Objective:To investigate the safety and utility of using polyester spacers in conventional pancreatico-enteric anastomosis in pancreaticoduodenectomy to achieve prevention of postoperative pancreatic fistula.Methods:The clinical data of 82 patients with pancreaticoduodenectomy completed by the same physician in Anyang People's Hospital from August 2018 to August 2023 were retrospectively analyzed, including 52 males and 30 females, aged (62.21±9.75) years. They were divided into two groups, test group ( n=40) and control group ( n=42) according to whether polyester spacers were used in pancreatico-intestinal anastomosis, the perioperative data of the two groups were compared, and Logistic analysis was used to analyze the risk factors affecting postoperative pancreatic fistula. Results:There was no statistically significant difference between the two groups in terms of biliary fistula, intestinal fistula, abdominal infection, abdominal bleeding, and postoperative mortality rate (all P>0.05). The incidence of postoperative pancreatic fistula in the test group was 20.0% (8/40) which was lower than that in the control group 45.2% (19/42), and the difference was statistically significant ( P=0.015). Soft pancreas texture ( OR=16.595, 95% CI: 1.891~145.657) was an independent risk factor for postoperative pancreatic fistula, while improved pancreatic enterostomy with polyester spacers ( OR=0.332, 95% CI: 0.114~0.969) could reduce the risk of postoperative pancreatic fistula. Conclusion:Use of polyester spacers to reinforce the pancreatico-enteric anastomosis during pancreaticoduodenectomy reduces the incidence of postoperative pancreatic fistulae with good safety and practicality.

Objective:To compare the clinicopathological features between patients with gallbladder adenosquamous carcinoma and gallbladder adenocarcinoma, and analyze the prognostic factors for overall survival.Methods:The clinical data of 135 patients with gallbladder cancer, confirmed by postoperative pathology, treated in Department of Hepatobiliary and Pancreatic Surgery of Ningbo Medical Center Lihuili Hospital within 5 years (from January 2018 to December 2022) were retrospectively analyzed. A total of 122 patients were enrolled in this study, including 55 males and 67 females, aged (68.0±9.8) years. Patients were divided into the adenosquamous carcinoma group ( n=14) and adenocarcinoma group ( n=108). The clinicopathological features (tumor size, differentiation of tumor, tumor TNM stage) and survivals of patients were compared. The survival rates were analyzed using the Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was performed to identify prognostic factors for overall survival. Results:Compared with the adenocarcinoma group, patients with adenosquamous carcinoma had a larger tumor size, higher incidence of liver invasion, higher proportion of poor differentiation of tumor, higher proportion of TNM stage Ⅲ-Ⅳ (all P<0.05). There was also a statistically significant difference in the extent of liver resection between the two groups ( χ2=9.22, P=0.016). The 1- and 2-year cumulative survival rates after surgery in adenosquamous carcinoma group were 28.6% and 9.5%, respectively, lower than those in adenocarcinoma group (78.7% and 60.5%, respectively; χ2=27.88, P<0.001). For patients with gallbladder adenosquamous carcinoma, the cumulative survival rate of patients who received postoperative adjuvant chemotherapy ( n=11) was significantly better than that of patients without postoperative adjuvant chemotherapy ( n=3) ( χ2=5.82, P=0.016). For patients with gallbladder adenocarcinoma, multivariate Cox regression analysis identified that the N stage (N 1/N 0HR=4.521, 95% CI: 1.399-14.612, P=0.012; N 2/N 0HR=8.644, 95% CI: 2.407-31.039, P=0.001) and M stage (M 1/M 0HR=4.699, 95% CI: 1.540-14.340, P=0.007) were associated with a poor survival. Conclusions:Compared to gallbladder adenocarcinoma, adenosquamous carcinoma had more aggressive features and a worse prognosis. For patients with gallbladder adenosquamous carcinoma, postoperative adjuvant chemotherapy was associated with an improved overall survival. For patients with gallbladder adenocarcinoma, N stage and M stage were independent risk factors for overall survival.

Objective:To analyze the expression and prognosis of B-cell lymphoma 7 protein family member A (BCL7A) in hepatocellular carcinoma, as well as the effect and mechanism of BCL7A expression on the invasion and migration of hepatocellular carcinoma cells.Methods:The cancer tissues and adjacent tissues of 40 patients with hepatocellular carcinoma who underwent radical hepatobiliary resection in the Department of Hepatobiliary Surgery, Affiliated Hospital of Nantong University from November 2017 to March 2018 were prospectively collected for protein extraction, including 29 males and 11 females, aged (58.5±10.4) years. The information of 374 cases of hepatocellular carcinoma and 50 cases of adjacent tissues were downloaded from The Cancer Genome Atlas (TCGA) database, and the hepatocellular carcinoma cell lines Hep3B and SMMC-7721 were transfected with overexpressing BCL7A plasmid and empty vector plasmid (negative control), respectively. Western blotting and immunohistochemistry were used to detect the expression of BCL7A, and Western blotting was also used to detect the expression of proteins related to epithelial-mesenchymal transition (N-cadherin, E-cadherin, snail). Transwell and cell scratch assays were used to detect cell invasion and migration.Results:Compared with adjacent tissues, the mRNA expression of BCL7A in 50 patients with hepatocellular carcinoma in TCGA was significantly increased ( t=13.38, P<0.001). According to the median mRNA expression level of BCL7A, 374 patients were divided into BCL7A high expression group ( n=187) and low expression group ( n=187), and the cumulative survival rate of BCL7A high expression patients was lower than that of low expression group, and the difference was statistically significant ( χ2=6.95, P=0.009). Western blot was used to detect the relative expression of BCL7A protein in cancer tissues, and found it was higher compared to adjacent tissues. Compared with the negative control group, the number of cells invaded by the BCL7A overexpression group of hepatoma cells Hep3B and SMMC-7721 was more than the negative control group respectively, (153.7±1.3) vs (63.7±4.7) and (307.7±25.14) vs (72.3±12.5), and the differences were statistically significant ( t=7.97, 8.38, both P=0.001) .The results of the cell scratch assay were consistent with the results of the Transwell invasion assay. The expressions of N-cadherin and snail in the BCL7A overexpression group were higher than those in the negative control group, and the E-cadherin was lower, and the difference was statistically significant (all P<0.05). Conclusions:The expression of BCL7A in cancer tissues of patients with hepatocellular carcinoma is elevated and is associated with poor prognosis. BCL7A may promote hepatocellular carcinoma cell metastasis and invasion by promoting epithelial-mesenchymal transition.

Objective:To compare the efficacy and safety of robotic surgery and open surgery in the treatment of hilar cholangiocarcinoma.Methods:PubMed, Embase, Cochrane Library, Web of Science, CNKI and Wanfang database were searched to compare the treatment of hilar cholangiocarcinoma by robotic surgery and traditional open surgery. Literatures were searched from the establishment of the database to July 2023. Compare operation time, intraoperative blood transfusion rate, R 0 resection rate, lymph node metastasis rate, postoperative complication rate and hospital stays between the two groups. The combined odds ratio ( OR) and mean difference ( MD) and 95% confidence interval (95% CI) were calculated using RevMan 5.4 software. Results:A total of 4 studies were included, including 267 patients with hilar cholangiocarcinoma. There were 177 males and 90 females, aged (58.8±5.7) years. A total of 267 patients were divided into open surgery group ( n=165) and robotic surgery group ( n=102) according to the surgical formula. The extract results show: operative time ( MD=-103.96, 95% CI: -216.90-8.98, P=0.070) and intraoperative blood transfusion rate ( OR=1.32, 95% CI: 0.43-4.07, P=0.630), R 0 resection rate ( OR=1.41, 95% CI: 0.71-2.81, P=0.330), lymph node metastasis rate ( OR=1.62, 95% CI: 0.46-5.63, P=0.450), postoperative complications ( OR=0.60, 95% CI: 0.28-1.31, P=0.200), and postoperative hospital stay ( MD=2.17, 95% CI: -11.56-15.90, P=0.760). Conclusion:In the treatment of hilar cholangiocarcinoma, robotic surgery is as safe and feasible as open surgery. However, due to the limited number and quality of included studies, the above conclusions need to be verified by more high-quality studies.

Ultrasound elastography is a non-invasive imaging technique that can measure tissue hardness and provide valuable information for diagnosis and treatment of hepatocellular carcinoma. It offers numerous advantages, including non-invasiveness, rapidity, safety, excellent repeatability, cost-effectiveness, and high patient acceptance. This article reviews the current research progress of ultrasound elastography in diagnosis, treatment evaluation, and prognosis prediction of hepatocellular carcinoma, aiming to help clinicians to tailor treatment strategy, reduce complications, and improve prognosis.

Liver regenerative medicine can use functional liver cells to repair or replace damaged liver tissue and it is expected to be rapidly developed as an alternative treatment to liver transplantation. However, regenerative medicine requires cells with stable proliferation ability and liver cell characteristics. Liver organoids are derived from adult stem cells or pluripotent stem cells. They can be proliferated in large quantities and cultured for a long time in vitro, meanwhile maintain genetic stability, and simulate the structural and functional characteristics of organs in the body, providing a new strategy for liver regeneration. This article reviews liver organoids and their research progress in liver regenerative medicine, and discusses their application potential and existing limitations.

Fluorescent surgical navigation has been widely used in liver and biliary surgery, including imaging of tumors, bile ducts, blood vessels, and other small lesions that cannot be identified by traditional methods. This helps surgeons obtain visual information during surgery and facilitates intraoperative decision-making. However, there are still many controversies in pancreatic tumor surgery, which is also the reason for the limited application of this technology in the pancreas at present. This article first summarizes the current status of the application of this technology in pancreatic tumor surgery. Based on our own experiences, we summarize the current problems of fluorescence imaging technology and propose corresponding optimization strategies. Finally, we look forward to its application prospects, hoping to provide a reference for the future application of fluorescence imaging technology in pancreatic tumors.

Objective:To evaluate the feasibility of abandoning prophylactic abdominal drainage in patients undergoing minimally invasive minor hepatectomy based on a propensity score matching (PSM) study.Methods:Retrospective review of a prospectively collected database of patients undergoing minimally invasive minor hepatectomy from July 2022 to May 2023 at the Department of Hepatopancreatobiliary Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital. A total of 108 patients were enrolled, including 48 males and 60 females, aged (60.8±13.7) years old. According to whether the abdominal drainage tube was prophylactically placed intraoperatively, patients were divided into two groups: the drainage group (with prophylactic placement of abdominal drainage tubes, n=76); the no-drainage group (without prophylactic placement of abdominal drainage tubes, n=32). PSM was used to compare the perioperative data between the groups, including extent of liver resection, intraoperative blood loss, operative time, and postoperative complications. Postoperative survival status within 90 days was followed up through telephone review. Results:Before PSM, the two groups differed significantly on age and the history of hypertension (both P<0.05). After PSM, there were 23 patients in each group. Patients in the two groups showed comparable results regarding the intraoperative parameters including the surgical method, pathological types, the number and maxium diameter of hepatic lesions, the extent and complexity of liver resection, and the duration of hepatic inflow occlusion (all P>0.05). No postoperative intra-abdominal bleeding occurred in either group. The incidences of postoperative complications were comparable between the groups, including fever, bile leakage, incision infection, and abdominal acupuncture for drainage (all P>0.05). After PSM, compared to patients wothout prophylactic abdominal drainage, prophylactic abdominal drainage group showed a decreased white blood cell counts on postoperative day 1 [9.39(6.30, 10.58)×10 12/L vs. 13.19(10.15, 14.90)×10 12 /L, P=0.006] and a shorter length of postoperative hospital stay [4(3, 5) d vs. 5(4, 5) d, P=0.033]. No postoperative death within 90 days occurred in either group. Conclusion:In minimally invasive minor hepatectomy, abandoning prophylactic abdominal drainage could be feasible, which facilitates fast recovery without increasing the incidence of postoperative fever, perihepatic fluid accumulation and postoperative abdominal acupuncture for drainage.

Objective:To investigate the expression of nuclear matrix protein 4 (NMP4) in hepatocellular carcinoma (HCC), and its relationship with clinicopathological features and survival prognosis of patients.Methods:The clinical data of 100 HCC patients who were treated with radical resection of liver cancer in the Department of Hepatobiliary Surgery of the Third Affiliated Hospital of Wenzhou Medical University from July 1, 2014 to July 1, 2019 were retrospectively analyzed. There were 63 males and 37 females, aged (58.5±10.4) years old. Immunohistochemical method was used to detect the expression of NMP4 protein in HCC cancer tissue and the corresponding adjacent normal tissue. According to the expression of NMP4 in HCC tissues, 100 patients were divided into two groups: the NMP4-positive expression group ( n=62) and the NMP4-negative expression group ( n=32). Univariate analysis was performed on the relationship between NMP4 expression and clinical pathological features as well as overall survival of HCC patients. Cox multivariate analysis was performed on the factors influencing postoperative prognosis of HCC patients. Results:Immunohistochemistry results showed that NMP4 was primarily expressed in the nucleus, the positive expression rate of NMP4 in HCC tissues was higher than that in adjacent non-cancerous tissues [62.0% (62/100) vs. 8.0%(8/100)], and the difference was statistically significant ( χ2=2.12, P=0.003). Univariate analysis revealed that the overall survival of HCC patients was correlated with the degree of tumor differentiation, tumor length, BCLC stage, number of tumor foci, vascular tumor thrombus and expression of NMP4 (all P<0.05). Cox multivariate analysis revealed that low differentiation, high BCLC stage (stage C), number of tumor foci (≥3), and positive expression of NMP4 were independent risk factors affecting postoperative survival and recurrence-free survival of HCC patients. The median overall survival and median recurrence-free survival of HCC patients in the NMP4-positive expression group were 22.3 months and 11.5 months, respectively. In contrast, that in the NMP4-negative expression group were 40.6 months and 19.4 months, respectively. The cumulative survival rate and recurrence-free survival rate of HCC patients in the NMP4-positive expression group were lower than those in the NMP4-negative expression group, and the differences were statistically significant (both P<0.05). Conclusion:Positive NMP4 expression was closely correlated with malignant biological progression and poor prognosis of HCC patients.

Objective:To analyze the influencing factors of postoperative bile leakage in laparoscopic liver lobectomy for hepatocellular carcinoma (HCC), and to create and validate an early warning model of postoperative bile leakage based on the synthetic minority oversampling technique (SMOTE).Methods:Clinical data of 120 patients with HCC undergoing laparoscopic lobectomy in Xiaolan People's Hospital of Zhongshan City from January 2016 to January 2022 were retrospectively analyzed, including 72 males and 48 females, aged (58.6±6.7) years old. The patients were divided into two groups according to the occurrence of bile leakage within 30 days after surgery: bile leakage group ( n=32) and non-bile leakage group ( n=88). Clinical data such as lesion size, remnant liver volume, intraoperative blood loss, and serum levels of alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were collected. The positive sample size in the original dataset was expanded according to the SMOTE algorithm, and the SMOTE risk warning model (P 2) was established based on the new dataset. The predictive efficacy of the model was accessed using the receiver operating characteristic (ROC) curve and the area under the curve (AUC). Results:The incidence of postoperative bile leakage was 26.67%(32/120) in the patients. Lesion size, preoperative cholangitis, remnant liver volume, intraoperative blood loss, serum level of ALT and AST differs between the groups (all P<0.05). The sample size of the bile leakage group was expanded to 96 cases by the SMOTE algorithm, and then the sample size ratio of the two groups would be close to 1. Subsequent re-fitting of the expanded data based on the SMOTE algorithm showed that a lesion size of ≥5 cm, preoperative cholangitis, increased intraoperative hemorrhage, elevated ALT and AST were independent risk factors for postoperative bile leakage in patients with HCC (all P<0.05), while a larger remnant liver volume was a protective factor for postoperative bile leakage ( P<0.05). An early warning model P 2 was established based on the above factors. The Hosmer-Lemeshow test showed that the model fitting was good ( P=0.842, coefficient of determination R2=0.647). The sensitivity and specificity of the model for predicting postopera-tive bile leakage was 93.75% and 82.95%, respectively, with an AUC of 0.955 (95% CI: 0.901-0.985). Conclusion:Lesion size, preoperative cholangitis, remnant liver volume, intraoperative blood loss, serum levels of ALT and AST were associated with postoperative bile leakage after surgery for HCC. The early warning model of postoperative bile leakage based on the SMOTE algorithm has a high predictive efficacy.