Great progress has been made in the surgical treatment of hepatocellular cancer (HCC) in recent years. Extended hepatectomy plays a predominant role in the treatment of HCC. Extended hepatectomy is effective but its indication should be controlled strictly when applied. In this article, the author summarize the recent advances in extended hepatectomy of HCC in terms of indications, preoperative evaluation, therapeutic effects, operative complications, controversy and suggestions.

Objective: To investigate the safety and feasibility of hemihepatectomy using anterior approach with liver hanging maneuver in patients with liver cirrhosis. Methods: From January 2008 to June 2011, 45 patients with liver cirrhosis scheduled for hemihepatectomy were selected and randomly designated either to using anterior approach with liver hanging maneuver (anterior approach group, 22 cases) or conventional approach (conventional group, 23 cases). Comparisons were conducted between the two groups in respect to the operative time, intraoperative blood loss, number of blood transfusion required, length of hospital stay and complications as well as the perioperative liver function parameters. Results: Operations were successfully performed in all patients of the two groups. In anterior approach group, 17 cases underwent right hepatectomy, 5 cases underwent left hepatectomy and the retrohepatic tunnel in all of them was created successfully. In conventional group, 19 cases underwent right hepatectomy and 4 cases underwent left hepatectomy. Compared with conventional group, anterior approach group had reduced intraoperative blood loss and number of blood transfusion required, shortened operative time, fewer postoperative complications, faster recovery of postoperative alanine aminotranferease (ALT) and aspartate aminotransferase (AST) levels (all P<0.05). No significant differences were seen in the length of hospital stay and change of postoperative total bilirubin (TBIL) level between the two groups (all P>0.05). Conclusion: Hemihepatectomy using anterior approach with liver hanging maneuver in patients with liver cirrhosis is safe and feasible, because it can reduce the intraoperative blood loss and operative time and accelerate liver function recovery.

Objective: To investigate the clinical efficacy of anatomic hemihepatectomy guided by middle hepatic vein (MHV). Methods: The clinical data of 58 patients undergoing hemiliver resection from March 2010 to December 2011 were retrospectively analyzed. In all the patients, the liver transection plane was defined following the course of MHV after it was completely exposed during the early stage of operation, and then the anatomic left or right hemihepatectomy was performed. Results: In the entire group, the average operative time was 5.78 (4.5–13) h, and average intraoperative blood loss was 238.3 (100–2 000) mL. No complications such as subphrenic abscess, bile leakage or hemorrhage occurred, and the average length of hospital stay of the patients was 12.5 (9–25) d. Conclusion: Resection plane along the course of MHV is a rational and correct option for anatomic hemihepatectomy.

Objective: To compare the clinical efficacy of anterior approach and conventional right liver resection for treatment of large right lobe liver tumors. Methods: The clinical data of 30 patients (observation group) with hepatocellular carcinoma undergoing anterior approach right hepatectomy from January 2007 to December 2009 were retrospectively analyzed, and another 30 similar patients undergoing conventional hepatectomy during the same period served as control group. The surgical efficacies between the two groups of patients were compared. Results: The average tumor size in observation group was larger than that of control group (P<0.05). There were no significant differences in operative time and number of tumor rupture cases between the two groups (both P>0.05), while the average amount of intraoperative blood loss, number of patients who had massive hemorrhage or required blood transfusion during operation, and average length of hospital stay in observation group were significantly reduced compared with control group (all P<0.05). The rates of postoperative complications, mortality, and recurrence between the two groups showed no obvious differences (all P>0.05), but the 1- and 3-year survival rate in patients of observation group were significantly higher than those of control group (both P<0.05). Conclusion: The anterior approach right hepatectomy can be used as the option of choice for large right lobe liver tumors, as it can reduce intraoperative bleeding and the rate of postoperative complications and death, and can increase survival rate of the patients.

Objective: To determine the feasible resection approach for giant cavernous liver hemangiomas in close proxmity to the porta hepatis region. Methods: The clinical data of 35 patients with giant cavernous hemangiomas adjacent to the liver hilum undergoing surgical treatment from April 2008 to March 2012 were retrospectively analyzed. Results: The range of intraoperative blood loss of the entire group was 100–7 000 mL. Different methods of hepatic inflow occlusion and surgical procedures were performed according to the tumor location and size. Of the patients, 11 cases underwent Pringle maneuver, 9 cases underwent modified Pringle maneuver and 15 cases underwent hemihepatic vascular occlusion; 24 cases were treated by extracapsular enucleation, 10 cases by liver resection and 1 case by suture ligation. The associated complications occurred in 18 patients after surgery, and no surgical death occurred. Conclusion: The essential points in operation for the giant cavernous hemangiomas near to the liver hilum are control and management of bleeding, and preservation of the normal hepatic parenchyma as much as possible and in addition, the operation is safe and feasible under the proper hepatic inflow occlusion and resection methods.

Objective: To assess the clinical efficacy of percutaneous thermal ablation and liver resection for small hepatocellular carcinoma by means of systematic review. Methods: The randomized controlled trials concerning percutaneous thermal ablation and hepatectomy for treatment of small liver cancer were collected through literature retrieval from native and foreign databases. The quality of included studies was assessed according to the Cochrane systematic review method and statistical analysis of data was performed using RevMan 5.1.17 software. Results: Four randomized controlled studies finally met the inclusion criteria, with a total of 683 patients, of whom, 340 cases underwent percutaneous thermal ablation and 343 cases underwent hepatectomy. The results of meta-analysis indicated that the 1- and 3-year overall survival rate, 1-year tumor-free survival rate and 1-year local tumor recurrence rate in the patients undergoing either of the two methods had no statistical difference (all P>0.05). The 3-year disease-free survival rate and 2-year local tumor recurrence rate in patients undergoing liver resection were better than those in patients with percutaneous thermal ablation (both P<0.05). The incidence of major complications in patients receiving percutaneous thermal ablation was significantly lower than that in patients undergoing liver resection (P<0.05), and patients after percutaneous thermal ablation showed shorter hospital stay, lower cost and better systemic conditions. Conclusion: For small liver cancer, percutaneous thermal ablation and liver resection present similar short-term efficacy, but liver resection has better long-term results.

Objective: To observe the liver function and histological alterations in rats after portacaval transposition (PCT). Methods: Seventy-two male SD rats were equally randomized into experimental group and control group. Rats in experimental group underwent PCT operation by end-to-end anastomosis of the proximal portal vein to the distal inferior vena cava, and end-to-end connection of the distal portal vein to the proximal inferior vena cava, while rats in control group underwent transient blood flow blockage of the portal vein and inferior vena cava for the same periods of the anhepatic phase as their counterparts in experiment group. At 6, 12 and 24 h, and 3, 7 and 28 d after surgery, 6 rats in each group at each time point were sacrificed, respectively. The serum levels of alanine aminotranferease (ALT) and aspartate aminotransferase (AST) in rats of the two groups were measured, the pathological examination and hepatocyte apoptosis assay of liver tissues were performed and the expression of the proliferating cell nuclear antigen (PCNA) in the liver tissues were also determined. Results: The serum levels of ALT and AST in rats of experimental group were significantly higher than those of control group at 6 and 12 h after operation (all P<0.05), both of which presented a declining trend and showed no significant difference with those of control group at 3, 7 and 28 d after operation (all P>0.05). The pathological examination showed that the liver tissues in control group were generally normal, and in experimental group showed mild pathological changes such as cellular swelling, spotty necrosis and small amount of inflammatory cell infiltration, which were most evident at 6 h after operation. A small amount of apoptotic liver cells were seen in both groups at each observation time points, but no significant difference was noted in the apoptotic index (AI) between the two group (all P>0.05). The PCNA expressions in the livers of experimental group were significantly higher than those of control group at 24 h, 3 and 7 d after operation (all P<0.05), but were decreased at 28 d after operation and showed no difference with that of control group (P>0.05). Conclusion: PCT can cause a certain degree of liver impairment in short-term of postoperative period, but it may not exert obvious impact on cell proliferation and apoptosis of the liver in long-term period.

Objective: To investigate the effect of docosahexaenoic acid (DHA) on proliferation and apoptosis of human hepatocellular carcinoma Bel-7402 cells and its mechanism. Methods: The cell proliferation characteristics and expressions of Bcl-2 and Bax proteins after exposure of Bel-7402 cells to different concentrations of DHA (0, 25, 50, 100 and 200 μmol/L) for different time periods (24, 48 and 72 h) were measured by MTT assay and Western blot analysis, respectively. Moreover, the apoptosis, Bim gene expression and caspase-3 activity in Bel-7402 cells exposed to the above concentration gradients of DHA for 48 h were determined by flow cytometry, real-time PCR and caspase-3 activity assay kit, respectively. Results: Different concentrations and time periods of DHA treatments showed that the proliferation of Bel-7402 cells was significantly inhibited in a concentration- and time-dependent manner (all P<0.05), and the Bax protein expression was increased while Bcl-2 protein expression was decreased in Bel-7402 cells in a concentration-dependent (all P<0.05) but time-independent manner (both P>0.05). After exposure to different concentrations of DHA for 48 h, the apoptosis, Bim gene expression and caspase-3 activity of Bel-7402 cells were all significantly increased in a concentration dependent manner (all P<0.05). Conclusion: DHA can inhibit the proliferation and induce the apoptosis of Bel-7402 cells, and the mechanism may possibly be associated with the activation of the mitochondrial apoptotic pathway.

Objective: To investigate the golgi protein 73 (GP73) expression in hepatocellular carcinoma (HCC) tissue and its relations with the clinicopathologic characteristics of the HCC patients. Methods: The expressions of GP73 mRNA and protein in 20 cases of HCC and their adjacent tissues as well as normal liver tissues of 10 cases were detected by RT-PCR and Western blot method, respectively, and the relations of its expression level with the clinicopathologic variables of the patients were analyzed. Results: Both expressions of GP73 mRNA and protein in the HCC tissues were significantly higher than those in their adjacent tissues and normal liver tissues (1.25±0.17 vs. 0.62±0.06 and 0.46±0.03; 2.20±0.26 vs. 0.87±0.07 and 0.26±0.04) (all P<0.05). The expression levels of GP73 mRNA and protein were significantly different between the groups stratified according to whether vascular invasion was present and the tumor differentiation grade, both of which were significantly higher in patients with vascular invasion and showing lower tumor differentiation grade than those in patients without vascular invasion and showing high tumor differentiation grade (both P<0.05). However, GP73 expression showed no obvious relations with the age, gender, tumor size and number and α-fetoprotein (AFP) level of the patients (all P>0.05). Conclusion: GP73 expression is increased in HCC tissue, and its expression level is closely related to invasive ability of HCC and therefore, it may serve as a potential marker for estimating the invasive ability and postoperative recurrence and metastasis of HCC.

Objective: To investigate the diagnostic value of the combination detection of the glypican 3 (GPC-3) mRNA expression in peripheral blood monouclear cells (PBMC) and plasma level of γ-glutamyl transpeptidase (GGT) for patients with α-fetoprotein (AFP)-negative hepatocellular carcinoma (HCC). Methods: The PBMC GPC-3 mRNA expressions in 39 patients with AFP-negative HCC, 39 patients with non-HCC liver diseases and 40 healthy volunteers were determined by RT-PCR method, and the plasma GGT levels (>58 U/L was considered as positive) in the 39 AFP-negative HCC cases were measured by using automatic biochemical analyzer. The positive rates by single or combination of the two detections were analyzed. Results: The detection rate of PBMC GPC-3 mRNA expression in the 39 AFP-negative HCC patients was 62% (24/39), while none of the cases in patients with non-HCC liver diseases and healthy subjects presented positive expression of PBMC GPC-3 mRNA, thus the specificity of PBMC GPC-3 mRNA for AFP-negative HCC was 100%. The positive rate of GGT elevation in the 39 AFP-negative HCC patients was 80% (31/39). The positive rate of the combination detection of PBMC GPC-3 mRNA and GGT reached 95%, which was significantly higher than that of either GPC-3 mRNA or GGT alone (both P<0.05). Conclusion: PBMC GPC-3 mRNA expression has a high specificity in AFP-negative HCC patients. The combination detection of GPC-3 mRNA and GGT is helpful to the early diagnosis of AFP-negative HCC.

Objective: To investigate the prognostic influence of tumor deposits (TDs) in patients after radical resection of gastric cancer. Methods: One hundred patients with stomach cancer undergoing radical operation over the past 6 years were selected. The surgical specimens of the patients were pathologically examined to analyze the relations of TDs with the pathological features of the patients. In addition, survival analysis was conducted according to the follow-up data of the patients. Results: Eighteen (18%) patients presented TDs positive results. Compared with the TDs negative patients, the TDs positive cases had large tumor size [(5.62±2.48) cm vs. (4.83±2.17) cm], high ratio of low differentiated tumors (66.7% vs. 51.2%), increased number of metastatic lymph nodes (9.2±8.4 vs. 5.3±7.5), high proportion of stage III gastric cancer (88.9% vs. 36.6%), and decreased survival rate (27.8% vs. 56.3%); all the differences had statistical significance (all P<0.001). Conclusion: TDs can be used as a prognosis factor for patients with gastric cancer after radical gastrectomy, and its positivity indicates a poor outcome.

Objective: To investigate the influential factors and prophylactic methods for portal venous thrombosis (PVT) after splenectomy and gastric pericardial devascularization. Methods: The clinical data of 1 300 patients with cirrhotic portal hypertension undergoing splenectomy and gastric pericardial devascularization over 12 years were reviewed. The incidence of PVT after operation was observed and the influential factors for PVT were analyzed. Results: The incidence of PVT after operation in the entire group was 30.15% (392/1 300). Statistical analysis showed that the postoperative PVT was associated with patients' age, concomitant diabetes, degree of esophagogastric varices, hepatic function grade, portal pressure, D-dimer level and spleen size as well as whether they received anticoagulant therapy (all P<0.05), but it was irrelevant to the sex, operative time and intraoperative blood loss of the patients (all P>0.05). Conclusion: Age, liver function, portal pressure, concomitant diabetes and spleen size are the influential factors for PVT following splenectomy and gastric pericardial devascularization, and anticoagulant therapy may reduce the incidence of postoperative PVT.

Objective: To investigate the clinical value of using probiotics in patients after liver transplantation. Methods: Fifty-five patients were randomly allocated either to probiotics treatment group or control group after receiving liver transplantation. All patients received immunosuppressant therapy after operation, while those in probiotics treatment group were additionally given bifidobacterium tetravaccine tablets for one week (siliankang, 1.5 g, 3 times daily). The serum levels of total bilirubin (TBIL), alanine aminotransferase (ALT), albumin (ALB) and prealbumin (PA) of the patients were measured before operation and on postoperative day (POD) 2, 5 and 8, respectively. In addition, the incidences of postoperative infection and gastrointestinal adverse events of the patients were observed and recorded. Results: The serum levels of TBIL and ALT between the two groups showed no difference before operation and on POD 2 (all P>0.05), but TBIL and ALT level in probiotics treatment group began to decrease significantly on POD 8 and POD 5 respectively compared with control group (both P<0.05). The serum levels of ALB and PA of the two groups had no obvious difference before operation and on POD 2, but both levels in probiotics treatment group were significantly higher than those of control group on POD 5 and 8 (all P<0.05).The incidences of infection and gastrointestinal adverse events of probiotics group and control group were 41.38% vs. 17.24% (P=0.038) and 69.23% vs. 42.31%) (P=0.041) respectively during the first week after operation. Conclusion: Application of probiotics can improve the nutritional status, promote liver function recovery, decrease the inflammatory response, and reduce the incidence of infection and gastrointestinal adverse reaction in patients after liver transplantation.

Objective: To investigate the regional characteristics of gastroesophageal reflux disease (GERD) causing respiratory symptoms and therapeutic effect of laparoscopic fundoplication combined with highly selective vagotomy in patients with this condition. Methods: The clinical data of 15 patients with GERD from Shuanglong Town of Baotou City, Inner Mongolia admitted between May 2011 to July 2012 were retrospectively analyzed. Results: Of the 15 GERD patients, 8 were males and 7 were females with average age of (50.00±6.88) years, and prominent respiratory symptoms in the majority of them. All of them underwent laparoscopic fundoplication plus highly selective vagotomy. The average operative time was 65 min, and no evident complications were noted. The average follow-up was (11.4±2.7) months, and the respiratory symptoms as well as other symptoms were significantly improved in all patients. Conclusion: GERD-induced respiratory symptoms is associated with the climatic conditions in the geographic region in which the patients live, as well as their lifestyle and eating habits. Laparoscopic fundoplication plus highly selective vagotomy is a favorable treatment procedure for GERD with prominent respiratory symptoms.

Objective: To investigate the utilization of damage control operation (DCO) in treatment of the severe thoracoabdominal injuries dominated by abdominal trauma. Methods: The clinical data of 71 patients with severe thoracoabdominal wounds admitted from March 2008 to June 2011 were retrospectively analyzed. Of the patients, 41 cases received DCO procedure, and another 30 cases underwent primary definitive surgery. Results: There were no significant differences in the lactate levels, pH value, body temperature, and prothrombin time (PT) between the DCO patients after resuscitation and patients undergoing primary definitive surgery (all P>0.05). All of the 71 patients were cured and discharged from hospital, while the patients receiving DCO had significantly lower incidence of adhesive ileus and infection compared with those undergoing primary definitive surgery (both P<0.05). Conclusion: DCO is a better treatment strategy for patients with severe thoracoabdominal injuries under the condition of a correct understanding of its indications.

Due to the special anatomical position of the liver caudate lobe and its complex blood supply and venous and bile drainage, its operative approach is difficult and risky, thus, the investigation of its applied anatomy and surgical approach has great importance. In this paper, the authors, based on the related literature review, address the issues of this concern.

Hepatic ischemia-reperfusion (IR) injury is a major cause of liver damage, and has become a hot and difficult field of study. Recent investigations reveal that heat shock protein 70 (HSP70) plays a critical role in protection of tissues and organs against IR injury. This paper overviews the actions of HSP70 in liver IR injury, which puts a special emphasis on the mechanisms underlying its protective effect such as regulation of inflammation factors, and anti-apoptotic and antioxidative effect.

Livin, a novel member of inhibitor of apoptosis proteins (IAP), is overexpressed in a variety of tumor tissues. Investigation of its structure and function, and its mechanisms of action has important significance for understanding the occurrence and development of the tumors and anticancer drug screening as well as treatment planning and prognosis estimation for cancers. This paper overviews the recent progress in the above relevant issues.