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Background and Objectives: The scope of laparoscopic surgery has expanded to encompass hepatic resections, specifically hepatic hemangioma. The most serious intraoperative complication is bleeding, often requiring laparotomy. Because risk factors associated with such massive blood loss have not been well evaluated, the intent of this retrospective study was to analyze these risk factors associated with laparoscopic resection of hepatic hemangiomas., Methods: From June 1, 2011 to January 31, 2021, 140 consecutive patients underwent laparoscopic surgery for hepatic hemangioma in our hospital. According to quantity of intraoperative blood loss, they were divided into massive (≥ 800 ml) and minor blood loss (< 800 ml) groups. Perioperative data were analyzed by univariate and multivariate analyses with logistic regression to identify the risk factors for potential massive blood loss during laparoscopic resection., Results: There were 24 and 116 patients in the massive and minor blood loss groups, respectively. Of four risk factors significantly associated with massive blood loss by univariate logistic regression analysis (location of hemangioma in the liver, postcaval or hepatic venous compression, hilar compression, and body mass index exceeding 28) the multifactorial logistic model identified only location in the liver of the hemangioma as statistically (P = 0.012) associated with intraoperative massive blood loss., Conclusions: Location of the hepatic hemangioma was the single statistically significant risk factor for massive blood loss during laparoscopic surgery for hepatic hemangioma. Of particular importance, location in Couinaud liver segments I, IVa, VII, and VIII necessitates precautions to mitigate the risk of massive blood loss., Competing Interests: Conflict of interests: none., (© 2021 by SLS, Society of Laparoscopic & Robotic Surgeons.)

Background: The location of liver haemangioma may affect surgical decisions, but no study has ever examined this issue., Methods: A retrospective study was performed on 338 liver haemangioma patients who visited at clinic. The collected data included demographics, location, symptoms and whether surgical treatment was performed. For patients with surgical treatment, the collected data included radiologic characteristics, surgical procedures, surgical variables, postoperative stay, morbidity, and mortality. According to the location, patients were divided into left or right group and comparison was made between them., Results: Compared to the right group, patients in the left group were more likely to have symptoms (P = 0.018), especially patients with 5- to 10-cm haemangiomas (P < 0.001). Patients in the left group had higher rates of exophytic lesions and gastric outlet compression (63.8% vs 7.1%, 56.5% vs 5.1%, P < 0.001 each), while patients in the right group had a higher rate of vessel compression (36.4% vs 21.7%, P = 0.043). Higher ratio of patients in left group received liver resection (75.4% vs 26.3%, P < 0.001). The surgical time, amounts of collected blood and autologous transfusion were all greater in the right group (P = 0.008, P = 0.001 and P = 0.003, respectively). The postoperative stay was longer in the right group (P = 0.007)., Conclusion: The location of liver haemangioma should be considered when making surgical decisions, and it may be one of the main considerations for surgical procedures., (Copyright © 2017 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.)

Background: Giant liver hemangioma >20 cm may cause severe complications; therefore, operative treatment can be highly difficult and risky. No studies have been performed to determine the characteristics of this subgroup., Methods: A retrospective study was performed on 141 patients who underwent operative treatment for liver hemangioma. The patients were divided into an extremely giant hemangioma group (>20 cm, 36 cases) and a giant hemangioma group (>10 cm but <20 cm, 105 cases). A comparison was then made between the groups. For patients in the extremely giant hemangioma group, further comparison was also made between liver resection and enucleation., Results: Compared with the giant hemangioma group, patients in the extremely giant hemangioma group had greater rates of leukopenia (P < .001), anemia (P < .001), thrombocytopenia (P < .001), pancytopenia (P < .001), prolonged prothrombin time (P < .001), and Kasabach-Merritt syndrome (P = .001). Patients in the extremely giant hemangioma group also had greater rates of compression of the hepatic vein (P < .001), inferior vena cava (P < .001), and porta hepatis (P < .001). The extremely giant hemangioma group had more blood loss (P < .001) and autologous transfusion (P < .001), greater rates of blood transfusion (P < .001), and greater postoperative stays (P < .001). Morbidity was greater in the extremely giant hemangioma group; however, this difference was not statistically significant (P = .076). For patients in the extremely giant hemangioma group, no differences were detected regarding autologous transfusion, blood transfusion, or morbidity between enucleation and liver resection., Conclusion: Extremely giant hemangiomas may cause abnormalities in the hematologic and coagulation systems. Operative treatment may be difficult and risky but can be completed safely., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Background: This study aimed to clarify the risk factors for survival and recurrence of hepatocellular carcinoma (HCC) in a cohort of Chinese HCC patients after hepatectomy and to compare 6 developed staging systems., Methods: A retrospective analysis was performed on 165 consecutive patients. The Kaplan-Meier method was used to calculate survival. Postoperative prognostic factors were evaluated using univariate and multivariate analyses. The overall predictive power of each staging system was evaluated by the area under the receiver operating characteristic curve., Results: The overall survival rates of 1, 3, and 5 years were 81.2%, 58.6%, and 56.7%, respectively, and the corresponding disease-free survival rates were 52.9%, 23.3%, and 15.5%, respectively. α-fetoprotein level and blood transfusion were correlated significantly with patients' overall survival, and portal vein thrombosis and tumor size (>5 cm) were correlated significantly with poor disease-free survival., Conclusions: The French staging system is better for predicting the prognosis of HCC patients receiving surgical treatment., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background and Aims: Primary hepatocellular carcinoma (HCC) is usually presented in inflamed fibrotic/cirrhotic liver with extensive lymphocyte infiltration. We examined the associations between the HCC early recurrence and alterations in serum levels of inflammatory cytokines., Methods: A cohort of 105 HCC patients with chronic hepatitis B virus infection were included. Pre-therapy, we quantified their serum concentrations of Th1-, Th2-, Th17-, Treg-related, and other cytokines that have been reported to be associated with poor prognosis in human cancers. IL17-producing T-cells were generated in vitro from HCC patients and co-cultured with HCC cell lines separated by a 0.4 µM transwell., Results: All the 105 cases of HCC patients had liver cirrhosis. The patients who suffered from HCC early recurrence had higher pre-therapy serum levels of IL17 and lower levels of IL10 than those who did not suffer from recurrence after curative hepatectomy. After adjustment for general tumor clinicopathological factors, elevated serum levels of IL17 (≥ 0.9 pg/ml) was found to be an independent risk factor for HCC early recurrence with a hazard ratio of 2.46 (95%CI 1.34-4.51). Patients with bigger tumors (>5 cm in diameter) and elevated serum levels of IL17 had the highest risk of early recurrence as compared to those with only one of these factors (P = 0.009) or without any (P<0.001). These factors showed similar effects on the HCC patient overall survival. Intrahepatic infiltrated T-cells in HCC patients were identified as the major IL17-producing cells. Proliferation of HCC cells, QGY-7703, was augmented QGY-7703, was augmented in the presence of IL17-producing T-cells. This effect diminished after neutralizing antibody against human IL17A or TNFα was included., Conclusion: Both tumors and IL17 from liver infiltrated T-cells contributed to HCC early recurrence and progression after curative resection. Pre-therapy serum IL17 levels may serve as an additional indicator for predicting high-risk patients.

Background: Although radiotherapy (RT) provides potential benefits for patients with hepatocellular carcinomas (HCCs) that are unsuitable for operation, the specific role of adjuvant RT in HCC after hepatectomy remains ill defined. The current study's aim was to evaluate the safety and efficacy of adjuvant RT for centrally located HCCs after narrow-margin (<1 cm) hepatectomy. Study Design: The study included 119 patients with centrally located HCCs who underwent narrow-margin hepatectomy between July 2007 and March 2012. Patients were prospectively randomized to receive adjuvant RT (n = 58) or were assigned to a control group (n = 61). Surgical outcomes, safety, and survival rates were evaluated. Results: Hepatectomy was successfully performed in all patients. No cases of radiation-induced liver disease were observed. One-, 3-, and 5-year recurrence-free survival rates were 78.1%, 56.5%, and 36.9% in the adjuvant RT group and 72.4%, 40.1%, and 16.0% in the control group, respectively (p = 0.06, log-rank test). Corresponding overall survival rates were 96.2%, 72.6%, 48.4%, and 89.6%, 74.5%, 37.2%, respectively (p = 0.48, log-rank test). One-, 3-, and 5-year recurrence-free survival rates in patients with small-diameter tumors (≤5 cm) were 88.8%, 67.4%, 42.9% in the adjuvant RT group and 82.3%, 42.9%, 21.5% in the control group (p = 0.03, log-rank test). Corresponding overall survival rates were 97.5%, 75.3%, 75.3%, and 94.7%, 84.1%, 65.4%, respectively (p = 0.92, log-rank test). Conclusions: Adjuvant RT for centrally located HCCs after narrow-margin hepatectomy was technically feasible and relatively safe. No significant between-group difference was observed in recurrence-free and overall survival. The post-hoc subgroup comparison showed that adjuvant RT improved recurrence-free survival considerably, but not overall survival, in patients with small HCCs (≤5 cm). More in-depth studies are needed to validate this finding. [Copyright &y& Elsevier]