The incidence of portal vein tumor thrombus (PVTT) is high with poor prognosis. It is the bottleneck to improve the overall efficacy of liver cancer. The existing treatment methods for PVTT include surgery, radiotherapy, transcatheter arterial chemoembolization and systemic therapy, among which radiotherapy is one of the fastest-growing fields in recent years. New radiotherapy techniques, such as three-dimensional conformal radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), stereotactic body radiotherapy (SBRT) and proton beam therapy (PBT), can significantly increase the therapeutic dose and protect normal liver tissues, which can proceed throughout the whole treatment process of liver cancer complicated with PVTT, and play a critical role in further enhancing treatment efficacy of PVTT when combining with alternative treatments. In this article, recent progress in radiotherapy for liver cancer complicated with PVTT was reviewed.

The postoperative recurrence rate of hepatocellular carcinoma (HCC) is high, which severely affects the survival of patients. Surgical treatment of recurrent HCC faces multiple challenges. Laparoscopic surgery has the advantages of mild trauma and rapid recovery in the treatment of recurrent HCC. Nevertheless, there are still difficulties in defining surgical indications and management of abdominal adhesion, etc. In this article, the indications of laparoscopic surgical treatment of recurrent HCC were illustrated, clinical efficacy between laparoscopic and open surgery was compared, and the advantages of laparoscopic surgery in reducing intraoperative bleeding, shortening the length of hospital stay and lowering the incidence of complications were highlighted. Although technical challenges still exist, laparoscopic surgery has a broad application prospect with the advancement in technology and multidisciplinary cooperation, which will provide new hope for prolonging overall survival and improving the quality of life of patients.

Surgery-based comprehensive treatment is primarily adopted for liver surgery-related diseases. Liver surgery is highly challenging, which involves complex anatomy and fine vascular anastomosis. How to reduce the amount of bleeding, improve the safety of surgery, simplify surgical procedures, reduce the incidence of complications and mortality rate have been the focus of research in the field of liver surgery. With the improvement of living standards, the requirements for medical quality have been elevated accordingly. The concepts of minimally invasive surgery, precision surgery and enhanced recovery after surgery (ERAS) have been integrated into the diagnosis and treatment of liver surgery to meet the requirements in the modern era. With the progress in science and technology, digital technologies represented by three-dimensional visualization technology have accelerated the development of intelligent, precise and minimally invasive surgery. In this article, recent changes in the concept and technical progress of liver surgery were reviewed.

Laparoscopic liver resection for posterosuperior tumors is a challenging procedure in laparoscopic liver resection. How to guarantee the safety of this procedure has been one of the keys issues for liver surgeons. In this article, the development history of laparoscopic liver resection was reviewed, and the naming of resection of tumors in the posterosuperior segment of liver (including S7, S8 and S4a) was discussed, and the importance of unified naming was emphasized. The challenges of liver resection for posterosuperior tumors were analyzed, including the difficulty of exposure due to deep location of S7 and S8 segments as well as bleeding control. Three main surgical approaches including lateral, thoracoscopic and abdominal approaches were illustrated, and their advantages and disadvantages were analyzed. Based on literature review combined with clinical practice, the key steps of this procedure were illustrated, including patient's posture, Trocar site, liver dissociation, dissociation of the third porta hepatis and liver partition, and the possibility of technical breakthrough in the future was predicted, including robot-assisted surgery and novel procedure using Laennec's capsule.

Liver transplantation (LT) is the ultimate treatment for portal hypertension (PHT). Pathophysiological changes such as portal vein thrombosis (PVT), cavernous transformation of portal vein (CTPV) and splenic artery steal syndrome (SASS) during PHT exert significant impact on the blood supply of liver allograft, which not only significantly increases the risk of LT, but also probably affects the long-term survival of liver allograft. Preoperatively, surgical indications should be selected reasonably, and it is recommended to prepare multiple regimens for vascular reconstruction. Intraoperative embolectomy and identifying usable veins are key procedures. Controlling wound surface and shortening the operation time play crucial roles in reducing perioperative complications and death. The monitoring of portal vein and hepatic artery perfusion should be performed throughout the whole process before and after LT. In this article, common pathological changes of portal vein and hepatic artery during PHT, underlying mechanism, short-term and long-term effects on intraoperative and postoperative periods of LT and corresponding countermeasures were illustrated and discussed.

Pancreatic cancer is one of the highly malignant tumors. Surgical resection remains the only effective treatment for patients with pancreatic cancer, saving the chance of cure and long-term survival. However, the overall prognosis of pancreatic cancer patients is extremely poor, and the 5-year survival rate of pancreatic cancer is less than 13%, mainly because it is difficult to be detected during the early stage. Early visualization of pancreatic tumors and early diagnosis of pancreatic cancer are the decisive factors for patients with pancreatic cancer to obtain long-term survival. Near-infrared fluorescence imaging is one of the key technologies to realize intraoperative navigation. In recent years, with gradual maturity of near-infrared-Ⅱ optical biological imaging theory, near-infrared-Ⅱ fluorescence imaging technology has become a research hotspot in the field of clinical surgical navigation. Despite of persistent technological progress in recent years, a series of practical problems remain unresolved. In this article, the progress in near-infrared fluorescence imaging in pancreatic cancer was reviewed, aiming to provide novel idea for precise diagnosis and treatment of pancreatic cancer.

To investigate the effect of preoperative HBV-DNA quantification levels and antiviral therapy on post-hepatectomy liver failure (PHLF) in patients with HBV-associated hepatocellular carcinoma (HBV-HCC).

A total of 853 patients with HBV-HCC who underwent partial hepatectomy at the First Affiliated Hospital of Sun Yat-sen University from January 2014 to December 2021 were enrolled. The local ethical committee approval was received and the requirement for written informed consent was waived due to the retrospective nature of the study. Among them, 756 patients were male and 97 female, aged from 18 to 84 years, with a median age of 53 years. Univariate and multivariate Logistic regression analyses were used to analyze the risk factors of PHLF. A prediction model for PHLF was constructed based on the independent risk factors of PHLF. The area under the ROC curve (AUC), calibration curve and decision curve analysis (DCA) were adopted to analyze the efficiency of the prediction model. Mann-Whitney U test was employed to compare the liver function parameters between two groups. The incidence rates were compared by Chi-square test or Fisher's exact test.

The incidence of PHLF in HBV-HCC patients was 23.9% (204/853). Multivariate Logistic regression analysis identified HBV-DNA≥2 000 IU/ml, age, major hepatectomy, intraoperative blood loss, prealbumin (PA), total bile acid (TBA), Plt and PT as independent risk factors for PHLF (OR=1.489 3, 1.020 2, 3.331 6, 1.000 2, 0.993 7, 1.014 9, 0.995 1, 2.240 3; all P<0.05). Based on the above 8 independent risk factors, a nomogram prediction model for PHLF was constructed. The AUC of this prediction model for PHLF was 0.816. The calibration curve showed high consistency between the risk of PHLF predicted by the model and the actual incidence of PHLF, with a C-index of 0.809 8. DCA also demonstrated that the prediction model yielded more clinical benefits. The incidence of PHLF in patients receiving regular antiviral therapy before surgery was 19.1%(47/246), significantly lower than 25.9%(157/607) in those without regular antiviral therapy (χ²=4.032, P=0.044).

For patients with HBV-HCC undergoing hepatectomy, preoperative HBV-DNA ≥2 000 IU/ml is an independent risk factor for PHLF. Regular antiviral therapy before surgery can effectively reduce the incidence of PHLF.

To evaluate the predictive value of preoperative inflammatory immune indexes for survival and prognosis of patients with hepatocellular carcinoma (HCC) undergoing hepatectomy.

Clinical data of 232 HCC patients who underwent hepatectomy in the Second Affiliated Hospital of Kunming Medical University from March 2018 to February 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 190 patients were male and 42 female, aged from 33 to 77 years, with a median age of 52 years. The optimal cut-off values of neutrophil-lymphocyte ratio (NLR), lymphocyte-monocyte ratio (LMR), systemic immune-inflammation index (SII), prognostic nutritional index (PNI) and hemoglobin, albumin, lymphocyte and platelet (HALP) scores were determined by using the ROC curve and Youden's index. Kaplan-Meier method and Log-rank test were used for survival analysis. Univariate and multivariate Cox's regression analyses were adopted to determine the independent risk factors of patients' survival and prognosis. A prediction model for prognostic index (PI) was constructed. The ROC curve was employed to analyze the prediction efficiency for 2-year overall survival of this prediction model.

During postoperative follow-up, 90 patients died and 142 survived. The 1-, 3-, and 5-year survival rates of HCC patients were 93.5%, 79.3% and 56.5%, respectively. The optimal cutoff values of NLR, LMR, SII, PNI and HALP were 2.38, 3.53, 429.89, 347.44 and 32.64, respectively. The 1- and 3-year survival rates of HCC patients in the high NLR group were 82.1% and 38.3%, respectively, and 89.6% and 68.1% in the low NLR group, respectively. The 1- and 3-year survival rates in the high LMR group were 92.0% and 69.0%, and 80.0% and 41.2% in the low LMR group, respectively. The 1- and 3-year survival rates in the high SII group were 84.6% and 37.9%, and 92.2% and 67.9% in the low SII group, respectively. The 1- and 3-year survival rates in the high PNI group were 94.0% and 75.4%, and 89.4% and 44.2% in the low PNI group, respectively. The 1- and 3-year survival rates in the high HALP group were 93.1% and 70.6%, and 60.5% and 5.0% in the low HALP group, respectively. The differences in these indexes were statistically significant between two groups (χ²=16.103, 23.882, 19.502, 23.059, 109.681; all P<0.001). Univariate and multivariate Cox's regression analyses showed that microvascular invasion, activated partial thromboplastin time, PNI and HALP were the independent prognostic factors (HR=1.667, 0.955, 0.997, 0.987; all P<0.05). PI model was constructed based on the independent prognostic factors, and the area under the ROC curve of the prediction model was 0.654.

Preoperative inflammatory immune indexes, such as NLR, LMR, SII, PNI and HALP, can predict postoperative survival of HCC patients after hepatectomy. PI model based on inflammatory immune indexes has certain predictive value for survival and prognosis.

To investigate the expression, biological function and clinical relevance of melanoma cell adhesion molecule (MCAM) in hepatocellular carcinoma (HCC), and its role in the survival prognosis and immunotherapy response of HCC patients.

The MCAM mRNA expression level and clinical information were retrieved from TCGA, UCSC Xena and GEO databases. Differential expression analysis was performed using ggplot2. The "survival" and "survminer" R packages were used for survival analysis. The expression of MCAM protein was evaluated by the data base of Clinical Proteomic Tumor Analysis Consortium (CPTAC). Gene ontology (GO) functional and KEGG pathway enrichment analyses were conducted by LinkedOmics. Single-sample gene set enrichment analysis (ssGSEA) and TIMER database were used to evaluate the relationship between immune cell infiltration and immune checkpoints. Immunohistochemical assay was validated by using clinical samples. The response to immunotherapy was predicted by the BEST database.

Multiomics analysis based on the TCGA-LIHC data set, GEO, UALCA and CPTACP databases showed that MCAM was highly expressed in HCC tissues. In TCGA-LIHC data set, the overall survival (OS) and progression-free survival (PFS) of patients with high expression of MCAM were significantly lower than those with low MCAM expression (HR=0.70, 0.68; both P<0.05). In GSE144269 and GSE54236 databases, the OS of patients with high expression of MCAM was lower than that of patients with low MCAM expression (HR=0.67, 0.72; both P<0.05). UALCA database demonstrated that high expression of MCAM in HCC patients was positively correlated with clinical stage, tumor grade and lymph node metastasis (all P<0.05). In TCGA-LIHC data set, the area under the ROC curve (AUC) of MCAM expression was 0.921 (95%CI: 0.887-0.954), indicating that MCAM had high diagnostic efficiency. GO functional and KEGG pathway enrichment analyses showed that the co-expressed genes of MCAM participated in the immune response pathway, including Th1/Th2 cell differentiation. High MCAM expression significantly affected the level of immune cell infiltration and participated in multiple cancer-promoting signal pathways. Immunohistochemistry found high expression of MCAM protein in HCC tissues. BEST analysis demonstrated that high MCAM expression might predict better response to targeted therapy of PD-1, PD-L1 and CTLA-4.

MCAM is highly expressed in HCC, which is associated with poor prognosis and immune regulation of HCC patients. MCAM can be used as a valuable biomarker for cancer prognosis and a potential predictor for clinical efficacy of immunotherapy.

To construct a predictive model for early identification of post-hepatectomy liver failure (PHLF) for liver cancer using the extreme gradient boosting (XGBoost), and evaluate its predictive efficiency.

Clinical data of 583 patients with liver cancer who underwent hepatectomy in Nanfang Hospital from November 2018 to January 2022 were retrospectively analyzed. Among them, 504 patients were male and 79 female, aged from 23 to 77 years, with a median age of 54 years. Clinical indexes of all enrolled patients before, during and after hepatectomy were collected, and relevant clinical scores were calculated. The data set was randomly divided into the training and validation sets according to a ratio of 8∶2. Based on XGBoost, the PHLF prediction model was constructed by using 5-fold cross validation and loss function to adjust the hyperparameters. The prediction efficiency of XGBoost model was evaluated by the ROC curve and compared with traditional scoring system. Meantime, the importance of the feature variables was ranked. Shapley additive explanation (SHAP) was used to visually explain the model.

Among 583 patients, 467 cases were assigned into the training set and 63 cases developed PHLF. 116 cases were allocated in the validation set and 15 developed PHLF. Univariate analysis and Lasso regression analysis showed that 8 clinical indexes including preoperative INR, AST, ALB, operation time, extensive hepatectomy, INR, AST and TB at postoperative 1 d (D1) were significantly associated with PHLF in the training set. The area under the ROC curve (AUC) of XGBoost model in training and validation sets was 0.973 and 0.904, respectively. SHAP value was employed to quantify the impact of each feature on the prediction results of the model, D1 INR had the largest weight, and high D1 AST was positively correlated with the increase of PHLF risk. Based on INR and AST, the PHLF prediction score formula was constructed, and the PHLF prediction score=-13.395+1.2×preoperative AST(U/L)/100+9.236×D1 INR. The AUC of the scoring model was 0.838, the sensitivity was 0.825 and the specificity was 0.748, respectively.

The PHLF prediction model based on XGBoost yields high accuracy and robustness in both the training and validation sets of liver cancer, which has the potential as an auxiliary tool for clinical decision-making, contributes to promptly identifying patients with high-risk PHLF and delivering immediate interventions, thereby improving clinical prognosis of patients with liver cancer.

To evaluate the application value of clinical pathway of enhanced recovery after surgery (ERAS) in liver resection under multi-disciplinary team (MDT) cooperation.

Clinical data of 1 046 patients who underwent liver resection in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology from January 2018 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 764 patients were male and 282 female, aged from 18 to 84 years, with a median age of 52 years. According to the implementation of clinical pathway of ERAS under MDT cooperation, 416 patients were assigned into the ERAS group and 630 cases into the non-ERAS group. The potential selection bias between two groups was minimized by propensity score matching (PSM). The length of postoperative hospital stay, indwelling time of gastric tube, urinary catheter and drainage tube between two groups were compared by rank-sum test. The incidence of postoperative complications was compared by Chi-square test.

After 1:1 PSM, 253 patients were matched in each group. There was no significant difference in baseline indexes between two groups (all P>0.05). After PSM, the length of postoperative hospital stay in the ERAS group was 9(7,12) d, significantly shorter than 11(8,13) d in the non-ERAS group (Z=-3.610, P<0.001). Postoperative indwelling time of gastric tube, urinary catheter and drainage tube in the ERAS group was 4(2,12) h, 27(21,44) h and 4(3, 6) d, significantly shorter than 21(16,24) h, 41(21,56) h and 5(4,7) d in the non-ERAS group (Z=-14.150,-2.235,-5.202; all P<0.05). The incidence of postoperative complications in the ERAS and non-ERAS groups was 5.9%(15/253) and 8.3%(21/253), with no statistical significance (χ²=1.077, P>0.05).

The application of ERAS clinical pathway in liver resection under MDT cooperation can significantly shorten the length of postoperative hospital stay and accelerate postoperative recovery.

To investigate the risk factors of massive ascites after liver resection for primary liver cancer (PLC) and construct a nomogram prediction model.

Clinical data of 739 PLC patients admitted to the Affiliated Hospital of North Sichuan Medical College from January 2018 to December 2022 were retrospectively analyzed. Among them, 585 patients were male and 154 female, aged from 21 to 89 years, with a median age of 60 years. According to the operation time and surgical department, all patients were divided into the training set (n=536) and validation set (n=203). The data in the training set were used for model construction, model evaluation and internal validation, and those in the validation set data were utilized for external validation. Clinical data of the enrolled patients were obtained by querying the scientific research data platform and special disease database of the hospital. In the training set, Lasso regression and binary Logistic regression analyses were used to construct the risk prediction model for postoperative massive ascites. Bootstrap method was adopted to conduct 1 000 repeated sampling in the training set for internal validation, and the data in the validation set were used for external validation. The area under the ROC curve (AUC) and calibration curve were employed to evaluate the prediction performance of this prediction model. Decision curve analysis (DCA) was utilized to evaluate clinical application value of the prediction model.

Lasso regression and Logistic regression analyses showed that liver cirrhosis, postoperative ALB, intraoperative blood loss and ALP were the risk factors for postoperative massive ascites in the training set (OR=3.107, 2.321, 2.472, 2.810; all P<0.05). Based on these four independent risk factors, a nomogram prediction model was constructed. The optimal cut-off value of the total score of the prediction model was 185.5. Patients with a total score of ≥185.5 were assigned into the high-risk group, and those with a total score <185.5 were allocated into the low-risk group. The AUC of the prediction model in the training and validation sets was 0.759 (95%CI: 0.716-0.802) and 0.805 (95%CI: 0.743-0.867), respectively. Calibration curve identified high consistency between the predicted risk and the actual risk estimated by the prediction model for of massive ascites after liver resection. DCA demonstrated that the prediction model had clinical value in predicting the risk of massive ascites, and its application could bring clinical benefits to the patients.

Prediction model for massive ascites after liver resection based on the independent risk factors including liver cirrhosis, postoperative ALB, intraoperative blood loss and ALP, in patients with PLC has high predictive ability and clinical applicability.

To evaluate perioperative safety and efficacy of total laparoscopic ALPPS in the treatment of colorectal liver metastasis (CRLM).

Clinical data of 12 patients with CRLM treated with total laparoscopic ALPPS in the Sixth Affiliated Hospital of Sun Yat-sen University from April 2021 to April 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 7 patients were male and 5 female, aged from 40 to 70 years, with a median age of 56 years. 11 cases were diagnosed with synchronous liver metastases and 1 case of metachronous liver metastasis. 5 patients had liver metastases in left and right lobes, 5 cases in the right lobe, and 2 cases in bilateral lobes and caudate lobe, respectively. The maximum diameter of liver metastases was 6.5 cm. Perioperative bleeding loss, incidence of complications and postoperative recovery were observed.

Among 12 patients undergoing total laparoscopic ALPPS, 1 case received simultaneous resection of liver and intestinal lesions, and 11 cases underwent staged resections. After primary and secondary ALPPS, transaminase levels peaked at postoperative 1-2 d, and then gradually declined. After primary and secondary ALPPS, total bilirubin levels were not significantly increased and maintained within 2 times of normal value. The median amount of bleeding during primary laparoscopic ALPPS was 100 (50-600) ml. 2 patients developed postoperative complications, including 1 case of pleural effusion and biliary fistula and 1 case of cardiac insufficiency, all of which were classified as Clavien-Dindo grade Ⅲa. No patient died after surgery. The median amount of bleeding during secondary laparoscopic ALPPS was 125 (50-1 000) ml. 7 cases suffered from postoperative complications, including pleural effusion, biliary fistula, poor wound healing, cardiac insufficiency and jaundice. 4 patients had Clavien-Dindo grade Ⅲa complications, and no Clavien-Dindo grade Ⅲb or above complications were reported. No patient died within postoperative 90 d.

Total laparoscopic ALPPS is a safe and feasible treatment for CRLM, which provides a radical resection opportunity for unresectable CRLM.

To evaluate clinical efficacy and safety of sequential surgery after conversion therapy in patients with unresectable hepatocellular carcinoma (HCC).

Clinical data of 5 patients with initially unresectable HCC who underwent sequential surgical resection following conversion therapy in Affiliated Hospital of North Sichuan Medical College from February 2020 to July 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 4 patients were male and 1 female, aged from 33 to 73 years, with a median age of 53 years. All 5 cases were complicated with liver cirrhosis. 4 patients were assessed with Child-Pugh grade A and 1 case of Child-Pugh grade B liver function. The Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores were ranged from 0 to 1. According to the China Liver Cancer (CNLC) staging, 2 patients were classified with Ⅰb and 3 cases of Ⅲa stage tumor.The conversion therapeutic, operative regimen and effect, survival prognosis of the patients were summarized.

All 5 patients were treated with TACE-based local therapy combined with immunotherapy and targeted therapy. Among them, 1 case was treated with TACE+ bevacizumab + PD-1 inhibitor, 3 cases with TACE+TKIs+PD-1 inhibitor, and 1 case with TACE+TKIs+PD-1 inhibitor combined with HAIC. The duration of preoperative conversion therapy was 138 (109-311) d. All 5 patients had different degrees of adverse reactions, all of which were grade 2 or below. After symptomatic treatment, all the patients were alleviated without interruption of medication. The operation time was 330 (225-360) min, intraoperative blood loss was 250 (200-900) ml, and the length of hospital stay was 20 (15-27) d. Postoperative pathological results confirmed that resection margins were negative in all cases. Complete necrosis of tumor cells was found in 2 cases, who achieved pathological complete remission (pCR), and partial necrosis of tumor cells in 3 cases, who obtained pathological partial remission (pPR). For microvascular invasion (MVI) grade, 3 cases were with M0 and 2 with M1. Follow-up time was ranged from 3 to 44 months, with a median of 27 months. During the follow-up, 1 patient recurred at postoperative 21 months, and no recurrence or metastasis was observed after ablation treatment. No recurrence was observed in the remaining 4 cases. No death case was observed during the follow-up.

Surgical resection after TACE combined with immunotherapy and targeted therapy can prolong the survival time of patients with initially unresectable HCC. However, the specific regimen and efficacy remain to be validated by multiple prospective studies.

To investigate the underlying mechanism of endoplasmic reticulum stress (ERS)-associated genes in the progression of nonalcoholic steatohepatitis (NASH) by bioinformatics analysis.

The GSE63067 dataset was downloaded from the Gene Expression Omnibus (GEO) database (https://www.ncbi.nlm.nih.gov/geo/). This dataset contains gene expression data of 9 patients with NASH and 7 healthy individuals. Differentially expressed genes between NASH patients and healthy controls were analyzed based on limma software package. Based on bioinformatics analyses, such as Gene Ontology (GO) functional analysis, KEGG pathway enrichment analysis and protein-protein interaction (PPI) network construction, the potential function of ERS-associated differentially expressed genes in the pathogenesis of NASH was illustrated.

14 ERS-associated differentially expressed genes were identified. Among them, the expression levels of 12 genes including BIRC3, CASP4, CASP7, FABP5, LECT2, PHLDA1, SGK1, TSLP, SGMS2, NAMPT, IRF1 and CD274 were up-regulated, whereas those of CEBPA and IGFBP2 were down-regulated in NASH. GO functional analysis showed that differentially expressed genes were mainly involved in cytokine signaling pathway, apoptosis, T cell proliferation regulation, cell activation and other related biological processes in the pathogenesis of NASH. KEGG pathway analysis demonstrated that differentially expressed genes were mainly involved in TNF signaling pathway, multi-species apoptosis pathway, nucleotide-binding oligomerization domain (NOD)-like receptor signaling pathway, BioCarta IL-1R pathway, Hinata NF-κB-targeted keratinocyte up-regulation pathway, Marzec IL-2 signal up-regulation pathway and Mense hypoxia up-regulation pathway. PPI network analysis further revealed potential interaction among these genes.

ERS-associated differentially expressed genes are involved in multiple biological processes related to the pathogenesis of NASH, such as cytokine signaling pathway, apoptosis, immune regulation and inflammatory reaction, providing novel clues for further unravelling the role of ERS in the pathogenesis of NASH.

Surgery is the main treatment for liver cancer, featuring long operation time, high difficulty and severe trauma. Consequently, it is of significance to strengthen preoperative management of patients with liver cancer. Pre-rehabilitation is a preoperative management regimen based on the concept of enhanced recovery after surgery, aiming to obtain active recovery before surgery, including preoperative exercise, nutritional support and psychological intervention to optimize clinical outcome of surgical patients. In this article, the content, opportunity and individualization of pre-rehabilitation were reviewed, aiming to provide theoretical basis for preoperative pre-rehabilitation of liver cancer patients.

ICG is a commonly-used organic dye in hepatectomy. ICG excretion test can accurately evaluate blood flow distribution and active transport function of the liver, which can be employed to evaluate liver function and predict postoperative liver failure. In addition, ICG fluorescence imaging combined with preoperative imaging data and intraoperative ultrasound can achieve precise tumor location and margin assessment, detect postoperative bile leakage, and assist surgeons to deliver precise intraoperative navigation. At present, certain clinical efficacy has been achieved in the application of ICG in hepatectomy. However, its clinical value remains to be validated by more high-quality research.

Liver resection is the optimal treatment for multiple types of benign or malignant liver diseases. Perioperative period is the key stage of liver resection, which covers preoperative preparation, intraoperative operation and postoperative recovery, etc. During this perioperative period, physical condition, surgery environment and surgical procedures may exert profound impact on surgical outcomes. Consequently, it is of significance to monitor and manage these factors during the perioperative period, which not only ensures the success and safety of surgery, but also improves the postoperative quality of life and prognosis of patients. In this article, perioperative monitoring and management methods were reviewed, aiming to provide evidence for perioperative management of liver resection.

Hepatocellular carcinoma (HCC) is one of the most common solid malignant tumors worldwide. Lung is the most common metastatic site of HCC. Although early diagnosis and treatment can improve clinical prognosis of HCC. However, a majority of HCC patients have been diagnosed with distant metastasis upon admission, especially lung metastasis. Therefore, the treatment of lung metastasis of HCC has gradually become a research hotspot. With the development of radiotherapy, multiple novel types of radiotherapy have been developed for lung metastasis of HCC, which provides more possibilities for enhancing efficacy. In this article, recent research progresses, including prognostic factors, therapeutic effect and application of the latest techniques, in radiotherapy for lung metastasis of HCC were reviewed and discussed from the perspectives of internal, external and combined radiotherapy, respectively.

Periampullary carcinoma is a relatively rare malignant gastrointestinal tumor, encompassing malignancies of the Vater's ampulla, pancreatic head, distal common bile duct, and duodenal papilla. The anatomy of this area is intricate, with a narrow spatial structure and complex surrounding relationships. When it comes to treating tumors in this area, surgery is the preferred option. However, in clinical practice, there are often situations where certain patients are unable to undergo surgery or experience postoperative recurrence due to various reasons. Consequently, the use of adjuvant treatment, particularly chemotherapy, has become an essential approach in managing periampullary cancer. The lack of unified and clear recommendations in domestic and foreign clinical guidelines is attributed to the diverse sources of tissue in this region, the complexity of chemotherapy regimens, and the unclear efficacy of chemotherapy. Therefore, the role of chemotherapy in periampullary carcinoma still needs to be further explored and studied. Through a comprehensive review of domestic and foreign literature and an analysis of clinically relevant treatment experiences, we have identified an important finding: (1) through HE staining and immunohistochemistry, it can be classified into intestinal type originating from intestinal tissues, pancreatic biliary type originating from pancreatic or bile duct tissues, and mixed type originating from both intestinal, pancreatic or bile duct tissues; (2) The chemotherapy regimen should be selected based on the tumor's histopathological origin, as choosing an appropriate regimen can improve the survival time of patients with periampullary carcinoma; (3) selection of 5-FU based on chemotherapy regimens for patients with intestinal-type (IN-type), selection of gemcitabine based on chemotherapy regimens may be more beneficial for patients with pancreatic biliary-type (PB-type) and ambiguous-type (AM-type). However, the final conclusion needs to be clarified by more rigorous prospective randomized controlled trials. Through a systematic analysis of research in this field, we believe that the traditional understanding of periampullary carcinoma should be changed in clinical work: firstly, in clinical work, we should collectively call the tumour in this region as periampullary carcinoma, instead of traditionally calling it duodenal papillary cancer, which will affect our judgement of the patient's prognosis and the choice of chemotherapy regimen. Secondly, we should discard the traditional concept that the prognosis of patients with periampullary carcinoma is better than that of pancreatic cancer and bile duct cancer. At present, the prognosis of patients with the IN-type may be better than that of patients with the PB-type; however, the prognosis of patients with the PB-type is not much different from that of patients with pancreatic and bile duct cancers. Thirdly, we need to be aware of histopathological typing, and it is recommended that chemotherapy regimens should be selected based on histopathological typing; studies should also be based on histopathological typing in clinical studies, which can eliminate some of the confounding factors and lead to more accurate conclusion.