Objective To confirm the feasibility and security of the liver hanging maneuver in difficult right hemihepatectomy.Methods Medical records of 40 conseeutive patients considered for difficult right hemihepatectomy were reviewed.The patients were grouped into two groups in pairs:group 1 (using the hanging maneuver) in 20 and group 2 (using the traditional maneuver) in the left 20.Results It was successful in 20 patients and the overall feasibility was 100%.Operative duration,bleeding,transfusion,average stay and complications in group 1 were lower than those of group2.Conclusion The liver hanging maneuver not only has high feasibility but also improves the security in difficult right hemihepatectomy.

Objective To evaluate the the safety and efficiency of precise liver resection for patients with primary liver cancer. Methods 86 patients with primary liver cancer were randomized to receive conventional routine hepatectomy (n=44) or the precise liver resection (n=42). Outcomes were compared between the precise hepatectomy group and the routine group, including, the blood loss, operation time, morbidity and mortality. Results There were significant differences in morbidity rates (7.1% vs. 20.5%; P<0.001), the blood loss [(320±315) ml vs. (613±526) ml;P<0.001) , postoperative alanine aminotransferase (ALT) value (in postoperation 7 d, 82.7 U/L vs.321.7 U/L; P<0.001) and length of hospital stay (12.3 d vs. 18.6 d; P<0.001) between precise hepatectomy and routine groups. The 1 year tumor recurrence rate and 1 year survival rate were 26.2%(11/42) and 78.6% (33/42) in precise liver resection group, 38.6% (17/44) and 65.9%(29/44) in routine liver resection group,with significant difference (P=0.010;P=0.018). Conclusion Precise liver resection is safe and effective in the treatment of liver tumor without much injury to patients.

Objective To prepare a redox-responsive doxorubicin-loaded nanoparticle,and to study its in vitro realease behavior and targeting effect on heptoma cells.Methods Cystamine was grafted on the side chains of hyaluronic acid with 1-(3-dimethylaminopropyl)-3-ethylcarbodiimide hydrochloride/N-hydroxysuccinimide catalyst,and then β-cyclodextrin (β-CD) was conjugated on the amine groups of the cystamine by Schiff's base reaction to prepare β-CD modified hyaluronic acid (HACD).The HACD/DOX nanoparticles were prepared by encapsulating DOX into HACD using dialysis method.The drug loading,encapsulation efficiency,particle size and distribution,zeta potential and other physical and chemical properties,as well as in vitro drug release behavior of the HACD/DOX nanoparticles were characterized.The cytotoxicity of HACD/DOX nanoparticles to HepG2 cells was studied by cell counting kit-8 (CCK-8) method.The targeting effect of HACD/DOX nanoparticles on HepG2 cells was studied using flow cytometry and confocal laser scanning microscopy (CLSM).Results HACD were successfully synthesized,which could carry DOX to form uniform homogeneous nanoparticles.The drug loading of DOX in the nanoparticles was (16.1±0.2)％ and the encapsulation efficiency was (64.2±0.9)％.The transmission electron microscope images indicated that the shape of the HACD/DOX nanoparticles was homogeneous sphere.The results of granularity analysis showed that the average size of the HACD/DOX nanoparticles was (203.1 ±2.5) nm with a narrow size distribution (PDI =0.202).The zeta potential of the HACD/DOX nanoparticles was (-29.1±0.8) mV.The in vitro release behavior of the nanoparticles exhibited obvious redox-sensitivity.The results of in vitro cytotoxicity showed that the blank carrier material HACD had no obvious toxicity to hepatoma cells,and the HACD/DOX nanoparticles could effectively kill hepatoma cells with the 0.38 μg/ml half maximal inhibitory concentration (IC50) value at 48 h.Flow cytometry and CLSM results demonstrated that the HACD/DOX nanoparticles could target hepatoma cells through the mediating effect of hyaluronic acid.Conclusions The prepared HACD/DOX nanoparticles have suitable particle size,high drug loading and encapsulation efficiency,and can release DOX under the stimulation of reducing agent.These nanoparticles have obvious targeting effect on hepatoma cells,which is expected to be applied as the drug delivery system of hepatocellular carcinoma (HCC) therapy.

Objective To evaluate hepatectomy for liver metastasis in breast cancer patients. Methods From May 1997 to May 2000, 18 primary breast cancer patients with metachronous liver metastases underwent hepatectomy. The clinicopathologic features and surgical results were analyzed. Results The actuarial 1,3-year survival rates after hepatic resection were 100% and 83. 3% for patients with solitary metastasis, and 90.9% and 54.5% for those with multiple foci. Conclusions Posthepatectomy long term survival was correlated with the number of foci in postmastectomy breast cancer patients suffering from heterochronous liver metastasis. Tumor size and TNM stage of breast cancer were not correlated with the survival. Aggressive surgery helps to prolong the survival.

Objective To evaluate the impact of the Blumgart anastomosis in pancreaticojejunostomy on the incidence of postoperative pancreatic fistula (POPF) after pancreaticoduodeneetomy (PD),and to study its safety and efficacy.Methods A total of 205 patients who underwent PD between January 2011 and February 2013 were retrospectively studied.The patients were divided into three groups depending on the pancreaticoenteric reconstruction:the Blumgart anastomosis group (n=37),the duct-to-mucosa anastomosis group (n =39) and the traditional invagination group (n=129).Postoperative morbidity were analyzed.Results The incidences of POPF after the Blumgart anastomosis (8.1％) was significantly lower than the duct-to-mucosa anastomosis group (23.1％ ; P=0.037) and the traditional invagination anastomosis group (30.2％ ; P=0.012).Multivariate analysis revealed soft pancreatic texture,pancreatic duct diameter ＜3 mm and non-Blumgart anastomosis were independent risk factors of POPF.On subgroup analysis,the Blumgart anastomosis was superior to the duct-to-mucosa anastomosis in patients with pancreatic duct diameter ＜ 3 mm (P=0.038),and showed advantages over the traditional invagination anastomosis in patients with soft pancreatic texture (P =0.001),as well as in patients with pancreatic duct diameter ＜ 3 mm (P=0.011).Conclusions The Blumgart anastomosis is a safe technique,and it could significantly reduced the rate of POPF.It should be routinely used for pancreatoenteric reconstruction after PD.

Liver is the most common metastatic organ in patients with advanced colorectal cancer. Once colorectal cancer liver metastasis (CRLM) occurs, the prognosis will be poor. Therefore early detection of CRLM has a great clinical significance for improving the prognosis of CRLM patients. Surgical resection of primary and metastatic lesion is the only possible curable option for CRLM, translational therapy, interventional therapy and multidisciplinary team also provide more treatment ideas. Long non-coding RNA, cancer stem cells and phosphatidylinositide-3-kinases/protein kinase B signaling pathway reveal the main mechanism of CRLM from different aspects. This article reviews the recent advances in the early diagnosis, treatments and main mechanisms of CRLM.

The 53rd annual meeting of the American Society of Clinical Oncology (ASCO) was held in Chicago,United States between June 2 and 6,2017.The latest advances in biliary tract cancer research from this meeting were summarized and analyzed in this paper.The adjuvant therapy in biliary tract cancer made a breakthrough in this meeting,the findings could provide the basis for a new standard of changing the current management model in the disease.The precision medicine and targeted therapy will be the development direction in the future.Doctors should attach great importance to the adjuvant and comprehensive therapy in biliary tract cancer and initiate high level multi-center clinical trials to improve the overall the diagnostic and treatment levels of biliary tract cancer.

Objective:To compare the relationship between the operative strategies and clinical outcomes of type Ⅲ and Ⅳ hilar chol-angiocarcinomas(HCs).Methods:We retrospectively analyzed the clinical data and long-term outcomes for 50 cases of type Ⅲ and Ⅳ HC that underwent surgery at the Tianjin Medical University Cancer Hospital.Results:Fifty patients were followed up and the median follow-up duration was 27 months.The hilar limited hepatectomy group included 13 cases;the median disease-free survival was 6 months,and 1-and 2-year disease-free survival rates were 30.8% and 23.1%,respectively.The median overall survival was 20 months, and the 1-and 2-year overall survival rates were 76.9% and 38.5%,respectively.The extended hepatectomy group included 37 cases;the median disease-free survival was 14 months,and 1-and 2-year disease-free survival rates were 59.5% and 32.4%,respectively.The median overall survival was 37 months,and the 1-and 2-year overall survival rates were 83.8% and 51.4%,respectively.Compared with the hilar limited hepatectomy group,the extended hepatectomy group had significantly longer median disease-free and overall survival(P<0.05).The 1-and 2-year disease-free and overall survival rates were higher for the extended hepatectomy group.There was no significant difference in morbidity and mortality between the two groups(P>0.05).Conclusions:Extended hepatectomy is a safe operation that delays recurrence at early time points and improves the prognosis for patients with type Ⅲ and Ⅳ HC.

Objective: To explore the prognosis of patients with T1b stage gallbladder carcinoma underwent different surgical procedure. Methods: The clinicopathological data of 97 patients with T1b stage gallbladder carcinoma came from 8 clinical centers from January 2010 to December 2016 and 794 patients who were admitted to the SEER database of USA from January 1973 to December 2014 were analyzed.There were 891 patients including 254 males and 637 females (1.0∶2.5) with age of (69.5±12.0)years. There were 380 patients who were less than 70 years old, 511 patients who were more than 70 years old. And there were 213 patients with the diameter of tumor less than 20 mm, 270 patients with the diameter of tumor more than 20 mm, 408 patients were unclear. There were 196 patients with well differentiation, 407 patients with moderately differentiation, 173 patients with poorly differentiation, 8 patients with undifferentiated, 107 patients were unclear. In the 891 patients with T1b stage gallbladder carcinoma, there were 562 cases accepted the simple cholecystectomy, 231 cases with simple cholecystectomy plus lymphadenectomy, and 98 cases with radical cholecystectomy. The time of follow-up were until June 2017. χ² test was used to analyze the enumeration data, rank-sum test was used to analyze the measurement data, the analyses of prognostic factors were used Cox proportional hazards model, the survival analysis was performed using Kaplan-Meier method. Results: The results of Cox proportional hazards model indicated, age, differentiation, surgical procedure were the risk factors of prognostic(1.929(1.594-2.336), P<0.01; 1.842(1.404-2.416), P<0.01; 1.216(0.962-1.538), P<0.01). The results of Kaplan Meier test indicated, the overall survival of T1b stage gallbladder carcinoma were (85.5±3.8)months, the overall survival of patients with simple cholecystectomy were (71.3±4.4)months, the overall survival of patients with cholecystectomy plus lymphadenectomy were(87.6±5.8)months, and the overall survival of patients with radical cholecystectomy were(101.7±9.3)months. The overall survival of patients with cholecystectomy plus lymphadenectomy and radical cholecystectomy were more than simple cholecystectomy(P<0.05). There were 329 patients with Lymph nodes examined in and after operations(231 patients with cholecystectomy plus lymphadenectomy, 98 patients with radical cholecystectomy). There were 265 patients with negative lymph node metastasis, the overall survival were(98.3±4.2)months. There were 64 patients with positive lymph node metastasis, the overall survival were(75.5±3.1)months. The overall survival of 38 patients with cholecystectomy plus lymphadenectomy were(62.7±2.6) months, and 26 patients with radical cholecystectomy were (82.2±3.7)months. The overall survival of patients with radical cholecystectomy were more than cholecystectomy plus lymphadenectomy(P<0.05). Conclusions The T1b stage gallbladder carcinoma patients with cholecystectomy plus lymphadenectomy or radical cholecystectomy has improved the prognosis comparing with simple cholecystectomy, significantly. When lymph node metastasis occurs, radical cholecystectomy has improved the prognosis comparing with cholecystectomy plus lymphadenectomy.

Hepatocellular carcinoma(HCC) is a common malignant tumor with high morbidity and mortality in China and even in the world.Due to its tumor heterogeneity and dissemination and distant metastasis,prognosis of patients with HCC is often poor.Surgical treatment such as radical hepatectomy is still the first choice for patients with HCC in the current clinical practice.However,the high recurrence and metastasis rate after surgery still hinder the survival and prognosis of these patients.In the era of target and immunotherapy,changes of surgical treatment strategy for HCC is particularly critical.This review focuses on the definition,the feasibility and the evaluation criteria of neoadjuvant therapy for HCC,to provide a new perspective on surgical treatment for HCC.