Abstract:Hilar cholangiocarcinoma (hCCA) is a malignant tumor originating from the epithelial cells of the bile duct, characterized by high malignancy, significant surgical challenges, high mortality, and poor prognosis, making it one of the most formidable challenges in the field of surgery. In recent years, advancements in surgical concepts and diagnostic and therapeutic techniques have led to improvements in the diagnosis and treatment of hCCA. However, standardizing the management of hCCA, enhancing treatment efficacy, and improving patient outcomes remain pressing issues. To confront these challenges, the Hepatobiliary Surgery Professional Committee of Hunan Medical Association, Hunan Provincial Clinical Research Center for the Prevention and Treatment of Biliary Diseases, Hunan Provincial Key Laboratory for the Prevention and Treatment of Biliary Diseases, Hunan Provincial Engineering Research Center for Digital Hepatobiliary Medicine, the Hepatobiliary Surgery Professional Committee of Hunan International Medical Exchange and Promotion Association, the Hunan Alliance of Hepatobiliary and Pancreatic Surgery, the Hunan Alliance for the Diagnosis and Treatment of Malignant Biliary Tumors, and the Hepatopancreatobiliary Disease Research Center of Furong Laboratory, convened a multidisciplinary panel of experts to develop the Hunan expert consensus on comprehensive diagnosis and treatment of hilar cholangiocarcinoma. This consensus aims to standardize the diagnosis and multidisciplinary treatment approach for hCCA, enhance overall diagnostic and therapeutic standards, and ultimately improve the overall prognosis of the disease.

Abstract:In the 2010s, laparoscopic hepatectomy (LH) rapidly gained popularity in Japan as a minimally invasive approach for liver resections. It offers significant advantages, such as reduced postoperative pain and faster recovery. The Glissonean pedicle approach, employed during LH, enables precise anatomical resection, particularly for hepatocellular carcinoma and metastatic liver tumors. Innovations in training, including the use of animal models and the Japan Society for Endoscopic Surgery certification program, have been instrumental in improving surgical expertise. However, complex hepatectomies involving vascular or biliary reconstruction pose substantial technical challenges. Robot-assisted hepatectomy (RAH) has shown great potential for improved precision and visualization, though its high costs and uncertain long-term benefits limit its widespread adoption. Further technological advancements, enhanced training programs, and large-scale comparative trials are necessary to evaluate the long-term efficacy of both LH and RAH.

Abstract:With the rapid development of artificial intelligence (AI) technology, especially deep learning, AI is playing an increasingly important role in the diagnosis and treatment of liver cancer. AI has shown great potential in improving diagnostic accuracy, reducing the workload of physicians, and providing personalized treatment plans. In imaging diagnosis of liver cancer, AI technology has been widely applied to ultrasound, CT, and MRI data, enabling automatic recognition and segmentation of liver lesions and differentiation between benign and malignant lesions. In some cases, its diagnostic accuracy can match or even surpass that of professional radiologists. In pathological diagnosis, AI assists pathologists in differential diagnosis and classification by analyzing whole slide image, improving diagnostic efficiency and accuracy. For treatment decision support, AI analyzes clinical, imaging, and pathological data to predict postoperative recurrence risk, evaluate the effectiveness of specific treatments, and identify biomarkers, providing new perspectives for precision medicine and assisting clinicians in designing personalized treatment plans. With the advancement of multimodal AI models that integrate imaging, pathology, and clinical data, it is possible to achieve a more comprehensive understanding of the biological behavior of liver cancer, thereby offering more precise diagnoses and treatments for patients. Despite its immense potential, AI in liver cancer diagnosis and treatment faces challenges such as data standardization, security, and privacy protection. The clinical translation of AI models requires further validation and refinement. With technological advancements and data accumulation, AI is expected to provide more precise and personalized medical services for liver cancer patients in the future. This article focuses on summarizing significant research advances in AI for liver cancer diagnosis and treatment, and briefly discusses its limitations and future directions.

Abstract:Hepatocellular carcinoma (HCC) is the most common primary liver cancer and the third leading cause of cancer-related deaths worldwide. Despite continuous advancements in diagnostic and therapeutic technologies in recent years, the overall treatment outcomes for HCC remain to be improved. With the advancement of artificial intelligence, radiomics has emerged as an innovative approach by extracting quantitative features from medical images imperceptible to the naked eye, enabling predictive modeling for the diagnosis, treatment decision-making, therapeutic evaluation, and prognostic prediction of HCC. This article systematically reviews the application of radiomics in the intelligent management of HCC, based on the latest research progress, aiming to enhance comprehensive treatment strategies.

Abstract:Translational therapy for liver cancer, as an emerging treatment strategy, is driving advancements in the management of intermediate and advanced liver cancer. Through continuous exploration by experts nationwide, translational therapy for liver cancer has reached a consensus, providing valuable scientific guidance for clinical practice. However, as treatment methods continue to evolve, translational therapy still faces numerous urgent challenges, particularly in areas such as personalized treatment, efficacy evaluation, and combined therapeutic strategies. These issues have become contentious and hotly debated topics, creating a situation where "consensus and controversy coexist, and opportunities and challenges intersect." To address these challenges, experts in the field of liver cancer must strengthen collaboration and communication, promote high-quality basic and clinical research, and continuously refine treatment protocols in practice, ultimately offering patients more scientific and precise therapeutic options.

Abstract:Primary liver cancer, particularly hepatocellular carcinoma, is one of the most common malignancies in China, and hepatectomy remains the primary curative treatment. However, the efficacy of hepatectomy is significantly limited due to the heterogeneity of liver cancer, its high recurrence rate, and the fact that most patients are diagnosed at advanced stages. In recent years, the development of precision medicine has brought new hope to liver cancer treatment, especially with notable advancements in preoperative assessment, systemic therapy, minimally invasive surgery, and personalized treatment strategies. Preoperative assessment, including imaging technologies such as three-dimensional visualization and molecular imaging, helps physicians accurately evaluate tumor characteristics and liver function, guiding the choice of treatment plan. The combined application of immunotherapy and targeted therapy has significantly improved survival rates for patients with advanced liver cancer. The strategy of combining systemic therapy with local treatment has provided new pathways for translational therapy, expanding the indications for hepatectomy. The optimal selection of patients based on tumor biological characteristics, especially molecular subtyping and liver function status, to maximize patient benefit still requires further exploration. The "seven-step" modular laparoscopic hepatectomy, by achieving scientific hepatectomy, demonstrates the clinical practice of maximizing patient benefit, further elucidating a multidisciplinary, personalized treatment model centered on surgical therapy.

Abstract:The development of classical anatomical liver resection has been a topic of considerable debate, particularly regarding its oncological efficacy in treating hepatocellular carcinoma. With continuous advancements in surgical techniques and iterative improvements in minimally invasive surgical equipment, laparoscopic portal territory anatomical resection (LPTAR) has gradually been adopted in clinical practice. Unlike classical anatomical liver resection, which approximates liver segmentectomy based on Couinaud's segmentation, LPTAR integrates technologies such as preoperative 3D visualization and intraoperative indocyanine green fluorescence navigation to target the true portal venous territory. Its core principle lies in achieving "precise liver segmentectomy" of the tumor-bearing portal venous territory. Currently, LPTAR is undergoing rapid development but faces several technical challenges, including the precise identification and control of hepatic pedicles, effective staining of difficult liver segments, and management of anatomical variations. Establishing standardized and streamlined technical protocols is crucial to addressing these issues, as it will improve surgical completeness and safety while enhancing oncological outcomes. Precision liver resection has long been a pursuit of surgeons, and laparoscopic liver resection, led by LPTAR, is poised to make a lasting impact in the field of precision hepatic surgery.

Abstract:Background and Aims Hepatectomy is an important treatment option for hepatic hemangioma, and the approach has gradually shifted from traditional open surgery to laparoscopic and robotic-assisted surgery. However, there is still no consensus on whether robotic assistance provides better treatment outcomes than laparoscopic surgery for hepatic hemangioma. Therefore, this study was performed to evaluate and compare the clinical efficacy and safety of robotic-assisted and laparoscopic hepatectomy for the treatment of hepatic hemangioma.Methods The clinical data of 184 patients who underwent minimally invasive hepatectomy for hepatic hemangioma in the Department of Hepatobiliary and Pancreatic Surgery, Second Affiliated Hospital of Kunming Medical University, between February 2021 and July 2024 were retrospectively collected. Among them, 30 cases were in the robotic group, and 154 cases were in the laparoscopic group. Propensity score matching (PSM) was performed based on baseline data such as patient demographics, tumor characteristics, and surgical resection range, with a 1∶2 matching ratio. Intraoperative and postoperative outcomes were compared between the two groups after matching.Results After 1∶2 PSM, 24 patients were in the robotic group and 48 in the laparoscopic group. Preoperative variables were well balanced between the groups (area under the ROC curve was 0.588). The robotic group had significantly shorter operative time (138 min vs. 168 min, P=0.024) and hepatic hilum blocking time (25 min vs. 45 min, P<0.001) compared to the laparoscopic group. Postoperative albumin levels on day 1 and day 3 were higher in the robotic group, while transaminase levels on postoperative day 1 and day 3 were lower (all P<0.05). However, the hospitalization cost was higher in the robotic group than that in the laparoscopic group (74 746 yuan vs. 49 644 yuan, P<0.001). No significant differences were found between the groups in terms of intraoperative blood loss, intraoperative transfusion rate, open conversion rate, postoperative length of stay, and postoperative complication rates as well as complication severity (all P>0.05).Conclusion For suitable cases of hepatic hemangioma, robotic-assisted laparoscopic hepatectomy is a safe and feasible treatment option. Compared to traditional laparoscopic surgery, it reduces operative time and hepatic hilum blocking time, and minimizes the impact on postoperative liver function. However, the treatment cost is higher, and selection should be based on the patient's individual needs.

Abstract:Background and Aims Body mass index (BMI), an important indicator of nutrition and health, is closely associated with postoperative complications. This study was performed to investigate the relationship between preoperative BMI and severe complications in patients undergoing liver resection for hepatolithiasis, aiming to provide preoperative guidance for clinicians, reduce the risk of postoperative complications, and ensure surgical safety and efficacy.Methods The clinical data of 484 patients with hepatolithiasis who underwent liver resection between May 2006 and December 2022 at the First Affiliated Hospital of Army Medical University and Beijing Tsinghua Changgung Hospital were retrospectively collected. Patients were classified into low BMI group (≤18.4 kg/m2), normal BMI group (18.5-24.9 kg/m2), and high BMI group (≥25.0 kg/m2) based on preoperative BMI. Baseline characteristics, overall complications, severe complications, and other postoperative outcomes were compared between the normal BMI group and the low group as well as the high BMI group. Risk factors for severe complications after liver resection were analyzed.Results Among the 484 patients, 79 (16.3%) were in the low BMI group, 328 (67.8%) in the normal BMI group, and 77 (15.9%) in the high BMI group. The high BMI group had significantly higher ASA score, preoperative albumin level, and proportion of hypertension compared to the normal BMI group (all P<0.05). Baseline characteristics in the low BMI group showed no significant differences compared to the normal BMI group (all P>0.05). The incidence rates of overall complications were not significantly among the three groups (P>0.05). However, the high BMI group had significantly higher incidence rates of severe complications (Clavien-Dindo grade Ⅲ-Ⅳ), postoperative infections, liver failure, and bile leakage compared to the normal BMI group; the low BMI group had significantly higher rates of perioperative blood transfusion, postoperative infections, liver failure, and reoperation compared to the normal BMI group (all P<0.05). Univariate and multivariate Logistic regression analyses identified high BMI and preoperative total bilirubin ≥54 μmol/L as independent risk factors for severe complications after liver resection in patients with hepatolithiasis (both P<0.05).Conclusion Preoperative BMI is closely associated with the occurrence of complications after liver resection in patients with hepatolithiasis, with high BMI being an independent risk factor for severe complications. To mitigate the risk of severe complications, clinical practice should prioritize monitoring and management of individuals with high BMI and other risk factors

Abstract:Background and Aims Precise localization of lesions and optimization of the surgical approach are crucial in laparoscopic left hepatectomy. Traditional surgical techniques have certain limitations, whereas indocyanine green (ICG) fluorescence navigation can accurately delineate the boundaries of liver lesions. The Laennec's capsule approach aids in clearly exposing intrahepatic structures. This study was conducted to evaluate the clinical effectiveness of combining ICG fluorescence navigation with the Laennec's capsule approach in laparoscopic left hepatectomy.Methods The clinical data of 44 liver cancer patients who underwent surgery at the Hepatobiliary Surgery Department of Xuanhan People's Hospital from January 2023 to November 2024 were retrospectively collected. Among them, 22 patients underwent laparoscopic left hepatectomy with Pringle's maneuver for total hepatic inflow occlusion (control group), while the other 22 patients received laparoscopic left hepatectomy using ICG fluorescence navigation combined with the Laennec's capsule approach (observation group). The two groups were compared in terms of intraoperative surgical time, average blood loss, intraoperative transfusion rate, liver function on postoperative days (POD) 1, 3, and 7 [total bilirubin (TBIL), aspartate aminotransferase (AST), alanine aminotransferase (ALT)], average length of hospital stay, gastrointestinal function recovery time, POD 1-6 drainage volume, incidence of postoperative complications, and short-term efficacy.Results The observation group had significantly shorter average surgical time than the control group [(218.19±39.18) min vs. (245.23±44.36) min, P<0.05] and less average blood loss [(320.44±78.62) mL vs. (456.37±88.16) mL, P<0.05]. The intraoperative transfusion rate between the two groups was not significantly different (13.64% vs. 9.09%, P>0.05). The observation group had significantly less postoperative drainage POD 1-6 than the control group [(431.19±152.18) mL vs. (528.23±184.36) mL, P<0.05]. The average hospital stay and gastrointestinal function recovery time were shorter in the observation group [(9.21±2.92) d vs. (12.72±3.24) d; (2.24±0.42) d vs. (3.35±0.53) d, both P<0.05]. Postoperative liver function tests (TBIL, AST, ALT) on days 1, 3, and 7 were significantly lower in the observation group compared to the control group (all P<0.05). The difference in the overall response rate between the two groups was not statistically significant (72.73% vs. 77.27%, P>0.05). No severe postoperative complications occurred in either group.Conclusion The combination of ICG fluorescence navigation with the Laennec's capsule approach demonstrates favorable clinical outcomes in laparoscopic left hepatectomy and is worthy of clinical promotion.

Abstract:Background and Aims Currently, the treatment of hepatocellular carcinoma (HCC) faces significant challenges due to recurrence and metastasis, with tumor immune evasion being one of the key mechanisms underlying these issues. Signal transducer and activator of transcription 3 (STAT3), an important transcription factor, is overactivated in many malignancies and is involved in both tumorigenesis and progression, closely associated with immune evasion. Programmed cell death ligand 1 (PD-L1), a key immune checkpoint, helps tumor cells evade immune surveillance when its expression is upregulated, thereby suppressing anti-tumor immunity. Studies have shown that STAT3 may activate the MYC signaling pathway through interaction with DNA-activated protein kinase (PRKDC), thereby promoting PD-L1 expression and inducing immune evasion. However, the specific mechanism of the STAT3/PRKDC/MYC axis in HCC remains unclear. This study aims to elucidate the molecular mechanism by which STAT3 regulates PD-L1 expression through the PRKDC/MYC signaling pathway, potentially inducing immune evasion in HCC, with the goal of providing potential targets for HCC immunotherapy.Methods The expressions of STAT3 in human normal liver cells (HL-7702) and human HCC cells (HuH-7, HepG2) were detected by qRT-PCR and Western blot. Plasmids with STAT3 knockdown (si-STAT3) and PRKDC overexpression (oe-PRKDC), along with their respective negative controls (si-NC, oe-NC), were constructed and transfected into HCC cells (HuH-7) according to the experimental design, with untreated HuH-7 cells as the blank control. Western blot was used to analyze the expression of STAT3, PRKDC, PD-L1, and MYC pathway-related proteins. Cell proliferation, invasion, migration, and apoptosis of HCC cells were assessed by CCK-8, Transwell, wound healing assay, and flow cytometry. After co-culturing HuH-7 cells with human peripheral blood mononuclear cells (hPBMCs), ELISA was used to detect the secretion of the immune regulatory factor interferon γ (IFN-γ). Co-immunoprecipitation and immunofluorescence co-localization were performed to verify the interaction between STAT3 and PRKDC proteins.Results Results of qRT-PCR and Western blot showed that the mRNA and protein levels of STAT3 were significantly elevated in HCC cells (both P<0.05). Functional experiments demonstrated that in the si-STAT3 group, HCC cell proliferation, migration, and invasion were significantly weakened, and cell apoptosis was notably increased; the expression of PD-L1 and MYC pathway-related proteins was significantly downregulated; the secretion of IFN-γ was significantly increased after co-culturing with hPBMCs (all P<0.05). After co-culturing with oe-PRKDC plasmids, the effects of STAT3 knockdown on HCC cells were significantly reversed (all P<0.05). Scansite 4.0 database analysis revealed that STAT3 and PRKDC have binding sites, and co-immunoprecipitation and immunofluorescence co-localization experiments confirmed the interaction between STAT3 and PRKDC proteins.Conclusion STAT3 is highly expressed in HCC cells and can promote HCC cell proliferation, migration, invasion, and immune evasion through interaction with PRKDC, suppress cell apoptosis, activate the MYC pathway, and increase PD-L1 expression. The STAT3/PRKDC/MYC axis may serve as a potential target for HCC immunotherapy.

Abstract:Background and aims Endovascular therapy is currently considered the first-line treatment for most patients with symptomatic peripheral artery disease. Recent research has primarily focused on short- or mid-term (≤2 years) follow-up periods, investigating the efficacy differences in endovascular methods for treating newly developed femoropopliteal arterial lesions. However, the optimal endovascular treatment method for newly developed femoropopliteal arterial lesions during long-term follow-up remains unclear. Therefore, this study conducted a network Meta-analysis of randomized controlled trials (RCTs) to compare the efficacy of common balloon angioplasty (BA), bare nitinol stent (BNS), drug-coated balloon (DCB), and drug-eluting stent (DES) implantation during short-term and long-term follow-up in the treatment of newly developed femoropopliteal arterial lesions.Methods After searching multiple medical databases, a total of 26 RCTs (with a total of 4 480 patients) were included, and a network Meta-analysis was conducted to assess the efficacy and safety of various methods. Outcome measures included primary patency rates at of follow-up, target lesion revascularization (TLR) rates, major amputation rates, and all-cause mortality rates during 1, 2, and/or 3 years of follow-up.Results In terms of primary patency rates at 1, 2, and 3 years of follow-up, DES consistently showed to be the most effective treatment method, with its 2-year primary patency rate significantly higher than BA (OR=11.11, 95% CI=3.06-40.28), BNS (OR=2.82, 95% CI=1.06-7.53), and DCB (OR=4.19, 95% CI=1.06-16.51). Regarding TLR rates at 1, 2, and 3 years of follow-up, DES again proved to be the most effective treatment method, with its 2-year TLR rate significantly lower than BA (OR=0.08, 95% CI=0.03-0.25), BNS (OR=0.43, 95% CI=0.19-0.97), and DCB (OR=0.29, 95% CI=0.09-0.88). There were no significant differences in major amputation rates among the treatment methods, but the surface under the values of cumulative ranking curve at 1, 2, and 3 years indicated that DCB was the most effective method in preventing major amputation. No significant differences were observed in all-cause mortality rates at 1, 2, and 3 years among the treatment methods.Conclusions For the treatment of newly developed femoropopliteal arterial lesions, DES demonstrated higher primary patency rates and lower TLR rates, while DCB may be the most effective method in preventing major amputations. Therefore, DES and DCB should be prioritized in the consideration for treatment.

Abstract:The European Society for Medical Oncology Asia Congress 2024 was held in Singapore from December 6 to 8, 2024. The conference unveiled several groundbreaking studies in the field of hepatobiliary and pancreatic tumors, covering clinical applications related to neoadjuvant and adjuvant therapies, translational treatments, later-line therapies, and tumor biomarkers. These studies provide new insights into the clinical diagnosis and treatment of hepatobiliary and pancreatic malignancies and drive the development of related fields. This article focuses on the key topics in hepatobiliary and pancreatic malignancies presented at the conference, aiming to interpret the latest advances in the field and explore the hot issues and future directions for development in this area.

Abstract:Liver cancers are characterized by high heterogeneity and complexity, posing significant challenges in early diagnosis and prognosis, which burden patients and healthcare systems. Blood metabolomics, an emerging system biology technology, analyzes small molecular metabolites in the blood to reveal metabolic features of tumors, offering novel insights for the early diagnosis and prognosis evaluation of liver cancers. In recent years, substantial progress has been made in identifying specific blood metabolic biomarkers for liver cancers, including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, and metastatic liver cancer, laying the foundation for more precise personalized treatments. However, current studies face limitations such as small sample sizes, insufficient biomarker validation, and the need for standardization. Large-scale, multi-center studies and integrated multi-omics analyses are urgently required to optimize and validate the application of blood metabolomics. This review summarizes the current state of research on blood metabolomics in liver cancers, focusing on its potential and challenges in early diagnosis and prognosis prediction, aiming to provide insights into precision diagnosis and treatment of liver cancers.

Abstract:The automation technology of surgical robots (SR) integrates key techniques such as force feedback, visual feedback, medical image alignment, and surgical navigation. This integration not only effectively reduces the workload of surgeons, enabling them to focus more on the overall execution of the surgical procedure, but also decreases reliance on surgical experience, contributing to the standardization and homogenization of surgical outcomes. Although most current SR systems are primarily used for assisting operations, some robots have demonstrated conditional automation capabilities, showcasing significant potential in automated surgery research. However, the development of automated surgery still faces numerous challenges, including limited perception capabilities, constraints of artificial intelligence algorithms, and technical bottlenecks in surgical navigation. This paper summarizes the key technologies of commonly used SR systems globally, analyzes the progress in automation research, and discusses the challenges and trends in future development.

Abstract:Hepatocellular carcinoma (HCC) is the most common type of liver cancer and a leading cause of cancer-related deaths worldwide. While early detection significantly improves prognosis, patients with alpha-fetoprotein-negative hepatocellular carcinoma (ANHCC) often face diagnostic challenges due to the lack of reliable biomarkers. This review systematically explores the potential of various circulating biomarkers in the early diagnosis of ANHCC, including AFP-L3, PIVKA-Ⅱ, lymphocyte-to-monocyte ratio, exosomes, circulating cell-free DNA (cfDNA), circulating tumor cells, osteopontin, paraoxonase 1, autoantibodies, and RNA-related biomarkers. The combined use of these markers, particularly AFP-L3 and PIVKA-Ⅱ, demonstrates enhanced diagnostic accuracy and specificity compared to single markers. Emerging evidence also highlights the diagnostic potential of exosomes, cfDNA, and RNA markers due to their non-invasive nature and high stability. Despite promising results, further large-scale, multicenter studies are needed to validate these findings, address challenges such as standardization of detection methods, and elucidate underlying mechanisms. These advances are anticipated to significantly improve early detection and personalized management of ANHCC.