Objective: To systematically evaluate the effect of combined vascular resection (VR) in surgical treatment of hilar cholangiocarcinoma (HCCA). Methods: The literature of studies comparing surgical treatment of HCCA in combination with VR versus that without VR was collected by searching several national and international databases. The safety and efficacy of combined VR were evaluated, and the subgroups analysis was also performed according to the types of the simultaneously resected blood vessel. Results: Twenty seven studies with a total of 3 218 HCCA patients were included, of whom 888 cases underwent combined VR treatment (VR combination group), and 2 330 cases had no combined VR treatment (control group). The results of Meta-analysis for overall group showed that the safety profile was unfavorable (mortality: OR=2.83, 95% CI=1.80–4.44; postoperative complications: OR=2.48, 95% CI=1.44–4.28) and the efficacy was less favorable (1-, 3- and 5-year overall survival: OR=0.60, 95% CI=0.49–0.73; OR=0.57, 95% CI=0.47–0.69; OR=0.61, 95% CI=0.41–0.91) in VR combination group compared with control group (all P<0.05). In portal vein resection subgroup compared with control group, although the incidence of complications was increased (P<0.05), no difference was found in other variables (all P>0.05); in hepatic artery resection subgroup, all the pooled results were consistent with the overall findings (all P<0.05). Conclusion: In HCCA patients, surgical treatment combined with VR is feasible for those with portal vein invasion, but VR should be made cautiously if the hepatic artery is involved.

Objective: To determine the application value of three-dimensional reconstruction in preoperative assessment of hilar cholangiocarcinoma. Methods: The clinical data of 34 patients with hilar cholangiocarcinoma undergoing hilar resection in combination with partial liver resection were collected. Of the patients, 15 cases had preoperative three-dimensional surgical planning (observational group), while 19 cases did not (control group). The relevant surgical variables between the two groups were compared. In observational group, the coincidence degree between tumor classifications from three-dimensional reconstruction data and postoperative actual findings, and the difference between two- and three-dimensional images for estimation of liver volume were analyzed. Results: In observational group versus control group, the average intraoperative blood loss (525.4 mL vs. 676.3 mL), operative time (5.0 h vs. 5.8 h) and time of tube removal (8.9 d vs. 11.4 d) were significantly reduced (P=0.014, P=0.020, and P=0.037), but the length of postoperative hospital stay and overall incidence of complications between the two groups had no statistical difference (both P>0.05). In observational group of patients, the coincidence rate of Bismuth-Corlette classification by three-dimensional reconstruction to actual results was 86.7% (13/15); the estimated liver resection volume calculated by the two- and three-dimensional techniques showed no statistical difference (404.9 mL vs. 411.2 mL, P>0.05). Conclusion: Three-dimensional reconstruction can provide a precise preoperative assessment for hilar cholangiocarcinoma, so it has certain guiding significance in surgical treatment of hilar cholangiocarcinoma.

Objective: To investigate the safety and effectiveness of using unidirectional barbed suture in laparoscopic hepatectomy with intraoperative bile duct exploration. Methods: The clinical data of 24 patients undergoing laparoscopic hepatectomy with synchronous bile duct exploration from December 2014 to August 2015 were retrospectively analyzed. Of the patients, the bile duct closure in 10 cases was accomplished with traditional suture (traditional suture group), and in 14 cases with unidirectional barbed suture (barbed suture group). The main clinical variables between the two groups of patients were compared. Results: The operations in all patients were successfully completed. The preoperative general data, intraoperative blood loss, incidence of postoperative complications (pulmonary infection), and length of postoperative hospital stay had no statistical difference between the two groups (all P>0.05), but the overall operative time (230.50 min vs. 354.68 min), and time for common bile duct (5.33 min vs. 33.82 min) and hepatic duct (9.04 min vs. 25.14 min) suturing were significantly reduced in barbed suture group compared with traditional suture group (all P<0.05). One month after discharge, all patient returned for T-tube cholangiography and T-tube removal, and no retained stones, bile leakage or biliary stricture was observed. Conclusion: Using unidirectional barbed suture in laparoscopic hepatectomy with bile duct exploration is safe and feasible, and the employment of the absorbable barbed suture can reduce the difficulty of laparoscopic suturing, and shorten the operative time and the technical learning curve, without increasing the risk of postoperative bile leakage.

Cirrhosis is a common chronic liver disease, and is associated with an increased incidence of gallbladder stones. The pathological profile of liver cirrhosis consists of two major aspects: portal hypertension and liver function decline, which may further cause local and systemic physiological changes, and play an important role in the pathogenesis of gallstone formation. In this paper, the authors address the pathological changes and pathogenesis of gallbladder stones associated with liver cirrhosis.