Laparoscopic isolated caudate lobectomy is still a challenging operation for surgeons. The access route of the operation plays a vital role during laparoscopic caudate lobectomy. There are few references regarding this technique. Here, we introduce a preferred inferior vena cava (IVC) approach in laparoscopic caudate lobectomy. Twenty-one consecutive patients with caudate hepatic tumours between June 2016 and December 2021 were included in this study. All of them received laparoscopic caudate lobectomy involving an IVC priority approach. The IVC priority approach refers to prioritizing the dissection of the IVC from the liver parenchyma before proceeding with the conventional left or right approach. It emphasizes the importance of the IVC dissection during process. Clinical data, intraoperative parameters and postoperative results were evaluated. Sixteen patients were performed pure IVC priority approach, while 5 patients underwent a combined approach. We subsequently compared the intraoperative and postoperative between the two groups. All 21 patients were treated with laparoscopic technology. The operative time was 190.95 ± 92.65 min. The average estimated blood loss was 251.43 ± 247.45 ml, and four patients needed blood transfusions during the perioperative period. The average duration of hospital stay was 8.43 ± 2.64 (range from 6.0 to 16.0) days. Patients who underwent the pure inferior vena cava (IVC) approach required a shorter hepatic pedicle clamping time (26 vs. 55 min, respectively; P < 0.001) and operation time (150 vs. 380 min, respectively; P = 0.002) than those who underwent the combined approach. Hospitalization (7.0 vs. 9.0 days, respectively; P = 0.006) was shorter in the pure IVC group than in the combined group. Laparoscopic caudate lobectomy with an IVC priority approach is safe and feasible for patients with caudate hepatic tumours.

Objective: To explore the clinical value of adjuvant therapy in patients with T3 gallbladder cancer (GBC) who have undergone R0 resection. Methods: Clinical and pathological data from 415 patients with T3 GBC who underwent surgical treatment in 7 tertiary centers in China from January 2013 to December 2018 were collected,including 251 males and 164 females,aged (61±11)years (range: 26 to 88 years). Depending on whether to receive adjuvant therapy after radical resection,the patients were divided into the radical resection group alone (group A,n=358) and the radical resection combined with the postoperative adjuvant therapy group (group B,n=57). The general data of the two groups were matched 1∶1 by propensity score matching method,and the caliper value was 0.02.Clinicopathological characteristics,overall survival and disease-free survival of the two groups were compared.The Cox regression model was used for multivariate analysis,and patients with at least one or more independent risk factors were classified as high-risk clinicopathological subtypes. Subgroup analysis was performed to assess the clinical value of adjuvant therapy after radical resection in patients with high-risk clinicopathological subtypes. Results: After the matching,there were 42 patients in each of the two groups. The incidence of gallbladder cancer and the number of dissected lymph nodes in group B after cholecystectomy were higher than those in group A (χ2=9.224,2.570,both P<0.05). There were no significant differences in overall survival rate and disease-free survival rate between the two groups before and after matching (all P>0.05). The results of the univariate and multivariate analysis showed that CA19-9>39 U/ml,nerve invasion,tumor location (liver side or bilateral),TNM stage ⅢB to ⅣB ,poorly differentiated tumor were independent prognostic factors of overall survival and disease-free survival of patients with T3 stage gallbladder cancer (all P<0.05).Three hundred and twenty-nine patients(79.3%) had high-risk clinicopathological subtypes,and the median survival time after curative resection with and without adjuvant therapy was 17 months and 34 months respectively,and the 3-year and 5-year overall survival rates were respectively 40.0%,21.3% and 46.0%,46.0% (χ2=4.042,P=0.044);the median disease-free survival time was 9 months and 13 months,and the 3-year and 5-year disease-free survival rates were 23.4%,13.6% and 30.2%,18.2% (χ2=0.992,P=0.319). Conclusions: Postoperative adjuvant therapy following radical surgery did not yield significant improvements in the overall survival and disease-free survival rates of patients diagnosed with T3 gallbladder cancer. However, it demonstrated a significant extension in the overall survival rate for patients presenting high-risk clinicopathological subtypes.

The fiber reinforcement efficiency of carbon fiber reinforced cement matrix composites (CFRCM) is limited by the low permeability of mortar to internal filaments in the fibers, leading to premature failure of the composites due to low bond strength. In this paper, three kinds of nano-silica materials were used to improve the bond properties of carbon fiber bundles to cement-based matrix by coating and electrophoretic deposition. It is found that different methods have different positive or negative effects on the improvement of bond properties, and the effects are different under different embedded lengths. The modification principle is due to the high impregnation of nano silica particles on the fibers and the reaction of volcanic ash of the particles, which promotes the formation of calcium silicate hydrate gel inside the fibers. Relevant research needs further exploration.

Objective:To investigate the clinical value of extended radical resection for stage pT3 gallbladder cancer (GBC).Methods:The clinical and pathological data of 323 patients with stage pT3 GBC who received regional radical resection or extended radical resection in 7 domestic hepatobiliary centers in China from January 2013 to December 2018 were retrospectively analyzed. The propensity score matching method was used to select 36 cases in each of the regional radical resection group (group A1) and the extended radical resection group (group B1). The surgical indicators and overall survival rates of the two groups were compared, and prognostic factors were analyzed.Results:The number of positive lymph nodes [2(0,3)] and the total number of lymph nodes removed [3(1,4)] in group B1 were both higher than those in group A1 [1(0,1), 4(2,7)] (all P<0.05). There was no significant difference in other clinical and pathological factors between the two groups (all P>0.05). The 1, 3, and 5-year survival rates of group A1 were 75%, 44%, and 29%, respectively, which were significantly higher than those of group B1 of 50%, 15%, and 11% (χ 2=11.311, all P<0.001). Extensive radical resection ( HR=2.161, 95 %CI: 1.222-3.821), hepatic parenchymal invasion ( HR=2.324, 95 %CI: 1.305-4.139), positive lymph node rate ≥1/3 ( HR=2.927, 95 %CI: 1.641-5.220), and ⅢB/ⅣB staging ( HR=3.325, 95 %CI: 1.750-6.320) are risk factors for the prognosis of GBC patients (all P<0.05), of which extended radical resection ( HR=1.969, 95 %CI: 1.083-3.581) was an independent risk factor for prognosis ( P<0.05). When the ratio of positive lymph nodes was<1/3 and the tumor invaded the hepatic parenchyma, the overall survival rate of group B1 was significantly lower than that of group A1 (all P<0.05). Conclusions:The overall survival rate in patients with stage pT3 GBC whose lymph node positive rate<1/3 and/or hepatic parenchymal invaded cannot be improved by extended radical resection. Extended radical resection is an independent risk factor for patient prognosis.

The effect of cirrhosis on the characteristics of intrahepatic cholangiocarcinoma (ICC) has not been fully elucidated. The purpose of this study was to investigate how cirrhosis affects the clinicopathological characteristics and survival of surgically treated ICC patients. A total of 1,312 ICC patients surgically treated between January 2007 and December 2011 at a single institution were retrospectively reviewed and the clinicopathological data were compared between cirrhotic and non-cirrhotic patients. Univariate and multivariate analyses were performed to identify significant and independent prognostic factors in this cohort. A total of 302 patients (23.0%) were cirrhotic. Compared with cirrhotic patients, the tumors in non-cirrhotic patients were usually larger, less differentiated, and more likely to have lymphatic metastasis, vascular and perineural invasion. Following resection, cirrhotic patients achieved a longer survival compared with non-cirrhotic patients (16.0 vs. 13.0 months, respectively; P<0.038). Multivariate analysis demonstrated that hepatitis B virus infection and cirrhosis were independent favorable prognostic factors, while the presence of cholelithiasis, elevated carbohydrate antigen 19-9 and carcinoembryonic antigen levels, multiple tumors, lymphatic metastasis, vascular invasion and positive surgical margin status were independent unfavorable prognostic factors. Overall, the clinicopathological characteristics of ICC patients with and without cirrhosis differed significantly. Compared with cirrhotic patients, in whom the biological behavior of ICC was similar to that of HCC, non-cirrhotic patients exhibited higher-risk pathological characteristics, lower curative resection rate and worse survival.

miRNAs (miRs) are short RNA molecules that are involved in the posttranscriptional regulation of mRNA. The roles of miRs in tumor pathogenesis have only recently become a focus of research. It is becoming increasingly clear that miRs are important regulators of apoptosis, proliferation, invasion, and metastasis in cancer cells during cancer genesis and progression, furthering our understanding of cancer. In the present review, we summarize and evaluate the recent advances in our understanding of the characteristics of miRs as well as their regulated functions in cancer stem cells (CSCs), the epithelial-mesenchymal transition (EMT), and the tumor microenvironment (TM), describing their roles in tumor pathogenesis and their possible use as new therapeutic targets and biomarkers.

Purpose: To identify prognostic predictors for overall survival of patients with hilar cholangiocarcinoma of Bismuth type III and IV (HCBT34), and to determine survival benefit and safety of total caudate lobectomy (TCL) in a Chinese centre.Methods: From January 2001 to December 2010, 171 patients with the diagnosis of HCBT34, who underwent a potentially curative resection, were included in this study. Cox proportional hazards regression models were used to determine the association between possible prognostic variables and survival time. Curative resectability rate, morbidity and mortality were investigated also.Results: Resection with TCL was significantly associated with more opportunity to achieve curative resection (p < 0.01), did not accompany with more morbidity (p = 0.39) and mortality (p = 0.67). Cox regression analysis demonstrated positive resection margins [Relative Risk (RR) 3.6, 95% CI 3.5-3.71, not well differentiation (RR 2.9, 95% Cl 2.7-3.1), higher preoperative scrum peak CA 19-9 level (RR 1.6, 95% CI 1.5-1.7) and regional lymph nodes involvement (RR 1.5, 95% CI 1.4-1.6) as independent adverse prognostic variables.Conclusions: Resection with TCL offers a long-term survival opportunity for HCBT34, with high curative resectability rates and an acceptable safety profile. (C) 2012 Elsevier Ltd. All rights reserved.

Objective To explore the prognosis factors of hilar cholangiocarcinoma, and investigate the relation between operative procedure and prognosis of it. Methods A retrospective cohort study was investigated in 198 patients with hilar cholangiocarcinoma, who were treated in our hospital from December 1997 to December 2002. There were 117 males and 81 females. The age ranged from 27 to 81 years old with a mean of 56. Jaundice(94.5%), pruritus(56.6%) and abdominal pain(33.8%) were the main present symptoms. According to Bismuth-Corlette classification, there were 14 type I cases, 19 type II cases, 12 type IIIa cases, 15 type IIIb cases, 112 type IV cases and 26 unclassifiable cases. One hundred and forty four cases received open operative treatment, and the others only were treated with endoscopic approach(including ERBD or EMBE 21 cases, ENBD 31 cases) or percutaneous transhepatic cholangiodrainage(2 cases). Tumor resection was performed on 120 cases with a resection rate of 83.3%, included radical resection 59 cases(41.0%). Twenty-four cases underwent paunched biliary exploration and drainage. Results The Cox's regression model analysis showed that occupation, preoperative maximum total serum bilirubin level, operative procedure and postoperative adjuvant radiation affected postoperative survival significantly, but gender, age, choledocholithiasis, hepatitis, preoperative serum CA19-9 level, Bismuth-Corlette type, histopathologic grading and postoperative chemotherapy were not significant prognostic factors. The postoperative survival of biliary drainage group, palliative resection group and radical resection group, which statistically differed pairwise. Between ERBD or EMBE group and palliative resection group, there was no statistical difference. So was between ERBD or EMBE group and biliary drainage group, or between ENBD group and biliary drainage group. The survival differed statistically between ERBD or EMBE group and ENBD group. Conclusions Operative procedure was the most important prognosic factor of hilar cholangiocarcinoma, radical resection still was the primary measure to cure and long term survival. For irresectable hilar cholangiocarcinoma. the effect of ERBD or EMBE could not be considered to be worse than that of open operative treatment.

Objective To study prognostic factors after surgical procedure for distal bile duct cancer. Methods A retrospective clinical analysis was made in 173 cases of distal bile duct cancer,admitted to our hospital from February 1996 to December 2002.Fourteen clinicopathologic factors that could possibly influence survival were selected. A multivariate analysis of these individuals was performed using the Cox Proportional Hazards Model. ResultsThere were 99 males and 74 females. The age ranged from 27 to 74 years old with a mean of 55.5.Radical resection was performed on 152 cases with radical resection rate of 87.9%.29 cases died of liver metastasis with a rate of 46.8% in total death cases. The statistical analysis showed that surgical procedure ,lymph node metastasis and pathological differentiation grade affected postoperative survival significantly,but transfusion,invasion of pancreas,postoperative radiotherapy and chemotherapy,ERCP,diameter of tumour,serum level of CA-19-9,preoperative total serum bilirubin level(TBIL),ratio of albumin to globulin(A/G),sex and age are not significant factors influencing postoperative survival. ConclusionsRadical resection is only curative treatment modality. Aggressive treatment and prevention on postoperative liver metastasis is a important strategy to improve the survival for distal bile duct cancer.