002,-3.441,-4.604,-3.266,P＜0.05),but the score of mental and psychologica status showed no difference (t =-1.522,P ＞ 0.05).The total scores of GIQLI,the scores of subjective symptoms,physiological status,and social activities at 6 months after surgery were significantly different from those at one month after surgery (t =-4.819,-2.313,-7.081,-3.172,P＜0.05),but the score of mental and psychological status had no significant difference (t =-1.154,P＞0.05).Conclusions The quality of life in patients with hepatic hemangioma can be improved by surgery.Surgical treatment is still effective for improvement of the total scores of GIQLI,the scores of subjective symptoms,physiological status,and social activities for those combined with other digestive diseases.

Research of preoperative biliary drainage of malignant obstructive jaundice / 国际外科学杂志

The optimal management of malignant obstructive jaundice has been the subject of much debate among hepatobiliary surgeons. However, there is currently no universal agreement in the clinical role for preoperative biliary drainage to relief the jaundice. In this current era where precision liver surgery is widely pursued, it is necessary to define the role of preoperative drainage according to the different anatomical levels of biliary obstruction so as to achieve the best outcomes and eventual prognosis.

Research advances in immunotherapy for liver metastasis of pancreatic cancer / 临床肝胆病杂志

Patients with liver metastasis of pancreatic cancer have poor prognosis and few opportunities for surgery, and conventional radiochemotherapy lacks a satisfactory effect. As a new therapeutic strategy for tumor, immunotherapy fights against cancer by enhancing patients′ immune function and may thus become an effective treatment regimen for liver metastasis of pancreatic cancer. This article reviews the latest research advances in immunotherapy for liver metastasis of pancreatic cancer from the aspects of immunomodulator, monoclonal antibody, immune checkpoint inhibitor, adoptive cellular immunotherapy, and tumor vaccine and points out that a combined treatment regimen has a promising future in clinical application.

Clinical analysis of microwave ablation assisted laparoscopic hepatectomy for hepatocellular carcinoma / 中华普通外科杂志

Objective To explore the safety and feasibility of microwave ablation assisted laparoscopic resection of liver cancer.Method The clinical data of 40 patients with liver cancer were retrospectively analyzed from April 2013 to June 2016 in Shengjing Hospital.Results Procedures were completed successfully without conversion to open laparotomy or serious complications.The average operation time,blood loss and postoperative hospital stay were (160 ± 68) min,(36 ± 27) ml and (7.6 _± 2.7) d,respectively.There was no tumor recurrence in surgical margins.The postoperative median tumor-free survival was 30 months,with cumulative 1-year and 2-year tumor-free survival rates of 89.4％ and 65.5％,respectively.The postoperative median overall survival time was 38 months,with cumulative 1-year and 2-year survival rates of 100％ and 90.9％,respectively.Conclusion Microwave ablation can effectively control intraoperative bleeding,and prevent tumor recurrence in surgical margins.Microwave ablation assisted laparoscopic hepatectomy is safe and feasible for hepatocellular carcinoma.

Current status of diagnosis and therapy of hepatoid adenocarcinoma of the gallbladder / 中华消化外科杂志

Hepatoid adenocarcinoma (HAC) of the gallbladder is a variant of extrahepatic adenocarcinoma with hepatic differentiation.With similar clinicopathological presentation,the main differential diagnoses are hepatocellular carcinoma (HCC) and gallbladder carcinoma (GBC).At present,HAC of the gallbladder have only been reported in a few researches.This article will summarize comprehensive researches on the histological origin,clinical characteristics,histopathological and immunohistochemical characteristics,differential diagnosis,therapy and prognosis of HAC of the gallbladder.

Prevention of surgical site infection after liver cancer resection / 临床肝胆病杂志

Surgical site infection (SSI) often increases the length of hospital stay, economic burden, and even mortality of patients undergoing liver cancer resection. Targeted preventive measures help to reduce SSI. This article introduces the preventive measures for SSI, including improvement of patients′ physical condition (such as preoperative smoking cessation, blood sugar control, and improvement of nutrition and liver function), improvement of surgical procedure (such as skin disinfection, incision management, precise liver resection, laparoscopic hepatectomy, liver section management, abdominal cavity flushing, placement of drainage tube, and prevention of intestinal injury and bile leakage), and prophylactic use of antibiotics. It is pointed out that the development of SSI after liver cancer resection is the result of multiple risk factors, and that the keys to SSI prevention include strict control of surgical indications, accurate preoperative assessment, precise intraoperative operation, careful postoperative management, and rational use of antibiotics.

Individulized treatment of synchronous colorectal liver metastases / 中华消化外科杂志

Liver metastasis is one of the critical prognostic factors for colorectal cancer.Complete surgical resection of liver metastases still remains the only potentially curative treatment for patients with liver metastases.There are still some controversies in how to choose the reasonable management for resectable colorectal cancer patients with simultaneous liver metastases,although neoadjuvant chemotherapy,tumor physical ablation technique and minimally invasive technology have made progress in recent years.One case of surgical treatment of synchronous rectal cancer liver metastasis at the Shengjing Hospital with laparoscopic microwave ablation + radical resection of colorectal cancer was disused in order to provide reference for individualized treatment for patients with the same disease.

Effect of exogenous interleukin-10 on liver regeneration in rats with biliary obstruction / 中华肝胆外科杂志

Objective To investigate the effect of exogenous interleukin-10 (IL-10) on liver regeneration in rats with biliary obstruction.Methods Male Wistar rats were divided randomly into either a sham operation (SO) group,obstructive jaundice (OJ) group,or IL-10 treated group.Rats in OJ and IL-10 treated groups underwent ligation and division of the common bile duct,while only the SO group had division of the common bile duct.Rats in the IL-10 treated group received daily intraperitoneal injection of IL-10 at a dose of 4 μg/kg after the operation.Quantitative fluorescence real-time PCR was performed to detect hepatic TGF-β1 mRNA expression.Immunohistochemistry for hepatic proliferating cell nuclear antigen (PCNA) labeling index was used to evaluate and epitope of IL-10.The serum levels of total bilirubin (T Bil),direct bilirubin (D Bil),alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were also measured.Results Hepatic TGF-β1 mRNA,PCNA labeling index and serum levels of ALT and AST in OJ group rats were significantly higher than SO group rats at days 3 and 7 after the operation (P＜0.05).Compared to the OJ group,the IL-10 group had significantly lower hepatic TGF-β1 mRNA and serum levels of ALT and AST.Conversely the IL10 group's hepatic PCNA labeling index was significantly increased as compared with those in OJ group 7 days after operation (P＜0.05).Conclusion Exogenous IL-10 could enhance liver regeneration and alleviate hepatic dysfunction by down-regulating hepatic TGF-β1 expression in rats with biliary obstruction.

Effects of Shenfu injection on prostacyclin, thromboxane A2 and activities of ATPases in rats exposed to hepatic ischemia-reperfusion injury / 中西医结合学报

OBJECTIVE: To explore the effects of Shenfu Injection on prostacyclin, thromboxane A2 and the activities of ATPases in rats exposed to hepatic ischemia-reperfusion injury. METHODS: Twenty-four male Wistar rats weighing 200-250 g were randomly divided into two groups: Shenfu Injection (SF)-treated group (rats were treated with Shenfu Injection of 10 ml/kg through intraperitoneal injection) and untreated group (rats were administered with normal saline at the same dose and served as a control group). Hepatic ischemia was caused by Pringle's maneuver and lasted for fifteen minutes, and then one-hour or three-hour reperfusion was performed. Venous blood samples for the measurement of thromboxane B(2) (TXB(2)) and 6-keto-prostaglandin F(1 alpha)(6-keto-PGF(1 alpha)) were collected three hours after reperfusion. Liver tissue samples were collected one hour or three hours after reperfusion for the measurement of Na(+)-K(+)-ATPase and Ca(+)-Mg(+)-ATPase and for morphological studies. RESULTS: Plasma TXB(2) was lower in the SF-treated group than that in the untreated group after three-hour reperfusion (P>0.05), while 6-keto-PGF(1 alpha) was higher in the SF-treated group than that in the untreated group (P>0.05). The ratio of TXB(2) and 6-keto-PGF(1 alpha) was significantly lower in the SF-treated group than that in the untreated group (P<0.05). The activities of Na(+)-K(+)-ATPase and Ca(+)-Mg(+)-ATPase in the SF-treated group were improved obviously. A three-hour reperfusion after fifteen-minute ischemia caused important hepatic histological alterations. Marked structural abnormalities were observed in the untreated group, such as massive hepatocyte swelling, necrosis, mitochondria edema and vacuolar changes. In the SF-treated group, hepatic tissue injury was reduced significantly. CONCLUSION: Shenfu Injection protects hepatic tissue from ischemia-reperfusion injury, and such protective effects are achieved by decreasing the ratio of thromboxane A(2) and prostacyclin, and increasing the activities of Na(+)-K(+)-ATPase and Ca(+)-Mg(+)- ATPase.

Study on induction of apoptosis of biliary duct cancer cells by ?-ray of the ~(103)Pd biliary stent / 中国普通外科杂志

Objective To investigate the mechanism and role of ?-ray of 103Pd in the treatment of biliary duct cancer.Methods A series of biliary duct cancer cells were treated with different ?-ray dose,and MTT [3-(4,5-dimethy thiazol-2-yl)-2,5-diphenyl terazolium-bromide] technique was used to determine the inhibition rate of ?-ray of 103Pd on the biliary duct cancer cells;and electron micro-technique,DNA agarose gel electrophoresis and flow cytometry to evaluate the morphological characteristics and apoptosis rate of the biliary duct cancer cells were also used.Results The ?-ray radiation of 103Pd resulted in significant inhibition of the biliary duct cancer cells.The features of biliary duct cancer cells apoptosis(e,g:apoptic bodies,DNA ladders band hypodiploid DNA peak) could be seen in the group with lower dosage(5.333mci),and cell necrosis was seen in higher dosage(more than 6.645 mci).Conclusions The ?-ray radiation could induce apoptosis of the biliary duct cancer cells,but with dose dependence,and apoptosis can be an important mechanism for radiation treatment of biliary duct cancer.