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Radiofrequency ablation (RFA) is an effective, minimally invasive treatment option for unresectable hepatocellular carcinomas (HCCs) located in high-risk areas or for patients with poor hepatic functional reserve. However, for tumors adjacent to major bile ducts and hepatic blood vessels, complete ablation is difficult to achieve for fear of causing a postoperative bile leak, bilioma or bile duct stenosis. Therefore, RFA is often combined with multiple alcohol injections to eliminate residual tumor tissues in adjacent bile duct or blood vessels; however, the injections directly affect the efficacy and prognosis of RFA. This study reports three successful "one-off" cases of complete ablation of HCCs adjacent to major bile ducts and blood vessels in neighboring hepatic segments or hepatic lobes, highlighting both the efficacy and safety of RFA for HCC tumors in these high-risk locations.

Background: Caudate lobectomy is now considered to be the most appropriate surgical treatment for benign tumors in the caudate lobe. But how to resect the caudate lobe safely is a major challenge to current liver surgery and requires further study. This research aimed to analyze the perioperative factors and explore the surgical technique associated with liver resection in hepatic caudate lobe hemangioma., Methods: Eleven consecutive patients with symptomatic hepatic hemangiomas undergoing caudate lobectomy from November 1990 to August 2009 at our hospital were investigated retrospectively. All patients were followed up to the present., Results: In this series, 9 were subjected to isolated caudate lobectomy and 2 to additional caudate lobectomy (in addition to left lobe and right lobe resection, respectively). The average maximum diameter of tumors was 9.65+/-4.11 cm. The average operative time was 232.73+/-72.16 minutes. Five of the 11 patients required transfusion of blood or blood products during surgery. Ascites occurred in l patient, pleural effusion in the perioperative period in 1, and multiple organ failure in l on the 6th day after operation as a result of massive intraoperative blood loss, who had received multiple transcatheter hepatic arterial embolization preoperatively. The alternating left-right-left approach produced the best results for caudate lobe surgery in most of our cases. All patients who recovered from the operation are living well and asymptomatic., Conclusions: For large hemangioma of the caudate lobe, surgery is only recommended for symptomatic cases. Caudate lobectomy of hepatic hemangioma can be performed safely, provided it is carried out with optimized perioperative management and innovative surgical technique.

Objective: To investigate the clinical significance and prognostic value of the expression of DNA methyltransferase 1 (DNMT1) and human leukocyte antigen-DRalpha (HLA-DRalpha) in hepatocelluar carcinoma (HCC)., Methods: Paraffin-embedded tissues of 234 HCC underwent curative liver resection and 18 healthy adult liver samples from January 1991 to June 2002 in our department were used for the tissue microarray. Immunohistochemical technique (EnVision) was applied to detect the expression of DNMT1 and HLA-DRalpha. The relationships between DNMT1, HLA-Ralpha and clinicopathological variables were analyzed statistically., Results: The rates of positive expression of DNMT1 and HLA-DRalpha were 27.4% and 39.3%. The significant correlation was present between DNMT1 and portal vein tumor thrombus, alpha fetoprotein (AFP) level or TNM staging (P < 0.05), but no significant correlation was present between DNMT1 and lymph node invasion. The significant correlation was present between HLA-DRalpha and lymph node invasion or TNM staging (P < 0.05), but no significant correlation was present between HLA-DRalpha and lymph node invasion or AFP level (P > 0.05). The postoperative median survival time was 6.87 months and the 1-, 3-, 5-year cumulative survival rate was (38.89+/-6.63)%, (19.92+/-5.48)%, (17.58+/-5.31)% respectively in HCC with positive DNMT1, while the median survival time was 40.33 months and the 1-, 3-, 5-year cumulative survival rate was (81.01+/-4.41)%, (50.78+/-5.84)%, (38.04+/-6.09)% respectively in patients with negative DNMT1(P < 0.001). The postoperative median survival time was 40.33 months and the 1-, 3-, 5-year cumulative survival rate was (81.01+/-4.41)%, (50.78+/-5.84)%, (38.04+/-6.09)% respectively in HCC with positive HLA-DRalpha, while the median survival time was 12.43 months and the 1-, 3-, 5-year cumulative survival rate was (51.72+/-6.56)%, (26.44+/-5.91)%, (13.71+/-6.83)% (P < 0.01) respectively in patients with negative HLA-DRalpha (P < 0.001)., Conclusion: DNMT1 and HLA-DRalpha are prognostic factors for HCC, which may be promising molecular prognostic factors for HCC.

Objective: To investigate the related factors of portal vein tumor thrombosis (PVTT) in patients with HCC., Methods: A total number of 234 patients with hepatocellular carcinoma (HCC) were included in this retrospective study. Uni-variate and multi-variate logistic regression analysis were employed to analyze the association between PVTT and 18 routine clinical parameters., Results: Among the 234 patients with HCC, 15% of patients (35/235) had PVTT. Univariate logistic regression analysis revealed significant association of age (P = 0.016), gamma glutamyl transferase (GGT, P = 0.003), number of segmental invasion (P = 0.007), microvascular invasion (P < 0.01), segment location of S2 (P = 0.001), S3 (P = 0.000), S4 (P = 0.004) and S6 (P = 0.016). Multivariate analysis shows potential significant predictors of PVTT in HCC were age (RR: 0.373; 95% CI: 0.146-0.954; P = 0.040), the tumor location of S3 (RR: 4.625; 95% CI: 1.916-11. 165;P = 0.001), GGT (RR: 4.091; 95% CI: 1.448-11.553; P = 0.008) and microvascular invasion (RR: 20.912; 95% CI: 4.745-92.172; P < 0.01)., Conclusions: PVTT occurred more commonly in the younger (< 50 years old), and those with high level of GGT, segment location of S3 and microvascular invasion.

Objective: To determine whether transforming growth factor betal (TGF-beta1)/Smad signaling pathway mediates p53-dependent apoptosis in hepatoma cell lines., Methods: Three human hepatic carcinoma cell lines, HepG2, Huh-7, and Hep3B, were used in this study. TGF-beta1-induced apoptosis in hepatic carcinoma cell lines was analyzed using TUNEL assay. For identifying the mechanism of apoptosis induced by TGF-beta1, cell lines were transfected with a TGF-beta1-inducible luciferase reportor plasmid containing Smad4 binding elements. After transfection, cells were treated with TGF-beta1, then assayed for luciferase activity., Results: The apoptosis rate of HepG2 cell lines (48.51% +/- 8.21%) was significantly higher than control (12.72% +/- 2.18%, P <0.05). But TGF-beta1 was not able to induce apoptosis of Huh-7 and Hep3B cell lines. The relative luciferase activity of TGF-beta1-treated HepG2 cell lines (4.38) was significantly higher than control (1.00, P < 0.05). But the relative luciferase activity of TGF-beta1-treated Huh-7 and Hep3B cell lines less increased compared with control., Conclusions: HepG2 cells seem to be highly susceptible to TGF-beta1-induced apoptosis compared with Hep3B and Huh-7 cell lines. Smad4 is a central mediator of TGF-beta1 signaling transdution pathway. TGF-beta1/Smad signaling pathway might mediate p53-dependent apoptosis in hepatoma cell lines.

Aim: To study the mechanism and treatment of severe biliary complications arising from hepatic artery embolization(HAE)., Methods: Of seven cases of intra- and extrahepatic biliary damage resulting from hepatic artery embolization reported since 1987, 6 patients suffered from hepatic haemangioma, the other case was due to injection of TH compound into the hepatic artery during operation. The hepatic artery was injected with ethanol so as to evaluate the liver damage in experimental rats., Results: All the cases were found to have destructive damage of intra- and extrahepatic bile duct at the hilum with biliary hepatocirrhosis. Experimental results revealed necrosis of the liver parenchyma, especially around the portal tract and obliteration of intrahepatic bile duct., Conclusions: To prevent the severe biliary complications of HAE, the use of HAE for hepatic haemangioma which was widely practiced in China, should be re-evaluated. Hepatic arterial embolization of hepatic haemangioma may resulte in severe destructive biliary damages and its indiscriminate use should be prohibited.