Hepatocellular carcinoma (HCC) is one of the most common cancers world-wide.Known risk factors and prognostic factors of the disease include virus infection of hepatitis B and hepatitis C,alcohol intake,carcinogenic substances such as aflatoxin B1.So far,multiple studies have identified the molecular genetic characteristics of the tumor utilizing nextgeneration sequencing technologies.The whole-genome and exome sequencing of HCC can help to find potential key oncogenes and tumor suppressor genes,as well as improving molecular diagnosis of HCC,which can help to find new therapeutic targets and determine prognosis.In 2011,The US researchers whole-genome sequencing (2 patients,with HBV and HCV infection,respectively),whole genome exome sequencing (47 patients,of which 33 with HCV infection,7 with HBV infection,and 7 with non-viral infection),Sanger sequencing (94 patients,of which 52 with HBV infection,36 with HCV infection,and 6 with non-viral infection),gene expression (4 patients,of which 2 with HBV infection and 2 with HCV infection),and Epigenetic inheritance (1 case,with HCV infection),as well as other research strategies in search of treatment approaches for liver cancer from genomics perspectives,in hope of improving long-term survival rate of patients with HCC[1].This review summarizes the HCC-related predisposing genes from whole-genome and exome studies with next generation sequencing technologies.

Since the concept of molecular imaging was put forward in 1999,optical molecular imaging techniques have been widely applied in the field of biomedical and clinical research.Its unique application value is especially shown in hepatobiliary surgery,such as in liver tumor imaging,anatomical liver resection,liver transplant angiography,cholangiography,and bile or pancreatic leakage prevention.Optical molecular imaging technique "lights up" targeted areas in surgical operations and provides convenience in carrying out precision operation.This paper reviewed the advantages of optical molecular imaging technology in clinical research and discussed its limitations in translational surgery,and put forward possible directions in improvement for the future.

Hepatobiliary and pancreatic surgery in the 21st century is undergoing major changes based on the concepts of precision surgery,minimally invasive treatment,information technology,and individualized and integrated management.These changes have been brought about by new developments in electrosurgical instruments and surgical equipments,advances in medical imaging and 3D reconstruction technique,digital technology,artificial intelligence,machine vision,and regeneration medicine.All these new advances make hepatobiliary surgery in the era of precision medicine to focus on the development of precision surgery,minimally invasive treatment,repair and regenerative medicine,and individualized treatment,with the ultimate aims to improve patient survival and quality of life.

Intraoperative ultrasound (IOUS) should be routine in modem liver surgery.It can be divided into open and laparoscopic IOUS.The two types of IOUS differ not only in technique,but also in ultrasound probes.IOUS probes can further be classified as sector and linear probes.IOUS has a wide application in liver surgery.It improves intraoperative diagnosis and staging of tumour.As a consequence,it changes the preoperative surgical plan in 23％ to 51％ of patients.Under IOUS guidance,surgeons can carry out biopsy or treatment of liver nodules.It helps liver surgeons to localize tumours,to determine resection margins,to determine hepatic parenchymal transection planes,to guide and monitor transection planes and to find major vessels in order to protect or to ligate them.Proper IOUS requires special equipments and personnel.IOUS has a very wide application in modem liver surgery.Its widespread use would depend on the establishment of a proper training programme.

Objective To study the clinical application of indocyanine green fluorescence fusion imaging (FIGFI) in anatomical hepatectomy.Methods The clinical data of 41 patients who underwent anatomical hepatectomy with guidance of FIGFI from March to June 2017 in our department were analyzed retrospectively.The data included:(l) Intraoperative data:surgical procedure,extent of hepatectomy,ICG fluorescent staining procedure and result,operation time,intraoperative blood loss and intraoperative blood transfusion.(2) Postoperative data:postoperative complications and pathology.Results Of the 35 patients who underwent laparoscopic anatomical hepatectomy,34 patients were successfully carried out under FIGFI guidance.One patient was converted to laparotomy.For the 6 patients who underwent laparotomy,liver resections were successfully carried out.Of all the 41 patients,37 had successful staining but 4 failed.Staining failure mostly occurred in patients who underwent anti-staining in liver segments with multiple vascular branching supply because not all the target liver pedicles were blocked before injecting ICG.Conclusions FIGFI guided anatomical hepatectomy is a very promising technique.The combination of preoperative imagings,intraoperative laparoscopic ultrasound guidance and FIGFI helped to achieve the goal of anatomical liver resection.

Objective To explore the clinical treatment strategies of laparoscopic hepatocellular carcinoma ablation for patients with severe cirrhosis background.Methods We analyzed the clinical data of 430 patients and analyzed the indications,key techniques,efficacy and safety of laparoscopic hepatocellular carcinoma ablation for patients with severe cirrhosis background,and summarized the related experiences.Results The first complete ablation rate for the entire cohort was 94％,the 2-year local recurrence rate was 2.8％.No significant complications were found postoperatively.Conclusions Laparoscopic hepatocellular carcinoma ablation is a minimally invasive,safe and effective treatment strategy for patients with small cancer under severe cirrhosis background.Especially when the tumor is located in the " high-risk parts" for ablation,it could be a preferred method for pre-transplant treatment of these patients.

Intraoperative ultrasonography (US) is the very important tool for liver surgery which not only provides the operating surgeon with useful real-time diagnostic and staging information that may result in an alteration in the planned surgical approach,but also provides the guidance for hepatectomy,vessel patency and intraoperative tumor ablation procedures.The indications,equipment,techniques and the benefits and limitations as well as future expectations are discussed.

Laparoscopic and robotic hepatectomies have proved to be safe and feasible with advantages of minimally invasive and enhanced recovery,despite the inherent defects of restricted endoscopic angle of vision and having no tactile sensing.In recent years,the development of intraoperative image-guided techniques,such as real-time intraoperative ultrasonography,intraoperative CT/MRI-guided navigation system,fusion ICG fluorescence imaging,and augmented reality,have greatly assisted surgeons with precise targeting of the tumors,preoperative surgical planning,along with supervision and in-time revision of the amputation plane of hepatic papernchyma.Therefore,it has enabled precise hepatectomy without damaging important vascular structures,reduced intraoperative blood loss,and increased the safety of surgical procedures.Besides,intraoperative image guide could compensate the defect of restricted vision in laparoscopic and robotic hepatectomies,pushing the limits of human vision field.This article will describes the application of imageguided techniques in laparoscopic and robotic hepatectomies.

Objective To determine the prognostic factors after radical resection (RR) for hepatocellular carcinoma (HCC).Methods Altogether 144 patients who had undergone RR for HCC from 1988 through 1995 were included for a univariate and a Cox multivariate analysis.Nineteen factors contributing to overall survival rate (SR) and disease-free SR were analysed.Results The 5-year SR and disease-free SR (N=144) were 47.3% and 23.9%,separately.Multivariate analysis revealed that classification of RR was the signficant factor to overall SR,and presence of vessel invasion was the signficant factor to disease-free SR.The 5-year SR and disease-free SR in the patholngically RR and clinically RR groups were 60.2%,29.0% and 14.0%,0%,respectively.The 5-year disease-free SR in the group without (or with) vessel invasion was 27.8% (or 0%).Conclusions The classification of RR is the determinative prngnostie factor.Pathologically RR is the first option for patients with in- dications.It is essential to improve adjuvant therapy to decrease postoperative recurrence and metastasis rates.

Objective To explore diagnosis and operative treatment of primary cholecy stocarcinoma. Methods One hundred and thirty-six cases of biliary carcinoma were analysed for their clinical and pathological data and selection of the method of operation.Results The prognosis of late-staged cases was very bad.B-US and CT are still the most helpful means for clinical diagnosis.Conclusion The early diagnosis and treatment of primary cholecystocarcinoma are of utmost importance.