Abstract:

The overall efficacy in treatment of hepatocellular carcinoma (HCC) is not satisfactory, and the huge gap between basic science and clinical practice is a major bottleneck for the failure of its further improvement. Translational medicine builds an important bridge to connect between HCC basic research and clinical practice from the respects of early diagnosis, drug screening, new intervention strategy making, and compensation for the shortcomings of the recent treatment methods as well as early prediction of recurrence and metastasis.

Abstract:Objective: To investigate the pathologic features and clinical outcomes of hepatocellular carcinoma (HCC) with hemorrhagic/necrotic phenotype (HN-HCC). Methods: Sixty-seven patients with HN-HCC that was confirmed by surgical findings and pathological examination were prospectively enrolled, and 37 HCC patients without hemorrhagic/necrotic phenotype (NHN-HCC) treated during the same period served as control. The difference in gross pathology between HN-HCC and NHN-HCC was observed, histopathologic profiles and expressions of the Ki-67, hypoxia-inducible factor-1α (HIF-1α) and cleaved-caspase-3 were examined in multiple regions of the HN-HCC specimens, the expressions of carbonic anhydrase IX (CA-IX) and E-cadherin in the HN-HCC specimens were measured, and the difference in postoperative survival rate between HN-HCC and NHN-HCC patients was compared. Results: HN-HCC and NHN-HCC presented notably different gross appearance. Histopathologic examination and immunohistochemical staining showed that among different intratumoral regions of HN-HCC specimens, there were different degrees of cell differentiation and significantly different expression levels of Ki-67, cleaved-caspase-3 and HIF-1α (all P<0.05). In HN-HCC specimens, the positive expression rate was 86.5% (58/67) for CA-IX and 25.3% (17/67) for E-cadherin, and there was a negative correlation between them (r=–2.601, P<0.05). In HN-HCC patients compared with NHN-HCC patients, both 1-, 3- and 5-year overall survival rate (71.9%, 10.7%, 2.8% vs. 87.5%, 35.6%, 3.6%) and tumor-free survival rate (67.0%, 15.4%, 3.2% vs. 81.2%, 34.3%, 4.0%) were significantly decreased (all P<0.05). Conclusion: Hemorrhagic/necrotic phenotype in HCC suggests that the tumor has strong intratumoral heterogeneity and metastasis potential, and the patients may face a poor prognosis.

Abstract:Objective: To investigate the relationship between the preoperative platelet-to-lymphocyte ratio (PLR) and prognosis of hepatocellular carcinoma (HCC). Methods: The clinical data of 256 HCC patients undergoing surgical treatment were retrospectively analyzed. According to the preoperative PLR level of the patients, the receiver operating characteristic (ROC) curve was drawn, the cut-off value was determined, and the relations of the preoperative PLR level with the clinicopathologic factors and prognosis of the patients were analyzed. Results: The area under the curve of ROC of PLR for diagnosis of tumor recurrence was 0.625 (95% CI=0.544–0.706), with a sensitivity of 0.53, specificity of 0.70, and cut-off value of 131.81. The preoperative PLR level was significantly associated with the clinicopathologic factors that included preoperative serum albumin level, Child-Pugh liver function classification, the presence or absence of ascites, vascular invasion, and TNM stage (all P<0.05). Cox hazards model analysis identified that TNM stage (HR=1.441, 95% CI=1.721–2.635, P<0.001) and PLR level (HR=1.737, 95% CI=1.317–2.291, P<0.001) were independent prognostic factors for HCC, and PLR level (HR=1.893, 95% CI=1.434–2.497, P<0.001) was independent prognostic factor for HCC recurrence. Survival analysis showed that the preoperative 1-, 3- and 5-year tumor-free survival rate in patients with low preoperative PLR level (81.2%, 52.3% and 29.6%) were significantly higher than those in patients with higher preoperative PLR level (62.4%, 32.2% and 11.6%). Conclusion: Preoperative PLR can be used as a prognostic marker for HCC patients, and those with high PLR level may have a high risk of recurrence and poor prognosis.

Abstract:Objective: To investigate the relationship between preoperative hepatitis B virus (HBV) DNA load and perioperative complications in patients with hepatitis B-related hepatocellular carcinoma (HCC). Methods: The clinical data of 374 HCC patients undergoing radical hepatectomy between January 2010 and December 2014 were collected. According to the preoperative HBV-DNA load, patients were divided into low-load group (HBV-DNA load<1.0 E+04 IU/mL) and high-load group (HBV-DNA load≥1.0E+04 IU/mL). The changes in postoperative liver function, occurrence of complications and length of hospitalization between the two groups were compared, and the relations of occurrence of complications with clinicopathologic factors were also analyzed. Results: The serum liver function indexes in both groups showed a general trend of initial increase and then decrease, but the increasing amplitudes and peak values of each index in high-load group were greater than those in low-load group (partial P<0.05).The incidence of postoperative pulmonary infection (18.9% vs. 5.2%) and bile leakage (15.4% vs. 2.3%), as well as overall incidence of postoperative complications (19.9% vs. 10.6%) were increased and hospital stay (13.70 d vs. 10.09 d) was prolonged in high-load group compared with low-load group (all P<0.05). Multivariate analysis identified that the preoperative HBV-DNA load (OR=0.865), Child-Pugh classification (OR=0.731) of liver function and tumor size (OR=0.535) were independent risk factors for occurrence of complications (all P<0.05). Conclusion: HCC patients with high preoperative HBV-DNA load may have an increased incidence of perioperative complications and prolonged postoperative hospital stay, and preoperative HBV-DNA is an independent risk factor for surgical complications.

Abstract:Objective: To assess the clinical effect of using “no-touch” isolation technique in surgical treatment of hepatocellular carcinoma (HCC). Methods: The clinical data of 70 HCC patients undergoing surgical resection with “no-touch” isolation technique (observational group) from January 2011 to January 2013, and 70 HCC patients undergoing conventional resection technique (control group) during the same period were retrospectively analyzed. The relevant surgical variables as well as the postoperative recurrence and survival between the two groups were compared. Results: In observational group compared with control group, the operative time was prolonged [(238.9± 44.8) min vs. (132.8±25.4) min, P<0.05], both intraoperative blood loss and blood transfusion rate showed no statistical difference [(461.0±112.6) mL vs. (464.6±109.0) mL; 31.4% vs. 28.5%, both P>0.05], and the hepatic portal occlusion rate was decreased (7.14% vs. 32.9%, P<0.05). No significant difference was noted in incidence of postoperative complications between the two groups (18.6% vs. 22.9%, P>0.05). The 1-year recurrence rate in observational group was significantly lower than that in control group (24.3% vs.44.3%, P<0.05), but the 1-year survival rate of the two groups had no statistical difference (88.6% vs. 81.2%, P>0.05). Conclusion: Using “no-touch” isolation technique in HCC surgical treatment may provide an active support for reducing postoperative tumor recurrence, and it has certain superiority to conventional technique.

Abstract:Objective: To determine the efficacy of sequential dual-target intensity-modulated radiation therapy combined with interventional therapy for giant liver cancer. Methods: Eighty-one eligible patients with giant liver cancer from January 2008 to January 2015 were enrolled. They were randomly divided into observational group and control group, and patients observational group (40 cases) underwent two-session interventional therapy followed by sequential dual-target intensity-modulated radiation therapy (30-40 Gy/15-20 F), and those in control group (41 cases) had a two-session interventional therapy followed by alternating hyperfractionated intensity-modulated radiation therapy (30-40 Gy/15-20 F). The efficacy and adverse reactions between the two groups were compared. Results: The AFP levels in both group were significantly decreased compared with their preoperative levels, and in observational group and control group, the overall response rate was 86.8% and 79.5%; the median survival time was 10.3 and 9.7 months, and the overall 6-month, and 1-, 2- and 3-year survival rate was 63.2% and 59.0%, 50.0% and 48.7%, 21.1% and 17.9%, 5.3% and 2.6%, respectively. The differences in all the above parameters between the two groups showed no statistical significance (all P>0.05). The incidence of grade 1/2 bone marrow suppression in observational group was lower than that in the control group (P<0.05) and the difference was statistically significant (P<0.05), but no significant difference was noted in incidence of other adverse reactions between the two groups (P>0.05). Conclusion: Either sequential dual-target intensity-modulated radiation therapy or alternating hyperfractionated intensity-modulated radiation therapy combined with interventional therapy can offer better clinical efficacy for giant liver cancer, with tolerable adverse reactions, so both methods are effective treatment modalities for giant liver cancer.

Abstract:Objective: To investigate the efficacy and feasibility of percutaneous microwave ablation (PMWA) in treatment of relatively large hepatocellular carcinoma (HCC). Methods: The clinical and follow-up data of 49 patients with unresectable and relatively large (5~6 cm) HCC who underwent ultrasound-guided PMWA from January 2007 to January 2010 were reviewed. The complete ablation (CA) rate, incidence of severe complications, overall survival rate (OS), and disease-free survival rate (DFS) as well as prognostic factors for OS of the patients were analyzed. Results: Of the 49 patients, the CA rate after initial PMWA was 85.7%, and CA was achieved in all cases after a second session of PMWA. The incidence of severe complications was 8.1%. At the end of follow-up (median follow-up time was 48 months), intrahepatic recurrence occurred in 41 cases (87.5%), the average survival time was (54.4±32.0) months, and the 1-, 3- and 5-year OS was 87.8%, 63.3% and 39 .1%, respectively; the average DFS time was (35.8±30.6) months and the 1-, 3- and 5-year DFS was 69.4%, 40.9% and 21.8%, respectively. Univariate analysis showed that preoperative positive quantitative HBV DNA and high level of alpha fetoprotein (AFP) were unfavorable factors for OS (both P<0.05), and multivariate analysis showed that preoperative high AFP level was independent influential factor for OS (HR=1.730, 95% CI=1.135–2.635, P=0.011). Conclusion: PMWA is a safe, feasible and effective treatment for relatively large HCC. However, the treatment of recurrence remains a challenge. High preoperative AFP level is independent factor of the OS after PMWA.

Abstract:Objective: To evaluate the clinical efficacy of using radiofrequency coagulation device for hepatic parenchymal transection in laparoscopic hepatectomy for liver cancer. Methods: The clinical data of 45 patients undergoing laparoscopic hepatectomy for liver cancer from July 2011 to December 2015 were retrospective analyzed. According to the hepatic parenchymal transection device used, the patients were divided into observational group (20 cases) using radiofrequency coagulation device for hepatic parenchymal transection and control group (25 cases) using ultrasonic scalpel for hepatic parenchymal transection. The relevant clinical variables between the two groups were compared. Results: In observational group compared with control group, the operative time showed no significant difference (P>0.05), the intraoperative blood loss [(325.00±111.80) mL vs. (628.00±119.09) mL], the proportion receiving blood transfusion (3/20 vs. 11/25) and the postoperative 24-h abdominal drainage volume [(110.00±57.95) mL vs. (334.40±209.56) mL] were all significantly decreased (all P<0.05). The postoperative liver function parameters, length of hospital stay, incidence of complications and total hospital costs showed no significant difference (all P>0.05). The overall survival rate (75.0% vs. 72.0%) showed no significant difference (P>0.05), but the tumor-free survival rate (75.0% vs. 36.0%) was significantly increased (P<0.05). Conclusion: In laparoscopic hepatectomy for liver cancer, using radiofrequency coagulation device for hepatic parenchymal transection can effectively control blood loss, reduce postoperative complications and improve tumor-free survival rate, and its short-term efficacy is superior to the intraoperative use of ultrasonic scalpel.

Abstract:Objective: To investigate the relationship between digital subtraction angiography (DSA) findings and efficacy of transcatheter arterial chemoembolization (TACE) therapy in primary liver cancer. Methods: Sixty-one patients with primary liver cancer undergoing DSA examination and TACE therapy from April 2012 to April 2014 were selected. According to the intraoperative DSA findings, the patients were divided into rich blood supply group (44 cases) and moderate blood supply group (17cases). Postoperative followed-up was conducted for 3 months to 2 years, the therapeutic response was assessed by mRECIST criteria, and the relations of DSA blood supply group of the tumor with the response and prognosis of the patients were analyzed. Results: Two months after TACE, in rich blood supply group, complete response (CR), partial response (PR), stable disease (SD), and progressive disease (PD) was found in 2 cases (4.5%), 29 cases (65.9%), 6 cases (13.6%) and 7 cases (8.6%), and the objective response rate (CR+PR) was 70.4%, and disease control rate (CR+PR+SD) was 84.0%, respectively; in moderate blood supply group, CR, PR, SD and PD was 0 case (0.0%), 5 cases (29.4%), 4 cases (23.5%) and 8 cases (47.1%), and the objective response rate and disease control rate was 29.4% and 52.9%, respectively. For rich blood supply group and moderate blood supply group, the median survival time was 14 and 7.9 months, and the accumulated 6-, 12- and 24-month survival rate was 91.0%, 68.2% and 20.4%, and 59.1%, 23.0% and 12.1%, respectively, and the differences had statistical significance (all P<0.05). Conclusion: For primary liver cancer, the DSA blood supply classification is closely related to the efficacy of conventional TACE therapy, and cases with rich blood supply may have a better response to TACE treatment.

Abstract:Objective: To systematically evaluate the short-term clinical efficacy of precise hepatectomy in treatment of primary liver cancer. Methods: The randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing precise hepatectomy and conventional hepatectomy for primary liver cancer were collected by searching several national and international databases. After screening for inclusion, quality assessment and data extraction, Meta-analysis was performed by the RevMan 5.3 software. Results: Six RCTs and 9 CCTs were finally included, with total of 1 367 patients, of whom 685 cases underwent precise hepatectomy (precise group) and 682 cases were subjected to conventional hepatectomy (control group). Results of the Meta-analysis showed that in precise group compared with control group, the intraoperative blood loss, perioperative blood transfusion and length of hospital stay were reduced, but the operative time was prolonged (MD=–175.45, 95% CI=–234.37––116.53; MD=–311.04, 95% CI=–444.53––177.55; MD=–3.11, 95% CI=–4.36––1.87; MD=31.72, 95% CI=12.00–51.44, all P<0.05), the complete resection rate was improved (OR=0.18, 95% CI=0.07–0.45, P=0.0003), recover of liver function was accelerated (ALT: MD=–81.75, 95% CI=–109.50––54.00; AST: MD=–67.27, 95% CI=–94.36––40.18; TBIL: MD=–4.54, 95% CI=–7.33––1.75; ALB: MD=3.75, 95% CI=0.54–6.97, all P<0.05), and the incidence of complications was decreased (OR=0.24, 95% CI=0.17–0.35, P<0.05). The 1-year recurrence rate was decreased and 1-year survival rate was increased (OR=0.56, 95% CI=0.37–0.85; OR=1.61, 95% CI=1.01–2.57, both P<0.05). Conclusion: Precise hepatectomy results in less trauma, quicker recovery and better short-term outcomes than the conventional method in treatment of primary liver cancer.

Abstract:Objective: To investigate the expression of interferon-induced transmembrane protein 3 (IFITM3) in hepatocellular carcinoma (HCC), and its significance. Methods: The protein expression of IFITM3 along with matrix metallopeptidase 9 (MMP-9) in 60 specimens of HCC and paired cancer adjacent tissues were determined by immunohistochemical staining and Western blot analysis. IFITM3 small interfering RNA fragments (psilencer3.1-shIFITM3) were constructed and transfected into HCC HepG2 cells, and after transfection, the changes in mRNA and protein expressions of IFITM3 and MMP-9, proliferative capacity, as well as invasion and migration ability of the HepG2 cells were examined by qRT-PCR, Western blot, CCK8 assay, and Transwell and scratch wound-healing assay, respectively. Results: Both positive expression rate and expression level of IFITM3 and MMP-9 protein expressions in HCC tissue were significantly increased compared with cancer adjacent tissue (positive expression rate: 81.67% vs. 13.33%; 88.33% vs. 8.33%, all P<0.05); in HepG2 cells after psilencer3.1-shIFITM3 transfection, both IFITM3 and MMP-9 expression were decreased at either mRNA or protein level, proliferation rate and the number of invaded cells were reduced, and wound closure was significantly delayed. The differences in all quantitative parameters had statistical significance (all P<0.05). Conclusion: IFITM3 expression is increased in HCC, and the high expressed IFITM3 may promote the proliferation, invasion and migration of HCC cells through regulating MMP-9 expression.

Abstract:Objective: To investigate the influence of downregulating CDl33 gene expression on biological behaviors of human liver cancer cells. Methods: Liver cancer SMMC7721 cells were transfected with the synthesized CDl33 siRNA and then transfection efficiency was determined. Using SMMC7721 cells without transfection or transfected with scrambled siRNA sequence as blank control and negative control respectively, the effect of CD133 gene silencing, and changes in the main biological behaviors in SMMC7721 cells after CDl33 siRNA transfection were observed. Results: The transfection efficiency reached (80.8±9.1) % at 24 h after transfection. Compared with blank control group, in SMMC7721 cells after CDl33 siRNA transfection, the expression level of CDl33 mRNA and protein was reduced to 10% and 35% of the level in blank control group respectively, the proliferative activity was significantly decreased, apoptosis rate was significantly increased with a marked S-phase arrest, and colony-forming ability was significantly decreased (all P<0.05). All indexes did not show any significant difference between negative control group and blank control group (all P>0.05). Conclusion: CDl33 gene may play an oncogene role in liver cancer cells and down-regulating its expression can suppress the malignant activity of liver cancer.

Abstract:Objective: To investigate the expression of JAK2/STAT3 signaling pathway in human hepatocellular carcinoma (HCC) tissue and its significance. Methods: The protein expressions of JAK2 and STAT3 in specimens of HCC tissues and matched adjacent non-cancer tissues from 75 patients were detected by immunohistochemical staining and Western blot analysis. The relations of their expressions with the clinicopathologic features and prognosis of the patients were analyzed. Results: Both positive expression rate (62.7% vs. 5.3%; 69.3% vs. 9.3%) and expression level of either JAK2 or STAT3 protein in HCC tissue were significantly higher than those in the adjacent non-cancer tissue (all P<0.05); there was significant correlation between the expressions of JAK2 and STAT3 protein in HCC tissue (r=0.383, P<0.01). Both expressions of JAK2 and STAT3 were significantly related to cirrhosis, portal vein tumor thrombus, degree of tumor differentiation, and clinical stage (all P<0.05). Survival analysis showed that both survival rate and survival time in patients with high JAK2 or STAT3 expression were significantly decreased compared with corresponding low expression cases (χ2=13.591; χ2=6.842, both P<0.05). Cox proportional hazard regression model analysis indicated that the expression of JAK2 and STAT3 protein along with portal vein tumor thrombus, degree of tumor differentiation, clinical stage were independent risk factors for HCC (all P<0.05). Conclusion: The activity of the JAK2/STAT3 signaling pathway is increased in HCC tissue and the degree of its activation is closely related to the prognosis of HCC patients.

Abstract:Objective: To investigate the long non-coding RNA (lncRNA) MALAT1 expression in hepatocellular carcinoma (HCC) and its function. Methods: The MALAT1 expressions in 80 surgical specimens consisting of tumor and adjacent normal tissue as well as in different HCC cells lines (HepG2, Hep3B, HCCLM3, and HuH7) and normal hepatic cell line (L02) were determined by qRT-PCR method. The changes in proliferation, migration and apoptosis in HCC cells (HepG2 and HuH7) after MALAT1 siRNA transfection were examined by MTT assay, wound healing assay and flow cytometry, respectively. Results: In 72 of the 80 paired samples (90%), the MALAT1 expression in HCC tissue was significantly up-regulated compared with its adjacent normal tissue, and the MALAT1 expression level in each examined HCC cell line was significantly higher to varying degrees than that in normal hepatic cell line (all P<0.05). In HepG2 and HuH7 cells after MALAT1 siRNA transfection, the proliferation rate was significantly decreased in a time-dependent manner, wound healing ability was significantly weakened (all P<0.05), the apoptosis rate was 17.0% and 16.41%, which in their corresponding group was 8.89% and 6.56% respectively, and the difference had statistical significance (both P<0.05). Conclusion: MALAT1 expression is up-regulated in HCC, which may be closely associated with the malignant behaviors of HCC, and further investigation of its action mechanism may probably uncover a potential new therapeutic target for HCC.

Abstract:目的：探讨硫化氢（H2S）预处理对肝硬化大鼠肝脏缺血再灌注损伤（HIRI）的影响及机制。 方法：将32只采用胆总管结扎法制作的肝硬化模型大鼠随机均分为4组，分别行假手术（假手术组）、30 min肝门阻断及4 h再灌注诱导HIRI模型（HIRI组）、硫氢化钠（NaHS，外源性H2S供体）预处理+HIRI模型诱导（NaHS组）、NaHS+雷帕霉素（RPM，mTOR抑制剂）预处理+HIRI模型诱导（RPM组），随后检测血清谷草转氨酶（AST）、谷丙转氨酶（ALT）浓度，分别用光镜与电镜观察肝组织病理学变化与自噬水平，Western blot检测肝组织LC3-II（自噬特异性标记）以及mTOR、磷酸化mTOR（p-mTOR）蛋白表达。 结果：除假手术组外，其余各组肝组织在肝硬化表现的基础上均出现明显的炎症反应、细胞肿胀与局灶性坏死等损伤改变，但NaHS组的损伤程度明显轻于HIRI组与RPM组。与假手术组比较，其他各组血清AST、ALT水平均明显升高、肝细胞内自噬体数量明显增多、肝组织LC3-II蛋白表达明显升高，而p-mTOR蛋白表达（p-mTOR/mTOR比值）明显降低（均P<0.05），但NaHS组转氨酶升高幅度、细胞内噬体数量、肝组织LC3-II蛋白升高及p-mTOR蛋白降低程度均明显低于HIRI组（均P<0.05），而RPM组与HIRI组间各项指标差异均无统计学意义（均P>0.05）。 结论：H2S预处理能减轻肝硬化大鼠HIRI，其机制可能与通过活化mTOR途径抑制自噬有关。

Abstract:Objective: To compare the difference in impact on quality of life in patients with liver hemangioma after enucleation and transcatheter arterial embolization (TAE). Methods: Through a questionnaire method, the gastrointestinal quality of life index (GLQI) was measured in 46patients with hepatic hemangioma before and 1 month, and 6, 12, and 15 months after operation. Of the 46 patients, 23 cases underwent enucleation (enucleation group) and 23 cases received TAE (TAE group). The changes in quality of life of the two groups of patients were compared. Results: There was no statistical difference in total GLQI between the two groups (P>0.05), but the overall changing trend of the total GLQI after operation was significantly different between the two groups, which showed a continuous increase from the first to the last month after operation in enucleation group, while an increasing trend during the first to sixth month but a evident decreasing trend for later in TAE group (F=5.331, P<0.05). Comparison between the two groups showed that the total GLQI was lower in enucleation group than that in TAE group at postoperative one month [(99.5±11.2) vs. (109.0±9.2), P<0.05], had no significant difference between the two groups at postoperative 6 months [(112.2±8.8) vs. (114.4±10.8), P>0.05], and was higher in enucleation group than that in TAE group at postoperative 12 or 15 months [(128.5±8.3) vs. (108.7±10.4), (129.2±8.5) vs. (108.2±9.5), P<0.05]. Intra-group comparison showed that in enucleation group, the total GLQI at postoperative 12 and 15 months was significantly increased compared with its preoperative one [(128.5±8.3), (129.2±8.5) vs. (111.7±9.3), P<0.05], and in TAE group, it was significantly increased at postoperative 6 months compared with its preoperative value [(114.4±10.8) vs. (108.3±9.8), P<0.05], but declined to its preoperative level at postoperative 12 and 15 months (both P>0.05). Conclusion: Enucleation is better than TAE for long-term postoperative recovery and improvement of quality of life in liver hemangioma patients.

Abstract:Objective: To determine the risk factors for posthepatectomy liver failure in patients with Child-Pugh A liver function. Methods: From October 2010 to April 2014, 427 consecutive patients with primary liver cancer and preoperative Child-Pugh classification score A liver function undergoing hepatectomy were enrolled. All operations were performed by the same surgical team and under hepatic inflow occlusion with a clamp/unclamp time of 15 min/5 min. The clinical data of the patients were collected, and the risk factors for posthepatectomy liver failure were analyzed. Results: Among the 427 patients, 362 cases were male and 65 were female, with an average age of (51.1±10.4) years; 391 cases underwent surgery for hepatocellular carcinoma (HCC), 31 cases for intrahepatic cholangiocarcinoma (ICC) and 5 cases for mixed HCC and ICC. Of the cases, 86.4% (369/427) had a background of hepatitis B virus infection and 54.8% (234/427) had concomitant cirrhosis; 358 cases (83.8%) had resections of ≤3 segments and 69 cases (16.2%) had resections of ≥4 segments. Seventeen patients (4.0%) developed liver failure after hepatectomy, of whom 10 cases manifested as hyperbilirubinemia unrelated to biliary obstruction or bile leak, 6 cases had clinically apparent ascites and prolonged prothrombin time, and one case had hepatic encephalopathy and died on postoperative day 21. Univariate analysis showed that age ≥ 60 and prealbumin <170 g/L were significantly related to posthepatectomy liver failure (P=0.045, P=0.009), and multivariate analysis identified that prealbumin <170 g/L was independent risk factor for posthepatectomy liver failure (HR=3.192; 95% CI=1.185–8.601, P=0.022). Conclusion: Serum prealbumin level is an independent influential factor for posthepatectomy liver failure in patients with Child-Pugh score A liver function. So improving the nutritional status of the patients may reduce the incidence of posthepatectomy liver failure.

Abstract:Objective: To systematically review the effectiveness and safety of the use of enhanced recovery after surgery (ERAS) in the setting of liver surgery. Methods: The randomized controlled trials (RCTs) regarding using ERAS in the setting of liver surgery were collected by searching several national and international online databases. The retrieval time was from inception of the database to June 2015. Article screening, data extraction and quality assessment were performed by two independent reviewers according to the defined inclusion and exclusion criteria, and then, Meta-analysis was performed by using RevMan 5.3 software. Results: Nine RCTs were finally selected with a total of 1 140 patients composed of 555 cases in ERAS group and 585 cases (undergoing traditional perioperative management) in control group. The results of Meta-analysis showed that in ERAS group compared with control group, the incidence of postoperative complications (RR=0.58, 95% CI=0.45–0.75, P<0.05), length of hospital stay (WMD=–2.47, 95% CI=–3.14––1.79, P<0.05), time to first flatus (SMD=–0.90, 95% CI=–1.43––0.36, P<0.05), hospitalization costs (SMD=–0.91 95% CI= –1.38––0.44, P<0.05), and intraoperative blood loss (WMD=–22.64, 95% CI=–41.23––4.05, P<0.05) were all significantly decreased. There were no statistical differences between the two groups in respects of the incidence of postoperative bleeding, bile leakage, liver failure, pleural effusion as well as operative time (all P>0.05). Conclusion: Use of ERAS protocols in the setting of liver surgery is safe and effective, and it can also reduce the length of hospital stay and incidence of postoperative complications, and thereby accelerate postoperative recovery of the patients.

Abstract:Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS), as a new surgical method, brings hope to patients who cannot tolerate extensive liver resection because of the low future liver remnant volume after the conventional resection technique. From the time this method was proposed, it has been favored by surgical scientists, and its improvements are continuously being made during practice. Initial results showed a relatively high incidence of complications and death of ALPPS. Recently, with the development of techniques, zero mortality has been reported. However, the long-term oncological result of ALPPS is still unknown. Here, the authors, based on literature review, address the application of this technique.

Abstract:As a member of the transient receptor potential (TRP) channels family, TRPV4 is a non-selective cation channel. It can be activated by heat, mechanical forces, phorbol ester derivatives and other physicochemical stimuli, and then participate in the maintenance of normal cell function. In recent years, many studies have focused on the role of TRPV4 in cell proliferation, differentiation, apoptosis and migration. The abnormal expression of TRPV4 is closely related to the occurrence and development of tumors. In this paper, the authors present the latest progress concerning TRPV4 channel in cancer.