Most patients with liver malignant tumors are diagnosed as in the middle or advanced stages when first diagnosed， while the prognosis is quite poor in these stages.Early diagnosis and treatment are the key to improve the curative effect of liver malignant tumors.Recently， with the sustainable development and progress of the treatment method， the prognosis of liver malignant tumors has been greatly improved.The surgical resection is still the first-choice in the treatment of liver malignant tumors.Precise hepatectomy is the guarantee to achieve the best surgical results， while precise preoperative assessment，intraoperative real-time lesion localization and real-time guidance are the priority to the precise hepatectomy.In order to improve the preoperative diagnosis， precise intraoperative resection and postoperative curative effect of liver malignant tumors， the Hepatobiliary and Pancreatic Disease Prevention and Control Specialty Society of Chinees Prevention Medicine Association and the Hepato-Oncology Branch of China International Exchange and Promotive Association for Medical and Healthcare organize experts to conduct in-depth discussion on the key points of precise localization and navigation of liver tumors and formulated the Chinese expert consensus on precision guidance technology in diagnosis and treatment of liver tumors （2024 edition），which could guide the clinical practice and promote the development of the subject.

Gallbladder cancer is a common malignant tumor in the biliary system， with high degree of malignancy and poor prognosis.Radical surgical resection remains the potential treatment.In recent years， minimally invasive surgery， especially laparoscopic surgery， has been widely applied in surgical treatment of multiple types of tumors of digestive tract， and it is recognized due to the advantages in accordance with the concept of enhanced recovery after surgery （ERAS）.At present， high-volume medical centers at home and abroad have gradually carried out minimally invasive radical cholecystectomy，mainly laparoscopic surgery， and yielded high safety and effectiveness in the treatment of early gallbladder cancer.However， surgical treatment of advanced gallbladder cancer remains in the exploratory stage.While promoting minimally invasive radical resection of gallbladder cancer， extensive attention should be paid to the standardization of diagnosis and treatment process， aiming to effectively improve clinical efficacy of minimally invasive surgical treatment of gallbladder cancer.

Hilar cholangiocarcinoma （HCCA） is the most common malignant tumor of bile duct.At present， radical resection is the only potential cure method for HCCA.However， the radical resection rate is low and clinical prognosis is poor due to delayed diagnosis and treatment， special anatomical location of the tumor， the characteristics of axial and lateral infiltration along the bile duct and high-risk invasion into surrounding vital vessels， etc.In recent years， along with the improvement of imaging diagnosis level， adequate preoperative evaluation methods， the development of minimally invasive technology， the advancement of surgical technology and perioperative management measures， significant progress has been made in the diagnosis and treatment effect and guaranteeing therapeutic safety for HCCA.Nevertheless，certain problems and challenges remain to be urgently investigated， such as low radical resection rate，controversial surgical timing after reduction of jaundice， difficulty in determining the range of radical resection， and lack of consensus the effect of extended lymph node dissection， etc.In this article， current state and research progress of HCCA classification， staging， early diagnosis， preoperative evaluation，surgical selection， improvement of surgical efficacy， combined vascular resection， lymph node dissection，minimally invasive surgery， liver transplantation and non-surgical treatment were reviewed， aiming to provide reference for further enhancing radical resection rate， prolonging survival time and improving quality of life.

Gallbladder polypoid lesion is a common benign disease of the gallbladder.Several controversial issues in the process of surgical diagnosis and treatment remain to be resolved， such as the range of gallbladder polypoid lesions with a malignant tendency， surgical indications of gallbladder polypoid lesions，how to improve diagnostic accuracy of tumor-like polypoid lesions and follow-up strategy.Clarification of these issues will contribute to making clinical diagnosis and treatment decisions for gallbladder polypoid lesions.In this article， existing controversies and strategies in surgical diagnosis and treatment of gallbladder polypoid lesions were reviewed， aiming to provide reference for individualized and precise clinical diagnosis and treatment decisions for gallbladder polypoid lesions.

Intrahepatic cholangiocarcinoma （ICC） is one of primary malignant tumors of the liver，and its incidence rate has been elevated year by year in China.Surgical resection is the major treatment for ICC patients to obtain long-term survival.In recent years， systematic therapy， especially immunotherapy， has developed rapidly and exerted significant impact on surgical treatment.In this article， the latest progress in surgical treatment of ICC was reviewed， focusing on surgery-based systematic treatment， such as adjuvant therapy and neoadjuvant therapy， etc.

Intrahepatic cholangiocarcinoma （ICC） is the second most common primary liver cancer secondary to hepatocellular carcinoma.Most patients are diagnosed in the middle and late stage and can only receive systematic and local treatments.In recent years， the therapeutic effect of selective internal radiotherapy with yttrium-90 for malignant liver tumors has been widely recognized at home and abroad，and it has become an important local treatment for malignant liver tumors.It’s effectiveness and safety in the treatment of malignant liver tumors have been validated by relevant clinical studies.In this article， the latest literature review of selective internal radiotherapy with yttrium-90 for ICC was conducted， and the safety， effectiveness and practicability of selective internal radiotherapy with yttrium-90 as a single option，combined with chemotherapy， radiation segmentectomy/hepatectomy and liver transplantation for ICC were summarized.

Gallbladder cancer is one of the most common malignant tumors in digestive system， which is characterized with hidden clinical symptoms， high invasion and metastasis and high mortality.Recent clinical studies have explored the neoadjuvant therapy， adjuvant therapy and translational therapy of gallbladder cancer，making tremendous efforts to improve the clinical prognosis of patients with gallbladder cancer.In this article，the pathogenesis and tumor microenvironment of gallbladder cancer were reviewed， and novel progress in clinical research of systematic treatment for gallbladder cancer in recent 5 years was analyzed and summarized.

The liver segmentation system described by Couinaud is the cornerstone of modern liver surgery.In recent years， with rapid standardization and maturation of laparoscopic anatomical hepatectomy， certain defects of Couinaud system have been gradually identified， and the concept of dynamic watershed theory has been proposed based on modern imaging technology.At the technical level， the scope of anatomical hepatectomy should include the watershed with complete portal vein blood supply and hepatic vein reflux.Therefore， the segmentation and naming of hepatic segments should not only clarify the supplying portal veins， but also emphasize the reflux path of hepatic veins.In this article， we suggest naming portal and hepatic veins at the subsegmental level， and recommend considering the blood supply of portal veins and the path of hepatic vein reflux to investigate the segmentation of hepatic lobes and segments， aiming to help achieve correct preoperative planning and facilitate the selection of surgical approach.

Objective

To evaluate the safety and efficacy of hepatic arterial infusion chemotherapy（HAIC） combined with PD-1/TKI in the treatment of unresectable hepatocellular carcinoma （uHCC）.

Methods

Clinical data of 184 patients with uHCC admitted to Sichuan Provincial People’s Hospital from March 2019 to June 2022 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 157 patients were male and 27 female，aged from 28 to 85 years， with a median age of 54 years.According to different treatment regimens， all patients were divided into the combined group （n=94） and control group （n=90）.In the combined group， patients were treated with HAIC combined with PD-1/TKI， and those in the control group were treated with HAIC alone.HAIC was given using mFOLFOX6.Adverse reactions were observed during the treatment and clinical efficacy was evaluated.The main indexes for efficacy evaluation were overall survival （OS） and progressionfree survival （PFS）， the secondary indexes were objective remission rate （ORR） and disease control rate（DCR）.The index for safety evaluation was the incidence of adverse reactions.The rates were compared with Chi-square test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.Prognostic factors were assessed by Cox regression analysis.

Results

The ORR and DCR in the combined group were 65%（61/94） and 89%（84/94）， significantly higher than 38%（34/90） and 70%（63/90） in the control group（χ²=13.530， 10.729； both P＜0.05）.In the combined group， the proportion of patients undergoing surgery after translational therapy was 26%（24/94）， significantly higher than 10%（9/90） in the control group （χ²=7.536，P＜0.05）.The median OS and PFS in the combined group were 17 and 14 months， significantly longer than 13 and 7 months in the control group （HR=0.29，0.47； both P＜0.005）.Cox regression analysis showed that combination with targeted immunotherapy was the independent protective factor of OS （HR=0.371， 95%CI：0.253-0.543； P＜0.05） and PFS （HR=0.284， 95%CI： 0.197-0.410； P＜0.05）.In the combined group， the decrease of WBC and the incidence of rash were 16%（15/94） and 27%（25/94）， significantly higher than 6%（5/90）and 2% （1/90） in the control group （χ²=5.135，24.610； both P＜0.05）.Adverse reactions were mitigated after symptomatic treatment or drug dosage adjustment.No treatment-related death was observed throughout the treatment.

Conclusions

Compared with HAIC alone， HAIC combined with PD-1/TKI can significantly improve clinical prognosis of uHCC and yield controllable adverse reactions.

Objective

To compare clinical efficacy and safety of hepatic arterial infusion chemotherapy （HAIC） combined with lenvatinib plus PD-1 inhibitor and HAIC combined with lenvatinib in the treatment of unresectable hepatocellular carcinoma （HCC）.

Methods

Clinical data of 84 patients diagnosed with unresectable HCC by pathological biopsy or imaging examination in the First People’s Hospital of Foshan from April 2020 to December 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them，76 patients were male and 8 female， aged from 32 to 75 years， with a median age of 54 years.According to different treatment methods， 48 patients received HAIC combined with lenvatinib plus PD-1 inhibitor（triple group）， and 36 cases were treated with HAIC combined with lenvatinib （double group）.HAIC was given using modified FOLFOX6 regimen.The progression-free survival （PFS）， overall survival （OS），objective remission rate （ORR）， disease control rate （DCR） and treatment-related adverse events were compared between two groups.The rate comparison between two groups was conducted by Chi-square test or Fisher’s exact probability test.Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Results

Survival analysis showed that the median PFS in the triple group was 10.6 months， significantly longer than 5.2 months in the double group （χ²=9.30， P＜0.05）.However， the ORR and DCR in the triple group were 70.8%（34/48） and 93.8%（45/48）， and 66.7%（24/36） and 86.1%（31/36） in the double group， with no statistical significance between two groups （χ²=0.167，-； both P＞0.05）.The incidence of adverse reactions in the triple and double groups were 96%（46/48） and 89%（32/36）， with no statistical significance between two groups （P＞0.05）.5 patients in each group underwent conversion surgery.Postoperative pathological examination indicated that 4 patients in the triple group achieved pathologic complete response （pCR）， and 1 patient in the double group achieved pCR.Multivariate Cox regression analysis showed that compared with triple therapy， double therapy was an independent risk factor of PFS （HR=1.924， 95%CI： 1.150-3.220，P＜0.05）.

Conclusions

The triple therapy of HAIC combined with lenvatinib plus PD-1 inhibitor is superior to HAIC combined with lenvatinib in delaying tumor progression， and triple therapy may yield a higher tumor necrosis rate.However， two regimens are equivalent in terms of ORR and DCR.

Objective

To investigate the process optimization of laparoscopic anatomical mesohepatectomy for hepatocellular carcinoma （HCC）.

Methods

Clinical data of 16 HCC patients admitted to Guangdong Provincial Hospital of Chinese Medicine and Zhuhai Branch of Guangdong Provincial Hospital of Chinese Medicine from January 2019 to January 2023 were retrospectively analyzed.Among them，14 patients were male and 2 females， aged （57±10） years on average， body mass index （BMI） of（22±3） kg/m².15 patients were complicated with HBV infection， including 7 cases of cirrhosis.The ICGR15 was calculated as 0.060±0.024， the number of tumors was （1.8±0.7）， the maximal diameter of tumors was （6.8±1.9） cm， and the residual liver volume accounted for （59.0±9.1）%.Anatomical liver surface markers were made， intraoperative ultrasound was used for localization，the route of liver parenchyma mesohepatectomy was prioritized and surgical process was optimized.Laparoscopic anatomical mesohepatectomy was performed.Perioperative status， complications and efficacy were observed.

Results

16 patients successfully underwent the surgery， and none was converted to open surgery.The operation time was （212±61） min， intraoperative blood loss was （191±125） ml， the time of hepatic portal occlusion was （46±9） min and hepatic surgical margin was （13±5） mm.Mild postoperative bile leakage occurred in 1 case， which was cured by conservative treatment.No severe complications such as bleeding， liver failure and infection or death were reported.The length of postoperative hospital stay was （10.9±2.2） d.Postoperative follow-up time was ranged from 8.0 to 34.0 months， and the median follow-up time was 22.6 months.During postoperative follow-up， 2 cases recurred and no death occurred.

Conclusions

Under the premise of mastering the highlights of laparoscopic hepatectomy， optimized laparoscopic mesohepatectomy is a convenient， safe and feasible treatment for HCC.

Objective

To investigate the safety and efficacy of simultaneous surgical resection for synchronous colorectal cancer liver metastasis （SCRLM）.

Methods

Clinical data of 100 patients with SCRLM who underwent radical surgery in Provincial Hospital Affiliated to Anhui Medical University， from August 2017 to February 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.According to different surgical timing，all patients were divided into the simultaneous surgery group （n=70） and staged surgery group （n=30）.Preoperative CEA and CA19-9 levels， primary tumor type， postoperative pathology， location， size and number of liver metastases， intraoperative blood loss， operation time， length of hospital stay， hospitalization expenses，postoperative complications and recurrence-free survival were compared between two groups.Perioperative indexes between two groups were compared by Mann-Whitney U test.The rates were compared by Chisquare test or Fisher’s exact probability test.Recurrence-free survival （RFS） was compared by Kaplan-Meier method and Log-rank test.Prognostic factors were analyzed by Cox proportional hazards regression model.

Results

No patient died within postoperative 30 d in two groups.In the simultaneous and staged surgery groups， the median operation time was 287（216，349） and 310（267， 399） min， intraoperative blood loss was 150（100， 200） and 100（50， 150） ml， the length of hospital stay was 18（15， 25） and 28（24， 32） d and hospitalization expense was 5.8×10⁴ （4.9×10⁴， 7.3×10⁴） and 8.6×10⁴ （7.9×10⁴， 9.6×10⁴） Yuan， respectively.The differences were statistically significant between two groups （Z=-2.03， 0.96， -4.94 and -0.86； all P＜0.05）.In the simultaneous surgery group， 21 patients received blood transfusion and 2 in the staged surgery group， and the difference was statistically significant （χ²=6.46， P＜0.05）.In the simultaneous and staged surgery groups， 50 and 22 patients experienced postoperative recurrence， and the median RFS was 6.0 and 8.5 months，with no statistical significance between two groups （χ²=0.46， P＞0.05）.Multivariate Cox regression analysis showed that stage T3-T4 primary tumor， multiple liver lesions， KRAS mutation， CA19-9＞100 kU/L and neoadjuvant chemotherapy were the independent risk factors for clinical prognosis （HR=10.88， 0.57， 3.66， 1.28，0.66； all P＜0.05）.

Conclusions

Simultaneous surgery can shorten the operation time and length of hospital stay， reduce hospitalization expenses for SCRLM patients.Although it increases the amount of intraoperative bleeding， it does not elevate the incidence of postoperative complications， and yields equivalent recurrence-free survival to staged surgery.Simultaneous surgery is safe and effective for patients with SCRLM.

Objective

To investigate the influencing factors， prevention and treatment of postoperative nausea and vomiting （PONV） in patients undergoing daytime laparoscopic cholecystectomy（LC）.

Methods

Clinical data of 495 patients with benign gallbladder diseases who received consecutive daytime LC in Beijing Chaoyang Hospital Affiliated to Capital Medical University from June 2019 to May 2021 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 176 patients were male and 319 female， aged from 19 to 69 years， with a median age of 43 years.Multi-mode prevention of PONV was adopted after LC.Medical records including gender， age， abdominal surgery， hypertension， smoking and cardiovascular and cerebrovascular diseases were collected and analyzed.Preoperative laboratory examination and American Society of Anesthesiologists （ASA） classification， intraoperative pneumoperitoneal pressure， intraoperative blood loss and operation time were also obtained.Influencing factors of PONV were identified by Logistic regression analysis.

Results

All 495 patients successfully completed LC and were discharged on the day of operation.The incidence of PONV was 13.9%（69/495）， which was relieved after use of antiemetic drugs.Multivariate Logistic regression analysis showed that gender （OR=0.144， 95%CI： 0.063-0.330）， age（OR=0.956， 95%CI： 0.931-0.982）， operation time （OR=1.017， 95%CI： 1.493-2.876） and pneumoperitoneal pressure （OR=2.072， 95%CI： 0.645-1.173） were the independent influencing factors of PONV in patients undergoing daytime LC （all P＜0.05）.

Conclusions

Gender， age， operation time and pneumoperitoneal pressure are the independent influencing factors of PONV in patients undergoing daytime LC.For young female patients， precaution should be strengthened， the pneumoperitoneal pressure should be reduced as much as possible during operation and surgical process should be accelerated.

Objective

To evaluate the safety and efficacy of ultrasound-guided percutaneous transhepatic cholangioscopic lithotripsy （PTCL） in the treatment of biliary stricture after bile duct injury repair.

Methods

Clinical data of 4 patients with biliary stricture after biliary tract injury repair admitted to the First Affiliated Hospital of Jinan University from July 2021 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 2 patients were male and 2 female， aged from 44 to 62 years， with a median age of 50 years.The liver function of 4 patients was graded as Child-Pugh B.The bile duct injury was graded as Strasberg D，E1， E2 and E4， respectively.Patients experienced biliary stricture and recurrent cholangitis after biliary tract injury repair.Ultrasound-guided PTCL was adopted.Ultrasound-guided puncture was performed to establish sinus tract.Stone removal was performed by rigid choledochoscopy and stent placement was conducted.The feasibility and safety of this procedure for patients with biliary tract injury were evaluated.

Results

4 patients successfully completed the operation.Among them， biliary drainage catheter was removed after 2 cycles of treatment in 3 patients.In 1 patient， biliary drainage catheter was maintained to support the biliary duct after 1 cycle of treatment.At 3 months later， secondary operation was performed including drainage catheter replacement， biliary tract repair and residual stone removal.The follow-up time was 3.0-24.0 months， with a median follow-up time of 12.5 months.No cholangitis was reported during postoperative follow-up.

Conclusions

Ultrasound-guided PTCL can be used as one of the efficacious interventions for biliary stricture after bile duct injury repair.

Objective

To investigate the causes of spontaneous bile leakage in hepatocellular carcinoma （HCC） patients undergoing hepatectomy after conversion therapy.

Methods

Clinical data of 41 HCC patients who underwent laparoscopic hepatectomy in Nanfang Hospital of Southern Medical University from October 2022 to September 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 31 patients were male and 10 female， aged from 28 to 73 years， with a median age of 60 years.All patients were divided into the conversion therapy group （n=10 cases） and non-conversion therapy group （n=31） according to whether conversion therapy was performed before operation.TACE， hepatic arterial infusion chemotherapy combined with targeted immunotherapy were adopted in the conversion therapy.The operation time and the length of postoperative hospital stay between two groups were compared by Man-Whitney U test.The incidence of bile leakage was compared by Fisher’s exact test.

Results

The incidence of postoperative bile leakage was 40%（4/10）in the conversion therapy group， and no bile leakage was reported in the non-conversion therapy group， and the difference was statistically significant between two groups （P=0.002）.In the conversion therapy group，the operation time was 222 （168，277） min， significantly longer than 146 （99，208） min in the non-conversion therapy group （Z=2.478， P＜0.05）.In the conversion therapy group， the length of postoperative hospital stay and time of indwelling drainage catheter were 11.9 （8.3， 12.8） and 11.0 （8.0， 14.0） d， significantly longer than 8.9 （7.6， 10.4） and 7.0 （4.0， 10.0） d in the non-conversion therapy group （Z=1.372， 2.163， both P＜0.05）.

Pathological examination showed that a large number of inflammatory cells were distributed adjacent to the portal area of liver in the paracancerous （non-surgical margin） tissues of patients after conversion treatment.Severe edema of liver cells and intracellular cholestasis were noted.Bile leakage occurred in the bile duct，and the lumen structure was basically intact.

Conclusions

The increased incidence of bile leakage in HCC patients undergoing radical resection after conversion therapy is probably correlated with the changes of liver tissue structure and texture after conversion therapy.For these patients， the drainage situation should be closely monitored after operation and the time of indwelling drainage catheter should be appropriately prolonged.

Objective

To evaluate the application value of ERCP combined with SpyGlass endoscopic radiofrequency ablation （RFA）+ photodynamic therapy （PDT）+ biliary stenting （BS） in advanced cholangiocarcinoma.

Methods

Clinical data of 1 patient with cholangiocarcinoma admitted to the Second Hospital of Lanzhou University in June 2023 were analyzed retrospectively.On June 13，2023， the 61-year-old female patient was admitted to the hospital due to “abdominal pain after eating for 1 month”.Physical examination： the skin mucosa and sclera were slightly yellow， and a firm and movable mass was palpable in the middle and upper abdomen and around the umbilicus.The left supraclavicular mass was approximately 2 cm×1 cm， without redness， swelling， pain and ulceration.Tumor markers：CA19-9＞1 000 kU/L， CEA 251 μg/L and CA72-4 32.8 kU/L.CT scan showed that the wall of the upper segment of common bile duct was slightly thickened and significantly enhanced.MRCP revealed that the circular thickening of the wall of common bile duct at the junction of the common hepatic duct and common bile duct， manifested as soft tissue shadow， which was considered as cholangiocarcinoma.Preliminary diagnosis of cholangiocarcinoma complicated with cervical lymph node metastasis was made.

Results

After comprehensive preoperative preparation， ERCP combined with SpyGlass endoscopic mucosal biopsy revealed signet ring cell carcinoma of the bile duct.A bare metal biliary stent （0.6 cm×1.0 cm） was implanted under endoscope combined with RFA and PDT.PDT was given once a day for 3 d.Postoperative adjuvant systemic therapy of albumin paclitaxel+capecitabine was delivered.After corresponding treatment， liver function indexes were significantly improved.CEA level was significantly declined from 251 μg/L to 169 μg/L.Repeated MRCP showed that the annular thickening of bile duct wall at the junction of the common bile duct and common bile duct was mitigated， and corresponding lumen stenosis and intrahepatic bile duct dilatation were also alleviated.

Conclusions

BS combined with RFA and PDT under ERCP provides a novel idea for comprehensive endoscopic treatment for patients with advanced cholangiocarcinoma， which will bring more benefits.

Objective

To evaluate the safety and clinical efficacy of transumbilical single-port laparoscopic cholecystectomy combined with umbilical hernia repair.

Methods

Clinical data of 5 patients with gallstones， cholecystitis complicated with umbilical hernia treated with transumbilical single-port laparoscopic cholecystectomy combined with umbilical hernia repair in the First People’s Hospital of Yunnan Province from September 2022 to October 2023 were analyzed retrospectively.Among them， 4 patients were male and 1 female， aged from 45 to 56 years， with a median of 49 years.Perioperative status and clinical efficacy were observed.

Results

All 5 patients successfully completed the operation.None was converted to open surgery and no additional port was created.The operation time was 65-90 min， with a median time of 82 min.Intraoperative blood loss was 10-25 ml， with a median of 16 ml.All patients were given with antiinfection and symptomatic treatments after operation.All 5 patients recovered well.No complications such as bleeding and bile leakage occurred.All patients were discharged at postoperative 5 d.No recurrence of gallstones or umbilical hernia was reported as of the paper submission date.

Conclusions

Transumbilical single-port laparoscopic cholecystectomy combined with umbilical hernia repair can shorten the length of hospital stay， avoid the injury induced by multiple operations and yield cosmetic surgical incisions， which is recommended for patients with gallstones complicated with umbilical hernia.

Objective

To evaluate the application value of modified “two-step” Appleby operation after neoadjuvant therapy in the treatment of locally advanced pancreatic body cancer.

Methods

Clinical data of two patients with locally advanced pancreatic body cancer admitted to Chongqing People’s Hospital from June 2021 to June 2022 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Both two patients were male， aged 56 and 64 years， respectively.CA19-9 level was 901 and 613 kU/L， and tumor diameter was 8.9 and 3.6 cm，respectively.Two patients were diagnosed with pancreatic ductal adenocarcinoma by endoscopic ultrasoundguided pancreatic biopsy.After MDT consultation， three cycles of neoadjuvant chemotherapy were performed.The regimen consisted of gemcitabine combined with albumin-bound paclitaxel， without targeted immunotherapy.Modified “two-step” Appleby operation was performed within 1-3 weeks after neoadjuvant therapy.The tumor changes， surgical completion， postoperative complications and survival of two patients after neoadjuvant therapy were analyzed.

Results

After neoadjuvant therapy， CA19-9 level was decreased significantly by over 50% in two patients.The tumor size was evidently reduced accompanied with decrease of vascular invasion， and surgical indications were evident.Surgical regimen： at the first step， common hepatic artery pretreatment， laparoscopic ligation of common hepatic artery were performed.Postoperatively，liver function was slightly abnormal and restored to normal within 2 weeks.Imaging examination indicated that the blood supply of liver and gastrointestinal tract was normal.At the second step， modified Appleby operation was performed after comprehensive preoperative preparation.Transient elevation of transaminase level occurred after operation， which was improved after liver-protection treatment.CA19-9 level was further decreased.Imaging examination showed that the blood supply of liver and gastrointestinal tract was normal，and no ischemic lesion was found.Two patients were discharged after recovery.Postoperatively， two patients continued to receive adjuvant chemotherapy of gemcitabine combined with albumin-bound paclitaxel.One patient developed multiple systemic metastases at 13 months after operation， and the other patient had liver metastases at postoperative 15 months.Both two patients survived as of the paper submission date.

Conclusions

Modified Appleby operation after neoadjuvant therapy can improve the R0 resection rate for locally advanced pancreatic body cancer.“Two-step” surgical design can reduce the incidence of postoperative ischemic lesions and perioperative complications， which is safe and feasible in clinical application.

Objective

To evaluate the safety and efficacy of total pancreatectomy in the treatment of pancreatic cancer.

Methods

Clinical data of 4 patients with pancreatic cancer who underwent total pancreatectomy in the First Affiliated Hospital of Guangxi Medical University from June 2019 to March 2023 were analyzed retrospectively.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them， 1 patient was male and 3 female， aged from 58 to 71 years， with a median age of 62 years.Perioperative status and postoperative complications were observed.

Results

Total pancreatectomy via the arterial route was successfully performed in all 4 patients， including 2 cases of open spleen-preserving total pancreatectomy， 1 case of laparoscopic spleen-preserving total pancreatectomy and 1 case of robot-assisted total pancreatectomy with spleen resection.The operation time was 488-784 min， with a median time of 643 min.Intraoperative blood loss was 200-900 ml， with a median blood loss of 400 ml.Postoperative pathological examination showed that 3 cases were diagnosed with pancreatic ductal adenocarcinoma and 1 case of pancreatic adenosquamous carcinoma.Postoperatively，4 patients developed brittle diabetes.Insulin pump was used to control the blood glucose level， and the fasting blood glucose level was maintained at 5-8 mmol/L.Meantime， pancreatin preparation was supplemented to support pancreatic exocrine function.No postoperative gastric emptying disorder， bile leakage and abdominal bleeding were reported.The length of postoperative hospital stay was 13.0-21.0 d， with a median time of 15 d.No patient died within postoperative 30 d.Postoperative follow-up time was ranged from 2.0 to 46.0 months，with a median time of 40.5 months.One case died of ketoacidosis at 4 months after operation.The remaining 3 cases obtained stable blood glucose levels， acceptable quality of life and no tumor recurrence.

Conclusions

Total pancreatectomy is safe and feasible treatment if surgical indications are properly managed.Long-term management of postoperative blood glucose level and recovery of gastric function are critical factors affecting patients’ quality of life.

Objective

To analyze the expression level of solute carrier family 29 member 3（SLC29A3） gene in liver cancer and its relationship with prognosis， clinical stage， immune cell infiltration，microsatellite instability and tumor mutational load.

Methods

Pan-cancer analysis of SLC29A3 expression was analyzed with TCGA database.The expression data of SLC29A3 mRNA in liver cancer and adjacent tissues were obtained from TCGA database， and SLC29A3 expression levels were compared between liver cancer and adjacent tissues.Survival analysis was performed by Kaplan-Meier Plotter.Prognostic factors were identified by univariate and multivariate Cox regression analyses.The correlation between gene expression and pathway score was analyzed by GSVA package of R software.

Results

TCGA database analysis showed that SLC29A3 was highly expressed in multiple tumors.The genetic information of SLC29A3 was obtained from 371 cases of liver cancer tissue samples and 50 cases of adjacent tissue samples based on RNA-seq data from TCGA database.The results revealed that the relative expression of SLC29A3 in liver cancer tissues was 2.7±0.6， significantly higher than 2.2±0.5 in normal liver tissues （t=5.529， P＜0.05）.Kaplan-Meier survival analysis showed that the median survival time of liver cancer patients with high expression of SLC29A was 37.2 months， 80.4 months for those with low expression of SLC29A.The prognosis of liver cancer patients with high expression of SLC29A was even worse （HR=2.209， P＜0.05）.Univariate and multivariate Cox regression analyses demonstrated that high expression of SLC29A3 was an independent risk factor for poor prognosis in patients with liver cancer （HR=1.67， 95%CI： 1.25-2.23； P＜0.05）.Correlation analysis showed that high expression of SLC29A3 in liver cancer was positively correlated with tumor proliferation-related signals， tumor inflammatory response and PI3K-AKT-mTOR signaling pathway （r_s=0.32， 0.12， 0.27； all P＜0.05）.High expression of SLC29A3 was positively correlated with the infiltration of regulatory T cells（Treg）， myeloid suppressor cells （MDSC） and cancer-associated fibroblasts （CAFs） （r_s=0.31， 0.28， 0.16； all P＜0.05）， and high expression of SLC29A3 was also positively correlated with microsatellite instability （MSI）score （r_s=0.11， P＜0.05）.

Conclusions

SLC29A3 expression is up-regulated in liver cancer， and its high expression is associated with poor prognosis.High expression of SLC29A3 can induce tumor proliferation，inflammation and activation of PI3K-AKT-mTOR signaling pathway by provoking the infiltration of Treg，MDSC and CAFs and MSI， thereby regulating the progression of liver cancer.

Liver cancer is a common and highly lethal malignant tumor， and clinical prognosis is affected by multiple factors.Recent studies have shown that prognostic nutritional index （PNI） and controlling nutritional status （CONUT） score can predict clinical prognosis of patients with liver cancer.PNI is used for comprehensive evaluation according to serum albumin level and total lymphocyte count， while CONUT score is utilized for comprehensive evaluation based on serum albumin level， total lymphocyte count and total cholesterol level.These two indexes comprehensively reflect the nutritional and inflammatory status of patients.In this article， the research progress in PNI and CONUT score in patients with liver cancer was reviewed， aiming to provide reference for the treatment and prognostic evaluation.

At present， comprehensive treatments mainly including TACE， ablation， targeted therapy， immunotherapy and stereotactic body radiotherapy （SBRT） have achieved high efficacy in patients with unresectable advanced hepatocellular carcinoma （HCC）.In recent years， immune checkpoint inhibitor（ICI） has completely revolutionized the treatment of HCC， whereas it still encounters challenges， such as low response rate， treatment resistance and tumor hyperprogression， etc.Locoregional interventional therapy can actively improve the tumor immune microenvironment， and combined application of immunotherapy can enhance efficacy through synergical effect， thereby elevating the survival rate of HCC.Although encouraging achievements have been made， multiple problems remain to be resolved urgently， including exploring the optimal combined regimen， how to determine the timing and sequence of treatment and how to identify serological and/or histological biomarkers that can effectively predict the response of ICI treatment， etc.Current studies have shown that immunotherapy combined with local or regional therapy can improve the efficacy of immunotherapy for HCC.Nevertheless， due to the limitations of small sample size and retrospective study design in several studies， prospective clinical trials with large sample size are required to analyze the potential benefits and evaluate the safety.In this article， the research progress in immunotherapy combined with locoregional therapy for HCC was reviewed， and the current status and future development were summarized and assessed.

Hepatic hemangioma （HH） is the most common benign tumor of the liver in clinical practice.With the progress in medical technology， the diagnostic rate of HH has been increased year by year，and extensive attention has been diverted to clinical treatment of HH.In recent years， more and more novel therapies and technologies have been applied to treat HH and achieve excellent effect.In this article， common treatment methods of HH were reviewed， aiming to provide treatment reference for clinicians.