Curative resection can offer a better chance for long-term survival than any other therapeutic modalities for hilar cholangiocarcinoma.This review highlights recent improvements in hilar cholangiocarcinoma management,with special attention to the new staging system for hilar cholangiocarcinoma,the perioperative management and the accurate dissection approach to achieve more adequate tumor-free resection margin.Overall,the precise surgical strategy and appropriate surgical techniques may provide an increased chance to cure patients with hilar cholangiocarcinoma.

Hepatocellular carcinoma (HCC) is the fifth most common cancer and the second leading cause of cancer-related death worldwide.Increase in incidence has been shown in HCC over the last few years and more than half of the cases were reported in China,where hepatitis B virus (HBV) infection is the main etiologic factor.Heterogeneity in HCC's distribution worldwide and difference in etiology may result in a more complicated issue about prognosis-estimation and choosing of treatment options for HCC patients.In the past decade,there have been several clinical staging systems developed in terms of relevant prognostic factors.Among them,the Barcelona Clinic Liver Cancer (BCLC) and the Hong Kong Liver Cancer (HKLC) staging system are the only two classifications that link prognostic classification to treatment indications.In this review,we mainly focus on the application of BCLC and HKLC staging systems in guiding decision making for HCC,the respective advantages and disadvantages of each classification,and the future perspective of our own prediction model in which some new clinical factors will be integrated.

Objective To compare the primary treatment efficacy of radiofrequency ablation and surgical resection in patients with solitary hepatocellular carcinoma (HCC) which the diameter is ≤5 cm.Methods Databases were searched for comparative studies on radiofrequency ablatiom vs surgical resection published from 2005 to 2012.A Meta-analysis was performed using a randomized or fixed effect model to compare the treatment efficacy between radiofrequency ablatiom and surgical resection.Results Five studies fulfilled the criteria and were included.For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation was equivalent to surgical resection for 1-,3-and 5-year overall survivals (P ＞ 0.05).However,surgical resection was superior to radiofrequency ablation in 1-,3-and 5-year disease-free survivals and there' s significant difference (P ＜ 0.05).Higher local recurrence rate was associated with radiofrequency ablation than surgical resection.Conclusions For HCC patients whose single tumors' diameter is ≤5 cm,radiofrequency ablation can achieve comparable overall survival as surgical resection,though with higher recurrence rate and lower disease-free survival.

Objective To evaluate the clinical diagnosis of gastric stromal tumors and the safety and feasibility with laparoscopic wedge resection.Methods The clinical data of diagnosis and treatment were retrospectively analyzed in 43 cases diagnosed as gastric stromal tumors by endoscopyic ultrasonography.Results Thirty-six cases were successful by laparoscopic surgery success rate being 83.7%.Endoscopic ultrasonography diagnosis rate was 69.0%.The positive rate of CD117 and CD34 in postoperative diagnosis of gastrointestinal stromal tumor wasl00%.The mean post-operative hospital stay was 5 days.Conclusion Endoscopyic ultrasonography can be selected as a main method for clinical diagnosis of gastric stromal tumors and laparoscopic resection was safe and feasible.

Cancer cells can secrete programmed death ligand 1 (PD-L1) to bind with inhibitory regulatory protein of programmed death 1 (PD-1) which lies on T-cell lymphocyte.Consequently,the activity of the T cells reduces,and the apoptosis cells increase.It's one of the pathways of newly discovered tumor immune escape.Primary hepatic cancer is one of the common malignant tumors of digestive system and closely related to viral hepatitis B in China.PD-1/PD-L1 pathway plays an important role in tumorigenesis and development of primary liver cancer.In this paper,the research updates of PD-1/PD-L1 in primary hepatic carcinoma were summarized.

Objective To explore the effect of multiplex methylation specific PCR for early diagnosis of nasopharyngeal carcinoma. Methods The methylation status of 18 genes were verified by MSP from 35 early nasopharyngeal carcinoma andmultiplex-MSP was established through the optimized working condition for rapid detection of several genes′ methylation status. Results The methylation rate of 12 genes exceeds 50%. The methylation specific products in only one group (Segment U) did reach the expected results while those from the other three groups were consistent with the MSP′s. Conclusion Multiplex-MSP is an efficient and low-cost method, and it can produce ideal experimental results similar to those by the MSP and DNA microarrays.

Cholangiolocellular carcinoma (CLC) is a rare type of primary liver cancer,which is thought to originate from hepatic progenitor cells.CLC is categorized as a different tumor type from the conventional intrahepatic cholangiocarcinoma (cICC) due to its unique histological and embryological features.This review summarizes the clinical,radiological and pathological characteristics and surgical outcomes of cICC and CLC.This pathological classification may provide important clinical implications for the treatment and outcome evaluation of this disease.

Objective To study the classification, its incidence and some related factors of neurological complications after liver transplantation.Methods 166 cases of orthotopic liver transplantation were retrospectively studied. The classification and the incidence of the neurological complications were analyzed. In addition, the patients were divided into two groups, according to whether they suffered from neurological complications or not, to study the difference of related factors, which included gender, age, primary disease, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen.Results Neurological complications occurred in 28 cases (32 times), which included encephalopathy, seizure, stroke, infection of central nervous system, serious para-pyramidal syndrome and peripheral neuropathy. The total incidence was 16.9 %. Between the neurological complication group and non-neurological-complication group, no difference was found in gender, age, type of operation procedure, operation time, non-hepatic time, ischemia time of donor liver, blood loss, blood infusion and immunosuppressive regimen, but the neurological complications were closely related with primary diseases. The incidence of neurological complications was 30 % in acute liver failure, followed by post-hepatitis B liver cirrhosis (21 %), primary liver carcinoma (17.8 %), Wilson disease (16.7 %) and primary biliary liver cirrhosis (12.5 %). Interestingly as a sole complication disease, the incidence of encephalopathy in acute liver failure was 15 %, that was much higher than that in other primary disease. So was the peripheral neuropathy, which was 10 % in primary liver carcinoma.Conclusions The neurological complication is a kind of serious disease with high incidence after liver transplantation. Its onset may have some relationships with the primary liver disease.

Objective To compare the safety and efficiency of laparoscopic cholecystectomy (LC) + laparoscopic common bile duct exploration (LCBDE) with endoscopic retrograde cholangiopancreatography (ERCP) /endoscopic sphincterotomy (EST) +LC for patients with concomitant gallstones and common bile duct stones.Methods The Pubmed,EMBASE and CNKI were searched for randomized controlled trials published from 1990 to March,2012.Revman 5.1 was used to perform the meta-analysis.The main outcomes were stone clearance rate,treatment morbidity,operative time and length of hospital stay.Results 9 studies with 1021 patients were included into the final analysis.Meta-analysis demonstrated that LC+LCBDE was similar to ERCP/EST+LC in the stone clearance rate (OR 1.55,95％CI 0.95～2.52,P=0.08),treatment morbidity (OR 1.12,95％CI 0.75～1.67,P=0.58),operative time (WMD-54.44,95％CI-107.7～-1.17,P=0.05) and length of hospital stay (WMD-0.22,95％CI-2.6～2.16,P=0.86).The P value of the stone clearance rate was approaching 0.05 with increased number of studies in the analysis.There was no significant difference in the operative time,probably because of small sample size.Conclusions LC-LCBDE was equivalent to ERCP/EST+ LC in stone clearance rate,treatment morbidity,operative time and length of hospital stay.There is a possibility that LC+LCBDE can be superior to ERCP/EST+LC in the stone clearance rate and the operative time with increase in sample size.

Objective To evaluate the viability of residual tumor after insufficient thermal ablation of rabbit VX2 liver tumor and investigated the efficacy of sorafenib as an adjuvant therapy.Methods Twenty-one rabbits were implanted with VX2 tumor to establish orthotopic liver tumor models.They were allocated randomly into 3 groups:control (n =7),ablation (n =7),and combination treatment (n =7).Microwave coagulation therapy was conducted with 20 W for 1 min and viable tumor tissue remained at the periphery.A laparotomy was performed in the control group.Sorafenib was given at 20 mg/kg/d during the following 10 days in the combination treatment group,and saline was given to the control and ablation group.Tumor volume was recorded before and after treatment,immunohistochemistry detected CD31 and proliferating cell nuclear antigen (PCNA) expression,and the micro-vessel density (MVD) and proliferation index (PI) were calculated accordingly.Results Ten days after insufficient ablation,tumor volume of the ablation group was larger than that of the control group (P ＜0.05).The MVD and PI of residual tumor were higher compared with those of the control group (P ＜ 0.05).With adjuvant therapy of sorafenib after insufficient ablation,tumor volume showed a decrease on the 10th day compared with tumors undergoing insurfficient ablation alone (P ＜ 0.05).The MVD and PI of residual tumor were lower than those of the ablation group (P ＜0.05).Conclusion Insufficient thermal ablation promotes residual tumor progression,but adjuvant therapy of sorafenib serves as an effective way to suppress the overgrowth and neovasculation of the residual tumor.