OBJECTIVES:To assess the impact of preoperative transarterial chemoembolization (TACE) on patients diagnosed with hepatocellular carcinoma (HCC) beyond the Milan criteria, and investigate the prognostic factors associated with long-term outcomes. MATERIALS & METHODS:From January 2013 to March 2018, 675 patients diagnosed with HCC beyond the Milan criteria, which were classified as Barcelona Clinic Liver Cancer (BCLC) stage A or B, were enrolled. Patients were assigned to two groups as follows: the surgery-alone group and the TACE + surgery group, to compare perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) following propensity score matching (PSM), a statistical method used to reduce selection bias. Univariable and multivariable Cox regression analyses were performed to identify the factors associated with OS and RFS. RESULTS:After PSM, 118 pairs of matched patients were selected. The postoperative 30-day morbidity (29.7 % vs. 27.1 %, p = 0.67) and length of hospital stay (12.0 days vs. 12.0 days, p = 0.90) were comparable between the two groups of patients. Patients in the TACE + surgery group demonstrated significantly improved median overall survival (median OS: 46.0 months vs. 29.5 months, p < 0.001) and median recurrence-free survival (median RFS: 24.0 months vs. 12.5 months, p < 0.001) compared with patients in the surgery-alone group. Multivariate Cox regression analysis revealed that preoperative TACE was an independent predictor of better overall survival (risk ratio [HR] 0.62, 95 % confidence interval [CI]: 0.47-0.82, p < 0.001) and recurrence-free survival (HR 0.47, 95 % CI: 0.36-0.61, p < 0.001). CONCLUSION:This study suggests that preoperative TACE is a safe procedure associated with improved OS and RFS for patients with HCC beyond the Milan criteria classified as BCLC stage A or B.

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.

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.

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.