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: To compare the clinical efficacy of laparoscopic surgery and open surgery in patients with stage III gallbladder cancer.Methods: The clinical characteristics and postoperative follow-up data of 184 patients who underwent radical cholecystectomy for gallbladder cancer in Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from May 2015 to May 2022, were retrospectively analyzed.There were 71 cases in the laparoscopic group and 113 in the open group.The two groups' general medical data (age, gender, BMI, liver function, albumin, tumour differentiation, etc.), surgery-related indicators (operation time, intraoperative bleeding, lymph node dissection, and the extent of liver resection); postoperative conditions (liver function, abdominal drainage tube removal time and postoperative hospital stay, etc.); complications (bile leakage, abdominal infection, thrombosis, etc.); overall survival and progression-free survival, were analyzed.Results: There was no significant difference between the two groups in general case data, operation situation, overall survival and progression-free survival.The laparoscopic group showed better postoperative liver function recovery (alanine aminotransferase, aspartate aminotransferase, albumin), earlier abdominal drainage tube removal (8.34 ± 5.00 days vs. 5.18 ± 3.90 days), shorter hospital stay (12.01 ± 5.99 days vs. 15.51 ± 9.89 days) and lower incidence of complications (14.1% vs. 31.9%),when compared with the open group (p < 0.05).Conclusions: Laparoscopic surgery for AJCC TNM stage III gallbladder cancer is comparable with open surgery in terms of efficacy.Compared with open surgery, laparoscopic radical resection of gallbladder cancer has the advantages of earlier removal of abdominal drainage tube, lower incidence of postoperative complications, and reduced hospital stay.

Objective:To study the clinical efficacy of laparoscopic radical cholecystectomy in the treatment of stage Ⅲ gallbladder cancer.Methods:The clinical characteristics and postoperative follow-up data of 184 patients (male 66, and female 118) who underwent radical cholecystectomy for stage Ⅲ gallbladder cancer at Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, from May 2015 to May 2022, were retrospectively analyzed. The age was (67.0±8.6) years old (range 38 to 85 years old). There were 71 patients in the laparoscopic group and 113 in the open group. The general medical data, surgery-related indicators and complications were analyzed. Follow-up was completed by outpatient visits and by telephone.Results:The laparoscopic group showed better postoperative alanine aminotransferase [67.5 (40.0, 138.5) vs. 104.0 (45.0, 252.2) U/L] and aspartate aminotransferase [41.5 (26.0, 71.2) vs. 53.0 (30.2, 153.5) U/L] recovery, higher albumin levels [32.05 (30.18, 35.20) vs. 30.50 (27.70, 33.50) g/L], earlier abdominal drainage tube removal [8.00(6.00, 10.25) vs. 10.00(6.00, 13.00)d], shorter hospital stay [10.00(8.00, 15.25) vs. 14.00(9.00, 19.00) d] and lower incidences of complications [(14.1%(10/71) vs. 31.9%(36/113)] when compared with the open group (all P<0.05). The 1 year (49.1% vs 61.0%), 2 years (24.0% vs. 28.5%), 3 years (16.0% vs. 14.5%) overall survival ( P=0.640), and the 3 years progression-free survival (18.3% vs. 15.0%, P=0.463) showed no significant difference between the 2 groups. Conclusion:Laparoscopic surgery for AJCC TNM stage Ⅲ gallbladder cancer showed comparable results with open surgery. When compared with open surgery, laparoscopic radical resection of gallbladder cancer had the advantages of earlier removal of abdominal drainage tube, lower incidence of postoperative complications, and shorter hospital stay.

Background Forkhead Box Protein C2 (FOXC2) belongs to the Forkhead/Wing-helix family. The regulatory role of this transcription factor in physiological function and carcinogenic activity has been proven in subsequent investigations. However, there is still scarcity of evidence on the relationship between FOXC2 expression and prognosis in human solid tumors. We conducted this meta-analysis to evaluate the role of FOXC2 as a prognosis factor and a possible target marker in human solid tumors. Methods PubMed, Web of Science, Embase, and the Cochrane library database were all searched methodically. Eligible publications on FOXC2 in human solid tumors were gathered and reviewed. The effect sizes were calculated using pooled hazard ratios (HRs) or odds ratios (ORs) with the corresponding 95% confidence interval (CI). Statistical analysis was conducted with Stata SE12.0. Results This meta-analysis comprised 3,267 patients from 20 studies covering a variety of solid tumors. Increased FOXC2 expression was related to shorter overall survival (OS) (HR = 2.05, 95% CI: 1.73–2.42). High expression of FOXC2 is associated with lymph node metastases (OR = 3.33, 95% CI: 2.65–4.19), TNM stage (OR = 3.09, 95% CI: 2.00–4.78), and age (OR = 1.26, 95% CI: 1.06–1.50), according to the pooled ORs. However, no significant association was observed between the high expression of FOXC2 and sex, tumor size or tumor differentiation. Conclusion Increased expression of FOXC2 is associated with unfavored OS, lymph node metastases, TNM stage, and age. FOXC2 is a promising prognostic marker and a novel target marker in human solid tumors.

Background:The large amount of lactic acid produced by glycolysis in the tumor microenvironment was previously thought to be merely a metabolic waste product.However, more and more studies have shown that lactic acid can play a role in promoting tumor progression.Methods: In this study, We obtained liver cancer data from The Cancer Genome Atlas (TCGA) database and identified 50 lactate-related genes that were differentially expressed between liver cancer and normal liver tissues.Based on these differentially expressed genes (DEGs), all liver cancer cases could be divided into two subtypes.Results: The prognostic value of each Lactate-related gene for survival was evaluated to construct a multigene signature using TCGA cohort.By applying the least absolute shrinkage and selection operator (LASSO) Cox regression method, a 2-gene signature was built and classified all liver cancer patients in the TCGA cohort into a low-or high-risk group.Liver cancer patients in the low-risk group showed significantly higher survival possibilities than those in the high-risk group (p < 0.001).Utilizing the median risk score from the TCGA cohort, Liver cancer patients from a Gene Expression Omnibus (GEO) cohort were divided into two risk subgroups, and the low-risk group had increased overall survival (OS) time.Combined with the clinical characteristics, the risk score was found to be an independent factor for predicting the OS of liver cancer patients.Conclusions: Lactate-related genes play an important role in tumor progression and can be used to predict the prognosis of HCC patients.

肝胆外科学是外科学教学中一门综合性强、教学难度高的重点学科.我国肝胆疾病具有发病率高、发病人群以老年人多见、诊断及治疗复杂等特点,在肝胆外科快速发展及我国人口老龄化的背景下,肝胆外科教学需要在传统教学方式的基础上取得突破.课程思政是将思政元素融入专业课程的一种创新教学方式,通过提高带教老师"思政"的意识与能力、挖掘肝胆外科教学思政元素、改进教学手段并建立科学的教学评价体系等措施,在提升学生专业能力的同时,进行潜移默化的思想政治教育.课程思政将思想价值引领贯穿在整个肝胆外科教学中,通过促进学生健康全面的发展,为提升肝胆外科教学水平、培养符合社会发展需要的人才提供了解决方案.

Introduction: Chronic myelomonocytic leukemia (CMML) is a rare hematological malignancy bearing of both myelodysplastic syndrome and myeloproliferative neoplasm characteristics. Despite the low incidence, the clinical diagnosis of CMML was difficult and the survival was poor. The optimal first-line therapy for CMML still remains a matter of debate. Methods: We retrospectively analyzed the clinical characteristics of 66 CMML patients in a single center during the past 10 years and studied the survival status of CMML patients in the real world and the influence of treatment methods on the prognosis of patients. Results: For the 66 CMML patients, the median age was 60 years old (IQR 47.0-67.0), and an approximately 1.6:1.0 male-to-female ratio was found. CMML-0, CMML-1 and CMML-2 accounted for 13.7% (9/66), 43.9% (29/66) and 42.4% (28/66), respectively. The chromosome abnormality rate was 27.2% (18/66). Gene mutation was detected in 60 patients by sequenced in first-generation with 51.1% (22/43) gene mutations and in NGS with 82.3% (14/17) gene mutations. The top three mutation genes were ASXL1MT (11/60, 18.3%), TET2MT (10/60, 16.7%), and SRSF2 MT (9/60, 15.0%). There were 27 patients in supportive therapy group, and 39 patients in chemotherapy group including patients undergoing HSCT. Patients in chemotherapy group showed better OS than those in the supportive group before and after PSM analysis with p < 0.05. Patients with blast cell in bone marrow >= 10% or WHO CMML-2 benefited more from chemotherapy treatment achieving better OS. Multivariate analysis showed that supportive therapy and intermediate-2/high in CPSS were independent risk factors for OS after PSM. Discussion: Chemotherapy including hypomethylating agents prolonged overall survival of CMML patients, especially in patients with blast cell >= 10% in bone marrow or WHO CMML-2 comparing with supportive therapy. Sequencing may provide direct insight into the molecular mechanism by detection of gene mutation, enabling personalized treatment in the future.