To identify the risk factors of post-hepatectomy liver failure (PHLF) in patients with hepatocellular carcinoma (HCC), and to construct a nomogram prediction model for PHLF.

Clinical data of 188 patients with HCC who underwent radical hepatectomy in the Third Affiliated Hospital of Sun Yat-sen University from January 2022 to April 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 165 patients were male and 23 female, aged from 24 to 75 years, with a median age of 55 years. The independent risk factors of PHLF were determined by Logistic regression analysis. The nomogram model was constructed. The discrimination and calibration degree of the model were evaluated by using the area under the ROC curve (AUC) and calibration curve. The constructed model was compared with the actual score of comprehensive liver function.

The incidence of PHLF was 25%(47/188), including3 cases of grade A PHLF, 42 cases of grade B and 2 cases of grade C, and one of them died of PHLF. Logistic regression analysis showed that ALT (OR=1.037, 95%CI: 1.007-1.068), TB (OR=1.176, 95%CI: 1.013-1.365), maximal tumor diameter (OR=1.414, 95%CI: 1.148-1.742), ALBI score (OR=0.173, 95%CI: 0.031-0.962) and ICGR15 (OR=1.081, 95%CI: 1.005-1.162) were the independent risk factors for PHLF (P<0.05). Based on ALT, ICGR15, TB and maximal tumor diameter (ARTL), the AUC of ARTL model was 0.816 (95%CI: 0.747-0.885), indicating it had high predictive capability. The calibration curve and calibration prediction curve fit well, and the predicted value was in high agreement with the observed value. The predictive efficiency and clinical benefit of ARTL model were better than those of ALBI score (AUC=0.607), FIB-4 index (AUC=0.672) and APRI score (AUC=0.730).

ALT, ICGR15, TB, maximal tumor diameter and ALBI score are the independent risk factors for PHLF. ARTL model has high predictive capability, which is superior to the existing three comprehensive scoring systems for liver function.

To identify the risk factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatments, and to construct a nomogram prediction model.

Clinical data of143 patients with cirrhotic portal hypertension treated in Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 2015 to January 2020 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 77 patients were male and 66 female, aged (56±12) years on average. 109 cases were diagnosed with liver cirrhosis after hepatitis B. Baseline data, medical history and laboratory examination results upon admission were collected. Follow-up time was 3 years. Re-hemorrhage after treatments was regarded as the main outcome event. All patients were divided into the re-hemorrhage (n=32) and non-hemorrhage groups (n=111) according to the incidence of re-hemorrhage. The risk factors of re-hemorrhage were identified by Logistic univariate and multivariate regression analyses. Relevant variables were screened by stepwise regression method. Nomogram prediction model was constructed by R software, and internal verification was carried out by Bootstrap method. Finally, the prediction efficiency and clinical effectiveness of this model were analyzed and validated based on the ROC curve, calibration curve and decision curve analysis (DCA).

Logistic univariate and multivariate regression analyses showed that age, weight, Child-Pugh grading above grade A and surgical treatment were the independent influencing factors of re-hemorrhage in patients with cirrhotic portal hypertension after treatment (OR=1.048, 0.947, 5.980, 0.238; P<0.05). Based on 4 independent influencing factors, the nomogram prediction model for re-hemorrhage was constructed. The area under the ROC curve of this prediction model was 0.806 (0.811 after validation), both of which were >0.75, indicating that this prediction model yielded high discrimination. Brier score was calculated as 0.114 (0.102 after validation), equally <0.25, and R² was 0.437 (0.477 after validation), equally >0.4, suggesting that the model had high calibration. The net benefit of DCA curve of this model was higher than those of two extreme curves, indicating that the prediction model had clinical effectiveness.

Surgery is an important approach to prevent and treat re-hemorrhage in patients with cirrhotic portal hypertension. Constructing nomogram prediction model contributes to identifying high-risk post-treatment re-hemorrhage patients with cirrhotic portal hypertension at early clinical stage.

To evaluate the safety and efficacy of three-dimensional visualization technology in laparoscopic resection of huge liver tumors.

Clinical data of 50 patients who underwent huge liver tumor resection in No. 900 Hospital from July 2016 to June 2021 were retrospectively analyzed. Among them, 19 patients were male and 31 female, aged from 38 to 65 years, with a median age of 45 years. The informed consents of all patients were obtained and the local ethical committee approval was received. The tumor diameter was ranged from 10 to 17 cm, with a median diameter of 13 cm. 23 patients were diagnosed with benign tumors and 27 cases of malignant tumors. According to different surgical methods, they were divided into two groups. In the combination group, 24 cases underwent three-dimensional visualization technology combined with laparoscopic resection. In the control group, 26 cases were treated with open resection of huge liver tumors. Intraoperative and postoperative conditions of patients betweentwo groups were compared by t test or Chi-square test. Survival analysis was performed by Kaplan-Meier analysis and Log-rank test.

All patients in two groups successfully completed the surgery, and no conversion to open surgery was reported in the combination group. In the combination group, the median C-reactive protein level at postoperative 1 d was 26(18, 72) mg/L, significantly lower than 57(44, 81) mg/L in the control group (Z=-2.700, P<0.05). At postoperative 1 d, the average time to first flatus, postoperative ambulation time and the length of postoperative hospital stay were (2.6±0.8), (3.1±1.3) and (13±4) d, significantly shorter than (3.1±1.1), (4.4±1.6) and (16±6) d in the control group (t= -2.180, -3.137, -2.062; P<0.05). The incidence of postoperative complications in the combination group was 25% (6/24) and 42% (11/26) in the control group, with no statistical significance between two groups (χ²=1.666, P>0.05). The postoperative 1-, 3- and 5-year overall survival and disease-free survival rates in the combination group were 78.8%, 52.5%, 26.3% and 57.1%, 28.6%, 0, and 70.6%, 36.4%, 12.1% and 51.3%, 22.0%, 0 in the control group, with no statistical significance between two groups (χ²=0.292, 0.764; P>0.05).

Three-dimensional visualization technology can be utilized to deliver accurate preoperative evaluation for patients undergoing laparoscopic resection of huge liver tumors, and to guide accurate intraoperative operation, thus mitigating inflammatory reactions and accelerating postoperative rehabilitation.

To investigate the prognostic value of platelet-related parameters in patients with intrahepatic cholangiocarcinoma (ICC) undergoing radical resection.

Clinical data of63 patients with ICC who underwent radical resection in No.909 Hospital from January 1, 2016 to December 31, 2019 were retrospectively analyzed. Among them, 41 patients were male and 22 female, aged from 39 to 65 years, with a median age of 52 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Prognostic factors of ICC patients were identified by univariate and multivariate Cox regression models. Survival analysis of ICC patients with different platelet-related parameters was conducted by using Kaplan-Meier method and Log-rank test. Receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficiency of Plt, platelet distribution width (PDW) and mean platelet volume (MPV) on disease-free survival (DFS) and overall survival (OS).

Univariate and multivariate Cox analyses showed that Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl and hilar invasion were the independent risk factors for DFS in ICC patients (HR=2.384, 2.546, 2.853, 3.933; P<0.05). Plt≥185×10⁹/L, PDW≥16.5%, MPV≤9.25 fl, hilar invasion and vascular invasion were the independent risk factors for OS (HR=3.100, 2.617, 3.313, 3.708, 3.685; P<0.05). Survival analysis showed that the postoperative 3-year DFS rates of patients with Plt≥185×10⁹/L, PDW≥16.5% and MPV≤9.25 fl were respectively 18.74%, 19.54%, 23.54%, and 89.34%, 78.21%, 85.45% in the control group (χ²=41.500, 29.545, 19.973; P<0.05). The postoperative 3-year OS of patients with Plt≥185×10⁹/L,PDW≥16.5% and MPV≤9.25 fl were respectively 19.53%, 18.64%, 20.43%, and 91.53%, 77.64%, 87.94% in the control group (χ²=41.352, 30.128, 19.909; P<0.05). ROC curve analysis revealed that the area under the ROC curve of Plt for predicting postoperative 3-year OS was 0.942, 0.968 for the sensitivity and 0.744 for the specificity, and 0.843, 0.742, 0.875 for PDW, and 0.886, 0.781, 0.935 for MPV, respectively.

Preoperative platelet-related parameters including Plt, PDW and MPV are the independent prognostic factors for ICC patients undergoing radical resection, which possess a great predictive value for survival and prognosis of ICC patients.

To analyze the relationship between cholecystectomy and colorectal and anal cancers based on two-sample Mendelian randomization (TSMR).

The data of single nucleotide polymorphism (SNP) related to colorectal and anal cancers after cholecystectomy were obtained from open biological databases, and all retrieved data were analyzed based on genome-wide association studies (GWAS) database. The genetic loci closely associated with cholecystectomy were selected as instrumental variables. TSMR analysis was performed by using MR-Egger regression method, median weighted (MW) and inverse-variance weighted (IVW) methods, respectively. The causal relationship between cholecystectomy and the risk of colorectal and anal cancers was evaluated by P value.

A total of 32 SNPs related to cholecystectomy were screened. There was no causal relationship between cholecystectomy and cecum cancer (OR=22.222, 95%CI: 6.280e-02, 7.864e+03; P=0.300), no causal relationship between cholecystectomy and the ascending colon cancer (OR=3.176, 95%CI: 1.939e-03, 5.204e+03; P=0.760), and no causal relationship between cholecystectomy and transverse colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and the descending colon cancer (OR=0.093, 95%CI: 6.683e-06, 1.297e+03; P=0.626), and no causal relationship between cholecystectomy and sigmoid colon cancer (OR=2.737, 95%CI: 4.24e-02, 176.696; P=0.636), and no causal relationship between cholecystectomy and rectal cancer (OR=0.306, 95%CI: 7.153e-03, 13.099; P=0.537), and no causal relationship between cholecystectomy and anal cancer (OR=13.14, 95%CI: 6.683e-07, 2.600e+06, P=0.764), respectively. Subsequent sensitivity analysis confirmed the robustness of the correlation.

Based on TSMR analysis, there is no genetic evidence supporting the correlation between cholecystectomy and the risk of colorectal and anal cancers. Cholecystectomy does not lead to the incidence of colorectal and anal cancers.

To visualized analysis the overall trend of immunotherapy for gallbladder cancer by scientometrics.

Relevant studies (articles or reviews) related to immunotherapy for gallbladder cancer were searched in the Web of Science Core Collection (WoSCC) database from January 1, 2000 to December 31, 2021, and input into VOSviewer 1.6.18.0 and CiteSpace 5.1.R8 SE (32-bit) software in plain-text format. All data were processed by using scientometrics. Authors, countries, institutions, highly cited publication, co-citation, keywords and references were subject to visualization analysis, and the research hotspots and trends were obtained.

121 studies were retrieved, including 860 authors, 306 institutions, 21 countries/regions and 82 journals. The data showed that the United States was the country with the largest number of published articles in the field of immunotherapy for gallbladder cancer (n=40), followed by China (n=36) and Japan (n=14). The top three authors with the largest number of published articles were Valle JW (n=5), Javle M (n=4) and Zhu AX (n=4). Chinese Academy of Medical Sciences (Peking Union Medical College), Christie NHS Foundation Trust, Nanjing Medical University and the University of Manchester were the institutions with the largest number of published articles. Cancers was the journal with the largest number of published articles in this field. Keyword analysis indicated that "immunotherapy", "cholangiocarcinoma" and "gallbladder cancer" were the high-frequency keywords. Current research hotspots gradually focused on immunotherapy, targeted therapy and drug use for gallbladder cancer.

In recent 21 years, the number of published articles in the field of immunotherapy for gallbladder cancer has been gradually increased, which has become a potential hotspot. The United States, China and Japan occupy a central position in this field.

To evaluate the application of intelligent auxiliary real-time image defogging technology in laparoscopic cholecystectomy (LC).

Clinical data of 128 patients with gallstones treated with LC in the First Affiliated Hospital of Xi'an Jiaotong University from September 2022 to April 2023 were retrospectively analyzed. Among them, 78 patients were male and 40 female, aged from 31 to 66 years, with a median age of 53 years. The informed consents of all patients were obtained and the local ethical committee approval was received. Intelligent auxiliary technology was adopted to identify and process the images. The grades and duration of different levels of fog identified by intelligent equipment were recorded. The defogging time was also recorded. The actual duration of fog and that identified by intelligent images were compared by the rank-sum test.

The duration of fog was ranged from 8 to 17 min, with a median duration of 13 min. Intraoperatively, the laparoscope was wiped for 3-11 times, with a median of6 times. The overall used time was 69-230 s, with a median time of 141 s. Application of intelligent defogging system could effectively identify the grade of fog generated during LC, and remove the fog as required. The processing time of single-frame image was 0.02-0.08 s, with a median time of 0.04 s. The success rate of image processing was 97%(15 522/16 000), which effectively shortened intraoperative image defogging time (Z=-2.167, P<0.05).

Intelligent auxiliary real-time image defogging technology is safe and feasible in LC, which can effectively process intraoperative fog, assist the surgeons to identify surgical margins, enhance surgical efficiency and lower the incidence of complications.

To evaluate the safety and efficacy of transumbilical single-port laparoscopic cholecystectomy (LC) in the treatment of cholecystolithiasis.

Clinical data of 201 patients with cholecystolithiasis who underwent LC in Hainan Cancer Hospital from June 2018 to June 2022 were retrospectively analyzed. Among them, 91 patients were male and 110 female, aged from 27 to 74 years, with a median age of 51 years. The informed consents of all patients were obtained and the local ethical committee approval was received. According to surgical methods, all patients were divided into single-port LC group (single-port group, n=107) and three-port LC group (three-port group, n=94). Operation time and satisfaction score between two groups were compared by t test. The incidence of complications and the conversion rate to open surgery were compared by using Chi-square test or Fisher's exact test.

All patients intwo groups successfully completed the surgery. 1 patient in the single-port group was converted to open surgery, and none in the three-port group, with no statistical significance between two groups (P=0.347). No statistical significance was found in intraoperative blood loss, operation time, length of hospital stay and hospitalization expenses between two groups (P>0.05). Subgroup analysis showed that for patients with cholecystolithiasis of >2 cm, the average operation time in the single-port group was (44±8) min, significantly shorter than (55±7) min in the three-port group (t=-12.685, P<0.05). The incidence of postoperative complications in the single-port group was 1.9%(2/107), and 2.1%(2/94) in the three-port group, with no statistical significance (χ²=0.418, P>0.05). In single-port group, the satisfaction score of patients was 42.8±2.8, significantly higher than 33.7±4.9 in the three-port group (t=32.710, P<0.05).

Transumbilical single-port LC is safe and efficacious treatment of cholecystolithiasis, which has the advantages of better cosmetic effect and higher satisfaction score. For patients with cholecystolithiasis of >2 cm, the operation time of single-port LC is shorter.

To evaluate the efficacy and effect of low-dose dexamethasone during perioperative period of laparoscopic transcystic common bile duct exploration (LTCBDE).

Clinical data of 97 patients with cholecystolithiasis complicated with choledocholithiasis who underwent LTCBDE in Renmin Hospital of Wuhan University from January 2021 to April 2022 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 53 female, aged from 17 to 86 years, with a median age of 54 years. All patients received magnetic resonance cholangiopancreatography (MRCP) before surgery. All patients were divided into the dexamethasone (n=40) and control groups (n=57) according to whether low-dose dexamethasone was used during perioperative period. In the dexamethasone group, 10 mgintravenous dose of dexamethasone was given before anesthesia induction and at postoperative 2 day, whereas dexamethasone or equivalent glucocorticoid drugs (hormones) were not used in the control group. Perioperative outcomes of all patients were observed. The WBC liver function and visual analogue scale (VAS) score were compared by t test between two groups. The incidence of postoperative nausea and vomiting (PONV) and bile leakage was compared by Chi-square test.

LTCBDE was successfully performed in two groups. No death or other serious complications were reported during perioperative period. The average WBC, ALT, AST, TB, DB and VAS score in the dexamethasone group were (8.8±2.4)×10⁹/L, (58±9) U/L, (57±10) U/L, (41.4±6.4) μmol/L, (25.8±3.5)μmol/L and 2.3±0.9, significantly lower than (10.0±2.1)×10⁹/L, (55±10) U/L, (44±7) U/L, (43.0±5.3) μmol/L, (27.0±2.1) μmol/Land 3.9±0.5 in the control group (t=-2.61, -1.87, -6.27, -6.72, -2.08, -8.19; P<0.05). The incidence of PONV in the dexamethasone group was 18%(7/40), significantly lower than 37%(21/57) in the control group (χ²=4.28, P<0.05). 3 and 6 patients developed bile leakage in two groups, and there was no significant difference in the incidence rate (χ²=0.26, P>0.05).

Perioperative administration of low-dose dexamethasone controbutes to reducing the incidence of postoperative pain and PONV of LTCBDE, improving postoperative liver function and mitigating postoperative inflammatory response without increasing the incidence of complications.

To evaluate the clinical efficacy and its influencing factors of liver transplantation for grade Ⅳ hepatic coma.

Clinical data of 16 patients with hepatic coma who underwent liver transplantation in the 900^th Hospital from January 2011 to December 2022 were retrospectively analyzed. Among them, 14 patients were male and 2 female, aged from 29 to 67 years, with a median age of 48 years. All patients had the symptom of hepatic encephalopathy before surgery, which met the diagnostic criteria of grade Ⅳ hepatic encephalopathy (hepatic coma) according to the West-Haven classification system. The duration of hepatic coma was 1-14 d with a median of 7 d. The informed consents of all patients were obtained and the local ethical committee approval was received. All patients received orthotopic liver transplantation with retrograde perfusion of the inferior vena cava. According to the 1-year survival of post-liver transplantation, they were divided into the survival and death groups. Perioperative conditions, postoperative complications and survival between two groups were compared by t test, rank-sum test and Fisher's exact test. Clinical efficacy and its influencing factors of liver transplantation for hepatic coma were analyzed.

The 1-year survival rate in the survival group was 63%(10/16), 3 cases died of primary graft dysfunction, 2 cases of severe infection and 1 case of brain death. In the survival group,9 cases underwent donation after brain death (DBD) donors and 2 cases of DBD donors in the death group, and the difference was statistically significant (P=0.018). In the survival group, the average intraoperative blood transfusion was (1 840±273) ml, significantly less than (3 550±1 750) ml in the death group (t=-2.640, P<0.05). In the survival group, the median Scr level after surgery was 53(47, 109) μmol/L, significantly lower than 205(84, 278) μmol/L in the death group (Z=-2.218, P<0.05). In the survival group, the postoperative WBC was (10±4)×10⁹/L, significantly lower than (15±4)×10⁹/L in the death group (t=-2.787, P<0.05). The Plt in the survival group was (62±15)×10⁹/L, significantly higher than (39±25)×10⁹/L in the death group (t=2.270, P<0.05).

Liver transplantation is an effective life-saving treatment for patients with grade Ⅳ hepatic coma. High-quality donor liver, protection of liver and kidney function, improvement of coagulation function, severe infection control and reasonable intraoperative blood transfusion play key roles in enhancing postoperative survival rate of liver transplantation recipients with hepatic coma.

To evaluate the safety and efficacy of microsurgical hepatic artery reconstruction in the treatment of intrahepatic cholangiocarcinoma involving the first porta hepatis (ICC-IFPH) and hilar cholangiocarcinoma (HCCA).

Clinical data of 11 patients diagnosed with ICC-IFPH or HCCA in the First Affiliated Hospital of Guangxi Medical University from June 2017 to October 2023 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 6 patients were male and 5 female, aged 44-73 years, with a median age of 55 years. All patients underwent tumor resection combined with hepatic artery resection and reconstruction. Perioperative data and follow-up data were observed.

The average operation time was (541±154) min. The median blood loss was 696 (200, 1 900) ml. The reconstruction time of hepatic artery was (23±6) min. The inner diameter of artery was (2.0±0.5) mm, and the length of resected artery was (3.3±1.0) cm. Postoperative patency rate of hepatic artery was 100% (11/11). R0 resection was performed in 10 cases and R1 resection in 1 case. According to the Clavien-Dindo classification, 2 patients developed grade Ⅲa complications, including postoperative bile leakage and liver abscess in 1 case and pancreatic fistula in the other case. No postoperative liver failure or perioperative death occurred. During postoperative follow-up, 3 patients died at postoperative 3, 10 and 48 months, respectively. The median follow-up duration was 10 months, and 7 patients were followed up for over 12 months.

Microsurgical hepatic artery reconstruction is a safe and feasible procedure for ICC-IFPH and HCCA, which can provide oxygen-enriched arterial blood for the remaining liver, lower the incidence of postoperative liver failure, enhance surgical resection rate of cholangiocarcinoma, and improve the quality of life and clinical prognosis of patients.