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Synchronous colorectal liver metastases:therapeutic considerations

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hepatobiliary Surgery and Nutrition 2021年第5期10卷 711-713页

作者： Michael R.Driedger Sean P.Cleary David M.Nagorney division of hepatobiliary and Pancreatic Surgery Atrium HealthCharlotteNCUSA division of hepatobiliary and Pancreatic Surgery Mayo ClinicRochesterMNUSA

More than 50%of patients will develop colorectal cancer(CRC)liver metastases(CRCLM)during the course of their disease,while 15-25%of patients will have metastatic disease present at the time of initial *** of CRCLM is possible in approximately one-in-four patients and 5-year overall survival(OS)rates have improved to nearly 60%in selected patients who undergo resection.

关键词： colorectal metastases patients

Therapeutic advances: Single incision laparoscopic hepatopancreatobiliary surgery

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World Journal of Gastroenterology 2014年第39期20卷 14329-14337页

作者： Stephen Kin Yong Chang Kai Yin Lee division of hepatobiliary and Pancreas Surgery Department of Surgery National University Singapore Hospital

Single-port laparoscopic surgery(SPLS) is proposed to be a step towards minimizing the invasiveness of surgery, and has since gained popularity in several surgical sub-specialties including hepatopancreatobiliary surgery. SPLS has since been applied to cholecystectomy, liver resection as well as pancreatectomy for a multitude of pathologies. Benefits of SPLS over conventional multi-incision laparoscopic surgery include improved cosmesis and potentially post-operative pain at specific time periods and extra-umbilical sites. However, it is also associated with longer operating time, increased rate of complications, and increased rate of port-site hernia. There is no significant difference between length of hospital stay. SPLS has a significant learning curve that affects operating time, rate of conversion and rate of complications. In this article, we review the literature on SPLS in hepatobiliary surgery- cholecystectomy, hepatectomy and pancreatectomy, and offer tips on overcoming potential technical obstacles and minimizing the complications when performing SPLS- surgeon position, position of port and instruments, instrument crossing position, standard hand grip vs reverse hand grip, snooker cue guide position, prevention of incisional hernia. SPLS is a promising direction in laparoscopic surgery, and we recommend step-wise progression of applications of SPLS to various hepatopancreatobiliary surgeries to ensure safe adoption of the surgical technique.

关键词： Single port laparoscopic Cholecystectomy Hepatectomy Pancreatectomy Liver resection

A complicated peribiliary cyst:An unusual hilar cholangiocarcinoma mimic

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hepatobiliary & Pancreatic Diseases International 2022年第2期21卷 193-195页

作者： Oriana Barrios Kristel Mils Laura Lladó Josefina Lopez-Dominguez Emilio Ramos division of hepatobiliary Surgery Bellvitge University HospitalBarcelona 08907Spain

To the Editor:Peribiliary cysts are cystic dilatations of the extramural peribiliary glands that appears in the connective tissue around the hepatic *** can affect up to the fourth order intrahepatic bile ducts and do not communicate with the bile *** is a rare entity first described in 1984 by Nakanuma et al.[1].Its diagnosis is usually an incidental discovery in patients with advanced liver disease,portal thrombosis,and portal hypertension [2].

关键词： biliary diagnosis

HCCDB v2.0:Decompose Expression Variations by Single-cell RNA-seq and Spatial Transcriptomics in HCC

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Genomics, Proteomics & Bioinformatics 2024年第1期22卷 131-142页

作者： Ziming Jiang Yanhong Wu Yuxin Miao Kaige Deng Fan Yang Shuhuan Xu Yupeng Wang Renke You Lei Zhang Yuhan Fan Wenbo Guo Qiuyu Lian Lei Chen Xuegong Zhang Yongchang Zheng Jin Gu Eight-Year Program of Clinical Medicine Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100006China MOE Key Laboratory of Bioinformatics BNRIST Bioinformatics DivisionInstitute for Precision Medicine&Department of AutomationTsinghua UniversityBeijing 100084China Department of Liver Surgery Peking Union Medical College HospitalChinese Academy of Medical Sciences&Peking Union Medical CollegeBeijing 100730China Fuzhou Institute for Data Technology Fuzhou 350207China University of Michigan-Shanghai Jiao Tong University Joint Institute Shanghai Jiao Tong UniversityShanghai 200240China Department of Automation Shanghai Jiao Tong UniversityShanghai 200240China International Cooperation Laboratory on Signal Transduction Eastern Hepatobiliary Surgery InstituteSecond Military Medical UniversityShanghai 200438China National Center for Liver Cancer Shanghai 201805China

Large-scale transcriptomic data are crucial for understanding the molecular features of hepatocellular carcinoma(HCC).Integrated 15 transcriptomic datasets of HCC clinical samples,the first version of HCC database(HCCDB v1.0)was released in *** the meta-analysis of differentially expressed genes and prognosis-related genes across multiple datasets,it provides a systematic view of the altered biological processes and the inter-patient heterogeneities of HCC with high reproducibility and *** four years having passed,the database now needs integration of recently published ***,the latest single-cell and spatial transcriptomics have provided a great opportunity to decipher complex gene expression variations at the cellular level with spatial ***,we present HCCDB v2.0,an updated version that combines bulk,single-cell,and spatial transcriptomic data of HCC clinical *** dramatically expands the bulk sample size by adding 1656 new samples from 11 datasets to the existing 3917 samples,thereby enhancing the reliability of transcriptomic meta-analysis.A total of 182,832 cells and 69,352 spatial spots are added to the single-cell and spatial transcriptomics sections,respectively.A novel single-cell level and 2-dimension(sc-2D)metric is proposed as well to summarize cell type-specific and dysregulated gene expression *** are all graphically visualized in our online portal,allowing users to easily retrieve data through a user-friendly interface and navigate between different *** extensive clinical phenotypes and transcriptomic data in the database,we show two applications for identifying prognosis-associated cells and tumor *** v2.0 is available at http://***/database/hccdb2.

关键词： Hepatocellular carcinoma Database Integrative analysis Single-cell RNA sequencing Spatial transcriptomics

Hepatic resection： an analysis of the impact of operative and perioperative factors on morbidity and mortality rates in 2008 consecutive hepatectomy cases

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Chinese Medical Journal 2009年第19期122卷 2268-2277页

作者： HUANG Zhi-qiang XU Li-ning YANG Tao ZHANG Wen-zhi HUANG Xiao-qiang CAI Shou-wang ZHANG Ai-qun FENG Yu-quan ZHOU Ning-xin DONG Jia-hong Institute of hepatobiliary Surgery of PLA Chinese PLA General Hospital Beijing 100853 China Institute of hepatobiliary Surgery Clinical Division of Surgery Chinese PLA General Hospital Beijing 100853 China

Background Hepatectomy is a standard hepatic surgica line with improvements in surgical techniques. This study with hepatectomy. technique. The safety of hepatectomy has been improved in analyzed the operative and perioperative factors associated Methods A total of 2008 patients who underwent consecutive hepatectomies between January 1986 and December 2005 were investigated retrospectively. Diagnoses were made based on pathological findings. Results Malignant and benign liver diseases accounted for 58.5% and 41.2%, respectively, of the conditions requiring resections. Primary liver cancers accounted for 76.1% of the malignant tumors, while hilar cholangiocarcinomas accounted for 6.7%. Hemangiomas （41.7%） and hepatolithiasis （29.6%） were the most common of the benign conditions. Microwave in-line coagulation was used in 236 of our liver resection cases. The overall postoperative complication rate was 14.44%, of which 12.54% of resections were performed for primary liver cancer, 16.40% for secondary liver cancer, and 16.32% for hepatolithiasis. The overall hospital mortality was 0.55%, and that for malignant liver disease was 0.51%. A high mortality （2.53%） was associated with extensive liver resections for hilar cholangiocarcinomas （two deaths in 79 cases）. Microwave in-line pre-coagulation resection, Child-Pugh grading, operating time, postoperative length of stay, and preoperative serum albumin level were independent predictors of morbidity. Blood loss, Child-Pugh grading, operating time and preoperative serum albumin level were independent predictors of mortality. Conclusions Hepatectomy can be performed safely with low morbidity and mortality, provided that it is carried out with optimal perioperative management and innovative surgical techniques.

关键词： hepatectomy perioperative intraoperative

Programmed death 1 and programmed death ligand 1 expressions in patients with chronic hepatitis B

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hepatobiliary & Pancreatic Diseases International 2013年第4期12卷 394-399页

作者： Wen-Jin Zhang Chuan-Hui Peng Shu-Sen Zheng division of hepatobiliary Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine

BACKGROUND: The role of programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) in persistent HBV infection is controversial. Increasing PD-1 and PD-L1 expression has been found in hepatitis B patients during immune clearance phase, but not in HBV-tolerant patients. We investigated PD-1 and PD-L1 expression and inflammation in chronic hepatitis B. METHODS: Twenty patients with chronic hepatitis B participated in this study. Fifteen patients were in the immune clearance phase, and 5 were in the immune inactive phase. Circulating HBV-specific T cells were analyzed by flow cytometric detection of major histocompatibility complex (MHC) class I peptide complexes, known as pentamers. Intra-hepatic PD-1 and PD-L1 expressions were analyzed by immunostaining. RESULTS: The frequency of pentamers, including core 18-27 (1.88%±0.36%), env 335-343 (1.85%±0.37%), and pol 575-583 (1.56%±0.29%) was 8.30-, 7.71- and 8.48-fold greater during immune clearance phase than those during the immune inactive phase. In addition, more than 70% of circulating pentamers were PD-1 positive. During immune clearance phase, the numbers of intra-hepatic PD-1 and PD-L1 positive cells were 108±23/HPF and 97±20/HPF respectively, in contrast, there was a paucity of PD-1 and PD-L1 positive cells in the immune inactive phase. The numbers of intra-hepatic PD-1 and PD-L1 positive cells were positively correlated with serum alanine aminotransferase and the number of intra-hepatic CD8 + T cells. Immunofluorescence showed that almost all of the intra- hepatic CD8 + T cells were PD-1 and CCR6 positive. These cells aggregated around macrophage inflammatory protein-3 alpha (MIP3α) positive cells and mixed with PD-L1 positive ***: PD-1 and PD-L1 expressions were significantly correlated with inflammation. CCR6 and PD-1 co-expressed in the same cells; these cells were increased both in circulation and the inflamed liver and aggregated around MIP3α positive cells. The mixture of CCR6 and PD-1, M

关键词： programmed death 1 receptor hepatitis B, chronic liver

Technical aspects of biliary reconstruction in adult living donor liver transplantation

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hepatobiliary & Pancreatic Diseases International 2011年第2期10卷 136-142页

作者： Xiao-Ning Feng, Chao-Feng Ding, Mei-Yuan Xing, Min-Xia Cai and Shu-Sen Zhengdivision of hepatobiliary and Pancreatic Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310003, China division of hepatobiliary and Pancreatic Surgery First Affiliated Hospital Zhejiang University School of Medicine

BACKGROUND: The last decade has witnessed great progress in living donor liver transplantation worldwide. However, biliary complications are more common in partial liver transplantation than in whole liver transplantation. This is due to an impaired blood supply of the hilar bile duct during organ procurement and recipient surgery, commonly encountered anatomical variations, a relatively small graft duct, and complicated surgical techniques used in biliary reconstruction. DATA SOURCES: MEDLINE and PubMed were searched for articles on 'living donor liver transplantation', 'biliary complication', 'anatomical variation', 'biliary reconstruction', 'stenting' and related topics. RESULT: In this review, biliary complications were analyzed with respect to anatomical variation, surgical techniques in biliary reconstruction, and protection of the arterial plexus of the hilar bile duct. CONCLUSION: Transecting the donor bile duct at the right place to secure a larger bile duct stump, anastomosing techniques, and stenting methods as well as preserving the blood supply to the bile duct are all important in reducing biliary complications.

关键词： living donor liver transplantation biliary complications biliary reconstruction biliary drainage biliary anatomy

Liver graft vascular variant with 3 extra-hepatic arteries

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hepatobiliary & Pancreatic Diseases International 2010年第3期9卷 319-320页

作者： Paulo N Martins Department of Surgery Division of Hepatobiliary Surgery and TransplantationNew York Medical College

Vascular anatomy of the liver is varied,and the 'standard'anatomy is seen in 55%-80%of *** is very important that extrahepatic arteries are identified precisely at the time of graft procurement to avoid injuries that might compromise the liver *** the present case the liver donor had the vascular anatomy of Michels typeⅦ,e.g.a hepatic artery originating from the celiac trunk and going to the left lobe,an accessory left hepatic artery coming from the left gastric artery,and a replaced right hepatic artery coming from the superior mesenteric *** pattern of vascular supply is uncommon,representing less than 5%of *** replaced hepatic artery was reconstructed in the back-table with polypropylene suture 7.0 by connecting it to the stump of the splenic artery,and the celiac trunk of the graft was anastomosed to the recipient common hepatic artery.

关键词： liver transplantation liver anatomy vascular variations right replaced artery accessory artery

Have we really understood when the efforts of laparoscopic liver resection are justified?-a complexity-based appraisal of the differential benefit

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hepatobiliary Surgery and Nutrition 2022年第3期11卷 363-374页

作者： Francesca Ratti Federica Cipriani Guido Fiorentini Marco Catena Michele Paganelli Luca Aldrighetti hepatobiliary Surgery division IRCCS San Raffaele HospitalMilanoItaly

Background:The implementation of minimally invasive liver resection surgery(MILS)programs starts from procedures with a low degree of technical *** regarding the real short-term advantage of laparoscopy according to technical difficulty are still *** aim of the present study is to evaluate the differential benefit of laparoscopic over open technique according to the technical difficulty of the procedures and to investigate if efforts associated with laparoscopic approach are always ***:Nine hundred and thirty-six MILS resections performed between 2005 and 2018 were stratified according to technical complexity(low,intermediate and high difficulty)and to approach(MILS or open)and matched in a 1:1 ratio using propensity scores to obtain three pairs of groups(Pair 1:Low-MILS and Low-Open,including 274 cases respectively;Pair 2:Int-MILS and Int-Open,including 237 patients respectively;Pair 3:High-MILS and High-Open,including 226 patients respectively).Results:MILS approach resulted in a statistically significant lower blood loss,reduced morbidity,reduced and shorter time for functional recover and length of stay within all *** evaluation of the differential benefit showed a greater advantage of laparoscopic approach in high degree procedures compared with intermediate and low degree,both in terms of blood loss(-250 and-200 mL respectively)and morbidity rate(-5.7%and-4.1%respectively).Conclusions:The favorable biological scenario associated with laparoscopic approach allows to obtain significant benefits in the setting of technically complex *** commitment towards MILS approach should be therefore stronger in this setting,where the advantage of laparoscopy seems to be enhanced.

关键词： Laparoscopic liver complexity outcomes