The progress of liver surgery is characterized by precision, minimal invasion and effectiveness in the early 21st century. Hepatectomy, as the mainstay treatment for hepatocellular carcinoma (HCC), has entered a precise era. However, key techniques involved in the precise hepatectomy for HCC remain unclear at present. The author, based on the systematic clinical investigations, proposes that the key techniques involve four aspects: accurate assessment and planning, precise dissection of the porta hepatis, meticulous hepatic parenchyma transaction and sophisticated postoperative management. There is an urgent need for the standardization of the key techniques of precise hepatectomy for HCC, and the evaluation of the efficacy and safety of precise hepatectomy for HCC from the perspective of evidence-based medicine, so as to further disseminate the precise hepatectomy as an appropriate technique in the country.

Objective: To evaluate the influence of Chen’s simplified technique of total hepatic vascular occlusion (Pringle’s maneuver plus infrahepatic vena cava occlusion) on the degree of bleeding from the cut surface of the liver. Methods: The clinical data of 280 patients undergoing liver resection from January 2010 to January 2013 were reviewed. The severity of bleeding from the cut surface of the liver was classified as grade 0 to grade IV, according to the clearness of operative field. Changes of the degree of bleeding of the liver section surface were recorded after performing the first hepatic portal occlusion (Pringle maneuver) and Chen’s occlusion. Results: The operative field was excellent in 98 (98/280, 35%) cases of the 280 patients after Pringle’s maneuver, which was classified as grade 0 in 45 cases and grade I in 53 cases. Of the remaining 182 patients undergoing additional infrahepatic vena cava occlusion, satisfactory operative field was achieved in 115 (115/280, 41.1%) cases, which was classified as grade 0 in 55 cases and grade I in 60 cases; the degree of bleeding from the cut surface was lessened in 47 (47/280, 16.8%) cases, which was classified as grade II in 39 cases and grade III in 8 cases, and showed no obvious improvement in 13 (13/280,4.6%) cases, which was classified as grade II in 10 cases and grade III in 3 cases; 3 (3/280, 1.1%) cases who developed massive hemorrhage due to the injury of the trunk of the hepatic veins were classified as grade IV; the procedure was abandoned in 4 (4/280, 1.4%) cases because the blood pressure dropped to below 60 mmHg (1 mmHg=0.133 kPa). Conclusion: Chen’s simplified total hepatic vascular occlusion can safely and effectively control bleeding from the cut surface during liver transection, is easy to perform, and may facilitate a bloodless and precise liver resection.

Objective: To investigate the influence of the anterior approach hepatectomy with selective inflow occlusion on the reperfusion injury in the contralateral non-tumor liver tissue and remnant liver function in treatment of huge hepatocellular carcinoma (HCC). Methods: Forty-five patients with huge HCC (≥10 cm in diameter) were divided into observational group and control group using Zelen’s single randomized consent design. Patients in control group underwent the conventional hepatectomy with total hepatic inflow occlusion, while those in observational group underwent anterior approach hepatectomy with selective inflow occlusion and a small contralateral non-tumor tissue specimen was taken from each patient in both groups after tumor removal. The levels of total bilirubin (TBIL), alanine transaminase (ALT) and prealbumin (PA) in the two groups of patients at one week after surgery were measured, and the apoptosis, and the parameters of intracellular calcium ion concentration ([Ca2+]i), malondialdehyde (MDA) content and superoxide dismutase (SOD) activity in contralateral non-tumor tissues were also determined. Results: Compared with control group, the ALT release was decreased and PA level was increased significantly (both P<0.05), while the TRIL level showed no obvious difference (P>0.05) at one week after surgery in observational group; the apoptosis, [Ca2+]i and MDA content was significantly reduced, while the SOD activity was significantly elevated in the contralateral non-tumor tissue in observational group (all P<0.05). Conclusion: Compared with conventional procedure, anterior approach hepatectomy with selective inflow occlusion for huge HCC is superior in reducing reperfusion injury of the contralateral non-tumor liver tissue and improving the function of remnant liver.

Objective: To compare the efficacy and safety of radiofrequency ablation (RFA)-assisted anterior approach right hepatectomy between conventional right liver resection for central liver tumors. Methods: Sixty patients with central liver tumor were equally designated, using random number table, to control group and observational group. Patients in control group underwent conventional right liver resection, and patients in observational group underwent RFA-assisted anterior approach hepatectomy. The intraoperative conditions, length of postoperative hospital stay, incidence of postoperative complications and 5-year survival between the two groups were compared. Results: There was no statistical difference in operative time between the two groups (P>0.05), however, the intraoperative blood loss, the number of cases with intraoperative tumor rupture and massive haemorrhage, the number of cases requiring blood transfusion, and length of postoperative hospital stay were significantly reduced in observational group compared with control group (all P<0.05). The overall incidence of postoperative complications in control group and observational group was 46.67% and 36.67% respectively, and the difference between them had statistical significance (P>0.05). Kaplan-Meier analysis showed that the 5-year survival rate in control group and observational group was 43.09% and 65.73% respectively, and the difference between them was statistically significant (P<0.001). Conclusion: RFA-assisted anterior approach right hepatectomy has demonstrable efficacy in treatment of central liver tumors, and is superior to the conventional right liver resection.

Objective: To analyze the recurrence profiles of the hepatitis C virus-related hepatocellular carcinoma (HCV-HCC) after radical resection and the risk factors, and discuss the individualized clinical interventions for different recurrent phases. Methods: The clinicopathologic data of 98 HCV-HCC patients undergoing radical resection were reviewed. The recurrence profiles of these patients after radical resection were analyzed, and the risk factors for recurrence were determined by both univariate and multivariate analysis. Moreover, the viral factor was evaluated using stratified analysis. Results: Two peaks of recurrence after radical resection were observed in the entire group of patients, and demarcation point between the early and late recurrence was at postoperative 24 months. COX proportional hazards regression model indicated that the low differentiation of tumor cells and microscopic vascular invasion were independent risk factors for early recurrence (P<0.001), whereas, the viral load was the independent risk factor for late recurrence (P=0.013). Further stratified analysis indicated that the patients with sustained negative viral load after surgery had a significantly longer tumor-free survival time than those with sustained high viral load or unstable viral load after surgery (P<0.001). Conclusion: Different risk factors are responsible for the early and late recurrence after HCV-HCC redical resection. Early recurrence is relatively high, and the postoperative prophylactic TACE may improve the tumor-free survival in early recurrence high-risk patients, while postoperative antiviral therapy may improve long-term outcomes of the patients.

Objective: To investigate the effects of acute normovolemic hemodilution plus low central venous pressure (ANH+LCVP) on coagulation function in patients undergoing liver cancer resection. Methods: Forty liver cancer patients with ASA I-II physical status scheduled for liver resection were equally designated to observational group and control group. Patients in observational group underwent ANH after general anesthesia, and controlled LCVP was performed from the time that the patients entered the operating room to the completion of liver parenchyma transection, while those in control group received the conventional treatment only. The intra- and postoperative blood loss, the number of patients undergoing second operation due to intra-abdominal hemorrhage, and the parameters that included hemoglobin (Hb) level, hematocrit (HCT), platelet (PLT) count, fibinoger (FIB) concentration, activated partial thromboplastin time (APTT), prothrombin time (PT), and international normalized ratio (INR) as well as activated clotting time (ACT), clot rate (CR) and platelet function (PF) in different time points were recorded. Results: The intraoperative blood loss in observational group was significantly less than that in control group (P<0.05), but the postoperative blood loss showed no significant difference between the two groups (P>0.05), and no case of either group required a second operation due to secondary hemorrhage. In observational group, the values of Hb, HCT, PLT, FIB, CR and PF were significantly decreased while the values of APTT, PT, INR and ACT were significantly increased at the time after blood collection, after liver cancer resection, and after intravascular volume restoration compared with their values before surgery, but these parameters were obviously improved after intravascular volume restoration compared to that after liver cancer resection. In control group, the values of Hb, HCT, PLT, FIB, CR and PF were progressively decreased while the values of APTT, PT, INR and ACT were progressively increased during the period from the beginning to the completion of operation. All the studied parameters in observational group were better than those in control group (P<0.05). Conclusion: ANH+LCVP technique can reduce the intraoperative blood loss, but has certain influence on the coagulation function, which does not lead to abnormal bleeding in liver cancer resection, so it can be safely used in liver cancer resection.

Objective: To discuss the surgical strategy of giant cavernous hemangioma of the caudate lobe of the liver. Methods: The clinical treatment data of 4 patients with giant cavernous hemangioma of hepatic caudate lobe were retrospectively analyzed. Results: In all patients, the liver function was improved to Child-Pugh A, and CT scan with three-dimensional reconstruction was performed before surgery, to examine the anatomical relations of the tumor with the hepatic artery, hepatic vein and portal vein. The tumors in two patients were resected via right or left approach plus anterior transhepatic approach, while the other two cases were treated by left hemihepatectomy plus caudate lobectomy. The giant cavernous hemangiomas in all patients were resected safely and successfully, and no serious postoperative complications occurred. Conclusion: With comprehensive preoperative assessment and meticulous intraoperative techniques, surgical treatment is effective for giant cavernous hemangioma of the caudate lobe of the liver.

Objective: To investigate the expression and significance of intermediate-conductance calcium-activated potassium channel protein 4 (SK4) in hepatocellular carcinoma (HCC). Methods: The surgical specimens of HCC and adjacent tissues from 46 HCC patients were collected. The expressions of SK4 and vascular endothelial growth factor (VEGF) in the two types of tissues were measured by immunohistochemical staining, and the correlation between SK4 and VEGF expression was analyzed. The SK4 mRNA expressions in the two types of tissues were determined by real-time PCR, and the relations of SK4 mRNA expression with the clinicopathologic factors were analyzed. The SK4 protein expressions in the two types of tissues were detected by Western blot analysis. Results: The results of immunohistochemical staining showed that the positive expression rates of both SK4 and VEGF in HCC tissue were significantly higher than those in adjacent tissue (both P<0.05), and there was a positive correlation between SK4 and VEGF expression in HCC tissue (r=0.364, P<0.05). The results of real-time PCR showed that SK4 mRNA expression in HCC tissue was significantly up-regulated compared with adjacent tissue (P<0.05), and the high SK4 mRNA expression was associated with poor differentiation and portal vein tumor thrombus (both P<0.05). The results of Western blot showed that the SK4 protein expression level in the cell membrane of cells from HCC tissue was significantly higher than that of cells from adjacent tissue, but the expression levels in the cytoplasm of both tissues had no obvious difference between them. Conclusion: The SK4 expression is increased in HCC, which may promote the invasion and metastasis of HCC through up-regulating VEGF expression or others.

Objective: To investigate the association of the genetic variation in the promoter region of microRNA 22 (miR-22) and the susceptibility of hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC) in Chinese population. Methods: Using a case-control approach, the venous blood samples from 1 020 HBV-positive HCC patients (case group) and 1 046 healthy subjects (control group) were collected. The genotypes of the polymorphic sites, rs6502892 (C→T) and rs721576 (A→G), in the promoter region miR-22 gene were determined by TaqMan allelic discrimination assay. According to the general data of the enrolled subjects, the relationships between different genotypes and risk of HBV-related liver cancer were analyzed by Logistic regression. Results: The rs6502892 genotype distributions had statistical difference between case group and control group (P=0.018), while the rs721576 genotype distributions showed no statistical difference (P>0.05). Compared with the rs6502892 wild-type (CC), the variant rs6502892 genotypes (CT/TT) showed a significantly increased risk of HBV-related liver cancer (adjusted OR=1.23, 95% CI=1.02–1.47, P=0.029). Further stratified analysis showed that the risk effect of variant rs6502892 genotypes (CT/TT) was more evident in those less than 52 years of age, and in females, smokers and alcoholics (all P<0.05), however, the variant rs721576 genotypes (AG/GG) showed decreased risk of HBV-related liver cancer in males and non-smokers (both P<0.05). Conclusion: In Chinese population, the variant rs6502892 genotypes (CT/TT) of miR-122 gene are associated with an increased risk of HBV-related liver cancer, whereas, the risk of HBV-related liver cancer is decreased in men and non-smokers with variant rs721576 genotypes. However, this conclusion still needs further confirmation with genetic association and functional studies.

Objective: To observe the expression changes of the clock genes in hepatocellular carcinoma (HCC) cells under cobalt chloride (CoCl2)-induced hypoxic condition. Methods: HCC Huh7 cells were exposed to different concentrations (0, 50, 100 and 200 μmol/L) of CoCl2 for 24 h, and then, the protein expressions of hypoxia-inducible factor-1α (HIF-1α) in the cells were determined by Western blot analysis and the mRNA expressions of the clock genes that included CLOCK, BMAL1, Per1, Per2, Per3, Cry1, Cry2 and CKIε in the cells were detected by real-time PCR method. Results: The results of Western blot showed that there was no visible HIF-1α protein expression in the Huh7 cells (0 μmol/L CoCl2), while the HIF-1α protein expressions were clearly seen in the Huh cells treated with each concentration of CoCl2, and the expression level was increased with CoCl2 concentration. The results of real-time PCR showed that the mRNA levels of Bmal1, Per1 and Cry2 were up-regulated while mRNA levels of CLOCK, Cry1, Per2 and CKIε mRNA levels were down-regulated significantly after CoCl2 treatment, and all presented a CoCl2 concentration-dependent manner (all P<0.05). Conclusion: Hypoxia microenvironment may be one of the causes for the abnormal expression of clock genes in HCC cells.

Objective: To investigate the protective effect of ulinastatin on the liver grafts in rats with orthotopic liver transplantation and tis mechanism. Methods: The livers removed from the donors were respectively perfused with UW solution alone (model group) or UW solution containing ulinastatin (ulinastatin group), heme oxygenase 1 (HO-1 group) inducer CoPP (CoPP group) or HO-1 inhibitor ZnPP (ZnPP group), with perfusate reservoired for 1 h, and then were orthotopically transplanted into the recipient rats. The liver grafts and blood samples were harvested from the recipient rats at 24 h after transplantation, the pathological examination and scoring for the liver was performed, the HO-1 mRNA and protein expressions in the liver grafts were determined by real-time PCR and Western bolt respectively, and the serum levels of IL-2 and IL-10 were detected by Elisa assay. Results: Compared with model group, the injuries in the liver grafts were remarkably alleviated and Suzuki scores were significantly decreased in ulinastatin group and CoPP group, while the liver injury was aggravated and Suzuki score was significantly increased in ZnPP group (all P<0.05); the HO-1 mRNA and protein expressions in the liver grafts were significantly up-regulated in ulinastatin group and CoPP group, but were significantly down-regulated in ZnPP group (all P<0.05); the IL-2 levels were decreased and IL-10 levels were increased significantly in ulinastatin group and CoPP group, while the IL-2 level was increased and IL-10 level was decreased significantly in ZnPP group (all P<0.05). Conclusion: The protective effect of ulinastatin on the liver grafts in rats may probably be associated with its up-regulating HO-1 expression and thereby reducing the reperfusion injury and inhibiting the rejection reaction.

Objective: To compare the surgical safety of different hepatic inflow occlusion methods for hepatectomy in rats with liver cirrhosis and subsequent impairments to the liver and bowel. Methods: Rats with liver cirrhosis induced by CCl4 plus ethanol underwent Higgins-Anderson 70% hepatectomy. According to different hepatic inflow occlusion methods used during operation, rats were divided into group A (using Pringle maneuver), group B (using hemihepatic vascular occlusion), group C (using hepatic inflow occlusion without hemihepatic artery control) and group D (using portal vein shunting hepatic inflow occlusion without hemihepatic artery control), with 30-min occlusion time for all groups. The surgical success rate, 24-h posthepatectomy survival rate and postoperative pathological changes in the liver and small intestine among groups were compared. Results: In group A, group B, group C and group D, the surgical success rate was 90.9% (10/11), 76.9% (10/13), 83.3% (10/12) and 76.9% (10/13) respectively, and the difference among them had no statistical significance (P>0.05); the 24-h posthepatectomy survival rate was 3/10 (30%), 10/10 (100%), 9/10 (90%) and 10/10 (100%) respectively, and which in all the latter three group were significantly higher than that in group A (all P<0.05). Pathological examination showed that the liver and small intestinal mucosal tissue in group A were severely damaged, while in the remaining groups, except for the intestinal mucosal injury in group C was similar to that in group A, the liver injuries were all milder than that in group A, and the intestinal mucosal tissues had almost no pathological lesions. Conclusion: In liver resection for rats with liver cirrhosis, the surgical safety and degree of liver damage of either procedures of hemihepatic vascular occlusion, hepatic inflow occlusion without hemihepatic artery control and portal vein shunting hepatic inflow occlusion without hemihepatic artery control are superior to Pringle maneuver.

Objective: To study the significance of p28GANK expression in hilar cholangiocarcinoma and its relation with the postoperative prognosis of the patients. Methods: The p28GANK expressions in hilar cholangiocarcinoma tissues (62 cases) and normal bile duct tissues (16 cases) were determined by immunohistochemical staining, and the relations of p28GANK expression level with the clinicopathologic parameters and postoperative survival of the patients were analyzed. Results: The p28GANK positive expression rate in cholangiocarcinoma tissues was 74.2% (46/62), while in normal bile duct tissues there was no expression, and the difference between them had statistical significance (P<0.01). The p28GANK expression levels in cholangiocarcinoma tissue showed no statistical difference between the groups divided by age or sex (both P>0.05), but were statistically different between or among the groups stratified by degree of tumor differentiation, TNM stage, portal vein invasion, and lymph node metastasis (all P<0.05). The 5-year overall survival rate of p28GANK positive expression patients was significantly lower than that of p28GANK negative expression patients (P=0.001). Conclusion: p28GANK expression is increased in hilar cholangiocarcinoma, and its high expression is closely associated with the degree of malignant progression of the tumor and also indicates a poor prognosis.

Objective: To investigate the carcino-embryonic antigen (CEA) expression in colorectal cancer tissue and its relationship with liver metastasis. Methods: The CEA expressions in the tissues that included the primary lesion and liver metastases of liver metastatic colorectal cancer, and colorectal cancer without liver metastasis as well as normal colorectal mucosa were detected by immunohistochemical staining. The CEA positive expression rates and expression intensities among the above 4 types of tissues were compared. Results: The CEA positive expression rate in the primary lesion and liver metastases of liver metastatic colorectal cancer, colorectal cancer tissue without liver metastasis and normal colorectal tissue was 97.22%, 100%, 91.67% and 19.44% respectively, which were all significantly higher than that in the normal colorectal mucosa (19.44%) (all P<0.05). The CEA expression intensity in a significantly increased to decreased order was: liver metastases, primary lesion of liver metastatic colorectal cancer, colorectal cancer without liver metastasis and normal colorectal mucosa (all P<0.05). Conclusion: The CEA expression level in colorectal cancer tissue may closely be associated with liver metastasis, and high CEA expression of the colorectal cancer tissue may predict an increased risk of liver metastasis.

Objective: To compare the transcriptional activity of human telomerase reverse transcriptase (hTERT), carcino-embryonic antigen (CEA) and cytomegalovirus (CMV) promoters in human colon cancer LoVo and SW480 cells. Methods: After the primer sets were designed, the hTERT and CEA promoters were cloned by PCR amplification from the genome of colon cancer cells. The CMV promoter was removed from the original vector pLVX-EGFP-3FLAG by double digestion and PCR method, and the hTERT and CEA promoters were introduced into the vector to construct the recombinant plasmid pLVX-hTERTp-EGFP-3FLAG and pLVX-CEAp-EGFP-3FLAG. Colon cancer LoVo and SW480 cells were transiently transfected with the above two recombinant vectors and the original vector (containing CMV promoter) respectively, and the expressions of green fluorescent protein in the two cell lines were determined. Results: Results of PCR, enzyme digestion and sequencing showed that the cloning products and plasmid constructions were completely correct. The transcriptional activities (number of cells expressing green fluorescence/total number of cells) of CMV, hTERT and CEA promoters in LoVo cells were 54.7%, 33.0% and 9.5%, and in SW480 cells were 16.5%, 10.1% and 8.5%, respectively. All the differences had statistical significance (all P<0.05). Conclusion: In human colon cancer cells, the transcriptional activity of CMV promoter is the highest, hTERT promoter is second and CEA promoter is the lowest. These results may provide information for the study of targeted gene therapy of colon cancer.

Objective: To compare the clinical efficacy of the use of PTFE-covered stent and bare stent in transjugular intrahepatic portosystemic stent shunt (TIPSS) for portal hypertension. Methods: Fifty-two patients with portal hypertension underwent TIPSS with PTFE-covered stent (covered stent group, 20 cases) or with bare stent (bare stent group, 32 cases). The shunt patency, changes in portal venous pressure, hematological examination results and improvement of ascites between the two groups were compared. Results: TIPSS was successfully performed in all patients of the two groups, and length of postoperative follow-up in covered stent group was (8.11±4.9) months and in bare stent group was (8.34±4.4) months. The shunt patency rate showed no statistical difference between the two groups during 6-month follow-up period (P>0.05), but it was significantly higher in covered stent group than that in bare stent group during the 12-month follow-up period (P<0.05). The postoperative portal venous pressures in both groups were significantly decreased compared with their preoperative levels (both P<0.05), but the decreasing amplitudes between the two groups showed no statistical difference (P>0.05). No statistical difference was noted in the incidence of hepatic encephalopathy between the two groups (P>0.05). The degree of white blood cell increase in bare stent group was significantly higher than that in covered stent group (P>0.05), but no statistical difference was seen in other hematological parameters (all P>0.05). The improvement of ascites of the two groups had no statistical difference (P>0.05). Conclusion: The long-term shunt patency of TIPSS for portal hypertension using PTFE-covered stent is higher than that of using bare stent.

Objective: To investigate the value of indocyanine green (ICG) clearance test in predicting the risk of portal vein thrombosis (PVT) after splenectomy in patients with liver cirrhosis from hepatitis C. Methods: The clinical data of 115 patients with liver cirrhosis due to hepatitis C undergoing splenectomy between January 2011 and December 2012 were reviewed. The relationship between the results of preoperative ICG clearance test and postoperative risk of PVT was analyzed. Results: Forty-one (35.65%) of the 115 patients developed PVT after surgery. The incidence of PVT was 20.51% in patients with ICG retention at 15 minutes (ICGR15) ≤10%, was 34.04% in cases with 10%

Objective: To investigate the efficacy of early enteral nutrition (EN) in patients after liver transplantation.
Methods: Fifty-five patients were given EN (27 cases, EN group) or parenteral nutrition (28 cases, PN group) support within 48 h after liver transplantation. The laboraotory parameters that included albumin (ALB), prealbumin (PA), lymphocyte count (LC), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), and direct bilirubin (DBIL) on postoperative day (POD) 1 and 9, the infection rate during 2 weeks after transplantation, mechanical ventilation time, and length of ICU and postoperative hospital stay between the two groups were compared.
Results: The differences in all the laboratory parametes between the two groups showed no statistical significance on POD 1 (all P>0.05), while on POD 9, the levels of ALB, PA and LC in EN group were significantly higher than those in PN group (all P<0.05), and the levels of ALT, AST, TBIL and DBIL between the two groups showed no statistical difference (all P>0.05), but were all decreased compared with their values on POD 1. The incidence of infection within 2 weeks post-transplantation in EN group was significantly lower than that in PN group (P<0.05). The mechanical ventilation time and length of ICU stay between the two groups had no statistical difference (both P>0.05), but the length of postoperative hospital stay in EN group was significantly reduced compared with PN group (P<0.05).
Conclusion: In patients undergoing liver transplantation, early application of EN support can effectively improve their nutritional status and immune function, as well as reduce the chance of infection and promote postoperative recovery.

The techniques of hepatic vein reconstruction have been performed more and more widely in hepatectomy. These techniques may prevent embolization in remnant liver vessels and recurrence of the vascular invading tumor after simple tumor resection. In this paper, the authors address the application scope, perioperative preparation, and benefits as well as limitations of hepatic vein reconstruction, so as to provide implications for clinical practice.                       

Recent studies have demonstrated that arsenic trioxide (As2O3) exerts antitumor effects not only on acute promyelocytic leukemia (APL) but also on a variety of solid tumors that include liver cancer. In this paper, the authors, after retrieval and extraction of domestic and foreign literature, address the research progress on the mechanism of arsenic trioxide action on liver cancer and its clinical application.

MicroRNA (miRNAs) is a class of highly conserved, single-stranded, noncoding small RNAs that regulate gene expression, and participate in several important biological processes such as cell proliferation, differentiation and apoptosis, and also act as tumor suppressor genes, by binding to complementary or partially complementary sequences of mRNA targets leading to a cleavage or a repression of post-transcriptional translation of the gene. MicroRNAs have recently been found to play an important role in the occurrence and development of liver cancer, with significant diagnostic and therapeutic potential. This paper addresses issues in this ?eld.

Selective portal vein embolization (PVE) can produce atrophy of the embolized segments and compensatory hypertrophy of the contralateral segments, which increases the size of future liver remnant (FLR), expands the scope of liver resection, and reduces the incidence of postoperative liver insufficiency. In this paper, the authors address the PVE-related issues and research progress in this field.