BACKGROUND:This study aimed to determine the effectiveness of postoperative adjuvant lenvatinib + PD-1 blockade for patients with early-stage hepatocellular carcinoma (HCC) with microvascular invasion (MVI). METHODS:A total of 393 patients with HCC (Barcelona Clinic Liver Cancer stage 0 or A) who underwent curative hepatectomy with histopathologically proven MVI were enrolled according to the inclusion and exclusion criteria and assigned to 2 groups: surgery alone (surgery-alone group) and surgery with lenvatinib and PD-1 blockade (surgery + lenvatinib + PD-1 group) to compare recurrence-free survival (RFS), overall survival (OS), recurrence type, and annual recurrence rate after the application of propensity score matching (PSM). The Cox proportional hazards model was used for univariate and multivariate analyses. RESULTS:Overall, 99 matched pairs were selected using PSM. Patients in the surgery + lenvatinib + PD-1 group had significantly higher 3-year RFS rates (76.8%, 65.7%, and 53.5%) than patients in the surgery-alone group (60.6%, 45.5%, and 37.4%) (P = .012). The 2 groups showed no significant difference in recurrence types and OS. Surgery alone, MVI-M2, and alpha-fetoprotein of ≥200 ng/mL were independent risk factors for RFS (P < .05), and history of alcohol use disorder was an independent risk factor for OS (P = .022). CONCLUSION:Postoperative lenvatinib + PD-1 blockade improved the RFS in patients with HCC with MVI and was particularly beneficial for specific individuals.

Non-alcoholic fatty liver disease (NAFLD) is a global health burden closely linked to insulin resistance, obesity, and type 2 diabetes.The complex pathophysiology of NAFLD involves multiple cellular pathways and molecular factors.Nuclear receptors (NRs) have emerged as crucial regulators of lipid metabolism and inflammation in NAFLD, offering potential therapeutic targets for NAFLD.Targeting PPARs and FXRs has shown promise in ameliorating NAFLD symptoms and halting disease progression.However, further investigation is needed to address side effects and personalize therapy approaches.This review summarizes the current understanding of the involvement of NRs in the pathogenesis of NAFLD and explores their therapeutic potential.We discuss the role of several NRs in modulating lipid homeostasis in the liver, including peroxisome proliferator-activated receptors (PPARs), liver X receptors (LXRs), farnesoid X receptors (FXRs), REV-ERB, hepatocyte nuclear factor 4α (HNF4α), constitutive androstane receptor (CAR) and pregnane X receptor (PXR).The expanding knowledge of NRs in NAFLD offers new avenues for targeted therapies, necessitating exploration of novel treatment strategies and optimization of existing approaches to combat this increasingly prevalent disease.

Objective:To evaluate the application value of Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy.Methods:Clinical data of 17 patients who underwent laparoscopic right hepatectomy in Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology from June 2018 to December 2018 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 13 patients were male and 4 female, aged from 19 to 74 years, with a median age of 55 years. In the robot-hanging group, Chen's liver-hanging maneuver was applied in robot-assisted laparoscopic right hepatectomy (n=5), whereas in the robot-no-hanging group, Chen's liver-hanging maneuver was not delivered during robot-assisted laparoscopic right hepatectomy (n=4). In the laparoscopy-hanging group, traditional laparoscopic right hepatectomy combined with Chen's liver-hanging maneuver was adopted (n=8). Perioperative conditions of patients were observed in 3 groups. The liver-hanging time, the time of liver dissection, intraoperative blood loss and the length of postoperative hospital stay among 3 groups were compared by rank sum test. The success rate of liver-hanging maneuver was compared by Fisher's exact test.Results:In the robot-hanging group, liver-hanging maneuver was successfully performed with a success rate of 5/5, and the median time of liver-hanging maneuver was 6(6) min. In the laparoscopy-hanging group, liver-hanging maneuver was successfully conducted in 6 cases with a success rate of 6/8, and the median time of liver-hanging maneuver was 12(11) min. The median time of liver-hanging maneuver in the robot-hanging group was significantly shorter than that in the laparoscopy-hanging group (Z=-2.487, P=0.013), and no significant difference was observed in the success rate between2 groups (P=0.053). No accidental injury to surrounding tissues or blood vessels, or massive bleeding occurred during two surgical procedures. In the robot-hanging, robot-no-hanging and laparoscope-hanging groups, the time of liver dissection was 65(80), 75(80) and 50(50) min, the intraoperative blood loss were 225(450), 300(500) and 225(340) ml, and the length of postoperative hospital stay were 8(12), 10(5) and 13(12) d, respectively. No significant differences were noted among 3 groups (H=2.784, 0.538, 1.857; P>0.05). No postoperative complications or death occurred with postoperative30 d in 3 groups.Conclusions:It is safe and feasible to apply Chen's liver-hanging maneuver in robot-assisted laparoscopic right hepatectomy. Compared with traditional laparoscopic hepatectomy, robot-assisted laparoscopic hepatectomy combined with Chen's liver-hanging maneuver is more convenient and faster.

Objective:To study the effect of preoperative transcatheter arterial chemoembolization (TACE) on postoperative complications after hepatectomy in patients with hepatocellular carcinoma (HCC) by propensity score matching analysis.Methods:Of 1 666 patients with HCC undergoing hepatectomy in Tongji Hospital, Tongji Medical College of Huazhong University of Science and Technology and Tianyou Hospital of Wuhan University of Science and Technology from March 2015 to March 2021 were retrospectively screened. Of 262 patients were enrolled, including 236 males and 26 females, aged (50.3±11.8) years. Of 131 patients were enrolled in both the single surgery group and the combined group (preoperative TACE + surgical resection). Factors affecting the complications after hepatectomy in patients with HCC were analyzed using univariate and multivariate logistic regression method.Results:After matching the propensity score, the incidence of postoperative complications in the single surgery group was 22.1% (29/131), lower than that in the combined group [41.2% (54/131), χ 2=11.02, P<0.001]. The incidence of bile leakage in the single surgery group [2.3% (3/131)] was also lower than that in the combined group [(9.2% (12/131), χ 2=5.73, P=0.017]. Multivariate logistic regression analysis showed that the combined group ( OR=2.43, 95% CI: 1.28-4.61, P=0.007) had an increased incidence of postoperative complications, so did patients with a preoperative alpha-fetoprotein > 400 μg/L, anatomic hepatectomy, long operation time, and hilar occlusion. Conclusion:Preoperative TACE could be a risk factor for postoperative complications in patients with HCC, especially for the postoperative biliary leakage.

目的 研究术前影像学诊断为肝细胞癌(hepatocellular carcinoma,HCC)的病人术后病理诊断为肝内胆管癌(intrahepatic cholangiocarcinoma,ICC)和混合型肝细胞胆管癌(combined hepa-tocellular-cholangiocarcinoma,cHCC-ICC)的比例及其危险因素.方法 纳入华中科技大学同济医学院附属同济医院和武汉科技大学附属天佑医院两中心 2016 年 1 月至 2021 年 12 月术前 HCC影像学特征的所有病人.采用单因素和多因素 logistic 回归分析确定 HCC 样影像特征病人的独立危险因素.结果 共纳入 2 402 例术前被影像检查诊断为 HCC 的病人,通过对比术后病理结果发现其中111 例(4.6％)病人确诊为 ICC(66 例)或 cHCC-ICC(45 例).经单因素和多因素分析后,女性、甲胎蛋白(AFP)≤400 μg/L、糖类抗原(CA)19-9＞37 kU/L、病毒感染性肝炎、无肝硬化和轻度肝硬化、低分化、以及肿瘤最大径≤5 cm是 HCC样影像特征的独立危险因素.结论 对于具有 HCC样影像特征高危因素的人群,提高其术前诊断性是必要的.

Objective: This study aims to investigate the proportion and distribution of female HPB surgeons in China, describe their current status, and analyze the possible barriers and challenges in their careers.Method: Tertiary hospitals with the division of HPB in mainland China in 2021 were enrolled and surgeon demographic information was collected through the review of official websites and/or telephone interviews.Results: The majority of female HPB surgeons (72.92%) were located in the first or second-tier cities in mainland China, with an increasing number of new female HPB surgeons entering the field annually, particularly after 2005 (from 27 to 52 per 5 years). Despite no significant difference in academic backgrounds, female HPB surgeons initiated their careers at an earlier age and took a longer time to obtain chief titles (P < 0.05). Interestingly, female HPB surgeons performed laparoscopic complex HPB cases at a similar rate (95.42%) to their male counterparts and were more likely to specialize in endoscopic surgery (P = 0.021), with a similar ratio of obtaining administrative positions.Conclusion: Minimally invasive surgery may provide females with unprecedented opportunities in the HPB surgery field. However, despite the increasing numbers of female HPB surgeons, the proportion remains low in China.

ObjectivesThis meta-analysis aims to evaluate the effect of n-3 polyunsaturated fatty acids (PUFAs) as a part of parenteral nutrition in patients undergoing liver surgery.DesignSystematic review and meta-analysis.Data sourcesPubMed, the Cochrane Central Register of Controlled Trials, Springer link, Web of Science, China National Knowledge Infrastructure and VIP Database.Eligibility criteriaWe included randomised controlled trials (RCTs) and evaluated the outcomes of liver function, inflammatory reaction, the influence of certain markers of the immune system, and specific clinical indexes for patients undergoing liver surgery and receiving parenteral nutrition with n-3 PUFAs.Data extraction and synthesisThe Cochrane Collaboration’s tool was used to assess the risk of bias for each study. Findings were summarised in Grades of Recommendation, Assessment, Development and Evaluation evidence profiles and synthesised qualitatively.ResultsEight RCTs, including 748 patients (trial: 374; control: 374), were included in the meta-analysis. Compared with patients in the control group, the patients in the n-3 PUFA group who underwent liver surgery had significantly lower aspartate aminotransferase (mean difference, MD −42.72 (95% CI −71.91 to –13.52); p=0.004), alanine aminotransferase (MD −38.90 (95% CI −65.44 to –12.37); p=0.004), white cell count (MD −0.93 (95% CI −1.60 to –0.26); p=0.007) and IL-6 (MD −11.37 (95% CI −14.62 to –8.13); p<0.00001) levels and a higher albumin level (MD 0.42 (95% CI 0.26 to 0.57); p<0.00001). They also had fewer infection complications (OR 0.44 (95% CI 0.28 to 0.68); p=0.0003) and a shorter duration of hospital stay (MD −2.17 (95% CI −3.04 to –1.3); p<0.00001) than the controls. However, there were no significant differences in terms of total bilirubin, TNF-α, IL-2, IgA, IgG, IgM and CD3, biliary leakage and mortality between the two groups.ConclusionsWe found that n-3 PUFAs can benefit patients undergoing liver surgery by improving liver function and certain clinical indexes and decreasing related inflammation factors. However, there are limited RCTs on the application of n-3 PUFAs for patients undergoing liver surgery. Further evidence of the benefit of n-3 PUFAs in these patients warrants further exploration.

Background. Intrahepatic cholangiocarcinoma (ICC) is the second most common liver malignancy after hepatocellular carcinoma (HCC), with a dismal prognosis and high heterogeneity. The oncological advantages of anatomical resection (AR) and nonanatomical resection (NAR) in HCC have been studied, but surgical strategies for ICC remain controversial with insufficient investigations. Materials and Methods. From Jan 2013 to Dec 2016, 3880 consecutive patients were retrospectively reviewed from a single center. Patients with ICC undergoing AR or NAR have been enrolled according to inclusion and exclusion criteria. Propensity score matching (PSM) analysis was performed between two groups with a 1 : 1 ratio. The primary endpoint was overall survival (OS), and the secondary endpoints included disease-free survival (DFS), intraoperative patterns, postoperative morbidity, mortality, complications and recurrence. A prognostic nomogram was developed by a multivariate Cox proportion hazard model. Results. After PSM, 99 paired cases were selected from 276 patients enrolled in this study. Patients in the AR group achieved better 1-, 3-, and 5-year OS (70%, 46%, and 34%, respectively) and DFS (61%, 21%, and 10%, respectively) than patients in the NAR group with statistical significance after PSM analysis. The postoperative complications and recurrence patterns were comparable between the two groups. Multivariate analysis identified NAR, tumor size >5 cm, multiple tumors, and poor differentiation as independent risk factors for OS ( p < 0.05 ). Selected patients can benefit most from AR, according to subgroup analysis. A prognostic nomogram based on six independent risk factors for OS and factors with clinical significance was constructed to predict OS in ICC patients. Conclusion. AR improved the long-term survival of ICC with comparable postoperative complications and similar recurrence patterns. AR is suggested in ICC patients with sufficient remnant liver volume. In addition to surgery strategy, malignant characteristics of tumors are risk factors for ICC prognosis.