Despite recent advances in preoperative diagnostic imaging and operative techniques for hilar cholangio-carcinoma, postoperative mid-or long-term survival has not improved. Moreover, it remains difficult to achieve curative resection with a negative resection margin for complicated hilar cholangiocarcinoma of Bismuth type ⅢorⅣ. Although it is questionable whether hepatic artery resection can improve the prognosis, combined vascular resection of the portal vein and hepatic artery for treatment of the tumor extending along the bile duct may be one of the key factors to achieve a negative resection margin. Further investigation is required to determine whether radical resection of the remaining liver parenchyma and limiting the amount of resection as much as possible, as well as the no-touch isolation technique, can improve the prognosis of patients.

Complex hilar cholangiocarcinoma is a great challenge to surgeons in hepatic surgery,not only because of its great degree of oper-ation difficulty,but also the high surgical risk and low R0 resection rate.Noticeably,R0 resection,lymph node infringement,and vessel re-section are regarded as three independent prognostic factors for complex hilar cholangiocarcinoma.In recent years,with the advancement of surgical techniques such as precise liver resection using preoperative 3D imaging,application of radical tumor resection while preserving nor-mal liver parenchyma for patients who are suitable for this surgical process,combined hepatic resection and vascular resection,and perform-ance of reasonable extent of lymph node dissection,it is hoped to increase the curative resection rate for patients with Bismuth typeⅢandⅣcomplex hilar cholangiocarcinoma,improve their quality of life,and prolong their survival time.

Liver cancer is one of the most common cancers worldwide and the third leading cause of cancer death.Partial hepatectomy and liver transplantation are the most effective therapies.However, postoperative tumor metastasis and recurrence are the main obstacles in the long-term survival.Liver cancer stem cells (LCSCs) within cancer tissues are associated with tumor occurrence, proliferation and tolerance to current therapy and are regarded as the major root of metastasis and recurrence.Eradication of LCSCs is a novel therapy of liver cancer.In this review, surface markers of LCSCs and mechanisms of pro-metastasis and recurrence, circulating LCSCs,microenvironment of LCSCs and their roles in the metastasis and relapse are summarized.

Hepatectomy is the main option of treatment for liver cancer,and how to control the blood loss is an important issue for the recovery of patients.Continuous hepatic vascular occlusion(Pringle maneuver)is the oldest and simplest way for vascular occlusion and still used in clinical practice.But continuous hepatic vascular occlusion often gives rise to postischemic reperfusion injury due to clamping the portal vein and the hepatic artery in the hepatic pedicle.So intermittent clamping or hemihepatic vascular occlusion is recommended in complex liver resections or for patients with liver cirrhosis.Total hepatic vascular exclusion has the advantages of occlusion of vascular inflow and outflow of the liver,and is mainly used for patients with tumors invading the caval veins.Major hepatic veins and limited inferior vena cava reconstruction has been also achieved under inflow occlusion with extraparenchymal control of major hepatic veins.It is crucial to know how to select the optimal methods of hepatic vascular occlusion according to the specific conditions.Focusing on this issue,we have reviewed and evaluated various methods and relevant researches in this paper.

Chronic inflammation has been demonstrated closely related to the tumor progression.Tumorassociated macrophage,as the most abundant immune cells in the tumor microenvironment,is a key element that links inflammation and cancer.Recently,studies found that the phenomenon and function of tumor-associated macrophage almost tend to M2 type macrophage.As an important indicator,tumor-associated macrophage usually predicts the poor progress with the cancer development.In China,Most of patients with hepatocellular carcinoma are associated with chronic viral infection.A large number of macrophages in the liver infiltrated in chronic inflammation,which are differentiated by variety of mechanisms under the chronic inflammatory stimulation,promote the development of liver cancer.In this paper,we will review the tumor-associated macrophages and the development of liver cancer.

Objective To evaluate single balloon dilatation and placenment of the stent for the treatment of Budd Chiari Syndrome.Methods Thirty four patients with Budd Chiari Syndrome underwent covagraphy catheterized through superior and inferior vena cava (IVC) simultaneously and single balloon dilatation of IVC and placement of metallic stents.Results Puncture and dilatation were successful in 33 patients.The obstructed segments of IVC were dilated to 10～20 mm in diameter.Nine metallic stents were placed in 9 cases. The caval pressure below obstruction were reduced from(2.71?0.78) kPa to(1.98?0.85) kPa in average.Conclusions Covagraphy catheterized through superior and inferior vena cava (IVC)simultaneously reveals the site and length of the obstruction clearly.Insertion of large single balloon is technically simple and dilatation is definite.Restenosis in segmental type may be prevented by stent insertion.

Hepatocellular carcinoma is a major disease for serious threat to human health, ranked third in the world of cancer causes of death and second in China' s in cancer mortality. There are gender differences in the incidence of HCC and numerous studies on estrogen' s role in the formation of HCC, and the formation of estrogen in the liver plays a protective role during the hepatocarcinogenesis. Some studies have shown estrogen inhibiting the expression of interleukin-6 thereby reducing the incidence of HCC. IL-6 and HGF have an important role in promoting HCC formation process, estrogen and these factors have are also important links. Now require in-depth exploration of novel adjuvant therapy is required to improve the survival rate of patients with HCC.

Recently, vasculogenic mimicry, a new form of tumor blood supply has been discovered,which is completely different with the classic model of tumor blood supply. It has important significance which perfect the mechanism of tumor blood supply, improve the treatment and prognosis of tumor. In the paper, its structure, mechanism, and clinical significance of tumor treatment are reviewed.

ObjectiveTo summarize the complications after precise hepatectomy for primary liver cancer and explore the prevention experiences.MethodsThe clinical data of 120 primary liver cancer patients who underwent precise hepatectomy in Anhui Provincial Hospital from August 2008 to October 2011 were retrospectively analyzed.The common complications after hepatectomy and the management measures of the complications were studied.Results Related complications were found in 19 cases,including 7 cases of pleuraI effusion,3 cases of pneumonia,1 case of intra- abdominal hemorrhage,2 cases of up gastrointestinal bleeding,1 case of abdominal abscess,1 case of hepatic failure,1 case of bile leakage,2 cases of would infection,1 case of urinary tract infection.ConclusionsPrecise hepatectomy has characteristics of preoperative accurate assessment,intraoperative fine operation and postoperative excellent management,which reduce the incidence of postoperative complications.

Liver transplantation is one of the most effective treatment of hepatocellular carcinoma.And rapamycin is a new class of immunosuppressors already in use after liver transplantation.Recently.more and more studies find that rapamyein not only can exert immunosuppressive effects but also has antitumor properties.Therefore,the research about rapamycin in hepatocellular carcinoma has become a focus.Herein,we review the progress of rapamycin in the treatment of hepatocelhlar carcinoma together with current results and future developments.