To compare targeted immunotherapy plus adjuvant transarterial chemoembolization (TACE) versus TACE alone in patients with borderline resectable hepatocellular carcinoma (BR-HCC). 297 BR-HCC patients who underwent liver resection were included. Among them, 86 patients received perioperative targeted immunotherapy combined with adjuvant TACE (combination therapy group, which included neoadjuvant therapy and adjuvant therapy), while 211 received adjuvant TACE alone (TACE-only group). After propensity score matching (PSM), the combination therapy group demonstrated significantly improved 1-, 3-, and 5-year OS rates (90.7%, 66.0%, and 58.1%, respectively) compared to the TACE-only group (86.0%, 55.2%, and 35.1%; p = 0.013). Similarly, 1-, 3-, and 5-year RFS rates were higher in the combination therapy group (66.3%, 36.9%, and 31.0%) than in the TACE-only group (55.8%, 23.1%, and 13.8%; p = 0.007). Multivariable analysis confirmed that combination therapy was an independent protective factor for both OS (HR: 0.619, 95% CI: 0.389-0.983) and RFS (0.665, 0.469-0.944). Subgroup analysis showed that in adjuvant therapy and TACE-only, TACE-only was an independent risk factor for OS (1.986, 1.105-3.566) and RFS (1.831, 1.132-2.962) compared with adjuvant therapy (receiving postoperative adjuvant targeted immunotherapy and TACE). Further analysis showed that in the combination therapy subgroup, adjuvant therapy was an independent risk factor for OS (2.701, 1.171-6.230) and RFS (2.051, 1.125-3.739) compared to neoadjuvant therapy (receiving both preoperative neoadjuvant and postoperative adjuvant targeted immunotherapy and TACE). No significant difference in complications/AEs following surgery/TACE was observed between the two groups. Perioperative targeted immunotherapy combined with adjuvant TACE significantly improves OS and RFS in BR-HCC patients without increasing the incidence of complications/AEs following surgery/TACE.

Vascular invasion critically determines intrahepatic and extrahepatic metastasis and early recurrence in hepatocellular carcinoma (HCC), yet its underlying mechanisms remain poorly defined. In this study, we employed EdU proliferation, colony formation, wound healing, transwell, spheroid formation, and immunofluorescence assays, along with xenograft tumor and liver/lung metastasis models, immunohistochemistry, and western blotting to investigate the biological functions of tissue factor (TF) and the therapeutic potential of targeting TF and its downstream signaling. Our results demonstrate that TF is upregulated in HCC tissues and correlates with poor prognosis. TF overexpression significantly enhanced HCC cell proliferation, migration, invasion, and spheroid formation in vitro, and promoted tumor growth and metastasis in vivo. Clinical sample analysis further revealed that high TF expression increases the dissemination potential of circulating tumor cells (CTCs) and circulating tumor microemboli (CTMs) in peripheral blood, thereby facilitating hematogenous spread. Mechanistically, TF activates PAR1 on HCC cell surfaces, leading to activation of both the Wnt/β-catenin and JAK2/STAT3 pathways, with nuclear translocation and accumulation of β-catenin and STAT3. Notably, nuclear STAT3 enhances TF promoter activity, forming a positive feedback loop that sustains downstream signaling. TF also promotes extracellular matrix degradation. Importantly, combined inhibition of TF with β-catenin and STAT3 blockers effectively suppressed HCC tumorigenesis and metastasis both in vitro and in vivo. These findings elucidate the oncogenic role of TF in vascular invasion-mediated HCC metastasis and suggest a promising combinatorial therapeutic strategy for HCC treatment.

Although the application of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) in intrahepatic cholangiocarcinoma (ICC) is still controversial, it continues to be attempted in selected patients. This video case discusses the key technical points for a complete laparoscopic ALPPS (L-ALPPS) of right hemihepatectomy and regional lymph node (LN) dissection for ICC. A 61-year-old ICC patient received L-ALPPS for right hemihepatectomy and regional LN dissection. The patient was deemed suitable as he only had two intrahepatic metastases, all in the right half of the liver, and no LN metastasis. The standardized remnant liver volume ratio (SRLVR) was only 38.17

Background:Lysosomes play an important role in the pathological processes of cancer development. However, its effects on the prognosis and tumor microenvironment of hepatocellular carcinoma (HCC) remain unclear. Therefore, we aim to explore the novel molecular subtypes of HCC via lysosome-related genes (LRGs) for prognosis and therapy prediction in this study. Methods:Using the data of TCGA, differential expression and survival analyses were performed. Consequently, 109 key LRGs were obtained and 374 HCC samples were clustered into two groups: C1 and C2. A three-gene prognostic prediction nomogram was constructed using WCGNA and Cox regression analyses. Furthermore, pathway enrichment conditions, immune infiltration, immune checkpoint expression, and drug sensitivity were analyzed for the two subtypes. RT-qPCR was also used to validate the expression of the selected key LRGs. Results:Key LRGs were highly expressed in the C1 subtype, and their prognosis was worse. The degree of immune cell infiltration and pathway enrichment results were also significantly different between the two subtypes. Furthermore, the three-gene prognostic prediction nomogram including LAPTM4B, PRKCD and LPCAT1, had a relatively high prognostic prediction ability. Meanwhile, the expression of immune checkpoints, human leukocyte antigen, and TIDE score were higher in the C1 subtype, suggesting that immune evasion was more likely to occur in this subtype. Drug sensitivity analysis showed that several drugs were more sensitive to C1 subtypes and might serve as drug candidates for these patients. Conclusion:We identified two novel molecular subtypes of HCC based on LRGs, and found that the LRGs related subtypes demonstrated significant efficacy in predicting the prognosis and therapeutic outcomes for patients with HCC. Moreover, a novel prognostic prediction nomogram was also developed, which possessed excellent prognostic prediction capabilities. We hope the novel LRG-related subtypes and nomogram of HCC would provide new insights and guidelines for clinical practice in the future.

Background: The lack of effective early diagnostic markers is an obstacle in clinical diagnosis and treatment of hepatocellular carcinoma (HCC). Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is an increasing popular approach for identification of clinically relevant parameters including biomarkers. Patients and methods: 540 subjects, including 274 HCC, 119 liver cirrhosis, 89 hepatitis, and 58 healthy volunteers were enrolled. MALDI-TOF MS was used to select potential novel biomarkers from serum of HCC patients. Its clinical application was evaluated by experiments and clinical data analysis. Results: We identified Thymosin beta 4 (T beta 4) in serum by MALDI-TOF MS. The expression of T beta 4 was detected up-regulating in HCC cells and tissues which enhanced motility of HCC cells. More important, the level of serum T beta 4 was significantly elevated in HCC patients. The AUROC showed the optimum diagnostic cut-off was 1063.6 ng/mL, ROC and 95% CI of T beta 4 (0.908; 0.880-0.935) were larger than that of serum AFP (0.712; 0.662-0.762; p < 0.001). The sensitivity (91.3% vs 83.1%) and specificity (81.2% vs 20.3%) of serum T beta 4 were higher than alpha-fetoprotein (AFP). In AFP-negative HCC, the sensitivity could reach to 80.5%. ROC analysis showed serum T beta 4 had a better performance compared with AFP in distinguishing early-stage and small HCC. T beta 4 is correlated with TNM stage (p = 0.016) and vascular invasion (p = 0.005). Survival analysis indicated the survival time of T beta 4 positive patients was shorter (p < 0.001). Cox analysis suggested T beta 4 could be an independent factor for HCC prognosis. Conclusion: T beta 4 may serve as a novel biomarker for HCC diagnosis and prognosis.

With the emergence of new virus variants, limited data are available on the impact of SARS-CoV-2 Omicron infection on surgery outcomes in cancer patients who have been widely vaccinated. This study aimed to determine whether undergoing hepatectomy poses a higher risk of postoperative complications for liver cancer patients who have had mild Omicron infection before surgery. A propensity-matched cohort study was conducted at a tertiary liver center from 8 October 2022 to 13 January 2023. In total, 238 liver cancer patients who underwent hepatectomy were included, with 57 (23.9%) recovering from preoperative SARS-CoV-2 Omicron infection and 190 (79.8%) receiving COVID-19 vaccination. Pre- and post-matching, there was no significant difference in the occurrence of postoperative outcomes between preoperative COVID-19 recovered patients and COVID-19 negative patients. Multivariate logistic regression showed that the COVID-19 status was not associated with postoperative major pulmonary and cardiac complications. However, preexisting comorbidities (odds ratio [OR], 4.645; 95% confidence interval [CI], 1.295–16.667), laparotomy (OR, 10.572; 95% CI, 1.220–91.585), and COVID-19 unvaccinated (OR, 5.408; 95% CI, 1.489–19.633) had increased odds of major complications related to SARS-CoV-2 infection. In conclusion, liver cancer patients who have recovered from preoperative COVID-19 do not face an increased risk of postoperative complications.

Objective. Skin lesion segmentation plays an important role in the diagnosis and treatment of melanoma. Existing skin lesion segmentation methods have trouble distinguishing hairs, air bubbles, and blood vessels around lesions, which affects the segmentation performance. Approach. To clarify the lesion boundary and raise the accuracy of skin lesion segmentation, a joint attention and adversarial learning network (JAAL-Net) is proposed that consists of a generator and a discriminator. In the JAAL-Net, the generator is a local fusion network (LF-Net) utilizing the encoder-decoder structure. The encoder contains a convolutional block attention module to increase the weight of lesion information. The decoder involves a contour attention to obtain edge information and locate the lesion. To aid the LF-Net generate higher confidence predictions, a discriminant dual attention network is constructed with channel attention and position attention. Main results. The JAAL-Net is evaluated on three datasets ISBI2016, ISBI2017 and ISIC2018. The intersection over union of the JAAL-Net on the three datasets are 90.27%, 89.56% and 80.76%, respectively. Experimental results show that the JAAL-Net obtains rich lesion and boundary information, enhances the confidence of the predictions, and improves the accuracy of skin lesion segmentation. Significance. The proposed approach effectively improves the performance of the model for skin lesion segmentation, which can assist physicians in accurate diagnosis well.

Hepatocellular carcinoma (HCC) is a common malignant tumor worldwide. Although the treatment strategies have been improved in recent years, the long-term prognosis of HCC is far from satisfactory mainly due to high postoperative recurrence and metastasis rate. Vascular tumor thrombus, including microvascular invasion (MVI) and portal vein tumor thrombus (PVTT), affects the outcome of hepatectomy and liver transplantation. If vascular invasion could be found preoperatively, especially the risk of MVI, more reasonable surgical selection will be chosen to reduce the risk of postoperative recurrence and metastasis. However, there is a lack of reliable prediction methods, and the formation mechanism of MVI/PVTT is still unclear. At present, there is no study to explore the possibility of tumor thrombus formation from a single circulating tumor cell (CTC) of HCC, nor any related study to describe the possible leading role and molecular mechanism of HCC CTCs as an important component of MVI/PVTT. In this study, we review the current understanding of MVI and possible mechanisms, discuss the function of CTCs in the formation of MVI and interaction with immune cells in the circulation. In conclusion, we discuss implications for potential therapeutic targets and the prospect of clinical treatment of HCC.

腹腔镜技术在肝脏外科领域的应用相较于其它手术起步较晚。1991年Reich首次报道了肝脏边缘的良性肿瘤腹腔镜肝切除术（laparoscopic hepatectomy，LH）[1]。3年后笔者所在中心海军军医大学第三附属医院周伟平报道了国内首例LH[2]。究其原因，一方面肝脏本身特有的脉管系统纵横交错，切除过程中极易出血；另一方面，腹腔镜下肝脏分离暴露困难、操作空间受限、止血手段少、缝合打结困难，且技术娴熟程度以及腔镜器械较为单一，限制了其普及和推广速度。LH容易引起出血原因包括主观因素和客观因素两个方面，如患者的肝功能、凝血功能、肝脏质地和肿瘤特征等客观因素；主刀和团队的腔镜经验和操作熟练程度等主观因素，因此很难单纯通过提高技术来完全杜绝出血的发生[3]。LH的难点在于出血的预防与控制，尤其是近年来随着LH适应证的扩大、手术难度的提高、断肝过程复杂性的增加，术中管道损伤、出血的风险也随之增加。笔者结合文献及所在团队的经验对LH出血陷阱的防控策略作以下总结，希望对同行们能有所裨益。

随着深度学习的发展,基于文本生成的隐写术取得了重大突破.现有基于文本生成的方法存在暴露偏差的问题,即训练阶段每个输入都来自真实样本标签,预测阶段的输入来自上一时刻预测的输出.训练和预测之间的输入样本差异会产生误差积累,使得生成样本与真实样本分布相差过大.针对这个问题,提出了一种基于生成对抗网络和多头注意力的文本隐写术—TS-GANMA.首先,利用生成对抗网络训练文本生成器,通过多头注意力机制提取多头注意力得分参与奖惩模块的奖励计算,得到更适合生成器的反馈信息.随后,生成器与鉴别器进行对抗训练,能够解决暴露偏差的问题,优化文本生成模型.最后,对文本生成模型输出的条件概率分布进行编码,实现秘密信息嵌入.实验结果表明,在相同的嵌入率时,TS-GANMA隐写术与 LSTM-vlc 和 ADG 相比,隐写文本的困惑度有显著的降低,这是因为采用TS-GANMA进行文本隐写,生成的隐写文本与真实文本的统计分布更加拟合,生成的隐写文本质量更高.

Objectives: To explore the effects of perioperative SARS-CoV-2 Omicron infection on postoperative complications in patients with liver cancer. Methods: A propensity-matched study was conducted, which included patients with primary liver cancer who underwent hepatectomy from September 01, 2022 to January 20, 2023. Patients who infected SARS-CoV-2 Omicron during the perioperative period (7 days before to 30 days after surgery) were matched 1:1 with noninfected patients. The primary outcomes, which were COVID-19-related major complications and liver resection-specific complications, were analyzed using multivariate logistic regression. Results: A total of 243 patients were included, with 63 cases of perioperative infections, of which 62 were postoperative infections. The overall 30-day postoperative mortality rate was 1.6% (4/243). Compared to noninfected patients, those with perioperative infections showed no significant difference in the occurrence of adverse postoperative outcomes. However, they had a higher rate of 30-day readmission after surgery (11.1% vs 0%, P = 0.013). Perioperative SARS-CoV-2 infection was not associated with “major cardiorespiratory complications” or “liver resection-specific complications”, but age, pre-existing comorbidities, and tumor type were related to these outcomes. Conclusion: Perioperative SARS-CoV-2 Omicron infection did not increase the incidence of postoperative complications in patients with liver cancer. However, those patients had a higher rate of 30-day readmission after surgery.

现有的深度哈希图像检索方法主要采用卷积神经网络，提取的深度特征的相似性表征能力不足.此外，三元组深度哈希主要从小批量数据中构建局部三元组样本，样本数量较少，数据分布缺失全局性，使网络训练不够充分且收敛困难.针对上述问题，文中提出基于类相似特征扩充与中心三元组损失的哈希图像检索模型（Hash Image Retrieval Based on Category Similarity Feature Expansion and Center Triplet Loss, HRFT-Net）.设计基于Vision Transformer的哈希特征提取模块（Hash Feature Extraction Module Based on Vision Transformer, HViT）,利用Vision Transformer提取表征能力更强的全局特征信息.为了扩充小批量训练样本的数据量，提出基于类约束的相似特征扩充模块（Similar Feature Expansion Based on Category Constraint, SFEC）,利用同类样本间的相似性生成新特征，丰富三元组训练样本.为了增强三元组损失的全局性，提出基于Hadamard的中心三元组损失函数（Central Triplet Loss Function Based on Hadamard, CTLH）,利用Hadamard为每个类建立全局哈希中心约束，通过增添局部约束与全局中心约束的中心三元组加速网络的学习和收敛，提高图像检索的精度.在CIFAR10、NUS-WIDE数据集上的实验表明，HRFT-Net在不同长度比特位哈希码检索上的平均精度均值较优，由此验证HRFT-Net的有效性.

在一致性正则化与熵最小化的基础上提出一种新的半监督学习算法Mean Mixup,集成数据的互补信息,然后使用熵最小化给未标记数据生成可靠的伪标签,在一致性正则化下进一步优化模型分类结果.在常用数据集SVHN和CIFAR10上对Mean Mixup算法进行了评估,实验结果表明,所提出的方法在分类准确率上优于一些已有的半监督学习算法.

目的 探讨不同肝门阻断对肝细胞癌(Hepatocellular carcinoma,HCC)患者术后预后的影响.方法 选取我院接受肝肿瘤切除术且肝门阻断时间在20～30分钟的274例HCC患者,分为持续性肝门阻断(持续组)和间断性肝门阻断(间断组),比较两组患者预后.结果 持续组(n=135)相比间断组(n=139),术后并发症发生率为11.9％vs.20.9％,差异有统计学意义(P=0.044).围手术期死亡率均为0.术后1、3、5年总体生存率和肿瘤复发率为86.6％、56.8％、30.9％vs.89.2％、62.7％、35.9％和28.1％、61.7％、80.0％vs.28.8％、53.3％、79.3％,差异无统计学意义(P =0.423;P=0.527).结论 肝肿瘤切除术中,阻断时间在20～30分钟的持续性肝门阻断和间断性阻断相比,术后并发症发生率更低,围手术期死亡、总体生存、肿瘤复发率无明显差异.

Background: Hepatocellular carcinoma (HCC), the fourth leading cause of cancer-related deaths worldwide, has risen public concern. Data from previous work have validated that long noncoding RNAs are active participators in the malignant processes of a host of cancers. Small nucleolar RNA host gene 7 (SNHG7) has been revealed to act as a tumor promoter in several cancers and SNHG7 inhibition was revealed to suppress cell invasion in HCC. Nevertheless, the specific role of SNHG7 in HCC deserves deeper exploration. Aim of the Study: This work aimed to uncover the role and the regulatory mechanisms of SNHG7 in HCC. Materials and Methods: The expression of SNHG7 and cyclin mediator 1 (CNNM1) in HCC cells were analyzed by quantitative real-time polymerase chain reaction. The influences of SNHG7 on HCC occurrence were studied by cell counting kit-8 (CCK-8), colony formation, flow cytometry analysis, and western blot assays. Luciferase reporter assay or RNA immunoprecipitation assay was conducted to confirm the relationship between miR-9-5p and SNHG7 (or CNNM1). Results: SNHG7 was overexpressed in HCC tissues and cell lines. SNHG7 facilitated cell proliferation, while suppressed cell apoptosis in HCC. Moreover, miR-9-5p expression was negatively modulated by SNHG7 and therefore was downregulated in HCC cells. We also found that CNNM1 existed in miR-9-5p induced RNA-induced silencing complex and a series of assays verified that CNNM1 acted as the target gene of miR-9-5p. Consequently, the messenger RNA and protein level of CNNM1 were detected to be inversely regulated by miR-9-5p. Moreover, rescue assays demonstrated that CNNM1 overexpression could countervail the SNHG7 depletion-mediated cellular functions of HCC cells. Conclusions: SNHG7 sponges miR-9-5p to upregulate CNNM1 in promoting HCC progression.

Background The tumor immune microenvironment is pivotal in predicting clinical outcomes and therapeutic efficacy in cancer patients. This study aims to develop an immune prediction model (IPM) to effectively predict prognosis and immunotherapeutic response in patients with hepatocellular carcinoma (HCC). Methods An IPM was constructed and validated based on immune-related genes. The influence of IPM on the HCC immune microenvironment, as well as the possible mechanism, was comprehensively analyzed. The value of the model in predicting the response of HCC patients to immunotherapy was also evaluated. Results A novel IPM based on eight genes was developed and validated to predict the prognosis of HCC patients. These genes are matrix metalloproteinase 12 (MMP12), heme oxygenase 1 (HMOX1), C-X-C motif chemokine receptor 6 (CXCR6), hepatoma-derived growth factor (HDGF), placental growth factor (PGF), tyrosine kinase 2 (TYK2), retinoid X receptor beta (RXRB), and cyclin-dependent kinase 4 (CDK4). High-risk patients showed significantly poorer survival than low-risk patients. A nomogram was also established based on the IPM and tumor, node, metastasis (TNM) classification, which showed some net clinical benefit. Gene set enrichment analysis (GSEA) revealed several significantly enriched oncological signatures and immunologic signatures. Furthermore, high-risk patients were characterized by severe clinicopathological characteristics and immune cell infiltration. Finally, we found the that the IPM showed a significant positive correlation with programmed cell death 1 (PDCD1), cluster of differentiation 274 (CD274), and cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) expression, suggesting a potentially enhanced effects of immunotherapy antibodies in HCC patients with a high risk score. Conclusions A novel IPM that could predict clinical prognosis and immunotherapeutic response in HCC patients was developed. Our findings not only provide new insights into the identification of HCC patients with poor survival, but also deepen our understanding of the immune microenvironment, as well as the mechanism of immunotherapy, in HCC.

Objective: To explore a method for culturing hepatocellular carcinoma and tumor-infiltrating lymphocytes (HCC-TIL) and investigate the mechanism of TIL in killing tumors. Methods: The distribution of regulatory T cells (Treg) in HCC was detected by immunohistochemistry. Conventional TIL and oligoclonal TIL were isolated by the traditional method of enzyme digestion combined with mechanical treatment for whole HCC and micro HCC tissue block culturing method. MTT was used to compare the killing activity of TIL. Flow cytometry was used to analyze the proportion of CD8+ T cells and Treg cells in TIL. Tumor-bearing mice were established, and TIL adoptive immunotherapy was performed. Results: Treg cells were mainly distributed in the stroma of HCC. In vitro experiments showed oligoclonal TIL had higher cytotoxicity to tumor cells which negatively correlated with the proportion of Treg cells. In vivo experiments showed oligoclonal TIL had a higher anti-tumor effect. IFN-γ in peripheral blood and the positive rate of intratumoral lymphocytic infiltration in oligoclonal TIL group were both higher. TGF-β and IL-10 in peripheral blood and the positive rate of intratumoral FoxP3 and IL-17 were both lower than those in conventional TIL group. Conclusion: The oligoclonal TIL culture method could obtain TIL with higher purity, and cytotoxicity to tumor cells was associated with Treg cells. The oligoclonal TIL had cytotoxicity to autologous HCC cells and significant inhibitory effect on the growth of transplanted tumors. The mechanism might be associated with the inhibition of Treg cells proliferation, increase of IFN-γ secretion, and decrease of TGF-β, IL-10, and IL-17 secretion.

BACKGROUND:Statins can reduce the malignancies through stimulating apoptosis. We aimed to elucidate the role of lovastatin in HepG-2 cells.METHODS:HepG-2 and non-tumor L-O2 cells were used as the cell models. CCK-8, flow cytometric analysis and carboxy fluorescein diacetate succinimidyl ester (CFDA-SE) labeling were performed to monitor the viability, apoptosis and proliferation.RESULTS:We found that lovastatin exerted the most tumor suppressing effects on liver cancer cells among the three tested statins. Lovastatin treatment significantly reduced cell viability and proliferation, and induced apoptosis in HepG-2. However, drug resistance effects were observed in the non-tumor L-O2 cells. The apoptosis triggered by lovastatin was accompanied by high intracellular levels of ROS. Pretreatment with the ROS blocker N-acetyl-cysteine (NAC) could mitigate the lovastatin-induced cytotoxicity in HepG-2 cells. Mechanistically, lovastatin increased HepG-2 cell apoptosis by triggering mitochondrial and endoplasmic reticulum (ER) stress pathways through ROS accumulation.CONCLUSIONS:Lovastatin significantly induced cell apoptosis by activating ROS-dependent mitochondrial and ER stress pathways in HepG-2 cells.

Objective To investigate the application value of hepatic portal reocclusion for the prevention of bile leakage after hepatectomy. Methods In this prospective study, 197 patients who underwent hepatectomy alone in the Eastern Hepatobiliary Surgery Hospital of the Second Military Medical University between March 2014 and November 2014 were recruited. According to the random number talbe method, the patients were divided into the hepatic portal reocclusion group (n=99) and traditional surgery group (n=98). In the hepatic portal reocclusion group, 81 cases were males and 18 females, aged (54±11) years old on average. Among them, 89 cases were diagnosed with primary liver cancer and 10 with benign liver lesions. After the liver resection with Pringle maneuver, the first porta hepatis was reoccluded to elevate the pressure of intrahepatic blie duct, and the bile duct was examined and tightly sutured. In the traditional surgery group, 82 cases were males and 16 females, aged (52±10) years old on average. Among them, 91 cases were diagnosed with primary liver cancer and 7 with benign liver lesions. The liver resection was performed using Pringle maneuver. The informed consents of all patients were obtained and the local ethical committee approval was received. The perioperative status and prognosis were observed and compared between two groups. The hepatic portal occlusion time and operation time between two groups were compared using t test or Kruskal-Wallis rank test. The rates were compared using Chi-square test or Fisher's exact probability test. Results The frequency of hepatic portal occlusion in the hepatic portal reocclusion group was 2(1-4), significantly higher than 1(1-3) in the traditional surgery group (Z=0.000, P<0.05). The hepatic portal occlusion time in the hepatic portal reocclusion group was (21±10) min, significantly longer than (17±9) min in the traditional surgery group (t=0.001, P<0.05). The postoperative length of hospital stay in the hepatic portal reocclusion group was (8±3) d, significantly shorter than (9±3) d in the traditional surgery group (t=-0.040, P<0.05). The incidence of postoperative bile leakage in the hepatic portal reocclusion group was 1%(1/99), significantly lower than 9%(9/98) in the traditional surgery group (χ2=6.830, P<0.05). The symptoms of bile leakage were effectively controlled after short-term drainage. Conclusions Application of hepatic portal reocclusion can effectively reduce the incidence of bile leakage after hepatectomy, and provides a simple and efficacious approach to prevent the incidence of bile leakage for the surgeons. Key words: Hepatectomy; Biliary fistula; Hepatic portal reocclusion

BACKGROUND/AIMS:To explore the possibility and feasibility of hepatic portal reocclusion for detecting bile leakage during hepatectomy.METHODS:Data were prospectively collected from 200 patients who underwent hepatectomy alone for removal of various benign or malignant tumors between March 2014 and November 2014. The surgical procedure used a conventional method for all patients, and one additional step (hepatic portal reocclusion) was included in group B. The postoperative outcomes of the patients in group A (subjected to the traditional procedure) and group B (subjected to hepatic portal reocclusion) were compared during the same period, and the incidence rates of postoperative bile leakage and other complications in the 2 groups were also analyzed.RESULTS:The incidence of postoperative bile leakage in group B was significantly lower than that in group A (1.0 vs. 9.2%, p = 0.009), although no significant differences in postoperative indicators of liver dysfunction and other complications were observed between the 2 groups (p > 0.05).CONCLUSIONS:Hepatic portal reocclusion effectively reduced the incidence of bile leakage compared to the traditional procedure, without significantly affecting liver function. Therefore, this method might be an alternative to other tests for bile leakage.