ObjectiveTo understand the current situation of surgical treatment of hilar cholangiocarcinoma. MethodThe literature relevant to surgical treatment of hilar cholangiocarcinoma at home and abroad in recent years was reviewed. ResultsThe various surgical treatment schemes of hilar cholangiocarcinoma had advantages and disadvantages. At present, there were still disputes and no unified consensus on preoperative preparation, selection of intraoperative surgical resection range, and applications of laparoscopy and robot, etc. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. The individualized surgical treatment plan should still be formulated based on the specific condition of the patient and the professional experience of the surgeon. ConclusionIt is believed that accurate preoperative condition evaluation should be carried out for each patient with hilar cholangiocarcinoma, so as to formulate the best surgical treatment plan, achieve individualized accurate treatment and benefit patients.
ObjectiveTo analyze the risk factors and develop a nomagram predictive model for early recurrence after curative resection for hepatocellular carcinoma (HCC). MethodsThe clinicopathologic data of the patients with HCC who underwent radical hepatectomy at the First Affiliated Hospital of Xinjiang Medical University from August 2017 to August 2021 were retrospectively collected. The univariate and multivariate logistic regression analysis were used to screen for the risk factors of early recurrence for HCC after radical hepatectomy, and a nomogram predictive model was established based on the risk factors. The receiver operating characteristic (ROC) curve and calibration curve were used to validate the predictive performance of the model, and the decision curve analysis (DCA) curve was used to evaluate its clinical practicality. ResultsA total of 302 patients were included based on the inclusion and exclusion criteria, and 145 (48.01%) of whom experienced early recurrence. The results of multivariate logistic regression model analysis showed that the preoperative neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), γ-glutamate transferase (GGT), alpha fetoprotein (AFP), tumor size, and microvascular invasion (MVI) were the influencing factors of early recurrence for HCC after radical resection (P<0.05). The nomogram was established based on the risk factors. The area under the ROC curve of the nomogram was 0.858 [95%CI (0.816, 0.899)], and the Brier index of the calibration curve of the nomogram was 0.152. The predicted result of the nomogram was relatively close to the true result (Hosmer-Lemeshow test, P=0.913). The DCA result showed that the clinical net benefit of intervention based on the predicted probability of the model was higher than that of non-intervening in all HCC patients and intervening in all HCC patients when the threshold probability was in the range of 0.1 to 0.8. ConclusionsThe results of this study suggest that for the patients with the risk factors such as preoperative NLR greater than 2.13, PLR greater than 108.15, GGT greater than 46.0 U/L, AFP higher than 18.96 μg/L, tumor size greater than 4.9 cm, and presence of preoperative MVI need to closely pay attention to the postoperative early recurrence. The nomogram predictive model constructed based on these risk factors in this study has a good discrimination and accuracy, and it could obtain clinical net benefit when the threshold probability is 0.1 to 0.8.
Objective To explore the impact of microvascular invasion (MVI) on the survival prognosis of patients after radical hepatectomy for hepatocellular carcinoma, to analyze its related risk factors, and to provide reference and support for the treatment of early postoperative recurrence. MethodsBy searching domestic and international medical literature databases, we screened studies related to MVI in hepatocellular carcinoma, focusing on the definition, grading, risk factors, preoperative prediction methods, and postoperative treatment strategies of MVI, and summarized the results of the existing studies. ResultsMVI is widely recognized as a significant risk factor for the intrahepatic metastasis and early postoperative recurrence of hepatocellular carcinoma. This paper aims to comprehensively investigate the characteristics of MVI and its impact on the postoperative recurrence of hepatocellular carcinoma, with a specific focus on identifying the risk factors associated with MVI. The study encompasses cutting-edge fields such as imaging genomics and genomics, with the objective of providing a scientific foundation for preoperative evaluation. Additionally, the paper examines postoperative treatment strategies for MVI, including comprehensive options such as local therapy, systemic therapy, and antiviral therapy, in order to establish a multidimensional intervention pathway for patients with hepatocellular carcinoma. The ultimate goal is to enhance prognosis and reduce recurrence rates. In the future, further refinement of MVI-related risk factors and optimization of preoperative prediction models, along with the development of personalized postoperative treatment plans, will be crucial areas of focus for hepatocellular carcinoma research and clinical practice. ConclusionsThe study of MVI and its targeted treatment strategies are important for reducing the postoperative recurrence rate of hepatocellular carcinoma and improving patient survival. The preoperative prediction model and postoperative treatment plan should be optimized in the future to provide more effective treatment reference for patients.
ObjectiveTo evaluate and analyze the clinical effect of ambulatory surgery applied to laparoscopic cholecystectomy (LC).MethodsThe patients who underwent LC in the First Affiliated Hospital of Xinjiang Medical University from June 2017 to February 2019 were collected, then were assigned to ambulatory surgery applied to LC group (ALC group) and conventional LC group (CLC group) according to the admission process mode. The patients in the ALC group received LC in the ambulatory ward and the patients in the CLC group received LC in the conventional ward. The preoperative waiting time, postoperative gastrointestinal recovery time, postoperative 6 h pain score, total hospitalization time, total hospitalization cost, patient satisfaction, and postoperative complications were compared between the two groups.ResultsA total of 433 patients underwent LC were included in this study, including 176 patients in the ALC group and 257 patients in the CLC group. There were no significant differences in the age, gender, type of gallbladder diseases, etc. between the two groups (P>0.05) except body mass index (P<0.05). There was no perioperative death in the two groups. One patient converted to laparotomy in the CLC group. Compared with the CLC group, the preoperative waiting time, postoperative gastrointestinal recovery time, and the total hospitalization time were shorter, the postoperative pain score was lower, the total hospitalization cost was less, and the satisfaction rate of patients was higher in the ALC group (P<0.05). There was 1 case of incision infection and 1 case of ascites in the operation area in the ALC group and CLC group, 1 case of fever in the ALC group and 3 cases of fever in the CLC group, respectively. There was no difference in the overall incidence of complications between the two groups (P>0.05). During the follow-up of 6 to 26 months, there was no readmission in both groups.ConclusionPatients who undergone LC based on ambulatory surgery mode recover quickly, and hospitalization cost is less, satisfaction rate is higher.