Patients with hepatobiliary malignancies often need to receive medium to long-term treatment plans such as systemic or conversion therapy, and they are constantly complicated with underlying diseases such as liver cirrhosis, hypersplenism or biliary tract infection, as well as complications such as jaundice and ascites, which increase the complexity and risk in the process of establishing and maintaining the vascular access. The current intravenous access guidelines cannot fully meet the clinical needs for the treatment of hepatobiliary malignancies. Therefore, Intravenous Infusion Committee of Eastern Hepatobiliary Surgery Hospital organized multiple discussions among multidisciplinary experts of the Consensus Committee and formulated the "Expert consensus on the selection and use of medium to long-term vascular access in patients with hepatobiliary malignancies", aiming to standardize the full-process management of the selection, implantation, use and maintenance of medium to long-term vascular access for hepatobiliary malignancies, and to improve the safety of treatment and the quality of life of patients.

Immunotherapy has become a milestone in the field of tumor treatment by strengthening host immune system to attack cancer cells. However, with widespread application of immunotherapy, the incidence of immune-related adverse events (irAEs) has been increased significantly. IrAEs can involve multiple organs and systems, such as skin, heart, digestive system and endocrine system, which can be life-threatening in severe cases and significantly affect the quality of life and clinical prognosis of patients. Most symptoms can be relieved by terminating medication for mild to moderate irAEs. Glucocorticoids are still the first-line treatment drugs for severe IRES, while anti-TNF-α drugs are effective for hormone-refractory cancer. Although studies have revealed the correlation between genetic factors, gut microbiota and cytokine levels and the risk of irAEs, precise prediction and diagnosis still face challenges. In this article, research progress in epidemiological characteristics, potential mechanism, prediction and treatment of irAEs was systematically reviewed, aiming to provide reference for clinical practice.

With persistent advancement and development of organ transplantation technology in recent years, transplantation technologies for different organs have gradually matured at home and abroad. Since the first case of liver transplantation worldwide, liver transplantation has become an important treatment for acute liver failure and end-stage liver diseases, which has been routinely carried out in major transplantation centers. However, the existing shortage of donor liver is still severe across the globe. Meantime, the incidence of chronic hepatitis B is high in Asian countries, and the number of recipients awaiting liver transplantation is increasing. Most patients with acute and critical liver diseases fail to receive blood type-matched donor liver, lose the operation opportunity or even die because of the disease deterioration. Considering the donor-recipient imbalance caused by fewer donors than recipients, ABO-incompatible liver transplantation (ABOi-LT), as an effective strategy to expand the source of liver donors, brings new hope to the recipients awaiting liver transplantation. However, liver necrosis, intrahepatic biliary complications, ABO blood group antibody-mediated rejection (AMR), postoperative infection, kidney injury are prone to occur after ABOi-LT, among which AMR is the most threatening complication. Therefore, preventing the occurrence of AMR is the key to success of ABOi-LT. In this article, the latest research results of ABOi-LT and immunosuppression strategies were summarized in combination with relevant literature review at home and abroad, aiming to provide reference for the study of clinical liver transplantation.

Hepatocellular carcinoma (HCC) is the sixth most commonly diagnosed cancer and the third most cancer-related cause of death worldwide. Hepatectomy is considered as the first-line treatment for early-and middle-stage liver cancer. However, the 5-year recurrence rate is as high as 70%-80%, and the median survival time is approximately 2 years. Among multiple prognostic factors, increasing studies have shown that microvascular invasion (MVI) is a high risk factor for postoperative recurrence and metastasis of liver cancer, and it is also an independent risk factor for postoperative recurrence-free survival (RFS) and overall survival (OS) of patients with liver cancer. Therefore, it is of significance to explore effective postoperative adjuvant treatment, thereby delaying the recurrence time and lowering the recurrence rate. In this article, research progress in clinical application of hepatic arterial infusion chemotherapy (HAIC), targeted therapy, immunotherapy and common postoperative approaches combined with TACE in patients with liver cancer complicated with MVI was reviewed, aiming to provide reference for clinical practice.

Laparoscopic anatomical hepatectomy plays an important role in the treatment of benign and malignant liver diseases. However, due to complex anatomical structures of the liver and lack of clear anatomical landmarks, it remains a major challenge to precisely determine the resection plane intraoperatively. In this article, theoretical basis and technical methods of plane positioning during laparoscopic hepatectomy were systematically discussed based on Couinaud's liver segment classification. The precision and safety of laparoscopic anatomical hepatectomy can be significantly improved by integrating three technologies including hepatic pedicle occlusion, ICG fluorescence staining and hepatic vein navigation. Multi-technology integrated plane positioning strategy during hepatectomy is an effective approach to precisely implement laparoscopic anatomical hepatectomy, which is worthy of clinical application.

Primary liver cancer (PLC) is one of the most common malignant tumors, with high morbidity and mortality rates among all cancers. Radiomics is an interdisciplinary subject that performs high-throughput feature extraction from medical images combined with clinical data, which can be applied in diagnosis, prognostic prediction and treatment decision-making. In this article, the latest progress in radiomics in diagnosis and comprehensive treatment of PLC was systematically reviewed, such as early and accurate diagnosis,predicting microvessel invasion (MVI) and metastasis and recurrence, promoting individualized treatment and optimizing multidisciplinary team (MDT) diagnosis and treatment decision-making and integrating with molecular biology and artificial intelligence (AI) technologies. The challenges and development prospects of radiomics were also discussed.

In recent years, three-dimensional visualization technology (3DVT), ICG fluorescence tracing and intraoperative real-time ultrasound (IORUS) have been widely applied in the diagnosis and treatment of liver cancer, which significantly improve the accuracy of early diagnosis, localization, surgical resection and postoperative monitoring of liver cancer. 3DVT provides surgeons with intuitive preoperative evaluation and intraoperative navigation by integrating anatomical liver structures and tumor information, which effectively reduces the risk of surgery. As a safe and efficient fluorescent dye, ICG can mark the blood supply status of tumors in a real-time manner, assist the surgeons to clearly identify the tumor margins and improve the success rate of tumor resection. Due to high-resolution imaging capability, IORUS can realize real-time monitoring of liver lesions, ensuring the accuracy and safety of the operation. The application of 3DVT, ICG fluorescence tracing and IORUS provides novel ideas for individualized diagnosis and treatment of liver cancer and promotes the development of precise treatment of liver cancer. In this article, the application of 3DVT, ICG and IORUS in the diagnosis and treatment of liver cancer was illustrated, aiming to provide novel insights for clinical diagnosis and treatment of liver cancer.

To construct a nomogram model for predicting post-hepatectomy liver failure (PHLF) based on machine learning (ML), and evaluate its application value in PHLF prediction.

Clinical data of 235 patients who underwent hepatectomy in Beijing Tiantan Hospital affiliated to Capital Medical University from June 2021 to June 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 118 patients were male and 117 female, aged from 27 to 83 years, with a median age of 57 years. All patients were randomly divided into the training and test sets at a ratio of 8∶2. ALT, TB, ALB, Plt, PT, INR, AST to Plt ratio index (APRI), total liver volume (TLV), remnant liver volume (RLV), spleen volume (SV), standard remnant liver volume (SRLV), remnant liver volume/weight ratio (RLV/Weight, RLV/W) and spleen volume/liver volume ratio (SV/LV) and other imaging indexes were observed. In the training set, LASSO regression and Logistic regression analyses were used to select features and screen key risk factors related to PHLF. ML-nomogram and Log-nomogram models were constructed, respectively. The predictive value of these two models was analyzed by the ROC curve. AUC between two models was compared by Delong test.

The incidence of PHLF was 16.2%(38/235), including 30 cases of grade A and 8 cases of grade B. In the training set, 6 variables including liver cirrhosis, Plt, APRI, SV, RLV/TLV and SV/LV were screened by LASSO regression as the key features of PHLF prediction. The AUC of the constructed ML-nomogram in the training and test sets was 0.937 and 0.839, respectively. Logistic regression analysis screened 3 risk factors including Plt, SV and RLV/TLV. The AUC of the constructed Log-nomogram in the training and test sets was 0.934 and 0.813, respectively. Both ML-nomogram and Log-nomogram had high predictive ability for the incidence of PHLF (Z=1.21, 1.19; both P>0.05).

In this study, ML-nomogram is successfully constructed for predicting PHLF. Both ML-nomogram and Log-nomogram are convenient and have high prediction efficiency and accuracy.

To evaluate the efficiency of prediction models constructed based on different machine learning technologies for early severe complications after liver transplantation.

Clinical data of 129 patients undergoing orthotopic liver transplantation in Nanfang Hospital of Southern Medical University from July 2018 to August 2024 were retrospectively analyzed. The informed consents of all patients or family members were obtained. Among them, 121 patients were male and 8 female, aged from 18 to 71 years, with a median age of 51 years. According to Clavien-Dindo classification, all patients were divided into the severe and non-severe complication groups according to the incidence of Clavien-Dindo grade Ⅲb or above complications within 90 d after liver transplantation. Normalization method was used to preprocess continuous variables. Information gain, Boruta and elastic network were utilized for feature selection. Common factors in the methods and results were included. Five machine learning technologies, including support vector machine (SVM), random forest (RF), logistic regression (LR), eXtreme Gradient Boosting (XGBoost) and naive Bayes, were adopted to construct prediction models for early severe complications after liver transplantation. The accuracy rate, precision rate, recall rate, F1 value and the area under the ROC curve (AUC) of different machine learning algorithms were calculated by ten-fold cross-validation. Shapley additive explanations (SHAP) was adopted in the optimal model to evaluate the relative importance of each feature in the prediction models.

The incidence of early severe complications after liver transplantation was 24.8%(32/129). Five features including preoperative controlling nutritional status (COUNT) score, preoperative psoas muscle thickness per height (PMTH), preoperative MELD score, anhepatic phase and intraoperative blood loss, were input into machine learning models. Considering all indexes, the average efficiency of the RF prediction model was high and yielded the highest recall rate (0.844) and F1 score (0.866), demonstrating excellent capability in practical application. The average AUC, accuracy and precision rates in the validation set were 0.808, 0.800 and 0.898, respectively. The visual ranking of the importance of prediction variables in RF prediction models was: COUNT score, anhepatic phase, preoperative MELD score, intraoperative blood loss and PMTH, respectively. According to the SHAP, preoperative COUNT score, intraoperative blood loss, anhepatic phase and preoperative MELD score were positively correlated with, while preoperative PTMH value was negatively correlated with the incidence of early severe complications after liver transplantation.

Prediction models for early severe complications after liver transplantation are constructed based on different machine learning technologies. RF prediction model has high prediction performance, which is of certain significance to investigate perioperative management of liver transplantation recipients.

To evaluate the clinical application value of laparoscopic cholecystectomy (LC) combined with ultra-thin choledochoscope in the treatment of cystic duct stones.

Clinical data of 62 patients with cystic duct stones who underwent LC in the First Affiliated Hospital of Anhui University of Science and Technology from September 2021 to September 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 12 patients were male and 50 female, aged from 24 to 80 years, with a median age of 54 years. According to whether ultra-thin choledochoscope was adopted during LC, 26 patients were assigned into the ultra-thin choledochoscope group and 36 cases in the control group. For all patients, "four-port LC" was performed by the same team. Intraoperative and postoperative recovery, the presence of residual stones and secondary common bile duct stones were compared between two groups. Operation time and hospitalization expenses were compared by t-test between two groups. The incidence of complications was compared by Fisher's exact test.

The operation time in the ultra-thin choledochoscope group was (77±16) min, significantly longer than (66±16) min in the control group (t=2.689, P=0.009). The hospitalization expense in the ultra-thin choledochoscope group was (1.3±0.1)×10⁴ yuan, significantly higher than (1.2±0.1)×10⁴ yuan in the control group (t=2.388, P=0.020). No abdominal bleeding, bile leakage and incision infection occurred after operation in two groups. In the control group, 2 cases developed residual stones in the cystic duct and 4 cases of secondary common bile duct stones, whereas none in the ultra-thin choledochoscope group. The difference between two groups was statistically significant (both P<0.05).

LC combined with ultra-thin choledochoscope prolongs operation time and increase hospitalization expenses for patients with cystic duct stones, but it can effectively reduce the risk of postoperative residual stones and enhance surgical safety, especially for patients with multiple stones or fragmented stones in the cystic duct.

To compare the safety and efficacy between repeated hepatectomy (RH) and radiofrequency ablation (RFA) in the treatment of recurrent hepatocellular carcinoma (HCC), and to explore the influencing factors of postoperative survival.

Clinical data of 96 patients with recurrent HCC admitted to the First People's Hospital of Foshan from January 2017 to December 2023 were retrospectively analyzed. Among them, 86 patients were male and 10 female, aged from 27 to 78 years, with a median age of 55 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to different treatment methods, all patients were divided into the RH (n=43) and RFA groups (n=53). Patients between two groups were matched by 1∶1 propensity score matching (PSM). Clinical efficacy and safety between RH and RFA in patients with recurrent HCC were also compared. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method and Log-rank test. Prognostic factors were determined by using multivariate Cox's regression analysis.

After PSM, the 1-, 3- and 5-year OS rates in the RH group were 93.1%, 81.8% and 71.9%, and 83.7%, 58.9% and 45.4% in the RFA group, respectively, with no statistical significance between two groups (χ²=3.133, P=0.077). The 1-, 3- and 5-year PFS rates in the RH group were 70.8%, 45.4% and 34.4%, and 45.1%, 7.6% and 4.0% in the RFA group, respectively, with statistical significance between two groups (χ²=12.308, P<0.001). PFS subgroup analysis revealed that RH was superior to RFA in small tumors, single and multiple lesion subgroups (Z=9.811, 6.699, 5.998; all P<0.05). Cox's regression analysis revealed that treatment regimen, liver cirrhosis and satellite lesion were the independent influencing factors of PFS in patients with recurrent HCC (RR=0.005, 0.015, 0.013; all P<0.05). After PSM, the length of postoperative hospital stay was 2 (1,2) d in the RFA group, also significantly shorter than 7 (6,9) d in the RH group (Z=-6.612, P<0.001). The incidence of complications was 10%(3/31) in the RFA group, significantly lower than 42% (13/31) in the RH group (χ²=6.823, P=0.009).

For patients with recurrent HCC, RH achieves better PFS benefits compared with RFA, especially in patients with small tumors, single and multiple lesions. Patients between two groups obtain similar OS.

To construct the Internet+enhanced recovery after surgery(ERAS) information system, explore the application value of this system in ERAS of liver cancer patients and put forward a scientific and efficient regimen for the information management of surgical recovery in hospitals.

Clinical data of 87 patients with liver cancer admitted to the Affiliated Hospital of North Sichuan Medical College from January 2023 to December 2023 were retrospectively analyzed. Among them, 53 patients were male and 34 female, aged (55±8) years on average. This retrospective cohort study has been approved by the ethics committee of the hospital. Patients given with routine nursing intervention from January to June, 2023 were assigned into the routine group, and those receiving Internet+ERAS information system from July to December, 2023 were allocated into the ERAS group. Internet+ERAS information system included three modules: daily measure reminder, clinical decision-making and closed-loop information. The implementation rate, the changes of the length of hospital stay and hospitalization expense, and adverse reactions were compared before and after ERAS nursing care. Patients in the routine and ERAS groups were subject to propensity score matching (PSM) at a ratio of 1∶1. The rates between two groups were compared by Chi-square test. Measurement data were statistically compared by t-test.

31 patients were assigned in either of two groups after PSM. No significant differences were observed in baseline data, such as gender, age, BMI, tumor diameter, Child-Pugh score, TNM classification, family residence and family income (all P>0.05). Health education, intraoperative heat preservation, multi-mode analgesia, early postoperative activities, catheter management, and postoperative eating were 28, 27, 28, 29, 28, and 29 cases in the ERAS group, and 21, 20, 19, 22, 21, and 20 cases in the routine group, respectively. The implementation rate of recovery nursing care in the ERAS group was significantly better than that in the routine group (χ²=4.769, 4.309, 7.123, 3.946, 4.769 and 7.884; all P<0.05). The length of hospital stay and hospitalization expense in the ERAS group were (10.9±1.2) d and (4.0±1.3)×10⁴ yuan, significantly lower than (11.7±1.1) d and (4.7±1.3)×10⁴ yuan in the routine group (t=2.688,2.219; both P<0.05). The incidence of adverse reactions in the ERAS group was 6%(2/31), significantly lower than 26% (8/31) in the routine group (χ²=4.292, P<0.05).

Internet+ERAS information system can improve the implementation rate of postoperative nursing care, shorten the length of hospital stay, lower hospitalization expense and reduce the occurrence of adverse reactions, providing potent guarantee for ERAS of liver cancer patients.

To evaluate the effect of fatty liver disease (FLD) on clinical efficacy and prognosis of immunotherapy-based systemic treatment for advanced intrahepatic cholangiocarcinoma (ICC).

Clinicopathological data of 54 patients with advanced ICC receiving immunotherapy-based systematic treatment in Zhangjiagang Hospital Affiliated to Soochow University from April 2019 to April 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 21 patients were male and 33 female, aged from 29 to 77 years, with a median age of 58 years. All patients were divided into the FLD group (n=24) and non-FLD group (n=30). Clinical efficacy was evaluated by Response Evaluation Criteria In Solid Tumours (RECIST). The objective remission rate (ORR) and adverse event (AE) between two groups were compared by Chi-square test. Overall survival (OS) and progression-free survival (PFS) were analyzed by Kaplan-Meier method and Log-rank test. Prognostic factors were analyzed and evaluated by Cox's regression model.

The ORR of all patients in this study was 22%(12/54), and 8%(2/24) in the FLD group, significantly lower than 33%(10/30) in the non-FLD group (χ²=18.793, P<0.001). The incidence of AE in the FLD group was 75%(18/24), significantly higher than 37%(11/30) in the non-FLD group (χ²=7.880, P=0.005). The incidence of grade 1-2 AE in the FLD group was 50%(12/24), significantly higher than 20%(6/30) in the non-FLD group (χ²=5.400, P=0.020). However, no significant difference was observed in the incidence of grade 3-4 AE between two groups (χ²=0.571, P=0.450). The median OS was 22.7 months and the median PFS was 5.8 months. The median OS was 11.7 and 27.3 months, and the median PFS was 4.4 and 8.3 months in the FLD and non-FLD groups, respectively. The OS and PFS in the FLD group were significantly shorter than those in the non-FLD group (χ²=14.967, 4.527; both P<0.05). Univariate Cox's analysis showed that FLD, ALB, immunoglobulin (Ig) G and IgM were the influencing factors of OS in ICC patients (HR=11.320, 6.176, 4.877, 6.452; all P<0.05). Multivariate Cox's analysis showed that FLD (HR=6.569, 95%CI: 1.407-30.680; P=0.017) and IgM<2.2 g/L (HR=3.914, 95%CI: 1.130-13.560; P=0.031) were the independent risk factor of OS.

FLD significantly reduces clinical efficacy of immunotherapy-based systemic therapy and shortens the survival time in patients with advanced ICC, suggesting that the influence of FLD on immunotherapy should be considered in clinical practice, thereby adjusting the treatment strategy.

To investigate surgical treatment and clinical efficacy of biliary tract variations complicated with complex hepatolithiasis, and perform literature review.

Clinical data of a patient diagnsed with biliary duct variations and complex hepatolithiasis who underwent surgical treatment in the Affiliated Hospital of North Sichuan Medical College in April, 2024 were retrospectively analyzed. A 36-year-old female patient was admitted due to "epigastric pain and discomfort for more than 1 month". AST level was 88 U/L, ALT 217 U/L, TB 27.8 μmol/L and DB 11.2 μmol/L, respectively. MRI and MRCP of the upper abdomen showed stones in the upper and middle common bile duct, hilar bile duct and left and right intrahepatic bile ducts complicated with bile duct dilatation and cholangitis. Biliary duct variations: the right anterior lobe and the left hepatic duct merged into the common bile duct in parallel, and the right posterior lobe bile duct dilated and merged into the common bile duct at the lower posterior end; and cholestasis. Preliminary diagnosis: intrahepatic and extrahepatic bile duct stones complicated with cholangitis; anatomical biliary variants, Couinaud segement Ⅳ; hepatic insufficiency; and cholestasis. The informed consent of this patient was obtained and the local ethical committee approval was received.

After comprehensive evaluation before operation, laparoscopic right hemihepatectomy, cholecystectomy, choledochoscopic exploration and lithotomy, bile duct repair and plasty combined with T tube drainage were performed under general anesthesia on April 10, 2024. The operation time was 185 min, intraoperative bleeding was estimated 100 ml, and no blood transfusion was delivered intraoperatively. The patient was discharged at postoperative 10 d. Pathological examination showed no sign of canceration. Pigment deposition was seen in partial cells of the right lobe, fibrous hyperplasia in portal area and surrounding area, lymphocyte infiltration and intrahepatic bile duct dilatation were also found. The patient was followed up by outpatient and telephone after discharge. T-tube cholangiography at postoperative 1 month confirmed no residual stones and T tube was removed subsequently. Postoperative follow-up was conducted to monitor the condition and prevent the recurrence. No recurrence has been reported as of the submission date.

Comprehensive preoperative evaluation, careful intraoperative operation and attentive postoperative management can effectively reduce the risk of anatomic variations of bile duct and vessels during laparoscopic hepatectomy in the treatment of hepatolithiasis, and enhance surgical safety and efficacy.

To investigate the diagnosis, treatment and prognosis of complicated hepatectomy for hepatoblastoma (HB) complicated with inferior vena cava (IVC) tumor thrombus, atrial tumor thrombus, renal vein tumor thrombus and bilateral lung metastases.

Clinical data of a child with HB admitted to PLA Rocket Force General Hospital on February 14, 2024 were retrospectively analyzed. The boy, aged 2 years and 7 months, weighing 12.3 kg, was admitted to the hospital due to the space-occupied lesion in the liver for more than 4 months. After comprehensive examinations, he was diagnosed with HB complicated with IVC tumor thrombus, atrial tumor thrombus and renal vein tumor thrombus, and postoperative bilateral lung metastases. After MDT consultation, liver tumor resection (extended right hemihepatectomy+caudate lobectomy), IVC replacement, allogenic vessel transplantation, renal vein-allogenic vessel anastomosis and hepatic vein-allogenic vessel anastomosis were determined. The informed consent of the patient was obtained and the local ethical committee approval was received.

The operation was carried out according to preoperative planning. The right atrium was partially resected (approximately 1 cm). Postoperative, ultrasound showed that the blood flow at the anastomosis was smooth. No evident abnormality in liver and kidney function was found after operation. No tumor cells were found at the atrial margin. The child was discharged at postoperative 13 d. He received 1 session of carboplatin+adriamycin chemotherapy in a local hospital. Warfarin was used for regular anticoagulation. At postoperative 4 months, he was admitted because of a large amount of abdominal and pelvic effusion. After examination, he was diagnosed with the stenosis of hepatic vein opening and given with balloon dilation.At postoperative 5 months, he was admitted due to abdominal distension and high fever. Hepatic venography under general anesthesia showed severe stenosis of hepatic vein opening, and balloon angioplasty was performed. At postoperative 7 months, he was hospitalized due to pericardial, peritoneal and pleural effusions, and underwent puncture drainage. The blood oxygen saturation was maintained at approximately 98%, and the child was transferred to ICU. After fluid therapy and volume expansion combined with internal environment correction, hepatic venography+balloon angioplasty+stent placement were performed under general anesthesia. Postoperative ultrasound showed that pericardial and pleural effusions were absent. Drainage catheter was removed, albumin was supplemented appropriately, and anticoagulation was performed. The child was discharged smoothly. At 16 months after operation, AFP level was decreased to 2 μg/L. No significant abnormality was detected in the liver, kidney, heart and lung.

The treatment of HB, especially in the case of IVC invasion, requires comprehensive MDT diagnosis and treatment. Radical surgical resection is still the curative treatments.

To investigate the expression of basic fibroblast growth factor (bFGF) and platelet-derived growth factor (PDGF) in hepatic hydatid cyst wall and surrounding liver tissues and their correlation with liver fibrosis.

Clinical specimens were collected from 82 patients with hepatic alveolar echinococcosis undergoing surgery in Traditional Chinese Medicine Hospital of Xinjiang Medical University from June 2020 to August 2024. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 51 patients were male and 31 female, aged from 19 to 59 years, with a median age of 38 years. Intraoperatively, cyst wall tissues and the tissues adjacent to the lesions were collected. All tissues were subject to liver fibrosis staging and scoring. The expression profile of bFGF, PDGF-A and PDGF-B at mRNA and protein levels in all tissues were determined by real-time fluorescence quantitative PCR and Western blot, respectively. The expression levels of bFGF, PDGF-A and PDGF-B in different tissues were compared by t-test. The stage of liver fibrosis was compared by rank-sum test. The correlation between bFGF, PDGF-A and PDGF-B and the stage of liver fibrosis was assessed by Spearman or Pearson correlation analyses.

Knodell fibrosis score of the cyst wall was 1 in 7 patients, 2 in 51 cases and 3 in 24 cases, respectively. Knodell fibrosis score of tissues adjacent to the lesions was 0 in 72 patients, 1 in 8 cases and 2 in 2 cases, respectively. The difference was statistically significant (Z=11.475, P<0.001). The relative expression levels of bFGF, PDGF-A and PDGF-B mRNA in the cyst wall were 2.27±0.56, 1.74±0.43 and 1.61±0.33, and 0.61±0.13, 0.41±0.12 and 0.56±0.11 in tissues adjacent to the lesions, respectively. The difference was statistically significant (t=26.251,23.213,27.223; all P<0.001). The relative expression levels of proteins in two groups were 2.11±0.59, 1.94±0.48, 1.52±0.34, and 0.55±0.14, 0.44±0.12, 0.49±0.12, respectively. The differences were also statistically significant (t=27.368, 26.972, 25.989; all P<0.001). Correlation analysis showed that the relative expression levels of bFGF, PDGF-A and PDGF-B mRNA in the cystic wall tissues were positively correlated with the stage of fibrosis (r_s=0.688, 0.787, 0.647; all P<0.001). A significant positive correlation was observed in the relative expression levels of bFGF, PDGF-A and PDGF-B mRNA (r=0.673, 0.604, 0.704; all P<0.001).

The expression levels of bFGF, PDGF-A and PDGF-B in the cyst wall of alveolar echinococcosis are significantly higher than those in the surrounding liver tissues, which are intimately correlated with the severity of fibrosis in the cyst wall.

Liver tumors are primarily treated with comprehensive therapy based on liver resection. The advantages of anatomical liver resection (ALR) in the treatment of liver tumors have been widely recognized in this field. However, it is challenging for the surgeons to precisely determine the scope of liver resection. ICG fluorescence imaging technology has been adopted for a long period of time and it is relatively safe, which can identify liver tumors during intraoperative imaging and enhance the precision of ALR. However, ICG has limited penetration and high false positive rate, and its clinical efficacy remains controversial. In this article, the development, application, imaging mechanism of ICG fluorescence laparoscopy in liver tumors, and its defects and limitations were reviewed, aiming to provide reference for the application of ICG fluorescence imaging technology in LAR in the future.

Precise hepatectomy is an important progress in liver surgery in recent years. Through precise preoperative evaluation, individualized surgical planning and accurate intraoperative resection, it can achieve minimal surgical trauma and optimal liver protection. Three-dimensional (3D) reconstruction and 3D printing technology provide surgeons with intuitive presentation of the liver and its vascular system before operation, which helps to formulate individualized surgical plans and reduce the risk of complications. The application of multi-modal molecular imaging technology and artificial intelligence further improves the precision of intraoperative monitoring and navigation, especially the fluorescence imaging technology can accurately identify the tumor margin and guide the range of resection. In addition, surgical safety and postoperative prognosis of patients can be effectively improved by adopting anesthesia management strategies such as low central venous pressure and monitoring stroke volume variability. Although this technology faces multiple challenges such as high cost and complex technology, precise hepatectomy is expected to be more widely applied in clinical practice along with persistent development of medical imaging and artificial intelligence technologies.

Hepatocellular carcinoma (HCC) is one of the major malignant tumors worldwide. Targeted therapy and immunotherapy have become important treatment options for advanced HCC. However, high incidence of skin complications severely affects the treatment compliance and quality of life of patients. Targeted therapy-related skin toxicities mainly include hand-foot skin reaction, rash and dry skin, among which the incidence of hand-foot skin reaction is as high as 45%-73%. The incidence of immunotherapy-related skin toxicities is approximately 30%-40%, mainly manifested as itching, maculopapular rash and immune-related dermatitis. In this review, the mechanism, clinical manifestations and grading criteria between two types of treatment-related skin toxicities were systematically compared, and the grading-and evidence-based management strategies were proposed based on the latest clinical research results. Standardized skin toxicity management includes pre-treatment evaluation, preventive treatment, early identification, grading treatment and follow-up management, which can effectively reduce the incidence and severity of skin toxicity and improve the quality of life of patients. Considering the characteristics of patients with liver cancer, the importance of liver function evaluation and individualized adjustment of drugs was emphasized. Implementing the skin toxicity management principle of "prevention first, early identification, grading treatment and multidisciplinary team cooperation" can provide safer and more effective targeted treatment for patients with liver cancer.

Non-alcoholic fatty liver disease (NAFLD) is the most common chronic liver disease worldwide. Recent studies have revealed that nucleotide-binding domain leucine-rich repeat and pyrin domain-containing receptor 3 (NLRP3) inflammasome, as the core regulatory node of innate immune system, play a key role in the progression from NAFLD to nonalcoholic steatohepatitis and liver fibrosis by integrating the signals of lipotoxicity, oxidative stress and gut-liver axis disorder. In this review, the molecular structure, activation pathway and core regulatory mechanisms of NLRP3 inflammosome were systematically summarized. In addition, small molecular inhibitors, natural compounds and gene editing technologies targeting NLRP3 have shown remarkable efficacy in preclinical models, suggesting its potential as a novel therapeutic strategy for NAFLD. However, current research still faces multiple challenges, such as unclear regulatory mechanism of cell heterogeneity, insufficient research on spatio-temporal dynamics and bottleneck of clinical translation. Subsequently, it is necessary to integrate single-cell and spatial genomics technologies to analyze the cell-specific activation mode of NLRP3 in liver microenvironment. The metabolic-inflammatory interaction network can be elucidated by combining multi-omics data. Allosteric inhibitors or targeted delivery systems can be developed to improve treatment specificity. Through interdisciplinary technological integration and clinical research innovation, NLRP3 inflammatosome-targeted therapy is expected to provide precise and safe intervention protocols for NAFLD patients and promote the translation from basic research to clinical application.