Large hepatocellular carcinoma (HCC) is one of the most common malignancies and was mistaked as "advanced and unresectable" . Liver resection is still the best curable treatment for HCC.The resection of large HCC is very difficult, which seriously restrict the progress of liver surgery.Our study proved that solitary large HCC (SLHCC) has unique clinicopathological and molecular biological characteristics.No matter how big the tumor size is, it belongs to early stage if there is no vascular invasion.Liver resection should be aggressively recommended for the patients with SLHCC, in which they can obtain good outcome, with 40% 5-year survival rate.We has also defined the borderline resectable hepatocellular carcinoma, and suggested that strictly master and correctly judge the surgical indications, syntheticly evaluate the surgical safety and patient′s tolerability for liver resection.After that, with hands of experienced surgeons, liver resection for SLHCC can be safely and reliablely performed.

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.

Objective:To examine the value of serum protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) detection in the early diagnosis and surveillance of hepatocellular carcinoma (HCC).Methods:The clinical data of 215 patients with HCC admitted to Department of Hepatobiliary-Pancreatic Surgery of China-Japan Union Hospital of Jilin University from October 2017 to May 2018 were analyzed retrospectively. There were 172 males and 43 females, aged of (59.0±9.3) years old (range 34 to 86 years old). In addition, there were 85 non HCC patients were enrolled in the control group, 42 males and 43 females, aged (54.2±11.3) years old (range 22 to 80 years old). The blood sample of 3 ml was drawn from the elbow vein at 6∶00 am on the next day of admission, and then was kept in low temperature away from light, and sent for PIVKA-Ⅱ detection on the same day. The positive value of AFP was ≥20 μg/L and PIVKA-Ⅱ was ≥32 AU/L. The data were analyzed statistically by χ 2 test, t test or rank sum test. The correlation between AFP, PIVKA-Ⅱ and tumor maximum diameter was analyzed by linear regression. Results:The sensitivity of PIVKA-Ⅱ detection only for the diagnosis of HCC in all stages was significantly higher than AFP or equivalent to AFP, the overall sensitivity of PIVKA-Ⅱ and AFP was 85.1% and 52.1%, respectively. But the specificity of PIVKA-Ⅱ was lower than that of AFP, they were 78.8% and 96.5%, respectively. In particularly, in the earlier stage of HCC (Ⅰa) , the sensitivity of PIVAK-Ⅱ to HCC was 64.5%, while the AFP was only 26.3%. Combined detection of PIVKA-Ⅱ and AFP significantly improved the diagnostic rate of HCC to 88.4%, and the specificity to 76.5%. Moreover, there was a positive correlation between PIVKA-Ⅱ level and the maximum tumor diameter ( r2=0.587, P<0.05), but there was no correlation between the AFP level and the maximum tumor diameter ( r2=0.296, P>0.05). The positive rate of PIVKA-Ⅱ in the diagnosis of HCC with vascular invasion was also significantly higher than that of AFP ( P<0.01) . Conclusions:PIVKA-Ⅱ can be used as a serological marker for HCC screening and diagnosis. In particular, PIVKA-Ⅱ detection was significantly sensitive than AFP in the earlier stage of HCC. Combined detection of PIVKA-Ⅱ and AFP can effectively improve the diagnostic rate of HCC in all stages. The significant elevation of PIVKA-Ⅱ is also helpful to determine the tumor aggressiveness, vascular invasion and prognosis of HCC patients.

The cirrhotic portal hypertension is very common worldwide and poses a serious threat to the health of patients.Over past three decades, the surgical treatment for cirrhotic portal hypertension was strongly challenged by the drugs, endoscopy, interventional therapy and liver transplantation.However, under the multidisciplinary team(MDT) cooperative diagnosis and treatment mode, the surgical treatment still plays a unique and irreplaceable role.Laparoscopic pericardial vascular devascularization is characterized by less injury and bleeding, rapid postoperative recovery, which will coexist with open surgery for portal hypertension. It is important to focus on the development and application of new methods, new technologies and new concepts under the MDT cooperative diagnosis and treatment mode, giving full play to the advantages of each discipline and advocate standardized, individualized and precise treatment should be emphasized to maximize patient clinical benefits.

Objective:To examine the value of serum protein induced by vitamin K absence or antagonist-Ⅱ (PIVKA-Ⅱ) detection in the early diagnosis and surveillance of hepatocellular carcinoma (HCC).Methods:The clinical data of 215 patients with HCC admitted to Department of Hepatobiliary-Pancreatic Surgery of China-Japan Union Hospital of Jilin University from October 2017 to May 2018 were analyzed retrospectively. There were 172 males and 43 females, aged of (59.0±9.3) years old (range 34 to 86 years old). In addition, there were 85 non HCC patients were enrolled in the control group, 42 males and 43 females, aged (54.2±11.3) years old (range 22 to 80 years old). The blood sample of 3 ml was drawn from the elbow vein at 6∶00 am on the next day of admission, and then was kept in low temperature away from light, and sent for PIVKA-Ⅱ detection on the same day. The positive value of AFP was ≥20 μg/L and PIVKA-Ⅱ was ≥32 AU/L. The data were analyzed statistically by χ 2 test, t test or rank sum test. The correlation between AFP, PIVKA-Ⅱ and tumor maximum diameter was analyzed by linear regression. Results:The sensitivity of PIVKA-Ⅱ detection only for the diagnosis of HCC in all stages was significantly higher than AFP or equivalent to AFP, the overall sensitivity of PIVKA-Ⅱ and AFP was 85.1% and 52.1%, respectively. But the specificity of PIVKA-Ⅱ was lower than that of AFP, they were 78.8% and 96.5%, respectively. In particularly, in the earlier stage of HCC (Ⅰa) , the sensitivity of PIVAK-Ⅱ to HCC was 64.5%, while the AFP was only 26.3%. Combined detection of PIVKA-Ⅱ and AFP significantly improved the diagnostic rate of HCC to 88.4%, and the specificity to 76.5%. Moreover, there was a positive correlation between PIVKA-Ⅱ level and the maximum tumor diameter ( r2=0.587, P<0.05), but there was no correlation between the AFP level and the maximum tumor diameter ( r2=0.296, P>0.05). The positive rate of PIVKA-Ⅱ in the diagnosis of HCC with vascular invasion was also significantly higher than that of AFP ( P<0.01) . Conclusions:PIVKA-Ⅱ can be used as a serological marker for HCC screening and diagnosis. In particular, PIVKA-Ⅱ detection was significantly sensitive than AFP in the earlier stage of HCC. Combined detection of PIVKA-Ⅱ and AFP can effectively improve the diagnostic rate of HCC in all stages. The significant elevation of PIVKA-Ⅱ is also helpful to determine the tumor aggressiveness, vascular invasion and prognosis of HCC patients.

Portal hypertension caused by liver cirrhosis is common and severely threatens the patients' health.The dominant position of the conventional surgical treatment was strongly challenged by the pharmacological,endoscopic esophageal variceal ligation (EVL),transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation.So,what the prospect of surgical treatment is and whether it has disappeared? In fact,the surgical treatment is not only far from disappearing,but also play a unique and indispensable role,and could not be displaced by other treatments.Nowadays,the laparoscopic pericardial devascularization is widespread used,shows the increasingly prominent and distinct advantages of less injury and bleeding,fewer complications and faster recovery.The generalizing of multidisciplinary treatment (MDT) will combine advantages of varies subjects then provide the individual and precise diagnosis and treatment plan to patients.Authors should pay attention to the problems and then organize the clinical multicenter RCT studies,provide high level evidences,explore new surgical procedures,compose new clinical guidelines and consensuses which consistent with our national situations,thus to guide the clinical practice and will further improve the treatment of portal hypertension and raise our country'voice in this subject.

Objective To analyze the clinicopathological characteristics and prognostic factors of combined hepatocellular-cholangiocarcinoma (cHCC-CC).Methods The retrospective cohort study was conducted.The clinicopathological data of 72 patients with primary hepatocellular carcinoma (HCC) who were admitted to the Xiangya Hospital of Central South University between January 2005 and December 2014 were collected.Thirty-two patients who were diagnosed with cHCC-CC by postoperative pathological examination were allocated into the cHCC-CC group and 40 patients who were diagnosed with HCC by postoperative pathological examination were allocated into the HCC group.Observation indicators:(1) clinicopathological characteristics:male,age ＞ 60 years,positive hepatitis B surface antigen (HBsAg),positive alpha-fetoprotein (AFP),positive CA19-9,positive carcinoembryonic antigen (CEA),liver cirrhosis,Child-Pugh grade A,tumor diameter ＞ 5 cm,tumor with capsule,solitary tumor,portal vein tumor thrombus (PVTT),cancer thrombus of the bile duct,positive lymph node metastasis,stage Ⅰ-Ⅱ of TNM stage,Edmondson-Steiner stage Ⅰ-Ⅱ;(2) pathological features of surgical incision specimens;(3) follow-up situations:median survival time,1-,3-,5-year survival rates and tumor-free survival rate;(4) prognostic factors analysis of patients with cHCC-CC:AFP,CA19-9,liver cirrhosis,tumor diameter,tumor capsule,number of tumor,PVTT,cancer thrombus of the bile duct,lymph node metastasis,Edmondson-Steiner stage,volume of intraoperative blood loss,intraoperative blood transfusion,distant from surgical margin.Follow-up using outpatient examination and telephone interview was performed to detect survival of patients and tumor recurrence or metastasis up to October 2015.Comparison of count data was analyzed using the chi-square test.The survival curve was drawn by the Kaplan-Meier method,and the survival analysis was done using the Log-rank test.The prognostic analysis was done using the COX regression model.Results (1) Clinicopathological characteristics:positive CA19-9,tumor with capsule,cancer thrombus of the bile duct and positive lymph node metastasis were detected in 16,4,12,6 patients in the cHCC-CC group and 5,17,1,1 patients in the HCC group,respectively,with statistically significant differences between the 2 groups (x2=10.471,9.723,13.005,4.009,P ＜ 0.05).(2) Pathological features of surgical incision specimens:pathological results showed that surgical incision specimens in the cHCC-CC group had characteristics of HCC tissues and cholangiocarcinoma tissues.The antigenic activity of hepatic cells in paraffin sections,Cytokeratin 7,Cytokeratin 19 and progenitor cell markers were positive by immunohistochemical staining detection.Patients in the HCC group had characteristics of HCC tissues,with positive AFP using immunohistochemical staining detection.(3) Follow-up situations:all the 72 patients were followed up for 5.0-74.0 months with a median time of 41.0 months.The median survival time,1-,3-,5-year survival rates,1-,3-,5-year tumor-free survival rates were 14.5 months,62.3％,38.9％,19.1％,50.0％,23.9％,4.0％ in the cHCC-CC group and 46.8 months,82.3％,57.4％,38.6％,72.9％,35.6％,17.6％ in the HCC group,respectively,with statistically significant differences in overall survival and tumor-free survival between the 2 groups (x2=4.231,3.881,P ＜ 0.05).(4) Prognostic factors analysis of patients with cHCC-CC:results of univariate analysis showed that CA19-9,tumor capsule,number of tumor,cancer thrombus of the bile duct,lymph node metastasis and Edmondson-Steiner stage were related factors affecting prognosis of patients with cHCC-CC [HR =1.824,0.227,0.441,1.421,1.887,2.745,95％ confidence interval (CI):1.126-2.172,0.118-0.654,0.318-0.764,1.071-4.231,1.017-5.643,1.223-6.421,P ＜ 0.05].Results of multivariate analysis showed that lymph node metastasis and stage Ⅲ-Ⅳ of Edmondson-Steiner stage were independent risk factors affecting prognosis of patients with cHCC-CC (RR =1.658,2.912,95％ CI:1.027-7.542,1.143-6.582,P ＜0.05).Conclusions The positive CA19-9,tumor without capsule,cancer thrombus of the bile duct and positive lymph node metastasis can partly predict cHCC-CC.The prognosis of patients with cHCC-CC is worse than that with HCC.The positive lymph node metastasis and stage Ⅲ-Ⅳof Edmondson-Steiner stage are independent risk factors affecting prognosis of patients with cHCC-CC.

Esophagogastric variceal hemorrhage caused by portal hypertension is common and severely threatens the patients' health.The conventional surgical treatment plays an important role in portal hypertension.Although surgical treatment is strongly challenged by the pharmacological treatments,endoscopic treatments and radioactive intervention therapies,the role in portal hypertension treatment is still unshakable and irreplaceable,and is also not the disappearing surgery.The multidisciplinary treatment modalities have also brought new impetus for the individualization and precision treatment of portal hypertension.The developments of new clinical guidelines and consensuses,new techniques and novel conceptions have promoted the treatment of portal hypertension to a standard procedure.

Objective To explore the prognostic factors that have affected the long-term survival of solitary large hepatocellular carcinoma (SLHCC) patients after hepatectomy.Methods The clinical data of 215 SLHCC patients accepted hepatectomy in the Xiangya Hospital,Central South University from January 2004 to December 2012 were retrospectively analyzed.There were 182 males and 33 females aged from 24 to 69 years(median age was 46 years).Using a variety of statistical methods,including the Kaplan-Meier estimator and the Log-rank test,the impacts of an array of clinicopathologic factors,such as age,gender,liver cirrhosis,chronic viral hepatitis,the Child-Pugh grading,microvascular invasion,macrovascular invasion and TNM staging,on the overall survival and the disease-free survival of SLHCC patients after hepatectomy were analyzed.The prognostic factors were evaluated by univariate and multivariate analyses for the long-term survival of SLHCC patients after hepatectomy.Results The whole group of patients with SLHCC showed 1-,3-,and 5-year overall survival rates of 88.1％,60.2％,and 41.7％,respectively,and exhibited 1-,3-,and 5-year disease-free survival rates of 80.1％,49.4％,and 33.6％,respectively.The 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with microvascular invasion were 82.0％,45.1％,29.0％ and 69.6％,36.1％,23.5％,respectively.In addition,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with macrovascular invasion were 64.7％,34.3％,18.3％ and 54.2％,24.1％,0,respectively.In contrast,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients without vascular invasion were 95.0％,72.3％,51.8％ and 90.1％,60.9％,42.9％,respectively.The results of univariate analysis indicated that liver cirrhosis,microvascular invasion,macrovascular invasion,TNM staging were hazardous factors for the overall survival of SLHCC patients (x2 =4.953,8.835,15.237,19.789 respectively,all P ＜0.05) ; while microvascular invasion,macrovascular invasion,TNM staging were risk factors for the diseasefree survival of SLHCC patients (x2 =12.974,13.247,24.516 respectively,all P ＜ 0.05).Furthermore,the multivariate analysis suggested that microvascular invasion,macrovascular invasion,TNM staging were the independent prognostic factors that have affected the overall survival and disease-free survival of SLHCC patients(all P ＜ 0.05).Conclusion Microvascular invasion,macrovascular invasion and TNM staging were the independent prognostic factors for the long-term survival of patients with SLHCC after hepatectomy.

Objective To explore the prognostic factors that have affected the long-term survival of solitary large hepatocellular carcinoma (SLHCC) patients after hepatectomy.Methods The clinical data of 215 SLHCC patients accepted hepatectomy in the Xiangya Hospital,Central South University from January 2004 to December 2012 were retrospectively analyzed.There were 182 males and 33 females aged from 24 to 69 years(median age was 46 years).Using a variety of statistical methods,including the Kaplan-Meier estimator and the Log-rank test,the impacts of an array of clinicopathologic factors,such as age,gender,liver cirrhosis,chronic viral hepatitis,the Child-Pugh grading,microvascular invasion,macrovascular invasion and TNM staging,on the overall survival and the disease-free survival of SLHCC patients after hepatectomy were analyzed.The prognostic factors were evaluated by univariate and multivariate analyses for the long-term survival of SLHCC patients after hepatectomy.Results The whole group of patients with SLHCC showed 1-,3-,and 5-year overall survival rates of 88.1％,60.2％,and 41.7％,respectively,and exhibited 1-,3-,and 5-year disease-free survival rates of 80.1％,49.4％,and 33.6％,respectively.The 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with microvascular invasion were 82.0％,45.1％,29.0％ and 69.6％,36.1％,23.5％,respectively.In addition,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients with macrovascular invasion were 64.7％,34.3％,18.3％ and 54.2％,24.1％,0,respectively.In contrast,the 1-,3-,and 5-year overall survival rates and disease-free survival rates of SLHCC patients without vascular invasion were 95.0％,72.3％,51.8％ and 90.1％,60.9％,42.9％,respectively.The results of univariate analysis indicated that liver cirrhosis,microvascular invasion,macrovascular invasion,TNM staging were hazardous factors for the overall survival of SLHCC patients (x2 =4.953,8.835,15.237,19.789 respectively,all P ＜0.05) ; while microvascular invasion,macrovascular invasion,TNM staging were risk factors for the diseasefree survival of SLHCC patients (x2 =12.974,13.247,24.516 respectively,all P ＜ 0.05).Furthermore,the multivariate analysis suggested that microvascular invasion,macrovascular invasion,TNM staging were the independent prognostic factors that have affected the overall survival and disease-free survival of SLHCC patients(all P ＜ 0.05).Conclusion Microvascular invasion,macrovascular invasion and TNM staging were the independent prognostic factors for the long-term survival of patients with SLHCC after hepatectomy.