The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics,virtual surgery s...The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics,virtual surgery simulation and using the created scenarios in real-time surgery using mixed reality.In this article,we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver transplantation.Furthermore,we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.展开更多
Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT)...Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT),an emerging,non-invasive,precision treatment,has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world.This article aims to review current guideline recommendations on SBRT,clinical evidence,and outcome comparisons with other local treatment modalities.Attempts are also made to compare the differences in clinical trials between Asian and Western countries.展开更多
The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Base...The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.展开更多
Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survi...Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.展开更多
Hepatocellular carcinoma(HCC)is one of the most common malignant tumors of the liver,with poor prognosis and high mortality.Traditional treatments for patients with HCC have shown poor efficacy especially for advanced...Hepatocellular carcinoma(HCC)is one of the most common malignant tumors of the liver,with poor prognosis and high mortality.Traditional treatments for patients with HCC have shown poor efficacy especially for advanced liver cancer.Compared with other organs,the liver has more natural immune cells such as Kupffer cells,natural killer cells and natural killer T cells.Immunotherapy for liver cancer has become the focus in current research.The theoretical basis of immunotherapy rests on immune tolerance and suppression in the tumor microenvironment.Common immunotherapy methods include vaccines,cytokines,adoptive cell therapies,immune checkpoint inhibitors,and oncolytic viruses.Compared with traditional treatment,immunotherapy can enhance the body’s immune function,delay tumor progression,and prolong survival.This article reviews the HCC microenvironment and immunotherapy both in the clinical and basic research aspects.展开更多
Small-for-Size Syndrome(SFSS)has emerged to be a critical challenge in living donor liver transplantation(LDLT)as the procedure involves utilisation of partial(therefore,smaller)liver grafts compared to whole liver gr...Small-for-Size Syndrome(SFSS)has emerged to be a critical challenge in living donor liver transplantation(LDLT)as the procedure involves utilisation of partial(therefore,smaller)liver grafts compared to whole liver grafts in deceased donor liver transplantation.SFSS often manifests as liver graft insufficiency due to inadequate volume,leading to significant post-transplant morbidity and mortality.展开更多
文摘The development of digital intelligent diagnostic and treatment technology has opened countless new opportunities for liver surgery from the era of digital anatomy to a new era of digital diagnostics,virtual surgery simulation and using the created scenarios in real-time surgery using mixed reality.In this article,we described our experience on developing a dedicated 3 dimensional visualization and reconstruction software for surgeons to be used in advanced liver surgery and living donor liver transplantation.Furthermore,we shared the recent developments in the field by explaining the outreach of the software from virtual reality to augmented reality and mixed reality.
基金supported in part by Shenzhen Science and Technol-ogy Program(grant number KQTD20180411185028798)a Varian Medical Systems Research Grant.
文摘Hepatocellular carcinoma(HCC)is a common malignancy with high mortality rates.While surgery can be curative in early-stage disease,80% of patients cannot undergo surgical resection.Stereotactic body radiotherapy(SBRT),an emerging,non-invasive,precision treatment,has shown promising results across various stages of HCC and has thus been adopted in practice to varying degrees around the world.This article aims to review current guideline recommendations on SBRT,clinical evidence,and outcome comparisons with other local treatment modalities.Attempts are also made to compare the differences in clinical trials between Asian and Western countries.
文摘The robotic liver resection(RLR)has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system,however,controversies still exist.Based on the foundation of the previous consensus statement,this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice.The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine(EBM).Relevant literature was reviewed and analyzed by the evidence evaluation group.According to the WHO Handbook for Guideline Development,the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022,a total of 14 recommendations were generated.Among them were 8 recommendations formulated by the GRADE method,and the remaining 6 recommendations were formulated based on literature review and experts’opinion due to insufficient EBM results.This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
文摘Background:Outcomes after liver resection(LR)and liver transplantation(LT)for hepatocellular carcinoma(HCC)are heterogenous and may vary by region,over time periods and disease burden.We aimed to compare overall survival(OS)and disease-free survival(DFS)between LT versus LR for HCC within the Milan criteria.Methods:Two authors independently searched Medline and Embase databases for studies comparing survival after LT and LR for patients with HCC meeting the Milan criteria.Meta-analyses and meta-regression were conducted using random-effects models.Results:We screened 2,278 studies and included 35 studies with 18,421 patients.LR was associated with poorer OS[hazard ratio(HR)=1.44;95%confidence interval(CI):1.14-1.81;P<0.01]and DFS(HR=2.71;95%CI:2.23-3.28;P<0.01)compared to LT,with similar findings among intention-to-treat(ITT)studies.In uninodular disease,OS in LR was comparable to LT(P=0.13)but DFS remained poorer(HR=2.95;95%CI:2.30-3.79;P<0.01).By region,LR had poorer OS versus LT in North America and Europe(P≤0.01),but not Asia(P=0.25).LR had inferior survival versus LT in studies completed before 2010(P=0.01),but not after 2010(P=0.12).Cohorts that underwent enhanced surveillance had comparable OS after LT and LR(P=0.33),but cohorts undergoing usual surveillance had worse OS after LR(HR=1.95;95%CI:1.24-3.07;P<0.01).Conclusions:Mortality after LR for HCC is nearly 50%higher compared to LT.Survival between LR and LT were similar in uninodular disease.The risk of recurrence after LR is threefold that of LT.
基金This study was funded by the National Natural Science Foundation of China(grant number 81670111).
文摘Hepatocellular carcinoma(HCC)is one of the most common malignant tumors of the liver,with poor prognosis and high mortality.Traditional treatments for patients with HCC have shown poor efficacy especially for advanced liver cancer.Compared with other organs,the liver has more natural immune cells such as Kupffer cells,natural killer cells and natural killer T cells.Immunotherapy for liver cancer has become the focus in current research.The theoretical basis of immunotherapy rests on immune tolerance and suppression in the tumor microenvironment.Common immunotherapy methods include vaccines,cytokines,adoptive cell therapies,immune checkpoint inhibitors,and oncolytic viruses.Compared with traditional treatment,immunotherapy can enhance the body’s immune function,delay tumor progression,and prolong survival.This article reviews the HCC microenvironment and immunotherapy both in the clinical and basic research aspects.
文摘Small-for-Size Syndrome(SFSS)has emerged to be a critical challenge in living donor liver transplantation(LDLT)as the procedure involves utilisation of partial(therefore,smaller)liver grafts compared to whole liver grafts in deceased donor liver transplantation.SFSS often manifests as liver graft insufficiency due to inadequate volume,leading to significant post-transplant morbidity and mortality.
