Hepatocellular carcinoma has a propensity to invade the intra-hepatic vascular system, especially the portal vein system and, therefore, leads to the formation of the portal vein tumor thrombus (PVTT). Once PVTT occurs, the disease will progress rapidly with a dismal prognosis. Based on the existing data of evidence-based medicine, particularly the results from research on hepatocellular carcinoma complicated with PVTT achieved by Chinese scholars, the Chinese Expert Consensus on Multidisciplinary Diagnosis and Treatment of Hepatocellular Carcinoma with Portal Vein Tumor Thrombus (2016 edition) has been developed by the National Research Cooperative Group for Diagnosis and Treatment of Hepatocellular Carcinoma with Tumor Thrombus. Here, the authors interpret the consensus from the aspects of the PVTT classification and treatment selection for different types of tumor thrombus, etc.

Surgical site infection (SSI) prevention is an essential component of surgical practice. The bullet points of Guideline for the Prevention of Surgical Site Infection have been updated for the first time in its 2017 edition, which adapted the levels of evidence and grades of recommendations mainly targeting toward 14 core areas of surgical practice based on the most comprehensive and extensive as well as the latest data of evidence-based medicine, and finally developed 42 sets of guideline recommendations that include the commonly used skin preparation, sterile surgical masks, and prophylactic use of antibiotics, etc.. The new guideline version relatively fully reflects the newest and most authoritative point of view on SSI prevention, and not only renovated the clinical procedure standards, but also may help frontline physicians renew their concept on surgical infections. So the authors interpret the important viewpoints of the new guideline.

Objective: To compare the influences between precise and conventional hepatectomy on changes of T lymphocyte subsets in liver cancer patients. Methods: Forty-seven liver cancer patients were randomly divided into two groups, and underwent precise hepatectomy (precise hepatectomy group, 26 cases) and conventional hepatectomy (conventional hepatectomy group, 21 cases) respectively. The main clinical variables, and the pre- and postoperative CD3+, CD4+ and CD8+ levels as well as CD4+/CD8+ between the two groups were compared. Results: In precise hepatectomy group compared with conventional hepatectomy group, the operative time was prolonged, but the amount of blood loss, length of hospital stay and incidence of postoperative bile leakage and intra-abdominal hemorrhage were all reduced (all P<0.05); the postoperative changes in liver function parameters in precise hepatectomy group were superior to those in conventional hepatectomy group (all P<0.05). At postoperative day (POD) 7, the values of CD3+, CD4+ and CD4+/CD8+ were significantly decreased in both groups compared with their preoperative levels, but the decreasing degrees of them in precise hepatectomy group were significantly less than those in conventional hepatectomy group (all P<0.05), and the CD8+ values were slightly increased in both groups compared with their preoperative levels (both P>0.05); at POD 14 the values of all these T lymphocyte subsets in both groups returned to their preoperative levels. Conclusion: Precise hepatectomy is superior to conventional hepatectomy in protection of immune function, which thereby benefits the recovery of liver function in liver cancer patients.

Objective: To investigate the clinical efficacy of selective hepatic artery embolization in treatment of grade III or IV liver trauma. Methods: The clinical data of 19 patients with grade III or IV liver trauma undergoing hepatic artery embolization (intervention group) from January 2006 to October 2016, and 19 comparable patients with grade III or IV liver trauma undergoing open surgery (laparotomy group) treated during the same period were retrospectively analyzed. The relevant clinical variables between the two groups of patients were compared. Results: Operations were successfully performed in both groups of patients. The postoperative serum transaminase and creatinine levels were significantly lower and the time for aminotransferase to return to normal was significantly shorter in intervention group than those in laparotomy group (all P<0.05); in intervention group compared with laparotomy group, the operative time (60.74 min vs. 128.11 min), postoperative fasting time (34.03 h vs. 56.00 h), length of hospital stay (13.58 d vs. 18.37 d) and hospitalization costs (34 860.90 yuan vs. 54 141.47 yuan) as well as incidence of complications (10.5% vs. 57.9%) were all significantly reduced (all P<0.05). No significant difference was noted in other clinical variables between the two groups (all P>0.05). Conclusion: Selective hepatic arterial embolization is a safe and effective method for grade III and IV liver trauma. For grade III or IV liver lacerations with stable hemodynamics or hemodynamic stability obtained after aggressive anti-shock therapy and blood or fluid transfusion, selection of interventional angiography is recommended.