Objective:To determine the risk factors for development of combined hepatocellular-cholangiocarcinoma (CHC) and intrahepatic cholangiocarcinoma (ICC).Methods:The clinical data of patients with ICC or CHC confirmed by pathology at Henan Provincial People's Hospital from January 2012 to December 2018 were retrospectively analyzed. Of 225 patients with ICC or CHC, there were 90 males and 135 females, aged (58.7±10.4) years old. Based on the pathological type, there were 172 patients in the ICC group and 53 patients in the CHC group. The healthy control group was selected from 450 individuals who underwent routine health examination in the same hospital, and there were 189 males and 261 females, aged (56.7±9.3) years old. Univariate and multivariate logistic regression were used to analyze the risk factors of ICC and CHC.Results:The risk factors of ICC included hepatitis B surface antigen (HBsAg) (+ )/hepatitis B core antibody (anti-HBc) (+ ) ( OR=9.373, 95% CI: 4.784-18.363, P<0.001), hepatitis C virus antibody (HCV-Ab) (+ ) ( OR=7.151, 95% CI: 1.195-42.776, P=0.031), diabetes mellitus ( OR=3.118, 95% CI: 1.733-5.612, P<0.001) and hepatolithiasis ( OR=18.650, 95% CI: 5.210-66.767, P<0.001). The risk factors of CHC included HBsAg (+ )/anti-HBc(+ )( OR=54.891, 95% CI: 17.434-172.822, P<0.001) and HCV-Ab (+ ) ( OR=37.785, 95% CI: 5.720-249.611, P<0.001). Conclusion:HBV infection, HCV infection, hepatolithiasis, diabetes mellitus and cirrhosis were risk factors for ICC. HBV and HCV infection were risk factors of CHC.

Abstract Objective We assess the predictive value impacted by tumor-infiltrating lymphocytes (TILs) for overall survival (OS) and progression-free survival (PFS) in patients with intrahepatic cholangiocarcinoma (ICC) undergoing complete resection. Methods Sixty-eight patients with resectable ICC were included in this study. We studied stromal TIL density and scored it by staining sections from surgically resected ICC patients with hematoxylin and eosin (HE). The clinical data and prognosis of patients with ICC were obtained by searching clinical and follow-up records. Results A stromal TIL negative status was a predictor of poor OS (HR = 0.41, 95% CI 0.20–0.83, p = .01) and poor PFS (HR = 0.47, 95% CI 0.23–0.97, p = .04) independently. Low stromal TIL density was associated with high levels of CA125 (p = .03) and CA19-9 (p < .01). The high level of CA19-9 (p = .05), high differentiation (p = .02), a large diameter (p = .05), a positive bile duct/vascular cancer embolus (p = .03) and positive satellite nodules (p = .02) were tendencies to develop tumors for patients with a negative status of stromal TIL. Conclusion Our data prompt for the prediction of the PFS and OS of patients with ICC after complete resection, stromal TILs play an important role.

INTRODUCTION:The safety and feasibility of laparoscopic splenectomy plus selective esophagogastric devascularization (LSSD) via the spleen bed for cirrhotic portal hypertension have not been well studied.AIM:To assess the safety and feasibility of LSSD via the spleen bed for patients with cirrhotic portal hypertension.MATERIAL AND METHODS:From June 2012 to December 2017, 423 patients suffering from portal hypertension and hypersplenism with liver cirrhosis underwent surgery in our department. One hundred and sixty-seven of these patients received totally LSSD, and the others received open splenectomy and esophagogastric devascularization (OSD). The characteristics, intraoperative and postoperative details and complications of the two groups were compared.RESULTS:The operations were successfully performed in all patients. Intraoperative blood loss volume and blood transfusion were similar between the two groups (all p-values > 0.05). Postoperative length of hospital stay and time to oral intake were significantly shorter, but operation time was longer in the LSSD group compared with the OSD group (all p < 0.05). However, postoperative portal vein diameter was significantly smaller in the LSSD group (p < 0.001). The postoperative grade of varices was significantly lower in the LSSD group (p = 0.030). No significant differences were detected between the two groups regarding postoperative liver function, but the incidences of pancreatic leakage, pleural effusion, and wound infections were higher in the OSD group (all p < 0.05).CONCLUSIONS:LSSD via the spleen bed is safe and feasible for liver cirrhosis and portal hypertension.

Introduction and objective: The purpose of this study was to investigate the expression levels and prognostic roles of alpha-fetoprotein (AFP), carcinoembryonic antigen (CEA), and Ki67 in tumor tissues of intrahepatic cholangiocarcinoma (ICC) patients. Patients or materials and methods: The study involved ninety-two ICC patients with complete clinicopathological data and follow-up information, who had previously undergone radical surgery. AFP, CEA, CD10, CD34, and Ki67 were detected in tumor tissues using immunohistochemistry. Statistical tests were used to identify independent risk factors and their associations with overall survival (OS) and disease-free survival (DFS). Results: AFP, CEA and Ki67 were strongly correlated with prognosis. Univariate analysis indicated that higher AFP (P = 0.002), CEA (P < 0.0001), Ki67 (P < 0.0001), CA19-9 (P = 0.039), and CA12-5 (P = 0.002), and larger tumor size (P = 0.001), as well as more advanced tumor node metastasis (TNM) staging (P < 0.0001) were all associated with worse OS. Meanwhile, higher AFP (P = 0.002), CEA (P = 0.001), and Ki67 (P < 0.0001), as well as more advanced TNM staging (P = 0.005) were associated with worse DFS. Multivariate analysis showed that higher AFP (HR = 2.004, 95%CI: 1.146-3.504 P = 0.015), CEA (HR = 2.226, 95%CI: 1.283-3.861 P = 0.004), and Ki67 (HR = 3.785, 95%CI: 2.073-6.909 P < 0.0001), as well as more advanced TNM staging (HR = 2.900, 95%CI: 1.498-5.757 P = 0.002) had associations with worse OS. Furthermore, higher AFP (HR = 2.172, 95%Cl: 1.291-3.654 P = 0.003), CEA (HR = 1.934, 95%Cl: 1.180-3.169 P = 0.009), and Ki67 (HR = 2.203, 95%Cl: 1.291-3.761 P = 0.004) had associations with worse DFS. Conclusion: High AFP, CEA, and Ki67 are significant prognostic indicators in ICC patients, and can be used to evaluate ICC biological behavior and prognosis. (C) 2020 Fundaci on Cl ' nica Medica Sur, A.C. Published by Elsevier Espana, S.L.U. This is an open access article under the CC BY-NC-ND license.

Objective: We conducted this study to assess the predictive value of tumor-infiltrating lymphocytes (TILs) for progression-free survival (PFS) and overall survival (OS) in intrahepatic cholangiocarcinoma (ICC) patients after complete resection. Methods: Sixty-eight patients with resectable ICC were included in this study. We studied stromal TIL density and scored it by staining sections from surgically resected ICC patients with hematoxylin and eosin (HE). The clinical data and prognosis of ICC patients were obtained by searching clinical and follow-up records. Results: A stromal TIL negative status was an independent predictor of poor OS (HR=2.84, 95% CI 1.48- 5.46, P<0.01) and poor PFS (HR=2.88, 95% CI 1.44-5.76, P<0.01). Low stromal TIL density was associated with high CA125 (P=0.03) and CA19-9 (P<0.01) levels. Patients with a stromal TIL negative status tended to develop tumors with a high level of CA19-9 (P=0.05), high differentiation (P=0.02), a large diameter (P=0.05), a positive bile duct/vascular cancer embolus (P=0.03) and positive satellite nodules (P=0.02). Conclusion: Our data suggest that stromal TILs play an important role in predicting the PFS and OS of ICC patients after complete resection.

Objective To evaluate the clinical application value of portal vein implantation pump for chemotherapy in patients with intrahepatic cholangiocarcinoma (ICC) after radical surgery.Methods The clinical data of 97 patients with ICC who underwent radical surgery in Henan People's Hospital from June 2012 to June 2016 were retrospectively analyzed.Results Among the 97 patients,14 patients received portal venous pump chemotherapy (portal group),33 patients received peripheral venous chemotherapy (peripheral group),and 50 patients did not receive postoperative chemotherapy (control group).There were no statistically significant differences in gender and age between the three groups.The results of survival analysis indicated that the disease-free survival (DFS) period and overall survival (OS) time in the portal group and the peripheral group were significantly better than that in control group (both P ＜ 0.05).In addition,despite the lack of statistical significance (P ＞ 0.05),for the control of intrahepatic metastasis,portal vein pump chemotherapy was better than that of systemic chemotherapy via peripheral vein,and almost all side effects of chemotherapy in the portal group were lower than those in the peripheral group.Conclusion Portal vein pump chemotherapy can improve the prognosis of intrahepatic bile duct patients,especially for the control of intrahepatic metastasis,and can reduce systemic side effects of chemotherapy.

Background: Pulmonary metastasis(PM) form hepatocellular carcinoma(HCC) is a major indicator of a poor prognosis after liver resection. The study aimed to probe into the influencing factors for PM following open liver resection(OLR) and laparoscopic liver resection(LLR) with HCC. Method: All patients who suffered from LLR and OLR for primary HCC, who developed pulmonary metastasis, as first extrahepatic metastasis, were retrospectively analyzed in our department from January 2014 to August 2020. Results: Thirty-three cases were included (median age 50 years,81.8% male). The patients with a single tumor had 23 cases (69.7%), and a total of 10 patients(30.3%) has two and more tumors. 21 cases (63.6%) were smaller than 10 cm of tumor diameter. The median of operation time was 200 minutes (110-360), Portal vein occlusion occurred in 12 patients(36.4%). Patients with intrahepatic recurrence received vertebroplasty combined chemotherapy(VPCC), targeted therapy , trans-arterial chemo-embolization(TACE) and radio frequency catheter ablation(RFCA) in 1(3%),1(3%),10(30.3%) and 7(12.1%) cases respectively. The 2- and 3- year cumulative probability of overall survival (OS) were 63% and 41%. The median OS was 30.8 months. The median recurrence time was 6 months(1.7-4.8). The median of confirmed PM time from HCC was 12.5 months(1.5-61.1) and 17(51.5%) patients died. Conclusion: Early detection of intrahepatic recurrence and treatment can prolong PM time and overall survival time.

Objective To investigate the clinical effect of three-dimensional laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.Methods The clinical data of 67 patients who underwent laparoscopic splenectomy for massive splenomegaly at Henan Province People's Hospital from Jan 2013 to Dec 2018 were collected.Results Operation time,volume of intraoperative blood loss and blood transfusion,number of patients with intraoperative blood transfusion,and conversion to laparotomy were in favor of 3D group,with statistically differences (t =12.900,18.255,19.711,x2 =10.747,0.685,P ＜ 0.05).Postoperative intraabdominal bleeding,pancreatic fistula,and postoperative hospital stay in 2D group were more than those in 3D group,with statistically differences (x2 =3.511,4.527,t =12.969,P ＜ 0.05).All patients were followed up for 5 to 60 months.Portal thrombosis occurred in 6 patients vs 5 patients,respectively (x2 =0.028,P ＞ 0.05) and resolved with oral coumarin.Conclusions Three-dimensional laparoscopic splenectomy can provide more realistic visual effects of surgical procedures and has an obvious advantage in laparoscopic splenectomy for massive splenomegaly secondary to liver cirrhosis.

Objective To explore the feasibility and safety of laparoscopic hepatectomy in the treatment of hepatic malignant tumors.Methods 136 liver cancer patients were divided into:laparoscopic surgery group (LR group,51 cases) and open surgery group (OR group,85 cases).Serum enzyme,inflammatory factors and postoperative complications were compared between the 2 groups.Results The operative time of LR group was significantly longer than that of OR group (252 ± 123) min vs.(169 ± 63 min),hospitalization time (10 ± 5) d vs.(12 ± 5) d and intraoperative blood loss in LR group were lower than those in OR group (381 ±156) ml vs.(523 ±325) ml (all P＜0.05).ALT,AST,ALP in LR group was significantly lower than that in OR group [ALT:(227 ±101) U/L vs.(690 ±575) U/L,AST:(187±107) U/Lvs.(551 ±529) U/L,ALP:(63 ±25)U/Lvs.(86 ±40)U/L,allP＜0.05].Prothrombin time in LR group was shorter than that in OR group [(14.3 ±0.8) s vs.(15.3 ± 1.6)s,P =0.000].The postoperative IL-6,TNF-α in LR group was lower than that in OR group [IL-6:(154 ±31)pg/ml vs.(182 ±34) pg/ml,TNF-α:(22 ±6) pg/ml vs.(30 ±7) pg/ml,all P ＜0.05].Postoperative complications in laparoscopic group were significantly lower than those in laparotomy group (3.9％ vs.11.8％,P ＜ 0.05).Conclusions Laparoscopic resection of liver malignant tumors is safer and has less complications,lower inflammatory stress response and liver injury.

Objective To evaluate the effect of modified basin-forming anastomosis for recurrent stones after choledochojejunostomy.Methods A total of 83 patients suffering from recurrent choledocholithiasis undergoing re-operation at our department from Jan 2013 to Dec 2017 were divided into two groups.46 patients treated by routine choledochojejunostomy (controls),and 37 patients by modified basin-forming biliary-intestinal anastomosis(study group).Results Control vs study group:intraoperative blood loss were(262 ±86)ml vs(121 ±77) ml,blood transfusion:(139 ±256)ml vs(22 ± 92) ml,and operative time:(316 ± 75) min vs (245 ± 73) min,the number of patients with liver resection were 8 vs 3 (all P＜0.05).The number of patients with fever,biliary tract infection,abdominal infection,anemia,and postoperative hospital stay were 14 vs 4,12 vs 3,7 vs 0,11 vs 1,(11.5 ± 1.8) d vs (8.5 ± 1.9) d (all P ＜ 0.05).Conclusions The modified basin-forming biliary-intestinal anastomosis is a simple,safe and effective surgical method for recurrent choledocholithiasis after choledochojejunostomy.

Objective To evaluate the role of tumor budding in the prognostic value of intrahepatic cholangiocarcinoma(ICC) after radical resection.Methods The clinicopathological data of patients undergoing radical resection for intrahepatic cholangiocarcinoma between 2011 and 2016 were retrospectively analyzed.The number of tumor budding was counted in a ×200 microscopic field (0.785mm2).Based on receiver operation curve (ROC),the number of tumor budding ≥ 15 was defined as high-grade group,and ＜ 15 was low-grade group.Multivariate analysis were performed on predictors of the tumor.Results Low-grade group was observed in 32 cases and high-grade group in 50.High-grade group appeared to develop tumors with higher CA199,poor differentiation,larger tumor diameter,advanced stage and high risks of lymphnode metastasis (respectively x2 =5.470,4.359,5.101,4.696,5.960,all P ＜ 0.05).Univariate analysis showed that tumor budding,CA199,differentiation,tumor diameter,T classification and lymphnode metastasis were related to the overall survival of patients with ICC (respectively x2 =11.704,4.876,5.056,5.152,8.442,16.725,all P ＜ 0.05).On multivariable analysis,high-grade group was a significant independent predictor of worse OS (HR =2.707 95％ CI 1.558-4.705,P ＜ 0.001).Conclusions High-grade tumor budding is an important negative prognostic factor for ICC.

Objective To evaluate the effects of laparoscopic splenectomy and esophagogastric devascularization(LSPD) vs.open procedure(OSPD) on stress and immune function in patients with portal hypertension due to cirrhosis.Methods From June 2015 to June 2017 a total of 66 patients underwent LSPD or OSPD procedures.Results Plasma cortisol concentration in the LSPD group was lower than that in the OSPD group (Fgroup =18.85,P =0.020).Cortisol concentration in the two groups increased firstly and then decreased with time extension (Ftime =532.08,P =0.000).The level of CD3 +,CD4 +,CD4 +/CD8 + in LSPD group was higher than that in OSPD group,and the level of CD8 + was lower than that in OSPD group (Fgroup =3.55,21.47,154.84,64.29,P ＜ 0.05),the levels of CD3 +,CD4 + and CD4 +/CD8 + in the two groups first decreased and then increased with the extension of time,and the levels of CD8 + increased firstly and then decreased (Ftime =199.22,298.48,864.33,510.23,P ＜ 0.05),the increase range of CD3 +,CD4 +,and CD4 +/CD8 + in LSED group was higher than that in OSPD group (Finteraction =19.27,18.21,79.55,35.21,P ＜ 0.05);there was no statistical significance in the complications such as:rebleeding,thrombosis and splenic fever in the two groups (x2 =0.05,0.67,0.07,0.16,P=0.829,0.413,0.789,0.693).But the postoperative chest/cavity effusion and fever (＞ 38.0 ℃,and ＞ 3 days) is OSPD group is higher than in the LSPD group(x2 =5.49,6.68,P =0.019,0.010).Conclusion LSPD effectively reduces postoperative stress,protects immune function,decreases postoperative pleural and abdominal effusion and fever.

Objective To evaluate the feasibility and safety of laparoscopic splenectomy and esophagogastric devascularization (LSPD) via spleen bed using endoscopic linear stapler (Echelon Flex 60 Endopath) versus open splenectomy and esophagogastric devascularization (OSPD) for cirrhotic portal hypertension.Methods A total of 390 patients suffering from liver cirrhosis and portal hypertension operated in our department from Jun 2012 to Jul 2016 were divided into two groups:145 for LSPD and 245 for OSPD.Characteristics,clinical data and postoperative complications were compared.Results There were no significant differences in estimated intraoperative blood loss between LSPD and OSPD groups.The operation time of LSPD group was longer than OSPD group.However,the time of hospital stay and time of oral intake were shorter in the LSPD group than the OSPD group (P ＜ 0.05).No significant differences were detected for liver function such as ALT,AST,T-BIL and ALB after operation,nor in the rate of postoperative complications between the 2 groups such as portal vein thrombosis,pancreatic leakage,pleural effusion and PLT ＞800 x 109/L.But amount of ascites and fever (＞38.0 ℃,＞3 d) in OSPD group was higher than LSPD group (P ＜ 0.05).Conclusions LSPD via spleen bed combined with endoscopic linear stapler for liver cirrhosis and portal hypertension is a safe and feasible procedure.

Objective To evaluate hepato-intestinal anastomosis in the treatment of complex stricture of high bile duct.Methods From Jan 2010 to Dec 2016,43 patients undergoing traditional biliary-intestinal anastomosis were grouped into control,45 patients undergoing hepato-intestinal anastomosis were allocated into study group.Results (1) Control vs study grounp,the operative time was (24 ±3)min vs.(15 ± 3)min,intraoperative blood loss and blood transfusion were (384 ± 51)ml vs.(280 ± 41) ml,(649 ± 3) ml vs.(454 ± 8) ml,number of patients with intraoperative blood transfusion,and liver resection were 10 vs.3,and 8 vs.3 respectively,with statistically differences (t =12.48,10.46,144.65,x2 =43.68,49.50,all P ＜ 0.05).(2) Postoperatively efficacy:fever was in 7 vs.3 cases,incision infection in 5 vs.3 cases,abdominal infection was in 5 vs.2 cases,biliary fistula was in 7 vs.3 cases,number of un-planed readmission was in 7 vs.3 cases,and postoperative hospital stay were (14.3 ± 1.5) d vs.(10.7 ± 0.7) d,respectively,between the control group and the study group,with statistically differences (x2 =52.55,58.91,62.23,52.55,52.55,t =16.28,all P ＜0.05).(3) Follow-up situation:all the 88 patients were followed-up for 6 to 96 months (median time,30 months).Biliary restenosis occurred in 5 vs.1 patients between the control group and the study group,respectively,with statistically differences (x2 =65.64,P ＜ 0.05).Conclusions Hepato-intestinal anastomosis is effective in the treatment of complex stricture of high bile duct.