Abstract:Objective: To observe the clinical efficacy and toxic effect of sorafenib in treatment of advanced cholangiocellular carcinoma (CCC). Methods: Fifteen patients with advanced CCC were enrolled and underwent continuous oral sorafenib administration at a dose of 400 mg twice daily with 3 weeks as a treatment cycle until disease progression or intolerant drug-related toxicity. The primary endpoints included response rate (RR) and the disease control rate (DCR) at 12 weeks, and the secondary endpoints included time to progression (TTP), progression-free survival (PFS), overall survival (OS), duration of treatment (DOT) and toxicity. Results: In the 15 patients, the median DOT was 3.2 (1.5-30) months, 4 cases achieved a partial response and 7 cases obtained a stable disease, according to RECIST criteria. The median TTP, PFS and OS was 3.2, 5.5 and 5.7 months, respectively. Treatment-related adverse reactions occurred in 9 cases, in which the grade 1-2 skin rash was most common toxicity reaction (33.3%), and grade 3 hand-foot syndrome occurred in one case (6.7%). Conclusion: Sorafenib monotherapy has proven efficacy and manageable toxicity in advanced CCC.

Abstract:Objective: To analyze the clinical characteristics, surgical efficacy and prognostic factors of extrahepatic cholangiocarcinoma in different locations. Methods: The clinical data of 87 patients with cholangiocarcinoma treated from May 2004 to April 2014 were retrospectively analyzed. Results: Of the 87 patients, 58 cases had hilar cholangiocarcinma and 29 cases had distal extrahepatic cholangiocarcinoma, and jaundice was the major symptom among them; 56 cases underwent radical resection, that included 33 cases (56.9%, 33/58) of hilar cholangiocarcinoma and 23 cases (79.3%, 23/29) of distal extrahepatic cholangiocarcinoma, while the remaining cases received either palliative treatment for remission of jaundice or no treatment. In patients with hilar cholangiocarcinoma, the 1-, 2- and 3-year survival rate after radical surgery was 62.2%, 35.1% and 27.0% respectively, the AJCC stage and lymph node metastasis were independent factors affecting overall survival time, and AJCC stage, lymph node metastasis and liver invasion were independent factors affecting the tumor-free survival time (all P<0.05). In those with distal extrahepatic cholangiocarcinoma, the 1-, 2- and 3-year survival rate after radical surgery was 91.6%, 54.2% and 37.5% respectively, and AJCC stage was the only independent factor affecting either overall survival time or tumor-free survival time (both P<0.05). Between patients with hilar cholangiocarcinoma and distal extrahepatic cholangiocarcinoma, the median overall survival time in the whole group, the median overall survival time and tumor-free survival time in those undergoing radical resection, and the median overall survival time in those without radical treatment showed no significant difference (all P>0.05). Conclusion: For extrahepatic bile duct cancer in different locations, radical resection is the common effective treatment method, and AJCC staging system is effective for estimating the prognosis.

Abstract:Objective: To investigate the clinical features of intrahepatic cholangiocarcinoma (ICC), for increasing the understanding of this disease, and reducing its misdiagnosis and inappropriate treatment. Methods: The clinical date of 42 ICC patients (ICC group) and 80 hepatocellular carcinoma (HCC) patients (HCC group) with pathological confirmation, admitted from January 2005 to December 2013, were retrospectively analyzed. Results: In ICC group compared with HCC group, there was no gender difference (number of male cases was more than female cases in HCC group); the number of cases with past or present cholelithiasis was increased, and most stones were on the same side of the tumors; the positive rate of HbsAg and AFP as well as their detection values were decreased, while the positive rate of CA19-9 and proportion of cases with high γ-GT level as well as their detection values were increased; the imaging profiles were more characterized by enlargement of abdominal lymph nodes, bile duct stones, peritumoral bile duct dilation and liver capsule retraction or lobe atrophy; the preoperative misdiagnosis rate was high, tumor cells showed histologically poor differentiation, and abdominal lymph node metastasis rate was increased; liver tumor resection plus abdominal lymphadenectomy was the most adopted procedure. All the difference had statistical significance (all P<0.05). Conclusion: ICC has some clinical features different from those of HCC, and a better understanding of ICC may reduce its misdiagnosis and wrong treatment.

Abstract:Objective: To investigate the expression of epidermal growth factor receptor ErbB4 in human intrahepatic cholangiocarcinoma (ICC) tissues and its significance. Methods: The ErbB4 expressions in 24 paired specimens of ICC tissue (ICC group) and adjacent bile duct tissue (tumor adjacent group), and 16 specimens of bile duct tissue from hepatolithiasis patients (hepatolithiasis group) were detected by immunohistochemical staining, and the relations of ErbB4 expression with the clinicopathologic factors of ICC patients were also analyzed. Results: The strong positive expression rate of ErbB4 in ICC group was 75.0%, which was significantly higher than that in tumor adjacent group (45.8%) or hepatolithiasis group (37.5%) (both P<0.05), nuclear expression rate of ErbB4 in ICC group was significantly higher than that in the other two groups (both P<0.05), while the membranous and cytoplasmic expression rates of ErbB4 showed no significant difference among the three groups (both P>0.05). High ErbB4 expression was significantly associated with lymph node metastasis and TNM stage of ICC patients (both P<0.05). Conclusion: Increased expression of ErbB4 and its transfer into cellular nucleus are closely related to the occurrence and development as well as infiltration and metastasis of ICC.

Abstract:Objective: To assess the clinical efficacy of percutaneous transhepatic cholangiodrainage (PTCD) under ultrasonic and X-ray guidance in management of malignant obstructive jaundice. Methods: The data of 46 patients with malignant obstructive jaundice undergoing PTCD under combined ultrasonic and X-ray guidance were retrospectively analyzed. Results: PTCD was successfully performed in 44 patients (95.65%), of whom, puncture and catheter introduction was completed in one session in 41 cases (93.2%), and in two sessions in 3 cases (6.81%). The daily postoperative drainage volume was 100-800 mL, and from the first day after PTCD, the jaundice of the patients began to show regression in varying degrees and their symptoms were gradually alleviated. At one week after PTCD, the serum levels of total bilirubin, direct bilirubin, alanine transaminase, aspartate transaminase and alkaline phosphatase of the patients were all decreased significantly compared with their preoperative values (all P<0.05). Biliary tract infection occurred in 2 cases and slight bleeding of the biliary tract occurred in 3 cases after PTCD, which were resolved by symptomatic treatments, and no other serious complications occurred. Conclusion: PTCD under combined ultrasonic and X-ray guidance has the advantages of being safe and convenient with few complications, and is an effective treatment method for malignant obstructive jaundice.

Abstract:Objective: To determine the relevant factors in pathogenesis of gallbladder cancer, so as to provide a theoretical reference for preventing and controlling the development of this disease. Methods: The clinical records of 802 patients with gallbladder cancer (gallbladder cancer group) admitted to the Department of hepatobiliary surgery, the First Affiliated Hospital of Medical College of Xian Jiaotong University from February 2008 to March 2013 were reviewed, and 815 non-gallblader cancer patients (excluding the population and diseases that had obvious relevance to the studied varibles) admitted during the same period served as control. Using a case-control design, the relevant risk factors for gallbladder cancer were analyzed. Results: After independent variable assessment by univariate analysis, multivariate Logistic regression was conducted and the results demonstrated that age (50–70), occupation (farmer), body mass index (≥27), gestational number (≥3), age of menopause (>50), blood type (type A), history of cholecystolithiasis and chronic cholecystitis were the independent risk factors for the occurrence of gallbladder cancer (all P<0.05). Conclusion: The above factors may provide reference for the specific case in clinical practice, and facilitate early detection and therapy of gallbladder cancer.

Abstract:Objective: To summarize the clinicopathologic characteristics of primary adenosquamous carcinoma of the gallbladder and its diagnosis and treatment. Methods: The clinical data of 4 patients with adenosquamous carcinoma of the gallbladder admitted from 1998 to 2012 were retrospectively analyzed. Results: Of the 4 patients, 3 cases underwent radical resection and one case underwent palliative surgery. Postoperative pathological reports showed the tumor tissues contained features of both adenocarcinoma and squamous cell carcinoma, with both CK8/18 and CK5/64 positive expressions. All the 4 patients died within one year after surgery due to tumor recurrence or metastasis, with a median survival time of 180 d. Conclusion: Adenosquamous carcinoma of the gallbladder is very rare, and characterized by high malignant potential, lack of specific clinical manifestations and often seen at advanced stages. No effective treatment is available for this condition at present, surgical treatment is still the main option, and its overall prognosis is worse than that of gallbladder adenocarcinomas.

Abstract:

Objective: To investigate the expression of FIG-ROS fusion gene in intrahepatic cholangiocarcinoma (ICC) cells and the effects of its intervention on biological behavior of ICC cells. Methods: ROS protein expression in 4 different specimens of ICC tissue and 3 types of ICC cell line (HUCCT1, REB and QBC939) was determined by Western blot analysis; the ROS positive cell line was selected for use and after transfection with a series of plasmids containing different sequences of ROS-shRNAs or FIG-shRNAs respectively, the protein expressions of ROS and FIG in the cells were measured by Western blot analysis. The sequences of ROS-shRNA and FIG-shRNA with highest inhibitory effect on ROS and FIG expression were chosen, which were alone or in combination transfected into the above cells, and after that, the cell proliferation, apoptosis, cell cycle and colony formation were observed. Results: Two specimens of ICC tissue and one ICC cell line (HUCCT1) showed positive ROS expression. Transfection of ROS1-6290 shRNA and FIG-363 shRNA had the most remarkable inhibitory effect on ROS and FIG expression, respectively. Compared with the HUCCT1 cells without any transfection, lone FIG-363 shRNA transfection had no obvious effect on proliferation, apoptosis or cell cycle phase (all P>0.05), but significantly reduced the colony formation of the cells (P<0.05); either ROS1-6290 shRNA transfection alone or in combination with FIG-363 shRNA showed significant effects of suppression of proliferation, induction of apoptosis and cell cycle arrest and inhibition of colony formation, and these effects were more remarkable in cells with combined transfection (all P<0.05). Conclusion: Some kinds of ICC have FIG-ROS fusion gene expression, and the combined inhibition of the two genes may probably provide a hopeful targeted treatment approach for these ICC.

Abstract:Objective: To investigate the killing effect of 5-fluorouracil (5-FU) loaded polycaprolactone nanoparticles on human cholangiocarcinoma cells in vitro, and its safety and mechanism. Methods: The 5-FU loaded polycaprolactone nanoparticles (5-FU-PCL-NPs) were prepared by ultrasonic emulsification. In vitro hemolysis of the empty nanoparticles and drug release of 5-FU-PCL-NPs was observed, and the inhibition of proliferation and induction of apoptosis of 5-FU-PCL-NPs in human cholangiocarcinoma Hccc-9810 cells were determined. Results: The 5-FU-PCL-NPs were successfully synthesized, with drug loading rate of 15.1% and encapsulation efficiency of 41.9%. The empty nanoparticles showed a negative result in hemolysis test. 5-FU-PCL-NPs exhibited a sustained 5-FU release and the 72-h release rate was 62.9%. Compared with pure 5-FU, 5-FU-PCL-NPs had a significantly increased inhibitory effect on proliferation in Hccc-9810 cells, significantly decreased IC50 value [(1.32±0.12) μg/mL vs. (2.5±0.39) μg/mL], and significantly enhanced effect on apoptosis in Hccc-9810 cells (all P<0.05). The empty nanoparticles exerted no obvious effect on apoptosis in Hccc-9810 cells (P>0.05). Conclusion: The 5-FU loaded polycaprolactone nanoparticles (5-FU-PCL-NPs) possess a sustained-release property that prolongs the suppressive effect of 5-FU, and have enhanced killing effect on human cholangiocarcinoma cells in vitro, with a satisfactory biological safety profile.

Abstract:Objective: To investigate the feasibility of using laparoscopic minimally invasive technique to create animal model of biliary occlusion. Methods: Six mongrel dogs underwent laparoscopic common bile duct (CBD) ligation. The operative and postoperative variables were recorded, the preoperative and postoperative (day 3, 7 and 10) levels of white blood cells, liver function indexes, C-reactive protein (C-RP) and procalcitonin (PCT) were determined, and the CBD dilation and liver pathological changes were observed on postoperative day 10. Results: The overall operative time, time to recovery from anesthesia, time to first food intake and defecation was (39.17±3.4) min, (59.17±12.8) min, (3.5±0.63) h and 1 d, respectively. The WBC level was significantly elevated at postoperative day 3 (P<0.05), but soon recovered (P>0.05); the postoperative C-RP and PCT levels remained normal (all P>0.05); the postoperative transaminase levels were initially increased and then decreased slowly, but all were significantly higher than those of preoperative levels (all P<0.05); the postoperative bilirubin levels showed continuous increase (all P<0.05). Obvious CBD dilation was seen macroscopically and pathological examination showed marked dilation of the bile capillaries. Conclusion: Establishment of canine model of biliary occlusion using laparoscopic technique is simple, minimally invasive and feasible, and this method of model creation may facilitate future experimental studies.

Abstract:Objective: To investigate the influence of different biliary drainage methods on serum endotoxin level and immune function in rabbits with obstructive jaundice. Methods: Thirty-six New Zealand rabbits were equally randomized into sham operation group, external drainage group and internal drainage group. Rabbits in external drainage group and internal drainage group underwent establishment of reversible obstructive jaundice model, followed by obstruction removal and then internal and external biliary drainage respectively at 7 d after model was established, while those in sham operation group were subjected to two sham operations with the same time interval. Blood samples were collected before and 7 d after model establishment, and 7 d after drainage as well, and then the liver function parameters, serum endotoxin level and the ratio of CD4+CD25+ regulatory T cells in peripheral blood were determined. Results: No significant change was noted in any of the indexes at any time point in sham operation group (all P>0.05). In external drainage group and internal drainage group at 7 d after model establishment, the serum levels of bilirubin, transaminase and endotoxin were all increased, but the ratios of CD4+CD25+ regulatory T cells were decreased significantly compared with the levels before model establishment. At 7 d after drainage, the liver function parameters, serum endotoxin level, and ratio of CD4+CD25+ regulatory T cells were all significantly recovered in either external drainage group or internal drainage group compared with those at 7 d after model establishment, but the degrees of recovery of the latter two parameters in internal drainage group were greater than those in external drainage group (all P<0.05). Conclusion: Internal biliary drainage for obstructive jaundice is more beneficial than external biliary drainage in eliminating endotoxin and accelerating recovery of immune function.

Abstract:

Objective: To observe the changes of myoelectric activity and pressure in sphincter function of Oddi (SO) after short-term partial bile duct obstruction in guinea pigs. Methods: Sixteen English short-hair guinea pigs were equally randomized into sham operation group and model group, and underwent sham operation and establishment of partial obstruction of the common bile duct (CBD) respectively, during which, the CBD diameters were measured. At one week after operation, the CBD diameters were measured again, and the liver function parameters, as well as the electrical activity and dynamic variables of SO were determined. Results: After operation, the CBD diameter in sham operation group showed no significant change (P>0.05), but it was significantly enlarged in model group (P<0.05). In model group compared with sham operation group, the serum levels of bilirubin and liver enzymes were significantly increased (all P<0.05); the voltage amplitudes of both rapid and slow waves of SO were significantly decreased (both P<0.05), while the frequencies of them had no significant difference (both P>0.05); the basal SO pressure was increased but peak SO pressure was decreased significantly (both P<0.05), while the SO contraction frequency showed no obvious difference (P>0.05). Conclusion: Partial CBD obstruction can cause decrease of voltage amplitudes of rapid and slow waves, basal pressure increase and peak pressure decrease in SO, and these changes may be one of the important mechanisms responsible for being prone to acute biliary pancreatitis in partial CBD obstruction.

Abstract:

Objective: To investigate and discuss the surgical practice and technical improvement of totally laparoscopic Roux-en-Y hepaticojejunostomy. Methods: The clinical data of 25 patients undergoing modified totally laparoscopic Roux-en-Y hepaticojejunostomy between October 2011 and October 2014 were retrospectively analyzed. Of the patients, 10 cases were congenital choledochal cysts (type I), 2 cases were common bile duct stone with distal inflammatory stricture, 6 cases were cancer in the head of the pancreas, 5 cases were distal bile duct cancer, and 2 cases were periampullary cancer. Results: Operation was successfully completed in all patients, with no need for open conversion. The operative time for choledochal cysts was (194.5±20) min and for obstructive jaundice caused by inflammatory stricture or tumors was (120±23.5) min; the time for hepaticojejunal anastomosis was (18.4±3.3) min and for jejunojejunal anastomosis was (17.4±2.3) min; the intraoperative blood loss was (38.8±35.8) mL, time to ambulation was (2.0±0.9) d and to first flatus was (2.48±0.7) d, and the length of postoperative hospital stay was (7.96±1.9) d, respectively. Minor bile leakage occurred in one patient after operation, which ceased after prolonged drainage. Follow-up was obtained in 24 patients (96%) for 1-36 months, postoperative reflux cholangitis occurred in one patient, which was resolved by anti-infective treatment, and no relapse of jaundice was noted in any of the cases. Conclusion: Totally laparoscopic Roux-en-Y hepaticojejunostomy is safe, effective, and feasible, and technical improvement can reduce the surgical difficulty, simplify the surgical procedure and shorten the operative time.

Abstract:

Objective: To investigate the causes and treatment strategy of recurrent intrahepatic stones after choledochojejunostomy for biliary drainage. Methods: The clinical data of 28 patients with recurrent hepatolithiasis after biliary-enteric drainage treated during January 2006 to June 2013 were retrospectively analyzed. Results: According to whether or not the continuity of the extrahepatic bile duct was preserved in former surgery, the 28 patients were divided into preservation group and non-preservation group, respectively. Of the 16 patients in preservation group, in 8 cases with normal function of Oddi’s sphincter, the original biliary-enteric anastomosis was taken down, and after the bile duct was repaired, a T-tube was inserted for external drainage; 7 cases with Oddi’s sphincter dysfunction underwent resection and reconstruction of the biliary-enteric anastomosis, and then standard Roux-en-Y choledochojejunostomy was performed; and one case underwent choledocholithotomy only due to unresectable bile duct tumor. Of the 12 patients in non-preservation group, 7 cases with anastomotic stricture underwent anastomosic repair and reconstruction, and 5 cases underwent stone removal by incision of the anastomosis and then its reconstruction. Among the two groups, postoperative complications occurred in 11 patients (39.3%) which included biliary fistula in 3 cases, wound infection in 6 cases, and intra-abdominal bleeding in two cases, and were all resolved. No perioperative death occurred. The immediate stone clearance rate and final stone clearance rate in preservation group was 68.8% and 87.5%, in non-preservation group was 66.7% and 83.3% respectively, and the good rate of living condition during follow-up was 85.7% in preservation group and 90% in non-preservation group. All differences between the two groups showed no statistical significance (all P>0.05). Conclusion: For patients with recurrent intrahepatic stones after choledochojejunostomy, the former surgical procedure and cause of stone recurrence should be ascertained, stones should be removed as completely as possible, and method of biliary drainage should be chosen according to the function of Oddi’s sphincter.

Abstract:Objective: To investigate the applicable value of self-designed internal biliary drainage tube in laparoscopic common bile duct exploration (LCBDE) with primary closure. Methods: Sixty-three patients with common bile duct stones admitted during January 2013 to June 2014 were selected. Of the patients, 25 cases underwent LCBDE with primary closure and internal drainage using self-designed biliary internal drainage tube (self-designed internal drainage tube group), and 38 cases underwent LCBDE plus conventional T-tube drainage (conventional T-tube drainage group). The relevant clinical variables between the two groups were compared. Results: In self-designed internal drainage tube group compared with conventional T-tube drainage group, the operative time and intraoperative blood loss showed no significant difference (both P>0.05); the time to postoperative ambulation, length of postoperative stay and hospitalization expenses were all significantly decreased (all P<0.05), but the time for recovery of bowel function had no significant difference (P>0.05). Time for the internal drainage tube to be discharged during defecation after operation was (11.2±2.6) d, and in one case (4.0%) the tube failed to be discharged during defecation, and it was then removed by endoscopy. Conclusion: In dealing with common bile duct stones, LCBDE with primary closure and internal drainage using self-designed biliary internal drainage tube has advantages over the traditional procedure.

Abstract:Objective: To compare the difference in laboratory indexes and imaging results among patients with gallstones in different locations, so as to provide reference for clinical diagnosis and differential diagnosis. Methods: The data of 146 patients with gallstones admitted from February 2011 to September 2013 were retrospectively analyzed. According to the location of stones, the patients were divided into gallbladder group (35 cases), intrahepatic group (49 cases) and extrahepatic group (62 cases), and the results of relevant laboratory indexes and imaging examinations among the three groups were compared and analyzed. Results: Liver function-related parameters: the levels of bilirubin and transaminases in gallbladder group were significantly lower than those in intrahepatic group and extrahepatic group, and the levels of alkaline phosphatase and γ-glutamyltransferase in intrahepatic group were significantly lower than those in gallbladder group and extrahepatic group (all P<0.05). Three routine tests: the number of white blood cells percentage of neutrophils in intrahepatic group were significantly lower than those in gallbladder group and extrahepatic group, and the urobilinogen level in in gallbladder group was significantly higher than that in intrahepatic group and extrahepatic group (all P<0.05); urine bilirubin test showed negative or weakly positive result in gallbladder group, and strongly positive result in intrahepatic and extrahepatic group; the color of stool in the gallbladder group was yellow, which was pale or clay-colored in intrahepatic and extrahepatic group. Imaging examinations: the detection rates of B-ultrasound and CT were relatively high in gallbladder group (88.6%, 91.4%), the detection rate of CT in intrahepatic group was relatively high (87.8%), and the detection rate of MRCP in extrahepatic group was relatively high (90.3%). Conclusion: The laboratory indexes and imaging results have certain reference value for diagnosis and differential diagnosis of gallstones in different locations, so a better understanding of their respective characteristics and complementary advantages may help in making a correct judgment.

Abstract:Objective: To review the experience of 10 years in diagnosis and treatment of Mirizzi syndrome (MS), so as to provide information for clinical practice. Methods: Twenty-seven MS patients admitted during 2004 to 2013 were reviewed. Of the patents, 3 cases received conservative treatment and 24 cases underwent surgical treatment, and the preoperative data, surgical procedures, postoperative recovery and follow-up result of the surgical patients were chiefly reviewed and analyzed. Results: In the 24 patients undergoing surgery, the preoperative diagnotic rate was 54.2% (13/24), the preoperative detection rate for MS by MRCP was higher than that by color Doppler ultrasound and abdominal CT scan, and 23 cases were diagnosed as chronic cholecystitis by postoperative pathology. In the 10 patients undergoing laparoscopic surgery, except for one case who was converted to open surgery due to severe intra-abdominal adhesions and had repeated abdominal pain after surgery, no intra- or postoperative complications occurred and long-term follow-up results were satisfactory in the remaining cases; in the 14 patients undergoing open surgery, small bile leakage occurred in 2 cases after surgery, and during follow-up, long-standing abdominal pain was noted in one case, one case had recurrence of jaundice and abdominal pain, T-tube removal was delayed in one case, and one case developed incisional hernia and intestinal obstruction. Conclusion: Preoperative diagnostic rate of MS is low, so the improvement of preoperative examination may help increase its preoperative diagnotic rate, thereby allowing a proper selection of operative procedure and reducing operative complications. Laparoscopic approach has certain superiority in treatment of MS.

Abstract:Objective: To investigate the efficacy and essential technical points of laparoscopic treatment for severe acute cholangitis (SAC). Methods: The clinical data of 117 patients with SAC secondary to common bile duct stones, who underwent laparoscopic treatment during January 2010 to November 2014, were retrospectively analyzed. Results: In the entire group, 110 patients (94.0%) underwent totally laparoscopic common bile duct exploration, and 7 patients required open conversion. The mean operative time was 144 min and intraoperative blood loss was 53 mL. The septic shock was exacerbated in 4 patients after operation, which improved by antishock measures, while postoperative duodenal fistula, bile leakage and intra-abdominal collection occurred in 1, 3 and 4 cases respectively, which were resolved by drainage and anti-infective treatment. The mean length of postoperative hospital stay was 7.2 d. Conclusion: Based on rigorous medical indications and proficient laparoscopic skill, laparoscopic therapy of SAC is safe and feasible.

Abstract:Objective: To evaluate the efficacy of antibiotic prophylactic regimens in elective laparoscopic cholecystectomy. Methods: The randomized controlled trials (RCTs) concerning use of prophylactic antibiotics in elective laparoscopic cholecystectomy publicly published between January 2003 and December 2013 were collected by searching the relevant online databases. After literature screening according to inclusion and exclusion criteria, data extraction and methodological quality evaluation, a Meta-analysis was performed using RevMan 5.2.10 software. Results: Nine RCTs were finally included, involving 2 316 patients with 1 165 cases in prophylactic group and 1 151 cases in control group. The results of Meta-analysis-based comparison between prophylactic group and control group showed no statistical difference (all P>0.05) in terms of the overall postoperative infection rate (RR=0.98, 95% CI=0.59–1.61), superficial incisional surgical site infection rate (RR=0.82, 95% CI=0.48–1.41) and positive rate of bile culture (RR=0.82, 95% CI=0.64–1.05), as well as no statistical difference in the overall postoperative infection rate and superficial incisional surgical site infection rate in the included RCTs that recruited patients with diabetes and biliary colic (both P>0.05). Conclusion: Antibiotics for prophylaxis cannot reduce the incidence of postoperative infection in elective laparoscopic cholecystectomy, but this conclusion still needs to be proven by large sample and multicenter prospective RCTs.

Abstract:Tumor stem cells are a group of cells in tumor tissue with distinct molecular markers and specific signal pathways, which possess the properties of stem cells and the ability of self-renewal and differentiating to different tumor cells. In this paper, the authors address the molecular markers or signaling pathways for identification of cholangiocarcinoma stem cells, and also discuss the issues associated with the aspect of target therapy for cholangiocarcinoma.

Abstract:Primary liver cancer (HCC) is one of the most common malignancies worldwide. A variety of factors may influence the prognosis of HCC, which can be grouped into three broad categories, namely: patient’s personal factors, tumor-specific factor, and treatment-related factors. In this paper, the authors offer an overview of those factors affecting the prognosis of HCC.