With the continuous improvement of long-term survival rates among solid organ transplantation (SOT) recipients, de novo malignancy (DNM) following transplantation have become a critical factor impairing long-term prognosis and causing non-organ-failure-related mortality. The risk profile and disease spectrum of DNM vary across different types of SOT recipients, modulated by multiple factors including ethnicity, primary underlying diseases, intensity of immunosuppression, regional environmental conditions, and patterns of viral infection. Distinct differences exist in demographic characteristics and cancer epidemiology between Chinese SOT recipients and their Western counterparts, rendering overseas evidence and recommendations not fully applicable to clinical practice in China. Against this backdrop, the Organ Transplantation Rehabilitation Committee of Chinese Association of Rehabilitation Medicine convened multidisciplinary experts to formulate the Clinical Practice Guidelines on De Novo Malignancies After Solid Organ Transplantation in Adult in China. Integrating domestic and international evidence-based medical data alongside real-world clinical experience in China, this guideline proposes clinical recommendations for risk assessment, screening, surveillance and management of post-transplant DNM specifically tailored to adult Chinese SOT recipients, so as to provide evidence-based references for clinical identification, monitoring and standardized management of DNM in this population.

The development of biliary surgery in China is a brilliant history from scratch to establishment, from traditional to modern technologies and from experience to standardization, which not only witnesses the progress of surgical medicine in China, but also demonstrates the exploratory spirit and innovation ability of Chinese medical community facing complex diseases. In this article, the development of biliary surgery in China was systematically reviewed from early clinical exploration to clinical application of modern technologies, from basic theoretical research to clinical diagnosis and treatment practice. It comprehensively showcased China's landmark achievements and existing challenges of biliary surgery in the fields of cholelithiasis, biliary tract infection and biliary tract tumors, and predicted the future development direction, aiming to provide reference for promoting sustainable development of biliary surgery in China and providing qualified medical services for patients with biliary tract diseases worldwide.

Cholelithiasis is a highly prevalent digestive system disease worldwide, and the evolution of its treatment strategies profoundly reflects the continuous advancement of minimally invasive surgical concepts and techniques. The coexistence of gallbladder stones and common bile duct stones significantly increases the complexity of clinical management. Although conventional open surgery can achieve definitive therapeutic efficacy through single-stage common bile duct exploration and stone removal, it has disadvantages including substantial surgical trauma, slow postoperative recovery, and a high incidence of complications. With the continued development of minimally invasive surgical concepts and technological advances, combined multi-endoscopic treatment strategies centered on laparoscopy, choledochoscopy, and endoscopy are reshaping the clinical treatment pathway for complex cholelithiasis by integrating the respective advantages of these techniques. These strategies fully demonstrate the comprehensive advantages of minimally invasive surgery in terms of stone clearance efficiency, anatomical precision, and quality of patient recovery. This article systematically reviews recent advances in the clinical application of mainstream combined minimally invasive procedures, providing a theoretical reference for optimizing the treatment of concomitant gallbladder stones and common bile duct stones.

Biliary tract cancer (BTC), including gallbladder cancer and cholangiocarcinoma, is characterized by difficulty in early diagnosis, strong invasiveness, high lymph node metastasis rate and poor prognosis. Radical resection is an effective treatment for BTC, whereas high postoperative recurrence rate severely shortens the long-term survival of BTC patients. Prognostic models can improve the levels of precision diagnosis and treatment through prognostic evaluation and precise identification of populations with high recurrence risk. These models have important guiding values for clinical treatment decision-making such as surgery, neoadjuvant therapy, adjuvant therapy and follow-up monitoring, which contribute to elevating the quality of life and prolonging the survival of BTC patients.With recent developments of interdisciplinary integration, on the basis of traditional methods, prognostic models for BTC based on machine learning, radiomics and other technologies have been continuously developed, showcasing certain advantages. In this article, development status and challenges in prognostic models for BTC were illustrated, aiming to provide reference for clinical practice and research in this field.

Gallbladder cancer is a highly aggressive malignancy with a poor prognosis. Radical surgery is an important means of improving prognosis. However, because early-stage gallbladder cancer lacks specific symptoms, most patients have already lost the opportunity for radical surgery by the time of diagnosis. Standardized diagnosis and treatment can help patients achieve more possible therapeutic benefit. In recent years, rapid advances in targeted therapy and immunotherapy have provided new directions for the treatment of gallbladder cancer. This article aims to summarize the currently recommended standardized diagnostic and therapeutic approaches, as well as emerging targeted therapy and immunotherapy strategies.

Biliary tract cancer (BTC) is a common malignancy originating from the biliary epithelia, characterized by high heterogeneity, strong invasiveness and poor prognosis. Surgical resection remains the only radical treatment. However, 60%-80% of BTC patients are diagnosed at advanced stage upon admission, limiting surgical efficacy. In recent years, with the advancement of next-generation sequencing and the development of novel clinical drugs, immunotherapy and targeted therapy have gradually emerged as new directions in clinical treatment. Antibody-drug conjugate (ADC), with dual characteristics of "precise targeting + efficient killing," has gradually become a research hotspot in the treatment of BTC. In this article, research progress in novel ADC drugs in the treatment of BTC was reviewed.

Single-incision laparoscopy (SIL) is established based on precise treatment of minimally invasive surgery. SIL can reduce surgical trauma and accelerate postoperative recovery. It has been gradually applied in multiple surgical fields. Ablation is an effective treatment for primary and secondary liver tumors. Current tissue ablation technologies include radiofrequency ablation (RFA) and microwave ablation (MWA), etc. MWA is widely applied in clinical practice due to convenient operation, wide range of ablation, high ablation efficiency and slight impact from neighboring vessels. With the development of navigation equipment and precision targeting technology, ablation combined with auxiliary equipment may become an option for precision surgery. In this article, the application of ultrasound-guided MWA during SIL in liver surgery was elucidated, and clinical experience of our center was summarized to evaluate its application status and prospect in liver tumors.

To construct a prognostic model for patients with hepatocellular carcinoma (HCC) based on multi-omics subtyping of ammonia-induced cell death features, and to explore the mechanism of tumor microenvironment (TME) remodeling and precision treatment strategy.

In this study, The Cancer Genome Atlas (TCGA), conventional transcriptome of International Cancer Genome Consortium (ICGC) cohort and multiple single-cell RNA sequencing (scRNA-seq) datasets were integrated. Firstly, the activity of ammonia-induced cell death pathway of samples was quantified by single-sample gene set enrichment analysis (ssGSEA), and the modules of key ammonia-induced cell death genes were identified by weighted gene co-expression network analysis (WGCNA). The risk scoring prognostic model was constructed by the least absolute shrinkage and selection operator (Lasso) regression analysis. Multiple immune infiltration algorithms, SCENIC, CellChat and drug sensitivity prediction were employed to systematically analyze the "endothelial-myeloid" immune rejection remodeling mechanism of high-risk TME and synthesize lethal intervention targets. Correlation analysis was conducted by Pearson or Spearman correlation coefficients. Survival analysis was performed by Kaplan-Meier method and Log-rank test.

Based on the sample data of 371 cases in TCGA-LIHC cohort, 17 gene co-expression modules were identified by cluster analysis. 1 073 genes in two key modules were defined as candidate genes of ammonia-induced cell death. Functional enrichment analysis showed that the above candidate genes were closely associated with immune regulation in biological function. Based on the genes related to ammonia-induced cell death, a risk scoring prognostic model of ammonia-induced cell death with independent prognostic value was successfully constructed. ROC analysis demonstrated that the model possessed high predictive efficiency. The area under the ROC curve (AUC) for predicting the 1-, 3-and 5-year survival rates of liver cancer was 0.855, 0.824 and 0.787, respectively. External validation of ICGC cohort confirmed that the model showed high cross-cohort consistency in identifying highly-invasive liver cancer subgroups and prognostic risk stratification. High-risk phenotype was mainly characterized with genomic instability driven by TP53 mutation. TME was characterized with "immune rejection" phenotype, with an "endothelial-myeloid" immune rejection barrier. The infiltration of CD4⁺ central memory T cells (CD4⁺ Tcm) was significantly down-regulated. Inhibitory myeloid cells represented by monocyte lineage were significantly up-regulated, and the infiltration scores of fibroblasts and smooth muscle cells were also significantly up-regulated. CD8⁺ T cells in TME were in an inactive resting state, manifested with a significant decrease in the proportion of terminal effector subsets and relative enrichment of transitional and naive cells. The regulatory network suggested that abnormal activation of MYC in high-risk endothelial cells promoted the recruitment of myeloid cells probably through the ANGPTL/JAM signal axis and participated in the construction of physical and immune barriers. In terms of therapeutic strategies, HCC patients of high-risk subtypes showed significant potential sensitivity to WEE1 inhibitors (adavosertib).

In this study, a risk scoring prognostic model of ammonia-induced cell death with independent prognostic value is established, which can effectively identify high-risk HCC subtypes with TP53 mutation. TME in the high-risk group is characterized with typical "endothelial-myeloid" immune rejection, accompanied by activation blockade of CD8⁺ T cells. WEE1 inhibitors are expected to become potential targeted interventional drugs for high-risk patients.

To investigate the application value of absorbable polymer tissue sealing film in distal pancreatectomy.

The study included 49 patients who underwent distal pancreatectomy in the Department of Hepatobiliary Surgery of the Seventh Medical Center of Chinese PLA General Hospital from April 2023 to April 2025. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 33 patients were male and 16 were female, aged from 37 to 77 years, with a median age of 59 years. The patients were randomly divided into the sealing film group (n=24) and the control group (n=25) using a random number table. In the sealing film group, TissuePatch^TM was applied to the pancreatic stump after transection of the pancreas using a linear stapler during surgery, while the pancreatic stump wound in the control group was left untreated. Operative time, intraoperative blood loss, postoperative drainage volume, amylase level in the drainage fluid, time to flatus, duration of drainage tube placement, and postoperative length of hospital stay were compared between the two groups using the Mann-Whitney U test. The incidence of complications and other categorical variables were compared using the Chi-square test or Fisher's exact test.

The amylase level on postoperative day 3 in the sealing film group was 488 (43-7 932) U/L, which was significantly lower than 2 933 (148-61 614) U/L in the control group (Z=-2.87, P=0.004). The time to flatus, duration of drainage tube placement, and postoperative length of hospital stay in the sealing film group were 48 (24-72) h, 8 (6-39) d, and 8 (5-15) d, respectively, all of which were significantly shorter than 72 (24-120) h, 15 (6-77) d, and 9 (5-37) d in the control group (Z=-2.39,-2.51, and -1.98; P<0.05). The postoperative complication rates in the sealing film group and the control group were 25% (6/24) and 28% (7/25), respectively, with no statistically significant difference (χ²=0.06, P=0.803). There were 8 cases of grade A pancreatic fistula and 4 cases of grade B pancreatic fistula in the sealing film group, compared with 10 and 5 cases in the control group, respectively. No grade C pancreatic fistula or reoperation occurred in either group, and there was no statistically significant difference in the clinical grading of pancreatic fistula between the two groups (P=0.832). No TissuePatch^TM-related complications, including intolerance or rejection, occurred in the sealing film group.

The use of absorbable polymer tissue sealing film during distal pancreatectomy can reduce pancreatic fluid leakage, shorten the duration of drainage tube placement and postoperative length of hospital stay, and facilitate rapid postoperative recovery.

To evaluate the efficacy and safety of endoscopic retrograde cholangiopancreatography (ERCP) plus biliary drainage combined with gallbladder drainage for acute cholecystitis complicated with cholangitis and to construct an efficacy prediction model.

Clinical data of 77 patients with acute cholecystitis complicated with cholangitis who received ERCP in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from September 2022 to April 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 44 patients were male and 33 female, aged from 61 to 86 years, with a median age of 70 years. According to the success of ERCP gallbladder drainage, all patients were divided into the success and failure groups. In the success group, ERCP plus choledocholithotomy/biliary drainage+gallbladder drainage were adopted. In the failure group, choledocholithotomy/biliary drainage combined with percutaneous gallbladder puncture and drainage or cholecystectomy were performed in some patients. The success rate, clinical remission rate and postoperative adverse events in two groups were observed and recorded. The independent risk factors of failed gallbladder drainage were determined by multivariate Logistic regression analysis in some patients. The predictive value of regression model for successful gallbladder drainage was assessed by the receiver operating characteristic (ROC) curve.

The clinical remission rate was 99%(76/77). Due to limited emergency operation conditions, the success rate of ERCP plus gallbladder drainage was 42%(32/77). The failure rate of gallbladder drainage was 58%(45/77). Among them, the symptoms of 12 cases were controlled by gallbladder puncture or emergency surgery, and 1 died of multiple organ failure. The remaining patients achieved clinical remission. No significant differences were found in the incidence and recurrence rate of adverse events between two groups (both P>0.05). Postoperatively, 5 patients developed hyperamylasemia, which were alleviated without special treatment. No bleeding or perforation occurred. In the success group, 1 patient experienced mild pancreatitis after surgery, which was mitigated after conservative medical treatment. 1 case developed postoperative pulmonary infection, which was improved after anti-infection treatment. At 6 months after ERCP, 6 cases had recurrent infection of the biliary system, including 5 in the failure group and 1 in the success group.Multivariate Logistic regression analysis showed that post-gastric bypass (OR=31.775, 95%CI: 1.711-590.155), the total operation time (OR=0.888, 95%CI: 0.820-0.961), direct vision under choledochoscope (OR=0.066,95%CI: 0.005-0.795) were the independent risk factors of failed gallbladder drainage (all P<0.05). According to multivariate Logistic regression analysis, the independent influencing factors were identified, and a regression model was constructed. The model formula was ln[p/(1-p)]=3.938+3.459×post-gastric bypass -0.119×total operation time -2.719×direct vision under choledochoscope. ROC curve analysis showed that the regression model had certain predictive value. The area under the ROC curve (AUC) was 0.804, the sensitivity was 0.911 and the specificity was 0.625, respectively.

Compared with conventional ERCP plus biliary drainage combined with gallbladder puncture or surgery, ERCP plus biliary drainage combined with gallbladder drainage is an effective treatment of cholecystitis complicated with cholangitis, which is simple and minimally invasive, and does not increase the incidence of postoperative adverse events. The logistic regression model yields certain predictive value for clinical efficacy.

To investigate the clinical risk factors for acute gangrenous cholecystitis (AGC), and to develop and validate an AGC risk prediction model based on these factors.

Clinical data of 265 patients with acute cholecystitis (modeling cohort) admitted to Taizhou Fourth People's Hospital from January 2022 to June 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 125 patients were male and 140 female, aged from 46 to 68 years, with a median age of 57 years. Perioperative clinicopathological data were collected and analyzed using univariate and multivariate logistic regression. An AGC risk prediction model was established in combination with postoperative pathological findings. An independent cohort of 108 patients with acute cholecystitis (validation cohort) enrolled from July 2024 to December 2024 was subsequently collected to validate the prediction model.

Multivariate logistic regression analysis showed that male sex, high body mass index (BMI), gas and fluid accumulation in the gallbladder on CT, gallbladder stones, impacted stones, and elevated white blood cell count were independent risk factors for AGC (OR=3.705, 1.202, 10.005, 9.718, 3.559, and 1.239, respectively; P<0.05). An AGC prediction nomogram was constructed. Nomogram analysis showed that the risk of gallbladder gangrene increased significantly when the total score exceeded 80 points and reached 99% when the total score increased to 280 points. The Hosmer-Lemeshow test showed good model fit. Receiver operating characteristic (ROC) curve analysis showed that the areas under the curve (AUC) for predicting AGC were 0.848 in the modeling cohort and 0.709 in the validation cohort, indicating reliable predictive performance for gallbladder gangrene. The Hosmer-Lemeshow goodness-of-fit test was performed for both datasets, and the calibration curves were highly consistent with the ideal curve, demonstrating the good predictive ability of the model. Clinical application data showed that the nomogram-based prediction model had substantial practical utility in real-world clinical settings.

Male sex, high BMI, gas and fluid accumulation in the gallbladder on CT, gallbladder stones, impacted stones, and elevated white blood cell count are independent risk factors for AGC. The prediction model based on key clinicopathological characteristics has high diagnostic value and can provide a simple and convenient clinical tool for the early diagnosis and intervention of AGC.

To evaluate clinical efficacy of laparoscopic cholecystectomy (LC) combined with laparoscopic transcystic bile duct exploration (LTCBDE) and primary suture in patients with cholecystolithiasis complicated with choledocholithiasis after failed endoscopic retrograde cholangiopancreatography (ERCP).

Clinical data of 158 patients with cholecystolithiasis and choledocholithiasis who experienced failed ERCP in Wuming Hospital of Guangxi Medical University from January 2020 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 70 patients were male and 88 female, aged from 25 to 84 years, with a median age of 54 years. All patients were divided into two groups according to different surgical procedures. In the primary suture group, patients were treated with LC+LTCBDE+primary suture (n=62), and those in the T-tube drainage group received LC+LCBDE+T-tube drainage (n=96).

All patients were successfully treated by laparoscopic surgery with no conversion to open surgery or death. Intraoperative blood loss in the primary suture group was 21(18,23) ml, significantly less than 31(29,34) ml in the T-tube drainage group (Z=-9.557, P<0.001). In the primary suture group, the time to first flatus, duration of antibiotic use and the length of hospital stay were 2.0(1.0,2.0), 5.0(3.0,6.0) and 7.0(5.0,8.0)d, significantly shorter than 2.5(2.0,4.0),7.0(5.0,8.0) and 9.0(7.0,10.8)d in the T-tube drainage group (Z=-5.289,-6.182,-6.246; all P<0.001). In the primary suture group, the incidence rates of postoperative acute cholangitis, bile leakage and residual stones were 10%(6/62), 2%(1/62) and 6%(4/62), compared with 10%(10/96), 6%(6/96) and 15%(14/96) in the T-tube drainage group. No significant differences were noted between two groups (all P>0.05). The incidence of postoperative abdominal infection in the primary suture group was 8%(5/62), significantly lower than 22%(21/96) in the T-tube drainage group, and the difference was statistically significant (χ²=5.226, P=0.022). No acute pancreatitis or biliary stenosis occurred in two groups after surgery.

For patients with cholecystolithiasis complicated with multiple common bile duct stones after failed ERCP, if the choledochoscope can pass through the diameter of cystic duct, LC combined with LTCBDE and primary suture can effectively remove the stones, mitigate surgical trauma, reduce antibiotic use, shorten the length of postoperative hospital stay and promote rapid postoperative recovery, which is a safe, effective and feasible surgical procedure.

To investigate the relationship between the optimal dose of indocyanine green (ICG) and the fluorescence intensity and development rate in endoscopic retrograde cholangiopancreatography (ERCP).

Thirty-six patients with common bile duct stones undergoing ERCP and indwelling nasobiliary drainage in the Second Affiliated Hospital of Guangdong Medical University from December 2023 to October 2024 were enrolled in this prospective study. Among them, 21 patients were male and 15 female, aged from 22 to 89 years, with a median age of 68 years.The informed consents of all patients were obtained and the local ethical committee approval was received. All patients were randomly divided into three groups. ICG was intravenously injected slowly at a dose of 0.30, 0.35 and 0.40 mg/kg at 30 min before postoperative removal of nasobiliary drainage, respectively. Bile images were collected by endoscopic fluorescence camera system. The fluorescence intensity of the collected images was measured by Image J software, and the fluorescence intensity and development rate at corresponding dose of the patient were calculated. The fluorescence effect was evaluated objectively by visual analogue scale (VAS). Correlation analysis was performed by Pearson linear correlation. The diagnostic value of fluorescence intensity and VAS score was assessed by receiver operating characteristic (ROC) curve.

In the 0.30 mg/kg, 0.35 mg/kg and 0.40 mg/kg dose groups, 8, 12 and 11 cases experienced 30-min development of bile ducts, and the differences were statistically significant(χ²=6.039, P=0.040), and the fluorescence intensities were 70±9, 99±13 and 97±16, and the differences were also statistically significant (F=18.93, P<0.01). The 30-min visualization rate in the 0.35 mg/kg group was 100%. The ICG fluorescence intensity and dose were positively correlated (r=0.619, P<0.01). The VAS evaluation showed that at intravenous ICG doses of 0.35 mg/kg and 0.40 mg/kg, 100% of patients achieved visualization above the intuitive level; at 0.30 mg/kg, 60% achieved visualization above that level. ROC curve analysis showed that the area under the ROC curve (AUC) of ICG fluorescence intensity in bile was 0.942 (95%CI: 0.850-1.000, P<0.01), the sensitivity was 0.774 and the specificity was 1.000, respectively. The AUC of VAS score of fluorescence effect was 0.735 (95%CI: 0.483-0.988, P>0.05), the sensitivity was 0.968 and the specificity was 0.400, respectively.

The optimal intravenous dose of ICG in ERCP is ranged from 0.35 to 0.40 mg/kg, which can achieve the optimal development rate and fluorescence effect in bile. The fluorescence intensity yields good diagnostic value.

To investigate the risk factors associated with bile leakage after hepatectomy for intrahepatic bile duct stones, and to develop and validate a prediction model.

The clinical data of 244 patients who underwent hepatectomy for intrahepatic bile duct stones at Mianyang Central Hospital from January 2019 to December 2024 were retrospectively analyzed. There were 162 males and 82 females, aged 25-84 years, with a median age of 60 years. This study was approved by the Ethics Committee of Mianyang Central Hospital. As a non-interventional retrospective study, the requirement for informed consent was waived. Patients were divided into a bile leakage group and a non-bile leakage group according to whether bile leakage occurred after surgery. Perioperative clinical indicators were analyzed using univariate and multivariate logistic regression, and a prediction model for bile leakage was constructed. The predictive performance of the model was evaluated using the receiver operating characteristic curve and area under the curve (ROC AUC). The accuracy of the model was assessed using the Hosmer-Lemeshow test and calibration curve. Decision curve analysis (DCA) was performed to evaluate the clinical utility of the model.

Postoperative bile leakage occurred in 30 patients, with an incidence of 12.3% (30/244). Among them, grade A bile leakage accounted for 60.0% (18/30), grade B for 33.3% (10/30), and grade C for 6.7% (2/30). Multivariate logistic regression analysis showed that a history of previous upper abdominal surgery, liver cirrhosis, hepatic inflow occlusion time, non-left lateral sectionectomy, and non-anatomical hepatectomy were independent risk factors for postoperative bile leakage (OR = 3.983, 3.661, 1.070, 5.390, and 3.724, respectively; P < 0.05). A prediction model was established based on these five factors, with the following formula: Logit (P) =-7.597 + 1.382×history of previous upper abdominal surgery + 1.298×liver cirrhosis + 0.068×hepatic inflow occlusion time+1.684×non-left lateral sectionectomy + 1.315×non-anatomical hepatectomy. ROC analysis of the prediction model showed that the model had an AUC of 0.862 and a C-index of 0.862. The diagnostic sensitivity and specificity of the model were 0.808 and 0.833, respectively, indicating that its predictive results were stable and reliable. The calibration curve and Hosmer-Lemeshow test showed good accuracy of the prediction model (χ²=2.662, P = 0.954). Internal validation was performed using the bootstrap resampling method with 1 000 samples, and the results showed that the model maintained good discrimination. DCA showed that when the threshold probability ranged from 0.03 to 0.81, applying this model to patient assessment yielded a net benefit, indicating that the model has certain clinical application value.

A history of previous upper abdominal surgery, liver cirrhosis, hepatic inflow occlusion time, non-left lateral sectionectomy, and non-anatomical hepatectomy are independent risk factors for bile leakage after hepatectomy for intrahepatic bile duct stones. The prediction model constructed based on these factors has good discrimination and calibration, and can effectively assess the risk of postoperative bile leakage.

To evaluate the safety and efficacy of three-port laparoscopic cholecystectomy (LC) via the umbilical approach.

Clinical data of 10 000 patients with benign gallbladder diseases who received three-port LC via the umbilical approach in Songjiang Branch of Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from November 2007 to May 2025 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 3 786 patients were male and 6 214 were female, aged from 18 to 94 years, with a median age of 65 years. 9 160 patients underwent elective surgery and 840 received emergency surgery. Conventional laparoscopic instruments were used in all cases. A 5-mm auxiliary port was created under the xiphoid process for those with anatomical difficulties. The operation time, intraoperative blood loss, postoperative pain intensity assessed by numerical rating scale (NRS) score and postoperative complications were recorded. The operation time, intraoperative blood loss and postoperative NRS score between male and female patients were compared by t-test. The surgical learning curve was delineated to analyze the quantitative relationship of learning process.

All patients successfully completed LC. In male patients, the operation time was (25±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.12). In female counterparts, the operation time was (26±11) min, intraoperative blood loss was (15±5) ml, and postoperative NRS score was (1.17±0.10). No significant differences were noted between male and female patients (t=-1.371, 0.946, -0.001; all P>0.05). The length of postoperative hospital stay was (2.0-4.0) d, with a median of 3.2 d. 43 patients developed postoperative complications. 3 cases experienced intraoperative bile duct injury, which were repaired by laparoscopy. 1 case of cross-sectional injury of common bile duct was converted to open surgery for end-to-end anastomosis of common bile duct. 1 case of cross-sectional injury of common hepatic duct was converted to open cholangioenterostomy. 1 case of massive hemorrhage was converted to open surgery for hemostasis. 4 cases of postoperative abdominal bleeding and 2 cases of postoperative bile leakage underwent unplanned laparoscopic surgery. 3 cases of incisional hernia received surgical repair. 3 cases of postoperative choledocholithiasis were treated by ERCP. 12 cases of bile leakage and 10 cases of incisional infection were cured by conservative treatment. No death was reported. Follow-up ranged from 2 to 60 months. The scars were hidden and the cosmetic effect was favorable. The learning curve showed that systematic training of approximately 100 cases was the key to realize technical maturity.

Three-port LC via the umbilical approach is suitable for elective and emergency surgeries, which is safe, feasible and yields favorable cosmetic effect. However, it should be carried out on the premise of ensuring the safety of patients and clear surgical field. Systematic training of approximately 100 cases was the key to realize technical maturity.

To evaluate the feasibility and safety of laparoscopic cholecystectomy (LC) combined with liver wedge resection in patients with preoperative highly-suspected gallbladder cancer.

Clinical data of 20 patients with preoperative highly-suspected gallbladder cancer who underwent LC combined with liver wedge resection in Department of Hepatobiliary Surgery, Huashan Hospital Fudan University from January 2022 to December 2024 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 11 patients were male and 9 female, aged from 29 to 88 years, with a median age of 64 (58, 72) years. After active preoperative evaluation and preparation, all patients underwent LC combined with liver wedge resection (en bloc) 2 cm from the gallbladder bed. Surgical condition and perioperative recovery were observed. Postoperative pathological data and short-term recurrence were analyzed.

All operations were successfully performed without conversion to open surgery. No intraoperative gallbladder rupture or bile leakage occurred. 12 patients underwent LC combined with liver wedge resection. The mean operation time was (92±13) min and intraoperative blood loss was 70 (50, 105) ml. 8 patients underwent LC combined with liver wedge resection plus regional lymph node dissection. The mean operation time was (155±18) min and intraoperative blood loss was 170 (135, 200) ml. The length of hospital stay was (4.7±1.4) d. Pathological examination revealed 8 cases of frozen section (-)/paraffin section (+), 8 cases of frozen section (+)/paraffin section (+), and 4 cases of frozen (-)/paraffin (+), respectively. Among 20 patients with preoperative highly-suspected gallbladder cancer, pathological paraffin section confirmed gallbladder cancer in 12 patients, including Tis (n=1), T1a (n=2), T1b (n=2), T2a (n=5), and T2b (n=2). Vascular invasion was observed in 1 case and perineural invasion in 3 cases. Cystic duct margins were negative in all cases. Pathological types included 7 cases of gallbladder adenocarcinoma, 3 cases of focal carcinoma, and 2 cases of neuroendocrine carcinoma. Based on frozen and paraffin section results, different additional surgical procedures were performed: 3 pTis/T1a patients with frozen section (-)/paraffin section (+) received no additional surgery; 1 pT2a patient with frozen section (-)/paraffin section(+) underwent salvage open hepatic segmentectomy (S4b+S5) plus regional lymph node dissection at postoperative 1 month. 8 patients with frozen section (+)/paraffin section (+) received intraoperative laparoscopic regional lymph node dissection and no salvage surgery. No perioperative death occurred. 1 elderly patient developed postoperative pulmonary infection, and no significant postoperative complications were observed in the remaining cases. The median follow-up time was 18.0 (9.5, 26.5) months. No tumor recurrence, metastasis or death was observed during the follow-up.

For patients with highly-suspected gallbladder cancer, LC combined with liver wedge resection (en bloc) is a safe and effective procedure. It effectively avoids iatrogenic dissemination and tumor residue during surgery, reduces the risk of recurrence and implantation, and improves clinical prognosis without increasing complications.

To evaluate the safety and efficacy of single-port laparoscopic cholecystectomy (LC) combined with laparoscopic common bile duct exploration (LCBDE) and biliary stent implantation and primary suture in the treatment of cholecystolithiasis complicated with common bile duct stones.

Clinical data of 18 patients with cholecystolithiasis and common bile duct stones who underwent single-port LC combined with LCBDE and biliary stent implantation and primary suture in Chengdu Second People's Hospital from November 2024 to March 2025 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 14 female, aged (54±21) years. 2 cases were complicated with pancreatitis and 1 case complicated with diabetes. Body mass index (BMI) was ranged from 19.3 to 33.2 kg/m², with a median of 23.5 kg/m². The operation time, intraoperative blood loss, postoperative complications, the length of hospital stay and follow-up outcomes were observed. To evaluate the learning curve of surgical technologies, 18 patients were divided into group A (n=9) and B (n=9) according to the date of surgery. The operation time between two groups was compared by t-test.

All 18 patients successfully completed the surgery without conversion to open surgery. The operation time was (131±31) min. Intraoperative blood loss was (24±8) ml. The diameter of common bile duct was 10 (8-23) mm. The maximum diameter of the stones was 6 (3-21) mm. The number of stones was 2 (1-12). Abdominal drainage catheter was placed in 11 out of 18 patients. The operation time in group A and B was (143±31) and (119±28) min, with no statistical significance (t=723, P=0.104). All patients were recovered well after surgery, and began to receive liquid diet at postoperative 1-2 d. The time to first flatus was 2-3 d after surgery. No perioperative death, incisional infection, biliary stricture, residual stone and bile leakage occurred. The length of hospital stay was 9 (6-10) d. During follow-up at postoperative 1 month showed that all stents fell off spontaneously. No residual stones, bile duct stenosis or other complications were found. All patients restored normal work and life.

Single-port LC combined with LCBDE and biliary stent implantation and primary suture is a safe and effective minimally invasive surgical procedure for patients with cholecystolithiasis and common bile duct stones, which can not only treat cholecystolithiasis and common bile duct stones, but also has multiple advantages of mild trauma, rapid recovery and favorable cosmetic effect.

To investigate the single-center experience in the surgical diagnosis and treatment of malignant transformation of choledochal cysts in adults.

The clinical data of 77 adult patients with choledochal cysts admitted to the First Affiliated Hospital of Guangxi Medical University from January 2013 to June 2025 were retrospectively analyzed. As a retrospective study, the requirement for informed consent was waived, and the study complied with medical ethical requirements. There were 21 males and 56 females, aged 18-76 years, with a median age of 37 years. Cases of malignant transformation of choledochal cysts were identified, and the relevant clinical data were analyzed. Survival analysis was performed using the Kaplan-Meier method and log-rank test.

Malignant transformation occurred in 10 of the 77 patients with choledochal cysts, with an incidence of 13% (10/77). Among them, there were 3 males and 7 females, aged 26-72 years, with a median age of 40 years. Seven patients underwent radical pancreatoduodenectomy (radical surgery group). The operative time ranged from 398 to 593 min, with a median of 510 min; intraoperative blood loss ranged from 300 to 1,400 ml, with a median of 800 ml. Two patients developed postoperative complications of Clavien-Dindo grade Ⅲa or higher, and no deaths occurred within 90 d after surgery. Three patients underwent palliative surgery (palliative treatment group), including liver metastasis biopsy, biliary stent implantation, and choledochal cyst resection combined with palliative internal biliary-enteric drainage in one case each. Follow-up ended on June 30, 2025. The follow-up duration of the 7 patients after radical surgery ranged from 1 to 146 months, with a median survival time of 16 months. During follow-up, two patients died at 12 and 18 months after surgery, respectively. The 1-, 2-, and 3-year survival rates were 83.3%, 62.5%, and 62.5%, respectively. The follow-up duration after palliative surgery ranged from 1 to 6 months, with a median survival time of 5 months. During follow-up, all 3 patients died at 1, 5, and 6 months after surgery, respectively; the 1-, 2-, and 3-year survival rates were all 0. Kaplan-Meier survival analysis showed that the median survival time in the radical surgery group was significantly longer than that in the palliative treatment group ( χ² = 8.64, P = 0.003), indicating a more pronounced survival benefit.

The primary preventive strategy for malignant transformation of choledochal cysts in adults is early diagnosis and complete excision of the choledochal cyst. Particular emphasis should be placed on complete management of the pancreaticobiliary junction and maximal removal of the intrapancreatic cyst wall to reduce residual choledochal cyst tissue. Lifelong regular follow-up is required after choledochal cyst excision. Once malignant transformation of a choledochal cyst is diagnosed, pancreatoduodenectomy should be attempted whenever feasible.

The incidence of hepatobiliary diseases is extremely high, and surgery is the main option. Conventional open surgery yields severe trauma and slow recovery, which can not meet the needs of practical treatment. With the continuous development and progress of minimally invasive technologies,the laparoscopic procedure provides significant assistance for the treatment of multiple hepatobiliary surgical diseases. Laparoscopic procedure is an effective technical approach, which has been widely applied in clinical practice. As a type of laparoscopic procedure, single-port laparoscopy has been widely employed in hepatobiliary surgery and achieved high efficacy. In this article, literature review combined with years of clinical experience was adopted to summarize the application of single-port laparoscopy in hepatobiliary surgery.

Cholangiocarcinoma is a malignant tumor with strong invasiveness and poor prognosis. The sensitivity and specificity of existing diagnostic markers are relatively low, and novel methods urgently need to be explored. Exosomes, as cystic vesicles carrying bioactive molecules such as proteins, lipids and non-coding RNAs, play a key role in the progression of cholangiocarcinoma. Proteins, such as B-cell specific Moloney murine leukemia virus integration site 1, liver kinase B1, lipids such as phosphatidylcholine, and non-coding RNAs such as miR-200 family and circ_0000284, are involved in the processes of tumor proliferation, invasion, metastasis and drug resistance. Exosomes in cholangiocarcinoma tissues, bile and blood have specific diagnostic values. Moreover, exosomes can be used as drug carriers for targeted therapy.However, the standardization of exosome separation technology, mechanism and clinical translation still face challenges. Efforts should be made for further breakthroughs to achieve diagnostic and therapeutic potentials.

Non-alcoholic fatty liver disease (NAFLD) is an important risk factor for hepatocellular carcinoma (HCC), and its global prevalence is rising rapidly. With the change of lifestyle and control of viral hepatitis, NAFLD is gradually becoming the primary cause of HCC. HCC is closely associated with chronic liver disease and has become an important cause of cancer-related death worldwide. Therefore, early intervention and monitoring of NAFLD patients and timely diagnosis of HCC patients play a significant role. In this article, clinical diagnosis, treatment and preventive measures of NAFLD-related HCC were systematically reviewed.

The proportion of digital medical technologies applied in hepatobiliary diseases has been gradually increased. These technologies can improve preoperative evaluation and precise measurement by using medical imaging, 3D reconstruction and 3D printing, thereby significantly enhancing clinical efficacy of high-risk surgery. In the diagnosis and treatment of hepatobiliary diseases, the application of digital medical technologies including artificial intelligence in medical image analysis, digital angiography and digital portal vein blood flow topology, which promotes early diagnosis and surgical planning of liver tumors. Meantime, the combination of optical imaging and nanotechnology accelerates the development of tumor visualization and combined therapy. Moreover, 3D visualization system has also achieved remarkable efficacy in hepatolithiasis and abdominal trauma surgery. However, digital medical technology still faces multiple challenges such as data processing quality, standardized data collection and ethical risks, highlighting the importance of implementing standardized data collection, quality control and interdisciplinary cooperation, etc. Widespread application prospects of digital medical technologies in hepatobiliary surgery can improve the precision and safety of diagnosis and treatment. In this article, the application of digital medical technology in hepatobiliary diseases was reviewed.