Abstract:Robotic surgery represents a major trend in the current surgical treatment of colorectal cancer. Based on the previous edition, the Robotic Surgery Group of the Colorectal Cancer Committee, Chinese Medical Doctor Association, convened national experts to discuss and reach a consensus on standardized practices for robotic colorectal cancer surgery, with the aim of facilitating its broader application and adoption.

Abstract:Hepatocellular carcinoma (HCC) is characterized by a high propensity for vascular invasion, frequently leading to the formation of tumor thrombi, which significantly affect prognosis and therapeutic decision-making. Microvascular invasion (MVI) is a key predictor of postoperative recurrence, whereas the presence of macrovascular tumor thrombus indicates advanced disease. In recent years, notable progress has been made in the standardized diagnosis, preoperative prediction, and individualized treatment strategies for vascular tumor thrombi. The integration of radiomics and biomarkers has markedly improved the accuracy of preoperative MVI prediction, while various neoadjuvant and adjuvant treatment approaches have shown potential in controlling postoperative recurrence. Despite continuous optimization of diagnostic and therapeutic systems, challenges remain, including tumor heterogeneity, the lack of dynamic monitoring tools, and the difficulty in improving survival rates in high-risk patients. This review summarizes recent advances in the field of vascular tumor thrombi in HCC, aiming to provide theoretical support for clinical practice and to promote the development of individualized precision therapy.

Abstract:Hepatocellular carcinoma (HCC) is a malignant tumor that poses a serious threat to human health. The burden of HCC in China is substantial, and most patients are diagnosed at intermediate or advanced stages, with a 5-year survival rate of only 14.4%. Conversion therapy aims to transform initially unresectable HCC into resectable disease to improve patient prognosis, but it faces numerous challenges in clinical practice. First, Chinese HCC patients differ significantly from those in North America, Japan, and other regions in terms of tumor characteristics and etiology, necessitating exploration of localized conversion therapy strategies suitable for Chinese patients. Second, the target population for conversion therapy remains unclear, with controversies over the distinction and patient selection between neoadjuvant and conversion therapies, and a lack of high-level evidence to guide practice. Third, the selection of conversion therapy regimens is challenging, as there are many drug options but no unified standards, and the choice and timing of combined local therapies are difficult to determine, requiring further clinical validation. Moreover, post-conversion treatment strategies are contentious; it remains unclear whether patients achieving radiological or clinical complete response should undergo surgery, preoperative prediction of complete pathological response is difficult, and postoperative sequential strategies and regimen selection are not well defined. Future efforts should focus on identifying biomarkers, conducting multicenter, large-sample, prospective clinical trials, and standardizing treatment protocols and processes to improve the prognosis and quality of life of HCC patients.

Abstract:Hepatocellular carcinoma (HCC) remains highly prevalent in China and worldwide, with less than 20% of newly diagnosed patients eligible for radical resection and a postoperative 5-year recurrence rate as high as 70%. Perioperative therapy is a key strategy to reduce recurrence, yet evidence for neoadjuvant therapy in HCC is still limited. In recent years, immune checkpoint inhibitors (ICIs) have shown significant progress in HCC treatment, and their potential in the neoadjuvant setting has attracted growing attention. Neoadjuvant immunotherapy can utilize the primary tumor as an antigen reservoir to induce sustained antitumor immunity, and its combination with targeted agents or local therapies may yield synergistic effects. Early studies have demonstrated acceptable safety and preliminary efficacy; however, optimal patient selection, ideal combination strategies, and reliable predictive biomarkers remain to be established. High-quality randomized controlled trials are warranted to verify its impact on long-term survival and to optimize treatment approaches.

Abstract:In recent years, immunotherapy represented by immune checkpoint inhibitors (ICIs) has created new opportunities for conversion therapy in intermediate to advanced hepatocellular carcinoma (HCC). The combination of ICIs with locoregional treatments, such as transcatheter arterial chemoembolization and hepatic arterial infusion chemotherapy, has demonstrated significant advantages in improving tumor response rates and eliciting systemic immune reactions, markedly enhancing the conversion rate of HCC compared to traditional approaches. However, the application of ICIs prior to liver transplantation also brings potential safety concerns, particularly the risk of graft rejection. These risks are exacerbated by the lack of standardized drug withdrawal intervals and the unpredictability of donor liver allocation, posing substantial challenges in clinical practice. This article systematically reviews the current status of ICIs in downstaging treatment prior to liver transplantation for HCC and discusses risk management strategies, aiming to provide reference for clinical decision-making and guideline development.

Abstract:Most patients with hepatocellular carcinoma (HCC) are diagnosed at an intermediate or advanced stage, losing the opportunity for surgical resection. Conversion therapy, which uses non-surgical approaches to render initially unresectable tumors resectable, has gradually become part of routine clinical practice and a research focus. However, multiple challenges remain, including the lack of clear criteria for identifying "potentially resectable" cases, difficulty in selecting individualized systemic regimens from multiple approved options and determining whether to combine them with locoregional therapy, controversy over the necessity of surgery in patients achieving radiological complete response, the need for optimization of perioperative assessment and management, uncertainty in determining the optimal timing of surgery, and the absence of consensus on postoperative sequential systemic therapy regimens and duration. Addressing these issues requires multidisciplinary collaboration and high-quality evidence from multicenter randomized controlled trials. With the accumulation of clinical experience, growing evidence, and advances in treatment, more patients with initially unresectable HCC are expected to gain surgical opportunities and achieve long-term disease-free survival.

Abstract:Background and Aims CNLC stage IIIb hepatocellular carcinoma (HCC) is often accompanied by extrahepatic metastases and carries a poor prognosis. The optimal treatment strategy for these patients remains controversial, and the role of local therapy lacks robust evidence. This study aimed to compare overall survival (OS) between patients receiving combined local and systemic therapy versus systemic therapy alone, and to assess the prognostic impact of oligometastatic status and the cumulative duration of no evidence of disease (NED).Methods A retrospective analysis was conducted on 76 CNLC stage IIIb HCC patients treated at Xiangya Hospital from January 2017 to December 2023. Forty patients received systemic therapy plus local therapy (local therapy group), and 36 received systemic therapy alone (no local therapy group). OS was compared between the two groups. Subgroup analyses were performed for oligometastatic and non-oligometastatic patients to evaluate the benefit of local therapy. In the local therapy group, the correlation between cumulative NED duration and OS was also examined.Results The 1-, 2-, 3-, and 5-year OS rates were 89.0% vs. 66.7%, 64.3% vs. 25.6%, 35.3% vs. 8.7%, and 8.3% vs. 0.0% for the local therapy and no local therapy groups, respectively, with a statistically significant difference (P=0.003). Among oligometastatic patients, the local therapy group had significantly better OS than the no local therapy group (P=0.008), whereas no significant difference was observed in non-oligometastatic patients (P>0.05). Multivariate analysis identified oligometastases as an independent prognostic factor (HR=2.213, P=0.045). In the local therapy group, cumulative NED duration was strongly correlated with OS (r=0.851, P<0.001). Local therapy was well tolerated, with no treatment-related deaths observed.Conclusion For CNLC stage IIIb HCC patients with well-controlled intrahepatic disease, local therapy can significantly prolong survival, particularly in those with oligometastases. Achieving and maintaining NED may represent an important therapeutic goal in this patient population.

Abstract:Background and Aims In recent years, with the continuous progress of systemic therapy, hepatic arterial infusion chemotherapy (HAIC) combined with immune checkpoint inhibitors and anti-angiogenic agents has demonstrated significant efficacy in the treatment of advanced hepatocellular carcinoma (HCC). However, direct comparisons between different immunotherapeutic targets, such as PD-1 and PD-L1 inhibitors, in terms of clinical benefit and safety remain limited. This study aimed to compare the efficacy and safety of HAIC plus bevacizumab and sintilimab (HAIC-BP1) versus HAIC plus bevacizumab and atezolizumab (HAIC-BPL) in advanced HCC.Methods A retrospective analysis was conducted on 88 patients with advanced HCC who received first-line HAIC-BP1or HAIC-BPL at Sun Yat-sen University Cancer Center between January 2020 and December 2022. Progression-free survival (PFS), overall survival (OS), objective response rate (ORR), disease control rate (DCR), and adverse events (AEs) were compared between the two groups. Cox regression analysis was performed to identify prognostic factors affecting PFS.Results A total of 47 patients were included in the HAIC-BP1 group and 41 patients in the HAIC-BPL group, with no statistically significant differences in baseline characteristics between the two groups (all P>0.05). The ORR (59.6% vs. 65.9%) and DCR (72.3% vs. 80.5%) did not significantly differ between the HAIC-BP1 group and the HAIC-BPL group (both P>0.05). After a median follow-up of 16.3 months, there were no significant differences in median OS (21.3 months vs. 22.4 months) or median PFS (6.7 months vs. 6.2 months) between the HAIC-BP1 group and the HAIC-BPL group (both P>0.05). The incidence of AEs was similar, and no treatment-related deaths occurred. Multivariate Cox regression analysis identified tumor diameter >10 cm as an independent adverse prognostic factor for PFS (HR=0.48, 95% CI=0.27-0.83, P=0.009).Conclusion Both HAIC-BP1 and HAIC-BPL demonstrated comparable efficacy and favorable safety profiles as first-line treatment options for advanced HCC. Tumor diameter >10 cm was an independent unfavorable prognostic factor for PFS, underscoring the importance of patient stratification in clinical decision-making.

Abstract:Background and Aims Hepatocellular carcinoma (HCC) is the most prevalent type of liver malignancy, accounting for 80% of all primary liver cancer cases. Partial hepatectomy is widely considered to be the treatment of choice for HCC. However, post-hepatectomy liver failure (PHLF) is the most serious complication and the leading cause of perioperative death. Therefore, an accurate assessment of the risk of PHLF is particularly critical. Patients with large hepatocellular carcinoma have larger tumors (tumor diameter ≥5 cm) and more resected liver tissue, and are more likely to develop PHLF. Previous studies have used various methods to assess the risk of PHLF, including liver function, Child-Pugh classification, model for end-stage liver disease, albumin-bilirubin (ALBI), and aspartate aminotransferase-to-platelet ratio index score. However, no model has been developed for data on hepatectomy for large HCC. Therefore, this study aims to analyze the risk factors of PHLF in HCC patients with large tumor and to construct a preoperative nomogram prediction model to guide and optimize clinical decision-making.Methods The clinical data of 927 patients with large liver cancer who underwent radical hepatectomy in the First Affiliated Hospital of Anhui Medical University (721 cases, training cohort) and the Second Affiliated Hospital of Anhui Medical University (206 cases, validation cohort) from January 2018 to June 2023 were retrospectively collected. The patients' baseline data, laboratory examination, imaging data, and surgical information were collected. Univariate analysis combined with multivariate analysis was used to screen out the independent risk factors for inducing PHLF, and binary Logistic regression was used to construct a prediction model for PHLF. ROC, calibration, and clinical decision curves verified the model's performance.Results There were no significant differences in all preoperative data between the training and validation cohorts (P>0.05). Grade B or C PHLF occurred in 192 of 927 patients (20.7%), including 8 patients with grade C PHLF. Univariate and multivariate Logistic regression analyses were used to determine the independent risk factors of PHLF, including tumor diameter, ALBI score, liver cirrhosis, vascular tumor thrombus, and intraoperative blood loss. These factors were included in the Logistic regression analysis, and a nomogram model was constructed to predict PHLF. The nomogram model was validated, and the C-index of the nomogram was 0.757. The ROC curve analysis of the prediction probability of the model showed that the AUC of the training set was 0.757 (95% CI=0.703-0.811), and the AUC of the validation set was 0.779 (95% CI=0.702-0.863). The validation showed that the model had good predictive ability.Conclusions Tumor diameter, ALBI score, liver cirrhosis, vascular tumor thrombus, and intraoperative blood loss are independent risk factors for PHLF. The nomogram prediction model constructed in this study can accurately assess the risk of preoperative PHLF, which is helpful for better clinical management, reducing the occurrence of PHLF, and improving the postoperative prognosis of patients.

Abstract:Background and Aims Primary hepatic diffuse large B-cell lymphoma (DLBCL) is rare and carries a poor prognosis, with no large-scale evidence supporting the value of chemotherapy. This study used real-world, large-sample data from the SEER database to evaluate the prognostic impact of chemotherapy in patients with primary hepatic DLBCL.Methods Clinical data of patients pathologically diagnosed with primary hepatic DLBCL between 2000 and 2019 were extracted from the SEER database and grouped according to whether they received chemotherapy. Kaplan–Meier survival analysis, Cox proportional hazards models, and random survival forest models were employed to identify factors influencing overall survival (OS) and cancer-specific survival (CSS), and subgroup analyses were performed.Results A total of 594 patients were included, with a median age of 66 years; 435 (73.2%) received chemotherapy. After a median follow-up of 17.5 months, the median OS was 81 (7-173) months in the chemotherapy group versus 11 (2-171) months in the non-chemotherapy group. The OS and CSS rates in the chemotherapy group were significantly higher than those in the non-chemotherapy group (67.99% vs. 47.77%; 71.03% vs. 52.87%, both P<0.05). Multivariate analysis showed that chemotherapy was an independent protective factor for OS (HR=0.39, 95% CI=0.31-0.48) and CSS (HR=0.37, 95% CI=0.29-0.48). In the random survival forest model, chemotherapy ranked highest in variable importance. Subgroup analyses produced consistent results.Conclusion Chemotherapy is an independent prognostic factor for patients with primary hepatic DLBCL and can significantly improve survival. The R-CHOP regimen may be the preferred therapeutic option.

Abstract:Background and Aims Colorectal cancer liver metastasis (CRCLM) is a major cause of poor prognosis in patients with colorectal cancer. Accurate and noninvasive preoperative diagnosis is essential for treatment planning. Conventional clinical biomarkers have limited specificity. This study aimed to develop an efficient predictive model for CRCLM by integrating multimodal MRI imaging omics features with machine learning algorithms, and to evaluate its clinical value.Methods A total of 150 patients with colorectal cancer who underwent preoperative MRI and were pathologically confirmed at Nanyang First People's Hospital between May 2022 and May 2024 were retrospectively analyzed. Patients were randomly divided into a training set (n=120) and a validation set (n=30), including 57 cases with CRCLM and 93 cases without. Univariate and multivariate analyses were performed to identify independent risk factors for CRCLM and to construct a clinical diagnostic model. Radiomics features were extracted from multimodal MRI, and the least absolute shrinkage and selection operator (LASSO) method was used for feature selection. Logistic regression (LR), support vector machine (SVM), and random forest (RF) models were built and compared for diagnostic performance. A combined clinical-imaging omics model was further established, and its performance and clinical utility were assessed using receiver operating characteristic curves and decision curve analysis (DCA).Results Carcinoembryonic antigen (OR=1.323, 95% CI=1.079-1.567), carbohydrate antigen 19-9 (OR=2.512, 95% CI=1.225-3.799), and neutrophil-to-lymphocyte ratio (OR=1.881, 95% CI=1.354-2.409) were identified as independent risk factors for CRCLM (all P<0.05). The clinical model constructed with these three factors achieved an AUC of 0.793. Among radiomics models, the RF model demonstrated the highest AUC in both training and validation sets (0.770 and 0.763), outperforming LR and SVM. The combined RF-based model yielded AUC of 0.913 and 0.947 in the training and validation sets, respectively, significantly exceeding the performance of the clinical or imaging omics models alone. DCA confirmed the superior net clinical benefit of the combined model.Conclusion The RF model showed the best diagnostic performance among imaging omics models. When integrated with clinical features, the combined RF model significantly improved the noninvasive diagnostic efficacy of CRCLM and demonstrated high potential for clinical application.

Abstract:Background and Aims Portal hypertensive colopathy (PHC) is a common complication of portal hypertension in patients with liver cirrhosis. It may lead to gastrointestinal bleeding, yet its underlying pathogenesis remains unclear, and systematic research in China is limited. This study aimed to analyze the colonoscopic features in cirrhotic patients and to explore their associations with relevant clinical factors.Methods A retrospective analysis was conducted on 99 cirrhotic patients who underwent colonoscopy at Xingtai People's Hospital between July 2020 and December 2024. Colonoscopy, gastroscopy, and clinical data were reviewed. Differences between patients with PHC and those without were compared in terms of sex, Child-Pugh classification, platelet count, presence of ascites, and hepatic encephalopathy. Multivariate logistic regression was used to identify independent risk factors for PHC. Additionally, colorectal lesion detection rates were compared with those of a contemporaneous cohort of 444 participants undergoing national colorectal cancer (CRC) screening at the same center.Results Among the 105 patients with cirrhosis, the detection rates of PHC, adenomatous polyps, and CRC were 32.32%, 28.28%, and 3.03%, respectively, while only 37.37% had no abnormal findings. No serious colonoscopy-related complications were observed. The proportion of males in the PHC group was significantly higher than in the non-PHC group(78.13% vs. 50.75%, P=0.009). The PHC group also showed significantly higher rates of Child-Pugh class B/C, and lower platelet count (all P<0.05). There was no statistically significant difference in the incidence of ascites and hepatic encephalopathy between the two groups (P>0.05).Multivariate analysis identified that male gender (OR=3.307, 95% CI=1.219-8.971) and Child-Pugh class B/C (OR=2.867, 95% CI=1.046-7.861) were independent risk factors for PHC. Compared to the CRC screening cohort, cirrhotic patients had a similar adenoma detection rate (28.28% vs. 25.00%, P=0.499), and a slightly higher colorectal cancer detection rate that did not reach statistical significance (3.03% vs. 0.68%, P=0.135).Conclusion Colonoscopy revealed a high rate of abnormalities in cirrhotic patients, with PHC and adenomatous polyps being the most common findings. Routine colonoscopy is recommended for cirrhotic patients without contraindications, especially males, and patients with Child-Pugh class B/C, to facilitate early detection of PHC and precancerous lesions, thereby reducing the risk of lower gastrointestinal bleeding and missed diagnoses of malignancy.

Abstract:Background and Aims Papillary thyroid carcinoma (PTC) is the most common endocrine malignancy, yet the molecular mechanisms underlying its invasion and metastasis remain unclear. This study aimed to investigate the role of the transcription factor ETV4 in PTC and its regulatory relationship with cadherin-3 (CDHP/CDH3).Methods Expression levels of ETV4 and CDHP were analyzed using TCGA and GTEx databases, and further validated in normal thyroid cells and multiple PTC cell lines by qRT-PCR and Western blot analysis. ETV4-knockdown models were established using siRNA, and changes in CDHP expression and cellular behaviors were assessed by qRT-PCR, Western blot, CCK-8, wound healing, and Transwell assays.Results Bioinformatics analysis revealed significantly higher expression of ETV4 and CDHP in PTC tissues compared to normal thyroid tissues (P<0.001). Correlation analysis demonstrated a strong positive association between ETV4 and CDHP expression (R²>0.5, P<0.01). In vitro assays confirmed that both ETV4 and CDHP were upregulated in all tested PTC cell lines at the mRNA and protein levels (all P<0.05). Knockdown of ETV4 led to marked reduction of CDHP expression (P<0.05), accompanied by decreased cell proliferation, migration, and invasion as demonstrated by CCK-8, wound healing, and Transwell assays (all P<0.05).Conclusion ETV4 may transcriptionally upregulates CDHP to promote proliferation, migration, and invasion of PTC cells. The ETV4/CDHP axis may serve as a novel biomarker and potential therapeutic target in PTC.

Abstract:Background and Aims Pancreatic cancer (PC) is a highly lethal gastrointestinal malignancy with poorly understood pathogenesis. Previous studies suggest that alterations in plasma metabolomics may be associated with PC development; however, traditional observational studies are prone to confounding and reverse causation, making it difficult to establish causal relationships. This study employed a two-sample Mendelian randomization (MR) approach to systematically evaluate the potential causal relationship between 325 nuclear magnetic resonance (NMR) metabolites and PC risk.Methods Genome-wide association study (GWAS) data of 325 NMR metabolites from the UK Biobank were integrated with GWAS data of PC from FinnGen. Single nucleotide polymorphisms (SNPs) significantly associated with metabolites were selected as instrumental variables. The inverse variance weighted method served as the primary analysis, supplemented by MR-Egger regression, weighted median, weighted mode, Bayesian weighted Mendelian randomization (BWMR), and constrained maximum likelihood (cML) for validation. Multiple sensitivity analyses were performed to assess the robustness of the results.Results Four metabolites were identified to have significant causal associations with PC risk. Higher phospholipid-to-total lipid ratios in intermediate-density lipoproteins (IDL) (GCST90445881) and small high density lipoproteins (HDL) (GCST90446027), as well as higher free cholesterol-to-total lipid ratios in extremely large very-low-density lipoproteins (VLDL) (GCST90446151), were inversely associated with PC risk. Conversely, an elevated triglyceride-to-total lipid ratio in chylomicrons and extremely large VLDL (GCST90446157) was positively associated with increased PC risk. The findings were consistently supported by multiple sensitivity analyses.Conclusion This study provides genetic evidence linking lipid metabolism alterations to PC risk. Elevated phospholipid and free cholesterol ratios appear protective, whereas increased triglyceride levels act as risk factors. These metabolite profiles may serve as promising biomarkers for early diagnosis and intervention in PC, offering novel insights for risk assessment and potential metabolic-targeted therapies.

Abstract:Background and Aims Autoimmune thyroid disease (AITD) are closely associated with metabolic dysregulation, but the causal role of specific metabolites remains unclear. This study aimed to systematically evaluate the causal relationships between approximately 1 400 blood metabolites and two major AITD subtypes-Graves' disease (GD) and Hashimoto's thyroiditis (HT)-using a two-sample Mendelian randomization (MR) approach, to identify potential risk or protective metabolites and provide genetic evidence for mechanistic studies and targeted metabolic interventions.Methods Summary-level genome-wide association study (GWAS) data for blood metabolites and AITDs were analyzed using inverse-variance weighted MR as the primary method, supplemented by MR-Egger, weighted median, and mode-based methods. Heterogeneity, pleiotropy, and robustness were assessed through Cochran's Q test, horizontal pleiotropy test, and leave-one-out analyses.Results Forty-nine metabolites showed significant causal associations with GD and 89 with HT. Hexanoylglutamine and ceramide (d18∶1/16∶0) were identified as GD risk factors, while N2, N2-dimethylguanosine and β-hydroxyisovalerylcarnitine were protective. Pregnanediol sulfate and theobromine were associated with increased HT risk, whereas dihomo-linolenate (20:3n3 or n6) and caprylate appeared protective. The α-ketoglutarate/succinate ratio was positively associated with both diseases, suggesting a shared metabolic risk pathway.Conclusion This MR study provides genetic evidence supporting causal links between multiple blood metabolites and GD or HT. Several metabolites may serve as predictive or protective biomarkers, offering novel insights into the pathophysiology, early screening, and personalized metabolic intervention strategies for AITDs.

Abstract:Background and aims Obesity is a major global health challenge, and laparoscopic sleeve gastrectomy (LSG) is a widely used bariatric procedure. However, weight loss outcomes vary considerably among patients. Psychological factors and eating behaviors are increasingly recognized as important determinants of postoperative success, yet the underlying mechanisms remain unclear. This study aimed to examine the relationship between self-control and 12-month postoperative weight loss (%EWL) after LSG, and to test the independent and chain mediating roles of depression and emotional eating.Methods In a cross-sectional study, 202 LSG patients from the Third Xiangya Hospital of Central South University completed the Brief Self-Control Scale (BSCS), Patient Health Questionnaire-9 (PHQ-9), and the emotional eating subscale of the Dutch Eating Behavior Questionnaire (DEBQ). %EWL within 12 months after surgery was calculated. Pearson correlations were conducted, and mediation was tested using Process v4.0 (model 6) with 5 000 bootstrap samples while controlling for sex and postoperative time.Results Overall, BSCS, PHQ-9, DEBQ-EE, and %EWL averaged 21.76±4.15, 5.54±3.91, 30.72±11.25, and (60.94±31.61)%, respectively. Self-control correlated negatively with depression (r=-0.697) and emotional eating (r=-0.441) and positively with %EWL (r=0.566; all P<0.01). %EWL correlated negatively with depression (r=-0.467) and emotional eating (r=-0.348, P<0.01). Adjusted regression showed positive prediction of %EWL by self-control (β=0.291 9, P<0.01) and negative prediction by depression (β=-0.155 6, P<0.05) and emotional eating (β=-0.115 8, P<0.05). Mediation analysis showed that the indirect effect through the path "self-control → depression → %EWL" was 0.848 8 (95% CI=0.178 7-1.573 0). The indirect effect through the path "self-control → emotional eating → %EWL" was 0.259 8 (95% CI=0.033 4-0.564 3). The chain indirect effect through the path "self-control → depression → emotional eating → %EWL" was 0.131 7 (95% CI=0.005 9-0.322 8); the total indirect effect accounted for 35.83% of the total effect.Conclusion Higher self-control after LSG enhances weight loss both directly and indirectly by alleviating depression and emotional eating. Routine psychological screening and eating-behavior interventions are warranted to consolidate long-term benefits.

Abstract:Background and Aims Totally implantable venous access ports (TIVAP) are widely used in patients requiring long-term intravenous therapy. Traditional butterfly needle puncture fixation methods have limitations, including low success rates, increased pain, and risk of needle-stick injury. This study aimed to design an adjustable puncture protection kit for butterfly needles and evaluate its clinical utility using a simulated device.Methods A prospective randomized controlled trial was conducted with 70 patients implanted with upper arm ports in the Hematology Department of Xiangya Hospital, Central South University, from January to December 2024. The patients were divided into a study group and a control group, with 35 cases in each, using a randomized block design. The study group underwent puncture with the simulated adjustable protection kit, while the control group used the traditional finger fixation method. Outcomes compared included first-attempt success rate, vertical puncture rate, pain score, puncture time, and complication rate.Results The baseline characteristics of the two groups were balanced. The study group had significantly higher first-attempt puncture success rate and vertical puncture rate than the control group (94.3% vs. 77.1%; 91.4% vs. 57.1%, both P<0.05). In the experimental group compared with the control group, pain scores were lower (1.80±1.13 vs. 2.94±1.33, P<0.05), and puncture time was shorter [(31.31±9.05) s vs. (41.80±23.97) s, P<0.05]. There was no significant difference in the incidence of puncture-related complications between the two groups (2.9% vs. 14.3%, P>0.05).Conclusion The simulated adjustable butterfly needle puncture protection kit effectively improves puncture success, enhances efficiency, reduces patient pain, and demonstrates good clinical safety. This innovative design provides a promising solution for reducing needle-stick injury risks and optimizing port puncture procedures, although larger, multicenter, and long-term studies are warranted.

Abstract:Iatrogenic bile duct injury (IBDI) is a common type of bile duct injury, most frequently occurring during cholecystectomy. With the widespread use of laparoscopic cholecystectomy, its incidence is significantly higher than that of open surgery, and the number of complex cases combined with vascular injury (VI) has been increasing, posing greater challenges for diagnosis and treatment. In severe cases, it may result in hepatic ischemia and atrophy. Hepaticojejunostomy is the standard reconstructive procedure after bile duct injury, whereas hepatectomy may be required when VI is involved. We report the case of a 53-year-old woman who was admitted with bile leakage following cholecystectomy. After two multidisciplinary team (MDT) discussions, preoperative evaluation revealed injury to the right hepatic artery and a portal vein branch, accompanied by atrophy of the right anterior lobe. Based on intraoperative findings, the patient underwent right hepatectomy combined with Roux-en-Y hepaticojejunostomy of the left hepatic duct. Postoperative recovery was uneventful, and the patient remained symptom-free during a 6-month follow-up. By reviewing the diagnosis and management of this case in conjunction with relevant literature, we summarize the clinical features, treatment strategies, and the value of MDT management in complex IBDI, aiming to provide reference for clinical practice.

Abstract:Hepatocellular carcinoma (HCC) is one of the most prevalent malignancies worldwide, and accurate prognostic assessment and treatment planning are vital for improving patient outcomes. Conventional prognostic models, which rely on limited clinicopathological parameters, often fail to capture the profound heterogeneity of HCC. In recent years, artificial intelligence (AI)-particularly machine learning and deep learning-has driven a paradigm shift in precision oncology by leveraging its powerful capabilities in data mining and pattern recognition. This review provides a comprehensive overview of recent advances in AI for prognostic assessment and treatment optimization in HCC, with an emphasis on key methodologies such as radiomics and multi-modal data integration. It further discusses the clinical potential and challenges of AI in predicting postoperative recurrence, evaluating therapeutic response, and supporting individualized treatment decisions, while also outlining future directions in this rapidly evolving field. The review aims to inform and facilitate the clinical translation of AI technologies into the management of HCC.

Abstract:Liver transplantation is a crucial treatment for end-stage liver disease, yet its complexity continues to limit clinical application. With the development of the internet and big data, artificial intelligence (AI) technologies have gradually expanded their use in liver transplantation surgery, covering donor liver evaluation, organ allocation, robot-assisted surgery, and postoperative management, demonstrating significant advantages. However, the application of AI also raises a series of ethical issues, notably fairness in resource allocation, conflicts between technical limitations and the principle of non-maleficence, ambiguous responsibility attribution, patient privacy security, and informed consent. This article systematically reviews the current applications of AI in liver transplantation surgery and the related ethical challenges, aiming to provide a reference for its rational use and sustainable development.

Abstract:Portal vein tumor thrombus (PVTT) is a common manifestation of advanced hepatocellular carcinoma (HCC), associated with poor prognosis and significant treatment challenges. Although various therapeutic options-including surgery, systemic therapies, and local treatments such as interventional procedures and radiotherapy-are available for HCC with PVTT, monotherapies often yield limited efficacy, highlighting the need for combined treatment strategies. With the advancement of radiotherapy technologies, stereotactic body radiation therapy (SBRT) has gained increasing recognition due to its high precision, ablative doses, and fewer treatment fractions. SBRT plays a crucial role in palliative care, conversion therapy, neoadjuvant, and adjuvant settings. Recent studies have demonstrated that SBRT, either alone or in combination with other modalities, significantly improves overall survival and local control rates in patients with HCC and PVTT. This review summarizes the current research progress of SBRT in the management of HCC with PVTT, emphasizing both monotherapy and combined approaches with surgery, interventional therapy, targeted agents, and immunotherapy, aiming to provide insights for clinical decision-making.

Abstract:Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide. As a typical immunogenic tumor, HCC has a complex immune microenvironment that plays a crucial role in its initiation and progression. In recent years, the interactive network between immunosuppressive cells and circulating tumor cells (CTCs) has drawn increasing attention for its role in promoting HCC immune evasion and metastasis. However, how CTCs escape immune surveillance and clearance by immune cells remains unclear. This article focuses on the regulatory networks between CTCs and immunosuppressive cells as well as the key pathways of immune evasion, introduces exosome-mediated regulation and single-cell multi-omics technologies to dissect mechanisms of cellular interactions, systematically discusses the clinical translational challenges of targeting pathways such as PD-L1 and CCL5, and proposes future prospects for personalized therapy driven by artificial intelligence.

Abstract:Hepatocellular carcinoma (HCC) is a highly heterogeneous malignancy with poor prognosis, closely linked to oxidative stress, metabolic reprogramming, and tumor microenvironment alterations. Aldehyde dehydrogenase (ALDH) plays multifaceted roles in HCC by regulating oxidative stress, modulating glucose and lipid metabolism, sustaining cancer stem cell properties, and promoting immune evasion, making it a promising therapeutic target. This review summarizes the expression patterns and mechanistic functions of ALDH in HCC, highlights advances in ALDH-targeted therapies, including inhibitors such as disulfiram and diethylaminobenzaldehyde, and ALDH-based peptide vaccines-and discusses their potential in combination with immunotherapy and chemotherapy. Current evidence suggests that ALDH inhibition can suppress tumor growth, reverse drug resistance, and enhance antitumor immunity. Future research should aim to improve drug selectivity and safety, and to develop personalized combination strategies to optimize clinical outcomes in HCC patients.

Abstract:Hyperlipidemic acute pancreatitis (HLAP) is triggered by severe disturbances in lipid metabolism, progresses rapidly, and is associated with a high risk of complications. Its pathogenesis involves multiple mechanisms, including chylomicron accumulation and free fatty acid toxicity, activation of inflammatory pathways, and disruption of intracellular calcium homeostasis. Recent studies have shown that polymorphisms in lipid metabolism-related genes can influence HLAP susceptibility, disease severity, and lipid-lowering drug efficacy by regulating lipoprotein metabolism, fatty acid oxidation, and inflammatory responses. This article systematically reviews the associations between major lipid metabolism gene polymorphisms and HLAP/hypertriglyceridemia, gene-gene and gene-environment interactions, and the potential impact of these polymorphisms on the therapeutic responses to fibrates, statins, and PCSK9 inhibitors. It also discusses the current status and challenges of genotype-based individualized prevention and treatment strategies, aiming to provide a theoretical basis and future directions for precision screening and personalized management of HLAP.

Abstract:背景与目的 恶性黑色素瘤常见于皮肤及眼部等部位，肝脏原发极为罕见，且缺乏特异性临床与影像学特征，易被误诊。本文报告1例肝脏原发性黑色素瘤（PHM），并结合文献回顾分析其临床特点、诊疗策略及预后。方法 回顾性分析1例经手术切除并病理确诊的PHM患者，检索中国知网、万方、维普及PubMed数据库相关病例，共纳入42例进行总结。结果 患者，男性，61岁，术前误诊为肝细胞癌，术后免疫组化示HMB45、Melan A、SOX10强阳性，确诊为PHM。行手术完全切除肿瘤，术后12个月复发并多发转移。文献分析显示，PHM多见于中老年男性，临床表现不典型，影像学缺乏特异性，确诊依赖病理及免疫组化。预后较差，25例有随访资料的患者中，6个月和12个月生存率分别为28.00%和12.00%。结论 PHM是一种罕见且预后不良的恶性肿瘤，早期诊断困难。手术切除仍是局限性病灶的首选治疗，结合分子靶向及免疫治疗可望改善生存；失去手术机会时，应优先考虑免疫治疗和靶向治疗的个体化方案。

Abstract:背景与目的 消化道恶性肿瘤常伴腹膜转移，早期微小病灶影像学检出率低，导致诊断与治疗延误。血清肿瘤标志物检测简便易行，但单项敏感度和特异度有限。循环肿瘤DNA（ctDNA）能够反映肿瘤分子特征，有望弥补传统方法不足。本研究旨在探讨血清CA125、CA19-9、CEA联合腹腔灌洗液ctDNA检测在消化道恶性肿瘤腹膜转移诊断中的价值。方法 回顾性分析2019年9月─2024年9月湖南省长沙市第一医院收治的180例消化道恶性肿瘤患者，依据腹膜转移情况分为腹膜转移组（120例）和无腹膜转移组（60例）。比较两组血清肿瘤标志物水平及阳性率，并结合ctDNA结果，采用ROC曲线评估诊断效能。结果 腹膜转移组CA125、CA19-9、CEA水平均明显高于无腹膜转移组（均P<0.000 1）。三项联合检测阳性率为85.0%，高于单项检测（均P<0.001）。ROC分析显示，CA125的AUC最高（0.925），三项联合检测AUC亦为0.925；联合ctDNA后AUC提高至0.942（95% CI=0.912~0.972），敏感度和特异度分别为92.5%和88.3%。结论 血清CA125、CA19-9、CEA联合腹腔灌洗液ctDNA检测可显著提升消化道恶性肿瘤腹膜转移的诊断效能，具有重要临床应用价值，并为个体化诊疗提供分子依据。