Over the years of exploration and development，the surgical techniques and prognosis of liver transplantation in China have been significantly improved，resulting in a notable decrease in the prevalence of postoperative complications. However，ischemic-type biliary lesion remain a non-negligible issue.The Third AffiliatedHospital of Sun Yat-sen University formulated and published the "Expert Consensus on the Diagnosis and Treatment of Ischemic-Type Biliary Lesions after Liver Transplantation in Mainland China"in 2015，which has now been updated into aguideline based on current conditions and literature reports. This guideline elaborates in detail on the definition，incidence，pathogenesis，diagnosis，prevention of high-risk factors，and treatment of ischemic-type biliary lesion，aiming to providestandardized and normative guidance for the diagnosis and treatment of ischemic-type biliary lesion after liver transplantation，thereby reducing the rate of re-transplantation and fatality，and to improve the overall quality of life of liver transplant recipients.

Benign gallbladder disease is one of the most widely distributed diseases in China with the largest number of patients. Benign gallbladder diseases can be pathologically divided into intragallbladder lesions and diffuse or localized thickening of gallbladder wall. Except for cholesterol polyps，most benign gallbladder diseases have the risk of malignant transformation. Scientific preoperative evaluation，intraoperative selection of appropriate surgical approaches，proper postoperative management of gallbladder samples and establishment of standardized diagnosis and treatment process for benign gallbladder diseases can effectively reduce misdiagnosis and inappropriate treatment of gallbladder cancer.

With China's entry into a deeply aging society，the incidence of biliary diseases in the elderly population has been increased significantly. In terms of the clinical characteristics of biliary diseases in elderly patients，such as rapid disease progression，multiple preoperative complications，poor surgical tolerance，high surgical risk and multiple postoperative complications，the hot controversial issues of biliary diseases in elderly patients were analyzed and elucidated from three perspectives including broadening the indications of laparoscopic surgery，urgently standardizing minimally invasive surgery，and improving the technologies of precision hepatobiliary surgery，aiming to fully understand the academic controversies of biliary diseases in elderly patients，actively utilize positive factors，effectively avoid negative factors，thereby enhancing therapeutic effect and bringing benefits to elderly patients with biliary diseases.

Gallbladder cancer is a rare tumor with high invasiveness and malignant metastatic potential. Traditional treatments，such as surgical resection，chemotherapy and radiotherapy，have certain limitations in improving the survival rate of patients. As a novel therapeutic strategy，immunotargeted therapy has attracted widespread attention in recent years. In this article，recent research progress in immunotargeted therapy for gallbladder cancer was reviewed. Immunotherapy can inhibit tumor growth and metastasis by activating the patients' immune system. Targeted therapy has shown certain efficacy in the treatment of gallbladder cancer via several targets. However，challenges still exist in immunotargeted therapy，such as immune tolerance，immune escape and immune-related adverse events，etc. Therefore，subsequent researches and clinical trials should be carried out to improve the therapeutic effect and survival rate of patients with gallbladder cancer.

Gallbladder cancer has high-degree malignancy and poor prognosis. Due to atypical clinical symptoms and anatomical structures during the early stage，most patients are diagnosed with moderate and advanced gallbladder cancer upon admission，losing the opportunity for radical resection. At present，specific adjuvant diagnostic method is still lacking for gallbladder cancer in clinical practice.In this article，research progress in adjuvant diagnostic methods for gallbladder cancer including liquid biopsy was briefly reviewed，aiming to provide useful reference for accurate diagnosis and treatment of gallbladder cancer in the future.

Patients with gallbladder cancer and cholangiocarcinoma have poor prognosis，and surgical resection is the final option. Hepatopancreatoduodenectomy （HPD） is the only radical surgical treatment for gallbladder cancer and cholangiocarcinoma patients with tumor widely spread and infiltrating the hilum and pancreatic bile duct. However，the application scope of HPD is limited due to high mortality and complication rates and uncertain survival benefits. Although perioperative mortality of HPD has been gradually decreased and survival rate has been improved in recent years，HPD has not become a common surgical procedure for patients with locally advanced gallbladder cancer and cholangiocarcinoma. In this article，the indications，key techniques，safety and efficacy of HPD in gallbladder cancer and cholangiocarcinoma were explicitly illustrated.

Gallbladder stones，gallbladder polyps，cholecystitis，cholelithiasis，choledochal cysts and other common and frequently-occurring biliary diseases are compulsory knowledge for physicians from Department of General Surgery，especially those from Department of Biliary Surgery. Screening appropriate diagnosis and treatment strategy is the key in multiple diagnosis and treatment procedures. It is not only necessary to accurately assess the degree of progression and the range of diseases from local to adjacent and even the whole body in diagnosis and differential diagnosis，but also to determine the optimal，secondary and basic diagnosis and treatment regimens after comprehensively considering the advantages and disadvantages in terms of patient tolerance and medical support from the diagnosis and treatment team.

Laparoscopic megasplenectomy （LSMS） has been previously considered as a contraindication for minimally invasive surgery. However，with persistent development of minimally invasive concept and technical equipment，LSMS has been gradually carried out in recent years，showcasing the characteristics of the era of flattening technology，which has been widely applied and has gradually become the optimal surgery. Based on relevant literature review and clinical experience，the development and surgical characteristics of LSMS were summarized，and the technical difficulties，countermeasures and future progress were also discussed and predicted in this article.

Objective

To evaluate the safety and clinical efficacy of donor livers with steatosis in adult split liver transplantation （SLT）.

Methods

Clinical data of 67 donors and recipients who underwent SLT in the Third Affiliated Hospital of Sun Yat-sen University from July 2014 to January 2022 were retrospectively analyzed. The informed consents of all donors and recipients or （and） their families were obtained and the local ethical committee approval was received. 56 donors were male and 11 female，aged（33±13） years on average，and 60 donors were DBD and 7 cases were DCD. Among 67 recipients，51 cases were male and 16 female，with an average age of （51±12） years. Primary diseases included 24 cases of liver cirrhosis induced by viral hepatitis B （HBV） or viral hepatitis C （HCV），20 cases of malignant liver tumors，21 cases of liver failure and 2 cases of hereditary metabolic diseases，respectively. The median model for end-stage liver disease （MELD） score was 25（8-40）. After strict screening and matching of the donors and recipients，the donors with stable circulation were selected. The cold ischemia time （CIT） was shortened to ≤ 8 h. The serum sodium levels of the donors were maintained at ＜160 mmol/L. The process of donor liver splitting was optimized. According to the grading of donor liver steatosis，the recipients who were transplanted with corresponding donor livers were divided into the S0 group （degree of steatosis＜10%）and S1 group （degree of steatosis between 10% and 20%）. The recovery of liver allograft function，the incidence of perioperative complications and clinical prognosis were observed two groups. The incidence of early allograft dysfunction （EAD） at postoperative 7 d was compared with Chi-square test. Postoperative survival analysis was conducted by using Kaplan-Meier method and Log-rank test.

Results

In the S0 and S1 groups，the incidence of vascular complications was 6%（3/54） and 0，7%（4/54） and 8%（1/13）for biliary complications，and 13%（7/54） and 23%（3/13） for postoperative EAD，respectively，and no significant differences were observed between two groups （P＞0.05）. All 67 patients were followed up for 13-115 months，with a median follow-up time of 57 months. 6 patients died during postoperative follow-up，including 4 recipients in the S0 group and 2 in the S1 group. No patient died within postoperative 30 d in two groups. In the S0 group，the 1-year and 3-year survival rates of recipients were 98.1% and 92.4%，and 92.3% and 80.8% in the S1 group，with no statistical significance between two groups （χ²=0.726， P=0.394）.

Conclusions

Donor livers with a degree of steatosis of ＜10% can be used for SLT. For the donor livers with a degree of steatosis between 10% and 20%，SLT can be performed cautiously and safely in adult by means of liver splitting in vivo，CIT control，higher graft recipient weight ratio （GRWR） and strict recipient selection.

Objective

To evaluate the safety and efficacy of laparoscopic surgery for elderly patients with acute obstructive suppurative cholangitis （AOSC）.

Methods

Clinical data of 67 patients with AOSC who underwent laparoscopic surgery in Beijing Electric Power Hospital of State Grid Corporation of China from July 2019 to September 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，34 patients were male and 33 female，aged 39-93 years，with a median age of 72 years. According to the age，all patients were divided into the elderly （≥80 years，n=19） and non-elderly groups （＜ 80 years，n=48）. Perioperative parameters were observed in two groups. Operation time and the length of postoperative hospital stay between two groups were compared by t test. The incidence of postoperative complications was compared by Chi-square test.

Results

There were 6，12，15 and 8 cases of atherosclerotic coronary heart disease，hypertension，hepatic insufficiency and hypoproteinemia before surgery in the elderly group，and 4，15，22 and 9 cases in the non-elderly group，respectively. The incidence of preoperative complications in the elderly group was significantly higher than that in the non-elderly group （χ²=5.793，5.760，6.036，3.921； P＜0.05）.All patients successfully completed laparoscopic surgery，and no case was converted to open surgery.37 cases underwent laparoscopic common bile duct exploration （LCBDE），28 cases received laparoscopic transcystic common bile duct exploration （LTCBDE） and 2 cases underwent micro-incision of the cystic duct confluence in common bile duct exploration （LTM-CBDE）. No significant differences were found in the operation time，intraoperative blood loss and length of postoperative hospital stay between two groups（P＞0.05）. The average length of postoperative hospital stay of patients treated with LTCBDE was （9.3±1.9） d，significantly shorter than （17.1±5.4） d of those undergoing LCBDE （t=-7.286， P＜0.05）. The cure rate of all patients was 100%. During postoperative 1-48 month follow-up，all patients normally survived without bile duct injury or recurrence of common bile duct stones.

Conclusions

The incidence of preoperative complications in elderly patients with AOSC is high. Laparoscopic surgery is safe and feasible under strict preoperative preparations，accurate surgical timing and technique and intimate perioperative monitoring.LTCBDE has evident advantages over alternative procedures.

Objective

To evaluate the value of procalcitonin （PCT） in predicting the severity of acute cholecystitis in elderly patients.

Methods

Clinical data of 243 elderly patients with acute cholecystitis who underwent cholecystectomy in Beijing Electric Power Hospital of State Grid Corporation of China from July 2013 to August 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，111 patients were male and 132 female，aged 60-92 years，with a median age of 68 years. According to the Tokyo Guidelines （2018），all patients were divided into acute mild and moderate cholecystitis （AMC） group and acute severe cholecystitis（ASC） group. Univariate analysis of ASC prediction was conducted by rank-sum test and Chi-square test.Multivariate analysis was performed by multivariate Logistic regression analysis. The receiver operating characteristic （ROC） curve was delineated to determine the optimal threshold values of PCT，WBC and high-sensitivity C-reactive protein （Hs-CRP）. The area under the ROC curve （AUC） was calculated.

Results

Multivariate Logistic regression analysis showed that perigallbladder or perihepatic effusion（OR=0.258，95%CI: 0.102-0.651），WBC （OR=1.262，95%CI: 1.072-1.486），Hs-CPR （OR=1.020，95%CI:1.012-1.028） and PCT （OR=0.712，5%CI: 0.559-0.906） were the independent predictive factors for ASC in elderly patients （P＜0.05）. ROC curve analysis showed that the AUC of perihepatic or perigallbladder effusion in the diagnosis of ASC in elderly patients was 0.694 （95%CI: 0.619-0.769）. The AUC of PCT，WBC and Hs-CRP in the diagnosis of ASC in elderly patients was 0.835 （95%CI: 0.784-0.886），0.875（95%CI: 0.827-0.924） and 0.876 （95%CI: 0.828-0.925），respectively. The optimal threshold values were 0.50 μg/L，10.9×10⁹/L and 66.2 mg/L，respectively. The sensitivity and specificity of PCT were 0.89 and 0.77，respectively. The AUC of these 4 parameters combined in the diagnosis of ASC in elderly patients was 0.914，higher than that of PCT，Hs-CRP，WBC and perigallbladder or perihepatic effusion alone.

Conclusions

PCT yields high diagnostic efficacy for ASC in the elderly patients. PCT combined with WBC，Hs-CPR and perigallbladder or perihepatic effusion possesses higher predictive efficacy and more reliable evaluation effect.

Objective

To compare the safety and efficacy of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma.

Methods

Relevant studies of ERCP with biliary stent and stent implantation across the duodenal papilla in the treatment of unresectable hilar cholangiocarcinoma were searched from PubMed，Embase，Web of Science，Cochrane Library，China Biomedical Literature Database （CBM），CNKI，Chongqing VIP and Wanfang Data from January 2003 to June 2023. Newcastle-Ottawa Scale （NOS） was used to evaluate the quality of the included studies，and RevMan 5.4 software was used for Meta-analysis.

Results

Five studies were included in this Meta-analysis. The results showed that the patency rate of patients with stent patency time ≥3 months after biliary stent implantation was significantly higher than that of those treated with stent implantation across the duodenal papilla （OR=4.18，95%CI: 1.81-9.68， P＜0.001）. The incidence of postoperative pancreatitis was significantly lower than that of their counterparts with stent implantation across the duodenal papilla （RR=0.18，95%CI: 0.03-0.93， P=0.04）. There was no statistical significance in the incidence rates of postoperative cholangitis （RR=0.79，95%CI: 0.41-1.52， P=0.47），postoperative stent occlusion （RR=1.06，95%CI: 0.83-1.34， P=0.65），postoperative stent displacement （RR=0.52，95%CI: 0.20-1.36， P=0.18），postoperative bleeding （RR=0.96，95%CI: 0.21-4.27， P=0.95） between two groups.

Conclusions

For patients with unresectable hilar cholangiocarcinoma，ERCP with biliary stent implantation not only yields longer postoperative patency time，but also has a lower incidence of postoperative pancreatitis compared with stent implantation across the duodenal papilla，which provides a novel idea for clinical treatment.

Objective

To investigate the optimal central venous pressure of controlled low central venous pressure （CLCVP） in hepatectomy.

Methods

58 patients undergoing hepatectomy in the Affiliated Hospital of Xuzhou Medical University by the same group of surgeons from January 2020 to January 2023 were enrolled in this study. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were treated with hepatic inflow occlusion combined with CLCVP. The target range of CLCVP was randomly set before surgery. According to the predetermined CVP target，23 patients were divided into group A （4-5 cmH₂O，1 cmH₂O=0.098 kPa），20 cases in group B （2-3 cmH₂O），and 15 cases in group C （0-1 cmH₂O）. Intraoperatively，the CVP was reduced by surgical interventions. If the target CVP was not reached，anesthesia was given to make the CVP reach the predetermined target. Perioperative data were recorded in three groups. The blood loss among three groups was compared by one-way ANOVA，and the rate was compared by Chi-square test.

Results

In group A，22%（5/23） of the patients required surgery combined with anesthesia to control CVP，significantly less than 75%（15/20） in group B and 93%（14/15） in group C （χ²=12.190，18.610； P＜0.05）. In group C，87%（13/15）patients needed fluid replacement and volume expansion to maintain blood pressure stability，significantly higher than 22%（5/23） in group A and 30%（6/20） in group B （χ²=12.850，8.930； P＜0.05）. The average blood loss in group A was （711±280） ml，significantly higher than （491±242） ml in group B and （468±241） ml in group C （LSD-t=2.729，2.755； P＜0.05）.

Conclusions

The optimal CVP of CLCVP should be maintained at 2-3 cmH₂O in hepatectomy，which significantly reduces the amount of bleeding during hepatectomy，exerts slight effect on blood pressure and decreases surgical difficulty.

Objective

To investigate the risk factors of recurrence in patients with hepatocellular carcinoma （HCC） within 1 year after TACE，and establish a nomogram prediction model.

Methods

Clinical data of 85 patients newly diagnosed with HCC who underwent transarterial chemoembolization（TACE） for the first time in the Third Affiliated Hospital of Sun Yat-sen University from August 2021 to August 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，78 patients were male and 7 female，aged （58±12） years on average. According to the China liver cancer （CNLC） staging system，22 patients were classified as CNLC stage Ⅰb，12 cases of stage Ⅱa，24 cases of stage Ⅱb，9 cases of stage Ⅲa and 18 cases of stage Ⅲb，respectively. The tumor diameter was ranged from 1.5 to 19.2 cm，with a median diameter of 6.0 cm. 49 cases had multiple tumors and 36 cases with single tumor. According to patients' situation of short-term recurrence after TACE，all patients were divided into the favorable and poor prognosis groups. Clinical data and detection parameters in two groups were collected. Cox's regression model was used to analyze the influencing factors of short-term prognosis，and R language was adopted to establish the nomograph model.The calibration curve was delineated and internal validation of the prediction model was performed. The area under the receiver operating characteristic （ROC） curve （AUC） was employed to evaluate the predictive value of this model. Decision curve analysis （DCA） was adopted to evaluate the clinical value of this model.

Results

Univariate Cox's regression analysis showed that AFP （HR=5.055，95%CI: 2.224-11.490），liver cirrhosis （HR=6.261，95%CI: 1.862-21.060） and differences of IL-6 levels （HR=0.409，95%CI: 0.171-0.979）and differences of C-reactive protein （CRP） levels （HR=2.905，95%CI: 1.158-7.287） were correlated with short-term recurrence after TACE （P＜0.05）. Multiple Cox's regression analysis showed that AFP≥400 μg/L（HR=3.722，95%CI: 1.543-8.978），liver cirrhosis （HR=4.406，95%CI: 1.249-15.548） and the differences of IL-6 levels≥18.79 pg/ml （HR=0.312，95%CI: 0.119-0.819） and the differences of CRP levels≥36.67 mg/L（HR=4.967，95%CI: 1.895-13.021） were the independent risk factors of short-term recurrence after TACE（P＜0.05）. A nomogram model was drawn based on these independent risk factors. Internal validation of this model showed that the concordance index （C-index） for predicting the recurrence of HCC after TACE was 0.875 （95%CI: 0.842-0.907），and the degree of discrimination was high. ROC curve analysis revealed that the AUC of this model for predicting 1-year recurrence-free survival was 0.794. DCA demonstrated that this model had large net benefit value and relatively high clinical value.

Conclusions

AFP，liver cirrhosis，the differences of IL-6 and CRP levels are the independent risk factors for postoperative short-term recurrence in HCC patients after TACE. Based on these parameters，a nomogram model for predicting postoperative recurrence of HCC is successfully established，which has certain practical value in predicting the recurrence of HCC.

Objective

To analyze the changing trends of serum Golgi protein 73 （GP73） before and after TACE for primary liver cancer （PLC） and its correlation with efficacy of TACE，aiming to explore the role of serum GP73 level in the evaluation of efficacy of TACE.

Methods

In this prospective study，51 patients with PLC who underwent TACE in the First Affiliated Hospital of Xinjiang Medical University from September 2020 to May 2021 were enrolled. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，45 patients were male and 6 female，aged 42-86 years，with a median age of 61 years. 50 healthy subjects were selected as normal controls.The efficacy of TACE was evaluated based on the modified response evaluation criteria in solid tumors（mRECIST）. According to efficacy，all patients were divided into the favorable efficacy group （n=18） and poor efficacy group （n=33）. Serum GP73 levels 1 d before TACE and 1，3，5，7 and 30 d after TACE were detected by ELISA. Serum GP73 levels between patients and normal controls were compared by t test.The effect of GP73 expression on TACE efficacy was evaluated by generalized estimation equation of repeated measurement data. Correlation analysis was performed by Pearson's and Spearman's correlation analyses.

Results

The average expression level of GP73 in PLC patients before TACE was （0.39±0.25） IU/ml，significantly higher than （0.03±0.01） IU/ml in normal controls （t=10.841， P＜0.05）. The expression level of GP73 at 1 d after TACE was significantly higher than preoperative level，which was decreased continuously at 3，5 and 7 d after TACE. In the favorable efficacy group，the average expression level of GP73 at postoperative 7 d was significantly lower compared with preoperative level，whereas the expression level of GP73 at postoperative 7 d was similar to that before TACE in the poor efficacy group.In the favorable efficacy group，the average expression level of GP73 at 30 d after TACE was further decreased compared with those before and 7 d after TACE，whereas the expression level of GP73 at 30 d after TACE was significantly higher than those before and 7 d after TACE in the poor efficacy group.There was an evident interaction effect between the efficacy and duration of TACE （F=15.037， P＜0.05）.There was statistical significance in the expression levels of GP73 at postoperative 5 and 30 d between the favorable and poor efficacy groups （t=4.987，26.788； P＜0.05）. A significant negative correlation was found between the changes of GP73 levels before and 30 d after TACE and efficacy of TACE （r_s=-0.687， P＜0.05）.An evident positive correlation was found between preoperative GP73 level and tumor diameter （r=0.543，P＜0.05）.

Conclusions

A significant negative correlation is found between the changes of GP73 levels before and after TACE and efficacy of TACE. The greater the decrease of GP73 levels at postoperative 1 month after TACE，the better the efficacy. GP73 level has potential value in evaluating the efficacy of TACE.

Objective

To evaluate the diagnostic value of GGT-Plt ratio （GPR） combined with neutrophil-lymphocyte ratio （NLR），Plt-lymphocyte ratio （PLR） and lymphocyte-monocyte ratio （LMR） for HBV-related hepatocellular carcinoma （HBV-HCC）.

Methods

Clinical data of 1119 patients with chronic hepatitis B，post-hepatitis B cirrhosis and HBV-HCC admitted to the Third Affiliated Hospital of Sun Yat-sen University from January 2012 to September 2018 were retrospectively analyzed. Among them，784 patients were assigned in the non-HCC group，648 male and 136 female，aged 18-82 years，with a median age of 43 years. 335 cases were included in the HCC group，303 male and 32 female，aged 21-83 years，with a median age of 54 years. Univariate analysis of HCC diagnosis was conducted by Mann-Whitney U test or Chi-square test. In univariate analysis，the parameters with P＜0.1 were used for collinear diagnosis，and the parameters with variance inflation factor of ＜5 were included into multivariate Logistic regression analysis to obtain the independent influencing factors，which were used to establish Logistic regression model for HBV-HCC. The diagnostic value was evaluated by the area under the ROC curve （AUC）.

Results

Multivariate Logistic regression analysis showed that male，PLR，GPR and age were the independent risk factors for HBV-HCC （OR=2.876，1.004，1.151，1.070； P＜0.05）. The AUC of Logistic regression model based on the above factors was 0.782 with a sensitivity of 0.740 and a specificity of 0.719. The AUC of this model combined with AFP was 0.855，which enhanced the diagnostic efficiency of AFP （AUC=0.778）（Z=-5.400， P＜0.05）.

Conclusions

The Logistic regression model based on GPR combined with PLR has certain clinical value for early diagnosis of HBV-HCC. This model in combination with AFP can improve the diagnostic efficiency of AFP.

Objective

To investigate the influencing factors of bile leakage in patients with liver trauma and rupture after treatment.

Methods

Clinical data of 357 patients with liver trauma and rupture admitted to the 909^th Hospital from January 2006 to December 2019 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，227 patients were male and 130 female，aged 21-64 years，with a median age of 44 years. According to American Association for the Surgery of Trauma （AAST） grading scale，125 cases were classified as gradeⅠ，201 cases as grade Ⅱ-Ⅲ，and 31 cases as grade Ⅳ-Ⅴ. 177 cases received surgery，122 cases by interventional therapy and 58 cases by conservative treatment after liver trauma and rupture. Logistic regression model was used for multivariate analysis of bile leakage.

Results

Bile leakage occurred in 56 cases after liver trauma and rupture，and the incidence of bile leakage was 15.7% （56/357）. Among them，35 cases were classified as grade A and 21 cases as grade B based on the International Study Group of Liver Surgery （ISGLS）classification. Multivariate Logistic analysis showed that Child-Pugh B and C，non-surgical treatment，bleeding volume ≥400 ml，T-tube free drainage，and grade Ⅱ-Ⅴ liver trauma were the independent risk factors for bile leakage （OR=4.121，3.575，12.923，72.168，5.501； P＜0.05）.

Conclusions

The incidence of bile leakage is high in patients with liver trauma and rupture. Liver function classification，treatment method，blood loss，T-tube drainage and liver trauma classification are the independent influencing factors for bile leakage. Extensive attention should be paid to preventing risk factors. Effective surgical treatment strategies should be employed to reduce the incidence of bile leakage.

Objective

To evaluate the predictive value of prothrombin activity-to-albumin ratio（PTAAR） for the short-term prognosis of patients with hepatitis B virus-related acute-on-chronic liver failure （ACLF）.

Methods

Clinical data of 286 ACLF patients admitted to the Third Affiliated Hospital of Sun Yat-sen University from 2019 to 2020 were retrospectively analyzed. The local ethical committee approval was received. Among them，243 patients were male and 43 female，aged 19-75 years，with a median age of 46 years. The patients received 3-month follow-up. All patients were divided into the survival group（n=238） and death group （n=48）. General data，biochemical parameters and coagulation function of patients were collected. The influencing factors of clinical prognosis of ACLF patients were screened by Logistic regression analysis. ACLF prediction model was constructed based on PTAAR. The predictive value of PTAAR model was evaluated by using the receiver operating characteristic （ROC） curve.

Results

The 3-month mortality rate of ACLF patients was 16.8%（48/286）. Multivariate Logistic regression analysis showed that age，total bilirubin （TB） and PTAAR were the independent factors affecting the short-term prognosis of ACLF patients （OR=1.058，1.003，0.212； P＜0.05）. The prediction model for short-term prognosis of ACLF patients was established based on PTAAR: Logit （P）=-4.365+0.077×Age+0.003×TB-1.813×PTAAR. The area under the ROC curve （AUC） of PTAAR model was 0.782 （95%CI: 0.711-0.853），significantly larger than 0.671 （95%CI: 0.583-0.758） of MELD score （Z=2.381， P＜0.05）. The cutoff values of the model based on PTAAR and MELD score were 0.133 and 22.886，and 0.854 and 0.792 for the sensitivity，and 0.601 and 0.529 for the specificity，respectively.

Conclusions

The 3-month mortality rate of patients with hepatitis B-related ACLF is relatively high. PTAAR is a predictor for the 3-month prognosis of patients with ACLF. The prediction model based on PTAAR can achieve higher prediction performance.

Objective

To investigate the diagnosis and treatment experience of acute graftversus-host disease （aGVHD） after liver transplantation.

Methods

Clinical data of 4 patients with aGVHD after liver transplantation admitted to the 900^th Hospital from January 2000 to January 2022 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，3 patients were male and 1 female，aged 67，59，50 and 51 years，respectively. Classical orthotopic liver transplantation was performed in 4 cases. Bile drainage tube and gastroenteric nutritional tube were routinely placed during the surgery. The immunosuppressant regimen was methylprednisolone + tacrolimus + mycophenolate mofetil. The diagnosis and treatment experience of aGVHD after liver transplantation was summarized and analyzed.

Results

The incidence of aGVHD after liver transplantation was 0.6%（4/650）. The onset time of aGVHD was 12.0-21.0 d after surgery，with a median time of 16.5 d. Clinical characteristics of aGVHD after liver transplantation were as follows:（1） The onset time was 2-4 weeks after liver transplantation；（2） Typical clinical manifestations included fever，rash，diarrhea and pancytopenia；（3） Typical pathological manifestations of skin biopsy，epidermal reticular hyperkeratosis+，dyskeratosis of colloid bodies+，vacuolar degeneration of basal layer+++，vacuolar interfacial dermatitis++，and formation of epidermal cracks；dermal pigment incontinence+，superficial perivascular inflammation+. Inflammatory cell composition: lymphocytes+ and monocytes+. Steroid hormone shock therapy was adopted，and then decreased to 20 mg oral maintenance therapy. Attention was paid to adjusting the immunosuppressant dosage. Infection and gastrointestinal bleeding were prevented.4 cases had normal transplanted liver function during the onset，1 case obtained alleviated clinical symptoms and normal myelogram after treatment. The remission rate of aGVHD was 1/4. 4 patients died within 7.0-41.0 d after onset，with a median survival time of 17.8 d. The mortality rate reached 4/4，including 1 case of gastrointestinal bleeding，1 case of cerebral hemorrhage and 2 cases of multiple organ failure.

Conclusions

The incidence rate of aGVHD is low，whereas the mortality rate is extremely high after liver transplantation. The diagnosis relies on typical clinical manifestations and pathological examination.At present，there is no unified and effective treatment regimen. Hormone shock，reducing or terminating the dosage of immunosuppressants and preventing infection may be effective treatment methods.

Objective

To systematically analyze the predictive value for lymph node metastasis of intrahepatic cholangiocarcinoma （ICC） based on preoperative radiomics.

Methods

Chinese searching words consisted of intrahepatic cholangiocarcinoma，lymph node metastasis，radiomics，imaging examination，CT，MRI，ultrasound and PET-CT. English searching words included intrahepatic cholangiocarcinoma，lymph node metastasis，radiomics，CT，MRI，ultrasonic and PET-CT. Relevant studies were searched in Chinese and international databases such as PubMed and CNKI from the inception date of the databases to March 1，2023，and the included studies were extracted and analyzed. Statistical description was expressed by frequency and percentage. The year of publication was illustrated by bar charts. The extracted radiomic data were presented in tables.

Results

15 articles were finally included，including 12 articles in English and 3 in Chinese. The year of publication was ranged from 2003 to 2023，with the largest number of articles （n=5） published in 2019. There were 14 retrospective cohort studies and 1 prospective cohort study.10 studies were performed in China，3 in South Korea and 2 in Japan. At present，radiomic analysis was mainly conduced for qualitative and quantitative data. Qualitative data included the number of tumors，tumor size，tumor site，vascular infiltration，lymph node size，whether satellite lesions，necrotic or cystic components and bile duct dilatation occurred or not，morphological classification，whether the margins of lesions were regular or not，whether hepatic capsule was retracted or not and whether visceral peritoneum was perforated or not，etc. The quantitative data consisted of CT value ratio，maximum standardized uptake value （SUV），maximum SUV ratio，Pyradiomics value，IBEX value and apparent diffusion coefficient（ADC），etc.

Conclusions

At present，qualitative and quantitative data are mainly employed in the field of preoperative radiomic research for ICC. Among them，qualitative data which comprise more parameters are fully utilized，whereas quantitative data consisting of less parameters are used in a single pattern.

Objective

To evaluate the application value of three-dimensional visualization combined with ICG imaging in laparoscopic hepatectomy for recurrent hepatocellular carcinoma （HCC）.

Methods

Clinical data of 5 patients with recurrent HCC who underwent surgery in Baoji People's Hospital from January 2022 to June 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，2 patients were male and 3 female，aged 49-78 years，with a median age of 66 years. Preoperatively，three-dimensional visualized liver reconstruction was performed by computer-aided surgical system，and combined with intraoperative ICG fluorescence imaging for laparoscopic hepatectomy. The safety and feasibility of this technology in the treatment of recurrent HCC were evaluated.

Results

All 5 patients successfully completed laparoscopic hepatectomy without conversion to open surgery. The average operation time was （274±18） min，and intraoperative blood loss was （390±85） ml. 1 patient developed postoperative bile leakage and was cured after adequate drainage. No bleeding，abdominal infection or liver failure occurred after operation. Surgical margin of the liver was negative. The length of postoperative hospital stay was （9.2±1.9） d. All 5 patients were followed up for 6-24 months，and there was no tumor recurrence during postoperative follow-up. No patient died within postoperative 90 d.

Conclusions

Three-dimensional visualization combined with ICG fluorescence imaging technology is safe and feasible for patients with recurrent HCC undergoing laparoscopic hepatectomy. Intraoperatively，it can precisely locate the tumor and has potential advantages of mild trauma and slight bleeding.

Objective

To investigate the clinicopathological characteristics，diagnosis，treatment and prognosis of Epstein-Barr （EB） virus-associated cholangiocarcinoma.

Methods

Clinical data of one patient with EB virus-associated cholangiocarcinoma complicated with multiple metastases admitted to Sun Yat-sen Memorial Hospital of Sun Yat-sen University in November 2022 were retrospectively analyzed.The 74-year-old male patient was admitted to our hospital due to "epigastric discomfort for more than one month" and underwent biopsy，confirming the diagnosis of EB virus-associated cholangiocarcinoma.He received 4 cycles of TACE combined with paclitaxel + camrelizumab + fluorouracil + gemcitabine chemotherapy. The informed consents of the patient was obtained and the local ethical committee approval was received. Studies related to "EB virus-associated cholangiocarcinoma" were searched from Wanfang Data，CNKI and PubMed from the inception date of databases until May 31，2023.

Results

A total of 21 articles were included. A total of 71 patients with EB virus-associated cholangiocarcinoma were searched，24 male and 47 female，including 45 cases aged＞ 50 years，and 26 cases aged＜50 years. The lesions were located in the left lobe of 28 patients and in the right lobe of 31 cases. 27 cases were infected with HBV，1 case with HCV and 12 cases with EB virus. AFP levels were increased in 2 cases and CA19-9 levels were elevated in 12 cases. 2 cases were complicated with liver cirrhosis and 7 cases with distant metastases.47 cases had single lesion without distant lymph node metastasis. 12 cases developed intrahepatic metastases，some of them had distant lymph node metastases. Among the three pathological subtypes of EB virus-associated cholangiocarcinoma，intrahepatic lymphoepithelioma-like cholangiocarcinoma（LELCC） is the dominant type，accounting for 68% （48/71），lymphoepithelioma-like hepatocellular carcinomas （LEL-HCC） accounted for 18% （13/71），lymphoepithelioma-like carcinoma （LELC） accounted for 14% （10/71），respectively. Approximately 87% （62/71） of the patients were distributed in the southeast coastal provinces，and only 13% （9/71） were distributed in Beijing，Sichuan and Hubei provinces.59 cases underwent surgical resection，1 case received PD-1 immunotherapy，1 case received radiofrequency ablation，and no specific treatment was described in 6 cases，respectively. Follow-up duration was ranged from 1 to 128 months. 59 patients were followed up. Among them，36 cases achieved tumor-free survival，10 cases survived with tumors，1 case underwent surgery after recurrence，and 12 cases died from tumors，respectively. At present，the patient in this report still survives with tumors.

Conclusions

EB virus-associated cholangiocarcinoma，as a rare subtype of cholangiocarcinoma，has completely different clinicopathological characteristics and prognosis. Upon the first admission，the lesion is mainly single. LELCC is the dominant pathological type. Regional distribution is highly different，with a high prevalence in the southeast coastal region. It yields better prognosis than common cholangiocarcinoma.

Objective

To evaluate the safety and efficacy of laparoscopic splenectomy in the treatment of hematological diseases.

Methods

Clinical data of 32 patients with hematological diseases who underwent laparoscopic splenectomy in the First Affiliated Hospital of Nanjing Medical University from June 2018 to December 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，9 patients were male and 23 female，aged （43±18） years on average. 15 cases were diagnosed with hereditary spherocytosis，9 cases of autoimmune hemolytic anemia，6 cases of primary immune thrombocytopenia and 2 cases of lymphoma.1 case was diagnosed with grade Ⅰ splenomegaly，18 cases of grade Ⅱ splenomegaly and 13 cases of grade Ⅲ splenomegaly. The maximum diameter of spleen was （17±4） cm. Perioperative clinical efficacy and complications were observed.

Results

All patients successfully completed laparoscopic splenectomy and none was converted to open surgery. The operation time was （152±39） min，and the median intraoperative blood loss was 100 （50，275） ml. All patients were successfully discharged，and the length of postoperative hospital stay was 6.0 （4.3，7.8） d. Postoperatively，4 patients developed portal vein thrombosis，2 cases of pancreatic leakage and 1 case of incisional infection. No perioperative death occurred.

Conclusions

Laparoscopic splenectomy is safe and efficacious treatment for hematological diseases，which should be carried out under the guidance of multidisciplinary cooperation.

Objective

To investigate the expression of vesicular over-expressed in cancer prosurvival protein 1 （VOPP1） in hepatocellular carcinoma （HCC） and its relationship with clinical prognosis of HCC patients.

Methods

Clinicopathological data of 90 HCC patients who underwent radical resection in the Third Affiliated Hospital of Sun Yat-sen University from February 2008 to August 2015 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them，81 patients were male and 9 female，aged 27-74 years，with a median age of 53 years. 11 cases were classified as TNM stage Ⅰ，29 cases of TNM stage Ⅱ，26 cases of TNM stage Ⅲ and 2 cases of TNM stage Ⅳ. The expression level of VOPP1 in HCC and adjacent tissues was determined by immunohistochemical staining，and the relationship between VOPP1 expression and clinicopathological parameters was analyzed. In addition，the expression level of VOPP1 mRNA in the cancer and adjacent tissues of 10 HCC patients was detected by qRT-PCR. Survival analysis was conducted by Kaplan-Meier method and Log-rank test. The independent risk factors of clinical prognosis were assessed by Cox regression model.

Results

qRT-PCR showed that the average relative expression of VOPP1 mRNA in HCC tissues was （4.91±1.98）×10^-3，significantly higher than （0.39±0.12）×10^-3 in paired adjacent tissues （t=2.284， P＜0.05）. Immunohistochemical staining showed that the positive expression rate of VOPP1 in HCC was 52%（47/90），significantly higher than 28%（25/90） in adjacent tissues （χ²=11.204， P＜0.05）.The high expression of VOPP1 in HCC tissues was correlated with histological grade （χ²=9.373， P＜0.05）.Survival analysis showed that the median recurrence-free survival （RFS） of HCC patients with high and low expression of VOPP1 after radical resection was 17 and 50 months，respectively. The RFS of patients with high expression of VOPP1 was significantly lower than that of their counterparts with low expression of VOPP1 （χ²=7.769， P＜0.05）. Cox regression analysis showed that T3 stage （HR=3.649，95%CI: 1.278-10.420），T4 stage （HR=6.157，95%CI: 1.297-29.235） and high expression of VOPP1 protein （HR=1.866，95%CI: 1.069-3.258） were the independent risk factors of postoperative RFS （P＜0.05）.

Conclusions

VOPP1 is highly expressed in HCC tissues. The expression level of VOPP1 is negatively correlated with clinical prognosis. VOPP1 is an independent risk factor of clinical prognosis of HCC，which can be utilized as a new and valuable prognostic factor.

Liver cancer is the sixth most common malignant tumor and the third leading cause of tumor-induced death worldwide. Clinical prognosis of advanced liver cancer is significantly worse than that of early liver cancer. Consequently，early diagnosis and treatment of liver cancer are of significance. At present，AFP detection combined with ultrasound is the main early detection and diagnosis of liver cancer，whereas this diagnostic method has limited value. Proteomics，as a novel high-throughput protein research method，provides a new technical approach for exploring new potential molecular markers by comparing the proteomes of body fluids or tissues at different stages of physiology，pathology and diseases. At present，it mainly focuses on proteomic analysis of the plasma，tumor interstitial fluid，tissues，tumor secreting proteins，urine，bile，saliva，ascites and other body fluids and tissues，among which plasma and tissues remain the main sources of proteomic analysis. In addition，secretory proteomics and proteomic analysis of tumor interstitial fluids also provide novel ideas for identifying early molecular markers of liver cancer. Qualified sample collection is the beginning of proteomic analysis. In this article，research progress in proteomic analysis of body fluid and tissue samples in early molecular diagnosis of liver cancer was reviewed.

Primary liver cancer （PLC） is the fourth common malignant tumor and the second cause of tumor-induced death in China，and it is one of the main reasons threatening people's safety and health. At present，hepatectomy is the optimal treatment for PLC patients. Although surgeons' understanding of liver anatomy and pathophysiology has been gradually deepened，and the treatment concept and methods have been also advanced over time，the mortality rate after hepatectomy is still as high as 12%. Comprehensive and individualized evaluation of liver function is the fundamental basis of surgery and the prerequisite of accurate liver surgery，which plays a significant role in reducing perioperative mortality. In this article，research progress in liver function evaluation was reviewed，aiming to raise the understanding of liver function evaluation.

The liver has a specific ability to regenerate. After partial resection，the total volume of residual liver can be partially or completely restored through the regenerative mechanism to maintain the physiological requirements of the body. Therefore，evaluation and prediction of residual liver regeneration ability before hepatectomy is the key to ensure perioperative safety of patients. At present，researches on liver regeneration primarily focus upon the evaluation of residual liver regeneration ability of donors/recipients in living donor liver transplantation，and researches of liver regeneration mechanism still stuck in the stage of animal experiments. Although precise hepatectomy requires preoperative assessment of the residual liver volume to confirm the maximal range of liver resection，how to predict preoperative function of the residual liver remains poorly understood. With the advancement of radiomics and artificial intelligence，it is expected to explore a more precise evaluation and prediction system of residual liver regeneration ability for hepatectomy.