Hepatocellular carcinoma (HCC) has a hidden onset and rapid progress. Most of the patients have lost the opportunity of surgery at the onset, and the systemic treatment effect is not satisfactory. In recent years, immune checkpoint inhibitors combined with targeted therapy have brought hope to HCC patients. In particular, treatment with atezolizumab combined with bevacizumab has been recommended by many domestic and foreign guidelines as the first-line treatment for patients with unresectable HCC who have not previously received systematic treatment. In this review, the application status of atezolizumab plus bevacizumab, coping strategies for treatment failure, cost-benefit analysis and side effects were described in order to provide reference for clinical treatment.

Objective:To investigate the epidemiological characteristics, diagnosis, treat-ment and prognosis of gallbladder cancer in China from 2010 to 2017.Methods:The single disease retrospective registration cohort study was conducted. Based on the concept of the real world study, the clinicopathological data, from multicenter retrospective clinical data database of gallbladder cancer of Chinese Research Group of Gallbladder Cancer (CRGGC), of 6 159 patients with gallbladder cancer who were admitted to 42 hospitals from January 2010 to December 2017 were collected. Observation indicators: (1) case resources; (2) age and sex distribution; (3) diagnosis; (4) surgical treatment and prognosis; (5) multimodality therapy and prognosis. The follow-up data of the 42 hospitals were collected and analyzed by the CRGGC. The main outcome indicator was the overall survival time from date of operation for surgical patients or date of diagnosis for non-surgical patients to the end of outcome event or the last follow-up. Measurement data with normal distribu-tion were represented as Mean±SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M( Q1, Q3) or M(range), and com-parison between groups was conducted using the U test. Count data were described as absolute numbers or percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was performed using the Logistic forced regression model, and variables with P<0.1 in the univariate analysis were included for multivariate analysis. Multivariate analysis was performed using the Logistic stepwise regression model. The life table method was used to calculate survival rates and the Kaplan-Meier method was used to draw survival curves. Log-rank test was used for survival analysis. Results:(1) Case resources: of the 42 hospitals, there were 35 class A of tertiary hospitals and 7 class B of tertiary hospitals, 16 hospitals with high admission of gallbladder cancer and 26 hospitals with low admission of gallbladder cancer, respectively. Geographical distribution of the 42 hospitals: there were 9 hospitals in central China, 5 hospitals in northeast China, 22 hospitals in eastern China and 6 hospitals in western China. Geographical distribution of the 6 159 patients: there were 2 154 cases(34.973%) from central China, 705 cases(11.447%) from northeast China, 1 969 cases(31.969%) from eastern China and 1 331 cases(21.611%) from western China. The total average number of cases undergoing diagnosis and treatment in hospitals of the 6 159 patients was 18.3±4.5 per year, in which the average number of cases undergoing diagnosis and treatment in hospitals of 4 974 patients(80.760%) from hospitals with high admission of gallbladder cancer was 38.8±8.9 per year and the average number of cases undergoing diagnosis and treatment in hospitals of 1 185 patients(19.240%) from hospitals with low admission of gallbladder cancer was 5.7±1.9 per year. (2) Age and sex distribution: the age of 6 159 patients diagnosed as gallbladder cancer was 64(56,71) years, in which the age of 2 247 male patients(36.483%) diagnosed as gallbladder cancer was 64(58,71)years and the age of 3 912 female patients(63.517%) diagnosed as gallbladder cancer was 63(55,71)years. The sex ratio of female to male was 1.74:1. Of 6 159 patients, 3 886 cases(63.095%) were diagnosed as gallbladder cancer at 56 to 75 years old. There was a significant difference on age at diagnosis between male and female patients ( Z=-3.99, P<0.001). (3) Diagnosis: of 6 159 patients, 2 503 cases(40.640%) were initially diagnosed as gallbladder cancer and 3 656 cases(59.360%) were initially diagnosed as non-gallbladder cancer. There were 2 110 patients(34.259%) not undergoing surgical treatment, of which 200 cases(9.479%) were initially diagnosed as gallbladder cancer and 1 910 cases(90.521%) were initially diagnosed as non-gallbladder cancer. There were 4 049 patients(65.741%) undergoing surgical treatment, of which 2 303 cases(56.878%) were initially diagnosed as gallbladder cancer and 1 746 cases(43.122%) were initial diagnosed as non-gallbladder cancer. Of the 1 746 patients who were initially diagnosed as non-gallbladder cancer, there were 774 cases(19.116%) diagnosed as gallbladder cancer during operation and 972 cases(24.006%) diagnosed as gallbladder cancer after operation. Of 6 159 patients, there were 2 521 cases(40.932%), 2 335 cases(37.912%) and 1 114 cases(18.087%) undergoing ultrasound, computed tomography (CT) or magnetic resonance imaging (MRI) examination before initial diagnosis, respec-tively, and there were 3 259 cases(52.914%), 3 172 cases(51.502%) and 4 016 cases(65.205%) undergoing serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis, respectively. One patient may underwent multiple examinations. Results of univariate analysis showed that geographical distribution of hospitals (eastern China or western China), age ≥72 years, gallbladder cancer annual admission of hospitals, whether undergoing ultrasound, CT, MRI, serum carcinoembryonic antigen, CA19-9 or CA125 examination before initially diagnosis were related factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.45, 1.98, 0.69, 0.68, 2.43, 0.41, 1.63, 0.41, 0.39, 0.42, 95% confidence interval as 1.21-1.74, 1.64-2.40, 0.59-0.80, 0.60-0.78, 2.19-2.70, 0.37-0.45, 1.43-1.86, 0.37-0.45, 0.35-0.43, 0.38-0.47, P<0.05). Results of multivariate analysis showed that geographical distribution of hospitals (eastern China or western China), sex, age ≥72 years, gallbladder cancer annual admission of hospitals and cases undergoing ultrasound, CT, serum CA19-9 examination before initially diagnosis were indepen-dent influencing factors influencing initial diagnosis of gallbladder cancer patients ( odds ratio=1.36, 1.42, 0.89, 0.67, 1.85, 1.56, 1.57, 0.39, 95% confidence interval as 1.13-1.64, 1.16-1.73, 0.79-0.99, 0.57-0.78, 1.60-2.14, 1.38-1.77, 1.38-1.79, 0.35-0.43, P<0.05). (4) Surgical treatment and prognosis. Of the 4 049 patients undergoing surgical treatment, there were 2 447 cases(60.435%) with complete pathological staging data and follow-up data. Cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb were 85(3.474%), 201(8.214%), 71(2.902%), 890(36.371%), 382(15.611%), 33(1.348%) and 785(32.080%), respectively. The median follow-up time and median postoperative overall survival time of the 2 447 cases were 55.75 months (95% confidence interval as 52.78-58.35) and 23.46 months (95% confidence interval as 21.23-25.71), respectively. There was a significant difference in the overall survival between cases with pathological staging as stage 0, stage Ⅰ, stage Ⅱ, stage Ⅲa, stage Ⅲb, stage Ⅳa and stage Ⅳb ( χ2=512.47, P<0.001). Of the 4 049 patients undergoing surgical treatment, there were 2 988 cases(73.796%) with resectable tumor, 177 cases(4.371%) with unresectable tumor and 884 cases(21.833%) with tumor unassessable for resectabi-lity. Of the 2 988 cases with resectable tumor, there were 2 036 cases(68.139%) undergoing radical resection, 504 cases(16.867%) undergoing non-radical resection and 448 cases(14.994%) with operation unassessable for curative effect. Of the 2 447 cases with complete pathological staging data and follow-up data who underwent surgical treatment, there were 53 cases(2.166%) with unresectable tumor, 300 cases(12.260%) with resectable tumor and receiving non-radical resection, 1 441 cases(58.888%) with resectable tumor and receiving radical resection, 653 cases(26.686%) with resectable tumor and receiving operation unassessable for curative effect. There were 733 cases not undergoing surgical treatment with complete pathological staging data and follow-up data. There was a significant difference in the overall survival between cases not undergoing surgical treatment, cases undergoing surgical treatment for unresectable tumor, cases undergoing non-radical resection for resectable tumor and cases undergoing radical resection for resectable tumor ( χ2=121.04, P<0.001). (5) Multimodality therapy and prognosis: of 6 159 patients, there were 541 cases(8.784%) under-going postoperative adjuvant chemotherapy and advanced chemotherapy, 76 cases(1.234%) under-going radiotherapy. There were 1 170 advanced gallbladder cancer (pathological staging ≥stage Ⅲa) patients undergoing radical resection, including 126 cases(10.769%) with post-operative adjuvant chemotherapy and 1 044 cases(89.231%) without postoperative adjuvant chemo-therapy. There was no significant difference in the overall survival between cases with post-operative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.23, P=0.629). There were 658 patients with pathological staging as stage Ⅲa who underwent radical resection, including 66 cases(10.030%) with postoperative adjuvant chemotherapy and 592 cases(89.970%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemotherapy and cases without postoperative adjuvant chemotherapy ( χ2=0.05, P=0.817). There were 512 patients with pathological staging ≥stage Ⅲb who underwent radical resection, including 60 cases(11.719%) with postoperative adjuvant chemotherapy and 452 cases(88.281%) without postoperative adjuvant chemotherapy. There was no significant difference in the overall survival between cases with postoperative adjuvant chemo-therapy and cases without post-operative adjuvant chemo-therapy ( χ2=1.50, P=0.220). Conclusions:There are more women than men with gallbladder cancer in China and more than half of patients are diagnosed at the age of 56 to 75 years. Cases undergoing ultrasound, CT, serum CA19-9 examination before initial diagnosis are independent influencing factors influencing initial diagnosis of gallbladder cancer patients. Preoperative resectability evaluation can improve the therapy strategy and patient prognosis. Adjuvant chemotherapy for gallbladder cancer is not standardized and in low proportion in China.

Objective To investigate the clinical effect of simultaneous surgical resection of hepatic and pancreatic lesions versus systemic chemotherapy in treatment of resectable pancreatic cancer with liver metastasis (PCLM). Methods A retrospective analysis was performed for related data of the patients with PCLM who were admitted to Shengjing Hospital of China Medical University from January 2013 to May 2020, and the patients with resectable PCLM were screened out and then divided into surgery group and chemotherapy group. The propensity score matching (PSM) method was used to reduce the impact of data bias and confounding factors. The independent samples t -test or the Mann- Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups. The Kaplan-Meier method was used to calculate survival time, and the log-rank test was used for evaluation. The univariate and multivariate Cox regression models were used to investigate the independent risk factors for survival. Results A total of 56 patients with resectable PCLM were screened out, with 33 patients in the surgery group and 23 patients in the chemotherapy group, and there were 15 patients in each group after PSM. The surgery group had a significantly shorter median overall survival time than the chemotherapy group before PSM (6.6 months vs 10.4 months, χ 2 =4.476, P =0.034) and after PSM (6.4 months vs 10.5 months, χ 2 =4.309, P =0.038). The multivariate Cox regression analysis showed that poorly differentiated tumor (hazard ratio [ HR ]=4.945, 95% confidence interval [ CI ]: 1.980-12.348, P =0.001) and absence of postoperative chemotherapy ( HR =3.670, 95% CI : 1.437-9.376, P =0.007) were independent risk factors for poor prognosis in patients with PCLM. Conclusion Compared with chemotherapy, simultaneous surgical resection of hepatic and pancreatic lesions fails to prolong the overall survival time of patients with resectable PCLM. Patients with poorly differentiated tumor and those without postoperative chemotherapy tend to have poor prognosis.

Insufficient volume of future liver remnant (FLR) often leads to the complications including liver failure and even death and thus remains a bottleneck for liver surgery. Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is a newly developed two-stage hepatectomy procedure which can promote rapid regeneration of FLR, but the related mechanism has not yet been elucidated. With reference to the recent research advances in China and foreign countries, this article reviews the hemodynamic and humoral factors for ALPPS in promoting liver regeneration, the effect of ALPPS on liver parenchymal cells, and the role of non-parenchymal liver cells (including hepatic stellate cells, natural killer cells, macrophages, and liver progenitor/stem cells) in regulating liver regeneration. It is pointed out that the interaction between non-parenchymal liver cells and parenchymal cells is a hotspot in the research on the mechanism of liver regeneration after ALPPS.

Objective:To evaluate the efficacy of three-dimensional (3D) visualization technology in the precision diagnosis and treatment for primary liver cancer.Methods:A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males (75.4%) and 410 females (24.6%) , with age of (52.9±11.9) years (range: 18 to 86 years) .The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data.Results:In the sample of 1 265 patients, 3D reconstructed models clearly displayed in follows. (1) tumor size: ≤2 cm in 155 cases (9.31%) , >2 cm to 5 cm in 551 cases (33.09%) , >5 cm to 10 cm in 636 cases (38.20%) , >10 cm in 323 cases (19.40%) . (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ (normal type) in 1 494 cases (89.73%) ,variant hepatic artery in 171 cases (10.27%) , including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%) ,variant hepatic veins in 470 cases (28.23%) , including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein: normal type in 1 315 cases (78.98%) ,variant portal veins in 350 cases (21.02%) , including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%) . Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%) . Three types of vascular variation in 4 cases (0.24%) , including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation: 1 499.3 (514.4) ml (range: 641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4) ml (range:306.1 to 5 638.0 ml) for residual function. (4) Operative methods: anatomical hepatectomy in 1 458 cases (87.57%) ; non-anatomic hepatectomy in 207 cases (12.43%) . (5) the median operation time was 285 (165) minutes (range: 40 to720 minutes) . (6) The median intraoperative blood loss was 200 (250) ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7) Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%) , cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%) . Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8) Postoperative complications in 207 cases (12.43%) , including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively.Conclusion:3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

Objective:To evaluate the efficacy of three-dimensional(3D) visualization technology in the precision diagnosis and treatment for primary liver cancer.Methods:A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males(75.4%) and 410 females(24.6%), with age of (52.9±11.9) years (range: 18 to 86 years). The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data. Kaplan-Meier curve was used to calculate overall survival and disease-free survival rate.Results:(1)In the sample of 1 265 patients, 3D reconstructed models clearly displayed as follows. tumor size: ≤2 cm in 155 cases (9.31%), >2 cm to 5 cm in 551 cases (33.09%), >5 cm to 10 cm in 636 cases (38.20%), >10 cm in 323 cases (19.40%). (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ(normal type) in 1 494 cases(89.73%),variant hepatic artery in 171 cases (10.27%), including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%),variant hepatic veins in 470 cases(28.23%), including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein:normal type in 1 315 cases (78.98%), variant portal veins in 350 cases (21.02%), including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%). Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%). Three types of vascular variation in 4 cases (0.24%), including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation:1 499.3 (514.4)ml (range:641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4)ml (range:306.1 to 5 638.0 ml) for residual function. (4)Operative methods: anatomical hepatectomy in 1 458 cases (87.57%); non-anatomic hepatectomy in 207 cases (12.43%). (5)the median operation time was 285(165)minutes (range: 40 to720 minutes). (6)The median intraoperative blood loss was 200(250)ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7)Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%), cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%). Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8)Postoperative complications in 207 cases (12.43%), including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively.Conclusion:3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

Objective:To evaluate the efficacy of three-dimensional (3D) visualization technology in the precision diagnosis and treatment for primary liver cancer.Methods:A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males (75.4%) and 410 females (24.6%) , with age of (52.9±11.9) years (range: 18 to 86 years) .The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data.Results:In the sample of 1 265 patients, 3D reconstructed models clearly displayed in follows. (1) tumor size: ≤2 cm in 155 cases (9.31%) , >2 cm to 5 cm in 551 cases (33.09%) , >5 cm to 10 cm in 636 cases (38.20%) , >10 cm in 323 cases (19.40%) . (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ (normal type) in 1 494 cases (89.73%) ,variant hepatic artery in 171 cases (10.27%) , including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%) ,variant hepatic veins in 470 cases (28.23%) , including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein: normal type in 1 315 cases (78.98%) ,variant portal veins in 350 cases (21.02%) , including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%) . Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%) . Three types of vascular variation in 4 cases (0.24%) , including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation: 1 499.3 (514.4) ml (range: 641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4) ml (range:306.1 to 5 638.0 ml) for residual function. (4) Operative methods: anatomical hepatectomy in 1 458 cases (87.57%) ; non-anatomic hepatectomy in 207 cases (12.43%) . (5) the median operation time was 285 (165) minutes (range: 40 to720 minutes) . (6) The median intraoperative blood loss was 200 (250) ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7) Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%) , cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%) . Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8) Postoperative complications in 207 cases (12.43%) , including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively.Conclusion:3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

Objective:To evaluate the efficacy of three-dimensional(3D) visualization technology in the precision diagnosis and treatment for primary liver cancer.Methods:A total of 1 665 patients with primary liver cancer who admitted to seven medical centers in China between January 2009 to January 2019, diagnosed and treated by 3D visualization protocol were analyzed, and their clinical data were retrospectively reviewed. There were 1 255 males(75.4%) and 410 females(24.6%), with age of (52.9±11.9) years (range: 18 to 86 years). The acquisition of high-quality CT images with submillimeter spatial resolution were conducted using a quality control system. By means of homogenization methods, 3D reconstruction and 3D visualization analysis were performed. Postoperative observation: pathology reports, microvascular invasion, perioperative complications and follow-up. SPSS 25.0 statistical software was used for statistical description and analysis of clinical data. Kaplan-Meier curve was used to calculate overall survival and disease-free survival rate.Results:(1)In the sample of 1 265 patients, 3D reconstructed models clearly displayed as follows. tumor size: ≤2 cm in 155 cases (9.31%), >2 cm to 5 cm in 551 cases (33.09%), >5 cm to 10 cm in 636 cases (38.20%), >10 cm in 323 cases (19.40%). (2) Classification of hepatic blood vessels. Hepatic artery: type Ⅰ(normal type) in 1 494 cases(89.73%),variant hepatic artery in 171 cases (10.27%), including type Ⅱ in 35 cases, type Ⅲ in 38 cases, and other types in 98 cases. Hepatic vein: type Ⅰ (normal) in 1 195 cases (71.77%),variant hepatic veins in 470 cases(28.23%), including type Ⅱ in 376 cases and type Ⅲ in 94 cases. Portal vein:normal type in 1 315 cases (78.98%), variant portal veins in 350 cases (21.02%), including type Ⅰ in 189 cases, type Ⅱin 103 cases, type Ⅲ in 50 cases, type Ⅳ in 8 cases. Hepatic artery variation coexisting with portal vein variation in 24 cases (1.44%). Hepatic vein variation coexisting with portal vein variation in 113 cases (6.79%). Three types of vascular variation in 4 cases (0.24%), including coexistence of type Ⅱ hepatic artery variation or type Ⅰ portal vein variation with type Ⅲ hepatic vein variation in 2 cases,coexistence of type Ⅲ hepatic artery variation or type Ⅲ portal vein variation with type Ⅱ hepatic vein variation in 2 cases. (3) Preoperative liver volume calculation:1 499.3 (514.4)ml (range:641.7 to 6 637.0 ml) of total liver volume, including 479.1 (460.1) ml (range:10.5 to 2 086.8 ml) for liver resection and 959.9 (460.4)ml (range:306.1 to 5 638.0 ml) for residual function. (4)Operative methods: anatomical hepatectomy in 1 458 cases (87.57%); non-anatomic hepatectomy in 207 cases (12.43%). (5)the median operation time was 285(165)minutes (range: 40 to720 minutes). (6)The median intraoperative blood loss was 200(250)ml (range:10 to 4 200 ml) and 346 cases (20.78%) had intraoperative transfusion. (7)Pathology reports: hepatocellular carcinoma in 1 371 cases (82.34%), cholangiocarcinoma in 260 cases (15.62%) and mixed hepatocellular carcinoma in 34 cases (2.04%). Microvascular invasion: M0 in 199 cases, M1 in 64 cases, and M2 in 27 cases. (8)Postoperative complications in 207 cases (12.43%), including Clavien-Dindo grade Ⅰ or Ⅱ in 57 cases, grade Ⅲ or Ⅳ in 147 cases and grade Ⅴ in 3 cases.There were 13 cases (0.78%) of liver failure and 3 cases (0.18%) of perioperative death. (9) The follow-up time was 3.0 to 96.0 months, with a median time of 21.0(17.8) years. The overall 3-year survival and disease-free survival rates were 80.0% and 56.5%, respectively. The overall 5-year survival and disease-free survival rates were 59.7% and 30.0%, respectively.Conclusion:3D visualization technology plays an important role in realizing accurate diagnosis of anatomical location and morphology of primary liver cancer, improving the success rate of surgery and reducing the incidence of complications.

Objective: To evaluate the postoperative quality of life after surgery of patients with hepatic hemangioma. Methods: The retrospective and descriptive study was conducted. The clinical data of 104 patients who underwent surgery for hepatic hemangioma at Shengjing Hospital of China Medical University from September 2011 to February 2017 were collected. There were 28 males and 76 females, aged (49±8)years, with a range of 27-78 years. Enucleation of hepatic hemangioma or hepatectomy was selected according to tumor location of patients. Observation indicators: (1) surgical and postoperative situations; (2) assessment of quality of life in patients; (3) assessment of quality of life in patients comorbid with other chronic digestive diseases. Measurement data with normal distribution were represented as Mean±SD, and measurement data with skewed distribution were represented as M (range). Repeated data were analyzed using repeated ANOVA. Count data were represented as absolute numbers. Results: (1) Surgical and postoperative situations: of 104 patients, 67 underwent enucleation of hepatic hemangioma, 37 underwent hepatectomy. The tumor diameter, volume of intraoperative blood loss, duration of postoperative hospital stay were (10±4)cm, 200 mL (range, 10-3 000 mL), (11±5)days. Seven patients had complications, including 5 of massive abdominal ascites, 1 of abdominal infection, and 1 of pulmanory obstruction. There was no death occurred. (2) Assessment of quality of life in patients with hepatic hemangioma: the total scores of Gastrointestinal-related Quality of Life Index (GIQLI), the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 121.0±8.3, 69.2±4.1, 18.5±2.6, 19.5±1.8, and 13.8±1.4 at preoperation. The above indices were 121.9±6.9, 71.2±3.8, 17.2±2.5, 19.6±2.3, and 13.8±1.3 of 104 patients with hepatic hemangioma at one month after surgery, respectively. The above indices were 127.8±6.2, 73.2±3.6, 19.8±2.5, 20.8±2.4, and 14.1±1.0 at 6 months after surgery. There were significant differences in changing trends of above indices (F=68.4, 64.6, 71.4, 17.8, 3.3, P<0.05). The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-5.780, 6.640, P<0.05), but the total scores of GIQLI, the scores of mental and psychological status, and social activities showed no difference (t=-1.569, -0.705, 0.240, P>0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and mental and psychological status at 6 months after surgery showed significant differences compared with those of preoperation (t=-8.897, -9.919, -5.375, -5.024, P<0.05), but the score of social activities showed no difference(t=-1.919, P>0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-10.835, -6.787, -12.277, -4.560, -2.476, P<0.05). (3) Assessment of quality of life in hepatic hemangioma patients comorbid with other chronic digestive diseases: 29 of 104 patients were comorbid with chronic gastritis, biliary diseases, and appendicitis. For the 29 patients comorbid with other chronic digestive diseases, the total scores of GIQLI, the scores of subjective symptoms, physiological status, mental and psychological status, and social activities were 117.5±7.5, 67.8±4.2, 17.4±2.2, 19.0±1.5, and 13.2±1.3 at preoperation. The above indices were 118.7±6.9, 69.5±4.5, 16.7±2.0, 19.2±1.9, and 13.2±1.3 at one month after surgery, respectively. The above indices were 124.6±6.5, 70.9±4.5, 19.8±2.1, 19.9±2.4, and 14.0±0.9 of 29 patients comorbid with other chronic digestive diseases at 6 months after surgery. There were significant differences in changing of the total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities (F=15.0, 9.0, 27.6, 7.5, P<0.05), except the score of mental and psychological status (F=1.6, P>0.05) . The scores of subjective symptoms and physiological status at one month after surgery showed significant differences compared with those of preoperation (t=-2.612, 2.191, P<0.05), but the total scores of GIQLI, the scores of mental and psychological status, and social activities showed no difference (t=-1.128, -0.587, -0.157, P>0.05). The total scores of GIQLI, scores of subjective symptoms, physiological status, and social activities at 6 months after surgery showed significant differences compared with those of preoperation (t=-4.002, -3.441, -4.604, -3.266, P<0.05), but the score of mental and psychologica status showed no difference (t=-1.522, P>0.05). The total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities at 6 months after surgery were significantly different from those at one month after surgery (t=-4.819, -2.313, -7.081, -3.172, P<0.05), but the score of mental and psychological status had no significant difference (t=-1.154, P>0.05). Conclusions The quality of life in patients with hepatic hemangioma can be improved by surgery. Surgical treatment is still effective for improvement of the total scores of GIQLI, the scores of subjective symptoms, physiological status, and social activities for those combined with other digestive diseases.