Objective: To investigate the efficacy of using liver hanging maneuver (LHM) in associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). Methods: The clinical data of 4 patients with primary liver cancer undergoing ALPPS procedure were retrospectively analyzed. Of the patients, 3 cases had tumor in the right lobe and one case in the caudate lobe. All patients underwent first-stage operation of in situ splitting of the liver parenchyma and right portal vein ligation guided by LHM, and a second-stage of complete tumor removal. Results: In all the 4 patients, the prior hepatic transection, hanging tape positioning and second-stage liver resection were performed successfully. In the first-stage operation, the operative time was 195–273 (232.2±35.3) min, intraoperative blood loss was 420–1 210 (735±344.3) mL, and bile leakage occurred in one case; in the second-stage operation, the operative time was 98–186 (139.5±36.6) min, and intraoperative blood loss was 100–320 (197.5±95.3) mL. No operative death occurred. The patients were followed-up for 3 months, at which time 3 patients were in good condition, and one patient had died of recurrence 2 months after operation. Conclusion: LHM is effective for inferior vena cava protection and clear exposure of the intrahepatic blood vessels and ductal system, so it can be routinely used in ALPPS procedure.

Objective: To compare the clinical efficacies of three hepatic inflow occlusion methods in hepatectomy for large hepatocellular carcinoma. Methods: The clinical data of 218 patients undergoing hepatectomy for large hepatocellular carcinoma (>5 cm) from January 2011 to March 2013 were retrospectively analyzed. During surgery, 88 cases were subjected to intermittent hepatic inflow occlusion with Pringle maneuver (portal occlusion group), 51 cases underwent selective hemihepatic blood flow occlusion (hemihepatic occlusion group), and 79 cases received infrahepatic inferior vena cava (IVC) clamping plus Pringle maneuver (combination occlusion group). The relevant clinical variables among the three groups of patients were compared. Results: There were no significant differences in preoperative conditions, operative time, inflow occlusion time and liver resection volume among the three groups (all P>0.05). In either hemihepatic occlusion group or combination occlusion group, the intraoperative blood loss, blood transfusion volume and blood transfusion rate were all significantly lower than those in portal occlusion group, and the blood transfusion volume and blood transfusion rate in combination occlusion group were also significantly lower than those in hemihepatic occlusion group (all P<0.05). All liver function parameters showed no significant difference among the three groups on postoperative day (POD) one, but the transaminase and total bilirubin levels in both hemihepatic occlusion group and combination group were significantly decreased compared with portal occlusion group on POD 3 and 7 (all P<0.05). No significant difference was noted in incidence of postoperative complications among the three groups (P>0.05). Conclusion: In large liver cancer resection, hepatic inflow control with combination of infrahepatic IVC clamping and Pringle maneuver can not only effectively reduce intraoperative blood loss, but also be advantageous for recovery of postoperative liver function.

Objective: To investigate the expressions of Numb and vascular endothelial growth factor (VEGF) in primary hepatocellular carcinoma (HCC), and the clinical significance. Methods: The Numb and VEGF expressions in the surgical specimens of HCC tissue along with tumor adjacent tissues from 60 HCC patients, and normal liver tissues from 27 cases with liver injury or hepatic hemangioma were determined by immunohistochemical staining. The relations of Numb and VEGF expressions with the clinicopathologic factors and prognosis of the HCC patients were analyzed. Results: Compared with normal hepatic tissue and tumor adjacent tissue, the positive Numb expression rate was significantly decreased, while the positive VEGF expression was significantly increased in HCC tissue (both P<0.05), further, there was a negative relation between Numb and VEGF expression in HCC tissue (r=–0.5248, P=0.01). Both Numb and VEGF expressions were significantly associated with TNM stage, and Edmondson grade, and the presence or absence of portal cancer embolus and tumor capsule (all P<0.05). The overall survival period in patients with negative Numb expression was significantly shorter than in those with positive Numb expression, but the finding for VEGF expression was the opposite of that (both P<0.05). Conclusion: Numb expression is decreased and VEGF expression is increased in HCC tissue, and waxing and waning between them may closely relate to the invasiveness and poor prognosis of HCC.

Objective: To evaluate the application value of microwave hemostatic device in laparoscopic hepatectomy. Methods: The clinical data of 28 patients undergoing laparoscopic hepatectomy with microwave hemostatic device (HeSetor) from July 2009 to June 2013 were retrospectively analyzed. Results: Laparoscopic hepatectomy was successfully completed in all the 28 patients and no conversion or surgical death occurred. The average operative time was (124±45) min and average intraoperative blood loss was (140±110) mL. No postoperative hemorrhage, bile leakage or liver function failure occurred in the entire group of patients. The mean length of postoperative hospital stay was (6.9±2.7) d. Follow-up was conducted for 6 to 53 months in the 28 patients, and intrahepatic recurrence occurred in 6 cases with hepatocellular carcinoma in postoperative 5–16 months, but no port site tumor implantation was observed. Conclusion: Laparoscopic hepatectomy with microwave hemostatic device can provide excellent hemostatic effect without severe postoperative complications, so it is a safe and feasible technique for liver resection.