Objective: To investigate the efficacy and prognosis of surgical treatment for hepatocellular carcinoma. Methods: This is a retrospective case series study. Clinical data of 927 consecutive patients who underwent initial hepatectomy for hepatocellular carcinoma(HCC) at the Department of Hepatobiliary and Pancreatic Surgery,Affiliated Hospital of Qingdao University from January 2013 to December 2020 were retrospectively collected. There were 766 males (82.6%) and 161 females (17.4%),with an age of (57.6±9.7)years (range: 17 to 85 years). Prognostic data were obtained through outpatient follow-up visits and telephone follow-up,and follow-up was continued until December 31,2024. Kaplan-Meier method was used to estimate survival rates and plot survival curves,and Log-rank test was used to compare survival differences among different tumor stages. Cox proportional hazards model was used to identify independent prognostic factors for recurrence and survival. When comparing the prognostic impact of laparoscopic versus open hepatectomy and postoperative adjuvant transcatheter arterial chemoembolization(TACE),propensity score matching was performed using 1∶1 nearest-neighbor matching with a caliper of 0.02. Results: (1) Among 927 patients,the median overall survival (OS) time was 130.5 months,and the 1-,3-,5-,and 10-year OS rates were 94.2%,79.9%,68.4%,and 52.3%,respectively. The median disease-free survival(DFS) was 37.8 months,and the 1-,3-,and 5-year DFS rates were 74.0%,52.0%,and 39.8%,respectively. The 5-year OS rates of patients with China Liver Cancer (CNLC) stage (Ⅰa,Ⅰb,Ⅱ,and Ⅲa were 78.0%,63.5%,43.1%,and 43.6%,respectively,and the corresponding 5-year DFS rates were 48.5%,35.0%,16.0%,and 20.1%,respectively. (2) Univariate and multivariate Cox analyses showed that sex,age,albumin,tumor differentiation,tumor number,microvascular invasion,and macrovascular invasion were independent prognostic factors for recurrence after initial hepatectomy for HCC (all P<0.05); age,albumin,tumor differentiation,tumor number,microvascular invasion,liver capsule invasion,and intraoperative blood loss were independent prognostic factors for survival after initial hepatectomy for HCC (all P<0.05). (3) Patients were divided into an adjuvant TACE group and a non-adjuvant TACE group according to whether postoperative TACE was administered. After propensity score matching,no significant differences in DFS or OS were observed between the two groups (both P>0.05). After adjustment for independent prognostic factors for recurrence using multivariate Cox regression,patients with microvascular invasion,maximum tumor diameter>5 cm,or multiple tumors had significantly better DFS in the adjuvant TACE group than in the non-adjuvant TACE group(all P<0.05). (4) Patients were divided into laparoscopic and open surgery groups according to whether laparoscopic hepatectomy was performed. After propensity score matching,no significant differences in DFS or OS were observed between the two groups (both P>0.05). Within the same CNLC stage subgroups (stage Ⅰa,Ⅰb,Ⅱ,and Ⅲa),no significant differences in DFS or OS were observed between the laparoscopic and open surgery groups (all P>0.05). Conclusions: Surgical treatment is an important means of achieving long-term survival in patients with HCC. Routine postoperative adjuvant TACE is not recommended after hepatectomy for HCC. However,postoperative adjuvant TACE may provide DFS benefits in patients with microvascular invasion,maximum tumor diameter >5 cm, or multiple tumors.
Liver resection for hepatocellular carcinoma (HCC) still faces the dual challenges of operative safety and high postoperative recurrence. Traditional precision surgery mainly focuses on operative manipulation, whereas the concept of scientific hepatectomy incorporates cirrhosis background, tumor biological behavior, and coordination with systemic therapy into a unified decision-making framework. This article discusses perioperative refined management strategies guided by scientific hepatectomy. Preoperatively, the severity of cirrhosis should be evaluated to define the safe extent of resection. Intraoperatively, oncological radicality should be balanced against liver parenchymal preservation. During the perioperative period, neoadjuvant therapy, conversion therapy, and adjuvant therapy should be integrated to promote the transition of HCC surgery toward comprehensive treatment. The focus of scientific hepatectomy is not merely to improve operative precision, but to select a more appropriate resection timing, resection extent, and treatment coordination strategy according to cirrhosis severity, tumor biological risk, and the need for subsequent treatment.
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) offers a curative surgical opportunity for patients with initially unresectable hepatocellular carcinoma (HCC) and insufficient future liver remnant(FLR), owing to its unique advantage of rapidly inducing FLR hypertrophy. With breakthrough advances in first-line systemic therapies for advanced HCC-including immune checkpoint inhibitor-antiangiogenic combinations, dual immunotherapy regimens, and locoregional combined with systemic therapies-conversion therapy has emerged as a pivotal strategy in liver surgery, and the integration of ALPPS with HCC conversion therapy has advanced its clinical application into a more individualized era. This article systematically analyzes the evolving role of ALPPS in the era of conversion therapy and delineates four distinct clinical application modalities:(1) conventional staged ALPPS aimed at improving the surgical resection rate;(2) salvage ALPPS for patients with persistently insufficient FLR following HCC conversion therapy;(3) the"dual conversion"strategy, in which stage Ⅰ liver partition is followed by systemic conversion therapy prior to stage Ⅱ hepatectomy, thereby achieving concurrent oncological and surgical conversion;(4) conversion therapy followed by portal vein embolization (PVE) as a minimally invasive approach, with salvage ALPPS as a rescue option when PVE-induced hypertrophy proves insufficient. The rationale for selecting among these four modalities is further elaborated across multiple dimensions, including the severity of FLR insufficiency, tumor burden and response to conversion therapy, and patient-specific conditions. The organic integration of surgical innovation with oncological advances, together with precise and individualized decision-making within a multidisciplinary team framework, holds the promise of achieving the transition from "unresectable" to "resectable", and ultimately from "tumor-bearing survival" to "tumor-free，drug-free，high-quality survival".
In recent years, a cluster of digital intelligence technologies, represented by artificial intelligence, three-dimensional visualization, augmented reality and optical imaging, has been reshaping the cognitive foundation and clinical practice of liver surgery. From the frontier perspective of medical-engineering integration, this article systematically reviews eight major advances and breakthroughs in digital intelligence-empowered liver surgery, encompassing preoperative precision diagnosis, intelligent three dimensional planning, augmented reality combined with fluorescence navigation, multimodal optical imaging, intraoperative dynamic perception, large language model-based decision support, personalized prognosis prediction, and standardized ecosystem development. The clinical value of these advances is thoroughly examined in terms of tumor diagnosis, navigational decision-making, postoperative management, and homogeneous promotion. This review aims to provide a theoretical reference for the intelligent transformation of hepatobiliary surgery.
Objective: To explore the optimal time window for evaluating gallbladder contraction function by oral standardized protein bar combined with olive oil, and verify the measurement stability of this novel method compared with the traditional fried egg test. Methods: This is a prospective, multicenter, single-blind, randomized crossover controlled trial. A total of 112 healthy volunteers from 4 centers (the First Hospital of Lanzhou University, First Hospital of Qinhuangdao, the Liaoning Jinqiu Hospital, and the Honghui Hospital Affiliated to Xi'an Jiaotong University) were enrolled and randomly assigned to two groups using a random number table, with a 1-week washout period between two intervention cycles. Group A received oral fried egg intervention in the first cycle and oral standardized protein bar plus 50 ml extra virgin olive oil in the second cycle; while group B received the interventions in reverse order. Gallbladder ultrasound was performed at fasting state and 30, 50, 70, 90 and 110 min after intervention to measure the long diameter, wide diameter and anteroposterior diameter of the gallbladder, and calculate the gallbladder volume and gallbladder contraction rate. The changing trends of gallbladder contraction rate at each time point were compared between the two interventions, the coefficient of variation (CV) was used to evaluate the measurement stability of the two methods, and paired t-test, repeated measures analysis of variance, and Feltz-Miller asymptotic test were used for statistical analysis. Results: Among the 112 subjects, 47 were male and 65 were female, with an age of (30.6±7.1) years(range:19 to 62 years) and a fasting gallbladder volume of (20.0±7.1) ml. Under both interventions, the gallbladder contraction rate of the subjects began to increase at 30 min after intervention, reached the peak at 50 to 70 min, and then gradually decreased. There was no significant difference in the level of gallbladder contraction rate between the two groups at the peak time point (t=0.421,P=0.674). The intragroup CV of gallbladder contraction rate at each time point in the oral protein bar plus olive oil group was significantly lower than that in the fried egg group (all P<0.05), indicating better measurement stability. No serious adverse events such as acute pancreatitis and gastrointestinal bleeding occurred in either group, and the incidence of mild gastrointestinal adverse events showed no significant difference between the two groups (χ²=0.269, P=0.604). Conclusions: The optimal measurement time window for evaluating gallbladder contraction function with oral protein bar combined with olive oil is 50-70 min after intervention. This method is easy to operate with favorable safety, and its measurement stability is significantly better than the traditional fried egg test, providing a new method option for standardized clinical evaluation of gallbladder contraction function.
