Hepatocellular carcinoma is one of the most common malignancies in the worldwide.Selected patients with hepatocellular carcinoma are candidates for curative resection,but nevertheless there is a high risk of tumor recurrence.Microvascular invasion (MVI) is an aggressive biological behavior and has repeatedly been identified as a risk factor for prognosis after curative treatment,meanwhile,it is now becoming increasingly concerned.It would be of great significance to distinguish MVI in an early stage and choose an appropriate treatment timely to get a definite improvement for the long-term survival in patients with hepatocellular carcinoma after curative treatment.This review focuses on some certain issues of MVI.

Objective To study the impact of anatomical resection (AR) for hepatocellular carcinoma with microvascular invasion on early tumor recurrence.Methods 178 consecutive patients with solitary hepatocellular carcinoma who underwent liver resection at the Affiliated Tumor Hospital of Guangxi Medical University from January 2012 to December 2015 were retrospectively studied.These patients were divided into four groups according the types of resection (anatomical resection AR or non-anatomical resection NAR) and the surgical margins (narrow or wide margin).All the patients were followed up until the tumor recurred or two years after surgery.The recurrence-free survival and the types of recurrence for the 4 different groups were compared.Results The 6 months,1-,2-year disease-free survival rates in the AR (n =55) and NAR groups (n =123) were 87.0％,79.2％,74.5％ and 78.5％,61.3％,45.7 ％,respectively,(P ＜ 0.05).Through pair-wise comparisons of the four groups,there were no significant differences in early recurrence between the narrow surgical margin group and the wide surgical margin group,regardless of the types of surgery.The early recurrence rates of the AR groups were significantly lower than that of the NAR groups,regardless of the widths of the surgical margins.Multivariate analysis showed that AR was a protective factor of early recurrence (HR =0.417,95％ CI 0.229 ～ 0.761).Further analysis of the recurrence patterns of AR and NAR showed that the recurrence types were mainly sohtary for AR (solitary,61.5％;multiple 30.8％) and multiple recurrence for NAR (solitary,32.2％;multiple 61.0％).Conclusion AR improved early recurrence-free survival of patients with microvascular invasion.

Objective:To investigate the expression of p21-activated kinase 2 (PAK2) in laryngeal squamous cell carcinoma and its relationship with the clinicopathological characteristics and chemosensitivity of patients.Methods:Transcriptome sequencing (RNA-seq) data for laryngeal squamous cell carcinoma were downloaded from the Cancer Genome Atlas (TCGA) database, and 123 patients were included in the study (12 cases had cancer tissues and normal tissues data, and the remaining 111 only had cancer tissues data). Differential expression of PAK2 in cancer and para-cancer tissues was analyzed by using R software, and the potential function of PAK2 in laryngeal squamous cell carcinoma was investigated by using the Kyoto Encyclopedia of Genes and Genomes (KEGG) database signaling pathway enrichment. A total of 34 patients with primary laryngeal squamous cell carcinoma tissues and corresponding para-carcinoma 34 tissue specimens who underwent surgical resection were retrospectively selected from Chaoyang Central Hospital between April 2016 and June 2021, and 20 cases of normal laryngeal mucosa tissues were selected as the controls. Immunohistochemistry was used to detect the expression of PAK2 in various tissues, and its correlation with clinicopathological factors was analyzed. A total of 35 supraglottic primary laryngeal squamous cell carcinoma patients were retrospectively collected before induction chemotherapy during the same period, including 20 patients sensitive to chemotherapy and 15 patients resistant to chemotherapy. Real-time fluorescence quantitative polymerase chain reaction (qRT-PCR) was used to detect the relative expression level of PAK2 mRNA in cancer tissues.Results:Analysis of TCGA database data showed that PAK2 expression was increased in cancer tissues compared with that in para-cancer tissues ( P = 0.012); KEGG database signaling pathways showed that the high expression of PAK2 in laryngeal squamous cell carcinoma was related to signal transduction pathways, cell cycle, and cancer. Immunohistochemistry showed that the proportion of PAK2 positive in 34 cases of laryngeal squamous cell carcinoma tissues was higher than that in adjacent tissues and normal tissues [58.82% (20/34) vs. 0.03% (1/34), 0 (0/20), all P < 0.001]. There were statistically significant differences in the proportion of PAK2 positive patients stratified with different degrees of differentiation [high differentiation vs. low or middle differentiation: 33.33% (6/18)vs. 87.50% (14/16)], lymph node metastasis [presence vs. absence: 90.91% (10/11) vs. 43.48% (10/23)], TNM staging [stage Ⅲ-Ⅳ vs. stage Ⅰ-Ⅱ: 82.35% (14/17) vs. 35.29% (6/17)] (all P < 0.05), and PAK2 positive patients were not associated with clinical type, tumor size, smoking history, drinking history, and age (all P > 0.05). qRT-PCR showed that the relative expression level of PAK2 mRNA in the chemotherapy-resistant group was higher than that in the chemotherapy-sensitive group (3.89±0.12 vs. 0.78±0.23, P < 0.001). Conclusions:The expression level of PAK2 in laryngeal squamous cell carcinoma tissues is increased, and the high expression of PAK2 is closely related to the malignant clinical characteristics of patients with laryngeal squamous cell carcinoma. The high expression of PAK2 may indicate the insensitivity to traditional chemotherapy regimens, and PAK2 may be a potential gene that targets and regulates the chemosensitivity of laryngeal squamous cell carcinoma.

【Objective】 To reduce the incidence of postoperative intestinal obstruction, we tried to improve surgical techniques by closing the cavity formed during radical cystectomy + ileal passage (Bricker) via laparoscopy to prevent the formation of abdominal hernia. 【Methods】 During Oct.2018 and Feb.2022, 41 patients were involved (conventional group). After standard laparoscopic radical cystectomy + pelvic lymphadenectomy, the ileum channel was established. The right medial retroperitoneum was sutured to cover the mesothelium and end of the ileum channel under open operation or endoscope. The space between the ureter and mesothelium of the ileum channel was sealed, and the end of the ileum channel and both ureters were externalized. During Feb.2022 and Dec.2022, 15 patients were involved (modified group). The right inner and outer lateral peritoneums below the ileal conduit were sutured to "bottom out" the gap between the ileal conduit and the right abdominal wall in addition to standard procedures. The recovery of intestinal function and incidence of bowel obstruction were compared between the two groups. 【Results】 In the conventional group, the intestinal function recovered within 2 to 6 days after surgery, with a median ventilation time of 3 days. Intestinal obstruction occurred in 3 patients, 2 of whom improved after conservative treatment while 1 underwent surgical exploration after ineffective conservative therapy. There were no significant differences in the time of discharge and ventilation between the two groups, but no intestinal obstruction occurred in the modified group. 【Conclusion】 Peritoneal externalization at the end of ileal passage can reduce the incidence of intra-abdominal hernia and postoperative intestinal obstruction, which is worthy of clinical application.