Radiofrequency ablation (RFA) has been widely utilized as a potential curative treatment modality for hepatocellular carcinoma (HCC) of early stage. Pathologically, HCC is characterized by the peritumoral microvascular invasion (MVI) and satellite lesion of various scope. Complete ablation of the main tumor, even with a 0.5- 1.0 cm ablative margin, is usually only imaging complete ablation with residual of MVI and satellite lesion, which will grow and affect the therapeutic results. While complete ablation of all the tumor tissue, including the main tumor, peritumoral MVI and satellite lesion, is the pathological complete ablation with no residual of viable tumor cell, which should be the main target of RFA for HCC. This paper summarizes the clinicopathological characteristics of HCC in the perspective of locoregional therapy, the mechanism of RFA to treat HCC, and the common strategies to obtain pathological complete ablaiton.

With increasing use of radiofrequency (RF) ablation in the treatment of liver cancer,more clinical problems are encountered.Translational research is urgently needed to solve these problems which include:(1) RF needle functional characteristics; (2) effects of RF ablation on liver cancer related changes in pathology; (3) changes in invasive ness and metastatic potential of residual liver cancer cells after incomplete ablation,and their mechanisms; (4) changes in tumor-associated endothelial cell function in residual liver cancer tissues after incomplete ablation,and their mechanisms; (5) prevention and treatment of residual liver cancer after RF ablation; (6) changes in the host's antitumor immunity after RF ablation of liver cancer.

Severe acute cholecytitis (SAC) is the severe type of acute cholecystitis,of which the pathological changes are both severe and complicated,resulting in poor response to conservative treatment.In the recent decade,emergent early laparoscopic cholecystectomy (LC) for SAC is getting more and more attention,but this procedure has both technique difficulties and a relatively high rate of complications including bile duct injury.So specific treatment and technical strategy are needed for LC management of SAC.For SAC,the main objective of emergent LC is to achieve prompt drainage of the gallbladder to alleviate the systemic inflammatory response.Complete removal of stones and gallbladder tissue should depend on the individual condition during LC,and should not be overtreated.The technical strategies for SAC includedome-down dissection technique,subtotal cholecytectomy, inside approach of the gallbladder technique,partial cholecystectomy and crocodile mouth shape incision of gallbladder.Although the names of these technical strategies are different,but the main focus is the same,that is, trying not to touch calot's triangle,not to dissect the cystic duct,with residual gallbladder wall in exchange for clinical safety,the core of which is to bypass the calot's triangle to prevent bile duct injury.In practice,multiple strategies are often applied in a mixed way.

With the widely use of radiofrequency ablation (RFA) in the comprehensive treatment for hepatocellular carcinoma (HCC),both the related basic and clinical research become more and more systematic.Accordingly,its role in the management of such patients is being increasingly definite,mainly including the following aspects:(1) For early HCC (≤3.0 cm) patients,under the premise of individualized strategies,RFA can be used as the first line treatment with the therapeutic efficacy comparable to those of liver resection and transplantation.(2) For selected patients with medium sized (3.1 ～ 5.0 cm) and unresectable HCC lesion,local RFA combined with transarterial embolization can experientially obtain satisfactory outcome.(3) For unresectable solitary large HCC (＞5.0 cm),repeated RFA combined with other local therapeutic tools could get satisfactory therapeutic efficacy.(4) For intrahepatic recurrent HCC,if the number of lesions is limited,RFA can be applied as the treatment of choice in most patients.(5) Emergency RFA is an effective strategy for achieving hemostasis in patients with ruptured HCC,and RFA could maximally eradicate the tumor.(6) For HCC patients awaiting liver transplantation,bridge strategy with RFA debulking may prolong long-term survival.(7) RFA can safely assist liver resection and reduce the bleeding.(8) RFA treatment,especially repeated RFA,can induce positive tumor specific immunoregulation.Taken together,these roles of RFA will help facilitate the transition in the HCC treatment mode.

Post operative pancreatic fistula (POPF) is a common complication and cause of death after pancreaticoduodenectomy (PD).With classical PD procedures,the predisposing factors and clinical characteristics of POPF are closely related to the single loop style of digestive tract reconstruction.For decades,based on the conventional thinking of technical improvement,the surgeons have tried to enhance the safety of PD procedure mainly by reducing the incidence of POPF and scarcely by paying attention to decreasing the seriousness of POPF.This paper introduced a new strategy to enhance the safety of PD by reducing the seriousness of POPF through a new method of digestive tract reconstruction.The technique is characterized by a dual-loop reconstruction guaranteeing isolated drainage of pancreatic fluid,which can avoid complex fistula of pancreatic fluid,bile and even gastro-intestinal fluid when pancreatic or biliary fistula occur and the subsequent potentiality of serial severe complication.Preliminary studies showed that this strategy could effectively enhance safety of PD by reducing the seriousness of pancreatic fistula.

Radiofrequency ablation (RFA) is increasingly used in the treatment of liver tumors,and its therapeutic role is gradually and widely accepted.Adequate and comprehensive knowledge on the complications arising from RFA treatment of liver tumors is of great importance to further promote and standardize its safe application.In this paper,a new classification on complications arising from RFA treatment for liver tumors was proposed.Based on the mechanisms of these complications,their management and preventive strategies were discussed.

Mirizzi syndrome (MS) is a complication of chronic cholelithiasis,whose pathological changes are severe and complicated.The preoperative diagnosis rate of MS is rather low,and the intraoperative bile duct injury rate is rather high.In the past,MS was considered as a contraindication for laparoscopy,but in the recent decade,with the increasing understanding on pathological changes of MS,the improvement of laparoscopic technique and the accumulation of experience,laparoscopic therapy has been increasingly used in treating MS.The piling experience and knowledge have been modified and optimized the traditional treatment for MS mainly in the following 3 aspects.First,if the skills and experience permit,exploration and treatment of MS may be completed safely and efficiently in laparoscopic route.Second,biliary-enteric anastomosis should be avoided as much as possible in the treatment strategy of MS Ⅲ.Intraoperatively,the wall of cholecystobiliary fistula and the Hartmann's pouch should be retained as much as possible in order to aid in the closure of the destroyed bile duct.When exploration is not needed,MS Ⅲ can be successfully treated with this technique in most cases.When exploration is needed,bile duct incision both in upper and lower directions from the fistula and T tube placement through the fistula are suggested.Third,for MS Ⅳ,bile duct repair and T-tube drainage can be used as the preferred method,and biliary-enteric anastomosis can only be considered as a remedial measure when the bile duct is completely transected or the continuity is not satisfactory.

Common bile duct exploration (CBDE) is a classic procedure for cholelithiasis. T-tube drainage (TTD) and primary duct closure (PDC) are the two therapeutical methods for bile duct repairment. Based on the literature review, it’s indicated that although PDC was the method used to repair the cut bile duct in the first case of CBDE in 1889, then, people realized that PDC was superior to TTD in terms of safety and minimally invasiveness, and there was no significant difference in the effect of treatment, however, until now, TTD has still been the main method to repair bile duct after CBDE. PDC has not been widely used as expected in the past years. The indications and contraindications of PDC and TTD have not been clearly defined. This paper reviewed the development of PDC for more than one hundred and thirty years, and summarized the clinical application research status in different development stages, and looks forward to the future development trend.

Currently,as various liver cancer-related treatments in China become developed,doctors also become super-subspecialized.This results in the doctors having more specialized skills and knowledge but a narrower vision.There is a tendency for these super-subspecialists to think and to make decisions based on a narrow perspective.As a consequence,interdisciplinary collaboration is becoming difficult.This hinders further improvement of treatment of liver cancer which has reached a plateau for many years.The present paper proposes a systematic perspective in decisionmaking for treatment of liver cancer.There are seven aspects which include the basic nature of medical care,the history of development of treatment,liver anatomical and functional characteristics,multicentric tumour occurrence,pathology,tumor immunology and biology.We aim to broaden the doctors’ vision and optimize their clinical thinking process.

A retrospective clinical study of 121 cases and a prospective one of 21 cases of acute cholargitis of severe type(ACST)were carried out in order to probe the optimal time of emergency operation for those patients with ACST.The results indicated that the principle of clinical management for ACST is a combination of emergency operation and energetic active conservation therapy.Conservative treatment is practically qualified for the majority of ACST,especially,those cases with short history and a few complication.The survival prediction mathematical model reported previously is helpful to select the optimal time for an emergency operation.The regression value 0.40 of the model can be a reference of the predictive critical point for an operation.The mathematical model possesses more advantage than the traditional method.