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25 March 2025, Volume 30 Issue 02 Previous IssueNext Issue

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Systemic therapy for advanced cholangiocarcinoma: divergences in global guidelines and regional clinical implementation LI Chun, MA Zuyi, SUN Jia, LI Binglu 2025, 30 (02): 93-100. DOI:10.16139/j.1007-9610.2025.02.01 Abstract( 239) HTML( 10) PDF(1032KB) ( 70) Cholangiocarcinoma (CCA) is a group of malignant tumors arising from the biliary epithelium, with systemic therapy serving as the primary treatment approach for patients with advanced disease. In recent years, advances in molecular classification and targeted therapy have led to rapid updates in treatment guidelines for CCA. This review summarized recent progress in systemic treatment strategies for advanced CCA and the relevant recommendations in both international and domestic guidelines, aiming to provide evidence-based references for clinical management and decision-making in patients with CCA. Figures and Tables|References|Related Articles|Metrics

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Role of organoid research in the biological benefit-dominated diagnosis and treatment of biliary tract carcinoma QI Zhong, CHENG Shi 2025, 30 (02): 101-104. DOI:10.16139/j.1007-9610.2025.02.02 Abstract( 165) HTML( 6) PDF(967KB) ( 38) Biliary tract carcinoma（BTC） is a highly malignant tumor with a poor prognosis. Although radical surgical resection remains the only curative treatment, only 20% of patients are eligible for curative resection. In recent years, comprehensive treatments combining chemotherapy with immunotherapy and targeted therapy, have become a key strategy in the current biological benefit-dominated therapeutic paradigm for BTC. However, the efficacy of these multimodal treatments remains suboptimal and heavily relies on precise individualized drug screening and response evaluation. The emerging tumor organoid technology faithfully recapitulates the histomorphological features and growth behavior of tumors, providing a novel platform for screening tumor-specific biomarkers. By enhancing tumor identification and margin delineation, this approach facilitates precise preoperative staging and optimize surgical planning. Furthermore, drug sensitivity testing based on patient-derived organoids enables personalized treatment strategies, demonstrating significant clinical value in improving comprehensive therapy for BTC. References|Related Articles|Metrics

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Controversial points in the surgical treatment of gallbladder cancer with delayed diagnoses LE Sen, ZUO Yue, DENG Zhengdong, WANG Jianming 2025, 30 (02): 106-111. DOI:10.16139/j.1007-9610.2025.02.03 Abstract( 149) HTML( 4) PDF(908KB) ( 38) Gallbladder cancer with delayed diagnoses, as a malignant tumor diagnosed intraoperatively or postoperatively incidentally in benign gallbladder diseases, radical surgical treatment is its core treatment, and the necessity of re-operation, timing of surgery, choice of surgical procedure, definition of resection extent, and preoperative neoadjuvant therapy still remain controversial. Re-operation for gallbladder cancer with delayed diagnoses needs to balance tumor radicalization, postoperative risk, and survival benefit, and combining neoadjuvant therapy to facilitate radical treatment, and develop individualized protocols. The multidisciplinary team should integrate innovative technologies and multi-center prospective studies to promote the development of precise treatment strategies for gallbladder cancer with delayed diagnoses and optimize the survival of patients. References|Related Articles|Metrics

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Prevention and management of immune-related adverse events for biliary tract cancers LIU Kun, GUO Wei 2025, 30 (02): 112-119. DOI:10.16139/j.1007-9610.2025.02.04 Abstract( 169) HTML( 4) PDF(1001KB) ( 36) Immune checkpoint inhibitors (ICIs) combined with chemotherapy has become the first-line standard treatment for advanced biliary tract cancers (BTC). However, the application of ICIs comes with its risks of immune-related adverse events (irAEs). BTC patients often face greater challenges in the diagnosis and management of irAEs, especially in the differential diagnosis of immune related hepatitis, due to the presence of special conditions such as underlying liver dysfunction and biliary obstruction. We aimed to systematically review the current status of BTC immunotherapy, the spectrum of irAEs, clinical characteristics, prevention strategies, and management principles. We focused to investigate the specificity and response measures of irAEs management in BTC patients, optimizing immunotherapy management for BTC patients, maximizing treatment benefits and ensuring patient safety, and exploring the future research directions. Figures and Tables|References|Related Articles|Metrics

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Application of the bile duct tree concept in minimally invasive surgery for intrahepatic bile duct stones LI Jingdong, HUANG Xujian, LI Qiang, ZHU Jianjiao 2025, 30 (02): 120-124. DOI:10.16139/j.1007-9610.2025.02.05 Abstract( 120) HTML( 3) PDF(6307KB) ( 35) Intrahepatic bile duct stones, as a prevalent disease in the field of hepatobiliary surgery in China, present multiple challenges in clinical management. The core factors contributing to stone retention and recurrence lie in the practical difficulties of implementing traditional anatomic hepatectomy and the limited efficacy in correcting biliary strictures. In response to this clinical dilemma, the specialty of biliary surgery has progressively developed a precise and minimally invasive resection concept guided by three-dimensional hepatic venous anatomy combined with lesioned bile duct tree distribution patterns. At the technical implementation level, it is imperative to establish a standardized operative system encompassing laparoscopic precision parenchymal transection, hilar bile duct plastic reconstruction, along with auxiliary techniques such as intraoperative ultrasound, indocyanine green fluorescence staining guidance, and multi-endoscopic combined stone extraction approaches. Figures and Tables|References|Related Articles|Metrics

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Clinical value of DSA in diagnosis and treatment of delayed pancreaticoduodenectomy hemorrhage WANG Jiwen, WANG Chunyan, SHEN Sheng, LIU Han, ZHANG Wei, LIU Houbao 2025, 30 (02): 125-131. DOI:10.16139/j.1007-9610.2025.02.06 Abstract( 151) HTML( 3) PDF(1645KB) ( 41) ObjectiveTo evaluate the clinical efficacy and application value of digital subtraction angiography (DSA) in the management of delayed pancreaticoduodenectomy(PD) hemorrhage(PPH).MethodsA retrospective analysis was conducted on the clinical data of 38 patients who underwent DSA for delayed PPH at Zhongshan Hospital, Fudan University, between January 2019 and December 2024. The technical success rate and clinical outcomes of interventional treatment were the primary focus of the evaluation.ResultsAmong 726 patients who underwent PD, 38 (5.2%) experienced delayed bleeding. Of these, 30 (78.9%) showed positive findings on DSA. The distribution of bleeding sites was as follows: gastroduodenal artery (18 cases), common hepatic artery (1 case), the first branch of the jejunal artery (2 cases), proper hepatic artery (2 cases), right hepatic artery (1 case), middle hepatic artery (1 case), left hepatic artery (3 cases), origin of the splenic artery (1 case), and right gastroepiploic artery (1 case). Interventional treatments included microcoil embolization (17 cases), microcoil combined with gelatin sponge embolization (4 cases), covered stent implantation (7 cases), and gelatin sponge embolization alone and microspheres embolization (1 case each). Successful hemostasis was achieved in 28 (93.3%) patients through DSA-guided interventional treatment, while 2 patients required surgical hemostasis due to recurrent bleeding.ConclusionsDSA-guided interventional embolization offers advantages such as minimal invasiveness, precise localization, and effective hemostasis, making it the preferred treatment strategy for delayed PPH. Figures and Tables|References|Related Articles|Metrics

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Best essential surgical technique training course to improve surgical residents′ laparoscopic peritoneal suturing skills: a cohort study CAI Zhenghao, SONG Haiqin, SUN Jing, XUE Pei, ZHANG Luyang, WU Chao, HONG Hiju, CHENG Xi, ZHANG Sen, ZHENG Minhua, ZANG Lu, PAN Ruijun, LI Jianwen, FENG Bo 2025, 30 (02): 132-137. DOI:10.16139/j.1007-9610.2025.02.07 Abstract( 175) HTML( 4) PDF(9965KB) ( 45) ObjectiveTo explore the effectiveness of an integrated laparoscopic simulation training course (best essential surgical technique training, BEST) in enhancing laparoscopic peritoneal suturing techniques in surgical residents.MethodsAs an integrated two-stage program, the BEST course applied basic laparoscopic training system with simple molds in phase Ⅰ training, and then adopted advanced laparoscopic training system, 3D Laparoscope andex-vivoanimal models in phase Ⅱ training. The laparoscopic suturing techniques were practiced in phase Ⅱ training. From August 2021 to July 2024, surgical residents in the second year of the national standardized training program were divided into pilot and control groups based on whether they had undergone the BEST course. Two cases of laparoscopic peritoneal suture were performed by the surgical residents under supervision in the department of gastrointestinal surgery. The operative time, quality of suture, and independent completion rate were compared between the two groups.ResultsA total of 33 surgical residents (19 in pilot group and 14 in control group) were included in this study, and a total of 66 cases of laparoscopic peritoneal suture were performed (38 in pilot group and 28 in control group). The operative time was significantly shorter in pilot group than that in control group (15.7 minvs. 17.5 min,P=0.025). The quality of suture was significantly better in pilot group compared to control group (P=0.023). In pilot group, all peritoneal sutures were performed by residents independently, whereas in control group, 3 cases (10.7%) were assisted by the supervisor, and the independent completion rate was different significantly (P=0.039).ConclusionsThe BEST course can help improve surgical residents′ laparoscopic peritoneal suturing techniques and could be promoted in the national standardized training program for surgical residents. Figures and Tables|References|Related Articles|Metrics

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Hernandezine induces autophagic cell death in hepatocellular carcinoma cellsviathe AMPK/mTOR signaling pathway WANG Jun, HU Gangfeng, GAO Weichen, WANG Lubing 2025, 30 (02): 138-145. DOI:10.16139/j.1007-9610.2025.02.08 Abstract( 139) HTML( 2) PDF(6716KB) ( 35) ObjectiveTo investigate the autophagy activation effect of hernandezine (HER) on hepatocellular carcinoma (HCC) cells and its role in inducing autophagic cell death.MethodsThe inhibitory effects of HER on the proliferation of HCC cell lines Hep 3B and Huh-7 were assessed using CCK-8 assay. HCC cells were treated with HER at different concentrations and time points gradient. Western blot analysis was performed to evaluate the conversion of autophagy marker LC3 from type Ⅰ to type Ⅱ and the levels of SQSTM1/p62. Stable red fluorescent protein(RFP)-LC3-expressing cell lines were established through lentiviral infection, and the accumulation of RFP-LC3 puncta following HER treatment was observed under confocal microscope. Autophagosomes in HER-treated cells were visualized using transmission electron microscopy. The effects of autophagy inhibitors, bafilomycin A1 (BafA1) or hydroxychloroquine (HCQ), in combination with HER were investigated by analyzing cell death ratesviaflow cytometry. The phosphorylation levels of adenosine 5′-monophosphate(AMP)-activated protein kinase(AMPK) and mammalian target of rapamycin(mTOR) were assessed by Western blot.ResultsHER inhibited the proliferation of HCC cells Hep 3B and Huh-7, promoted the conversion of LC3-Ⅰ to LC3-Ⅱ, and activated autophagy in a dose- and time-dependent manner. Confocal microscopy and transmission electron microscopy revealed a significant increase in autophagic vesicles in HER-treated cells. HER-induced cell death was attenuated by the autophagy inhibitors BafA1 or HCQ. HER treatment increased AMPK phosphorylation levels while decreasing mTOR phosphorylation levels.ConclusionsHER induces autophagy and promotes autophagic cell death in HCC cellsviathe AMPK/mTOR signaling pathway. Figures and Tables|References|Related Articles|Metrics

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Observation on changes of trace elements and amino acids in serum of patients with hepatocellular carcinoma LUO Xi, JIANG Yongmei, MA Di, LU Qiuya, GU Xiaohan 2025, 30 (02): 146-150. DOI:10.16139/j.1007-9610.2025.02.09 Abstract( 132) HTML( 2) PDF(963KB) ( 39) ObjectiveTo explore the changes in trace elements and amino acid profiles in serum of patients with hepatocellular carcinoma(HCC) providing a reference for clinical diagnosis and treatment.MethodsA total of 104 patients with HCC who underwent surgical treatment in the Department of Hepatobiliary Surgery of our hospital from January 2024 to April 2024 were selected as the study group, and 139 patients with benign biliary diseases during the same period were selected as the control group. Atomic absorption spectrometry was used to detect the levels of six trace elements (copper, zinc, calcium, magnesium, iron, and lead) in the serum of both groups, and liquid chromatography-tandem mass spectrometry was used to measure the concentrations of 21 amino acids.ResultsCompared with the control group, the serum copper level in the HCC group was significantly increased (P<0.05), while the levels of zinc and iron were significantly decreased (P<0.05). Amino acid profile analysis revealed that, compared with the control group, the concentrations of tyrosine, methionine, and phenylalanine in the HCC group were increased (P<0.05), while the concentrations of valine, leucine, isoleucine, glutamine, and arginine were decreased (P<0.05). Further analysis of the correlation between trace elements and amino acids with statistical differences between the groups showed that copper was negatively correlated with valine and leucine (P<0.05), while zinc and iron were positively correlated with valine, leucine, and isoleucine (P<0.01).ConclusionsImbalances in trace elements and amino acid metabolism changes are common in patients with HCC, and there may be an intrinsic connection between the two. Figures and Tables|References|Related Articles|Metrics

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Meta-analysis of comparative clinical outcomes between primary closure and T-tube drainage following laparoscopic common bile duct exploration and extraction combined with cholecystectomy WANG Ping, BAO Hui, SONG Zhenshun 2025, 30 (02): 151-158. DOI:10.16139/j.1007-9610.2025.02.10 Abstract( 169) HTML( 2) PDF(1525KB) ( 41) ObjectiveTo systematically evaluate the comparative efficacy of primary closureversusT-tube drainage following laparoscopic common bile duct exploration (LCBDE) and extraction combined with cholecystectomy in the management of choledocholithiasis with concomitant cholecystolithiasis.MethodsA comprehensive search of databases including PubMed, CNKI, Wanfang, and VIP was conducted from January 1, 2012, to December 31, 2021. Eligible studies were screened based on predefined inclusion/exclusion criteria, and meta-analysis was performed using Review Manager 5.4 software.ResultsTen studies involving 1 589 patients (783 primary closurevs. 806 T-tube drainage) were included. Meta-analysis demonstrated that primary closure significantly reduced operation time [MD = -15.59, 95% CI: (-23.74, -7.45),P= 0.000 2], intraoperative blood loss [MD = -6.49, 95% CI: (-12.74, -0.24),P= 0.04], postoperative gastrointestinal recovery time [MD = -0.39, 95% CI: (-0.60, -0.19),P= 0.000 2], postoperative hospital stay [MD = -1.41, 95% CI: (-2.19, -0.62),P= 0.000 4], and hospitalization costs [SMD = -0.66, 95% CI: (-1.21, -0.12),P= 0.02].ConclusionsBoth closure methods are safe and effective for choledocholithiasis with cholecystolithiasis. However, primary closure offers advantages including shorter operative duration, reduced blood loss, decreased hospital stay, and lower costs, warranting broader clinical adoption. Figures and Tables|References|Related Articles|Metrics

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Stent location and effectiveness in different types of iliac vein compression XUE Song, YAN Dong, SHI Huihua, ZHAO Zhen, LU Xinwu, YIN Minyi 2025, 30 (02): 159-164. DOI:10.16139/j.1007-9610.2025.02.11 Abstract( 135) HTML( 1) PDF(1142KB) ( 37) ObjectiveTo investigate the stent location and effectiveness in different types of iliac vein compression.MethodsA retrospective analysis was conducted on patients with left iliac vein compression who underwent stent implantation at our department from June 2021 to December 2023. Based on the location of compression, patients were categorized into high, classical, and low types. The patients’ general information, lesion characteristics, stent details, stent patency, and clinical outcomes were analyzed and followed up.ResultsA total of 242 patients were included in this study. And 90. 9% (220 cases) were the classical type, 5.4% (13 cases) were the high type, and 3.7% (9 cases) were the low type. There was no significant difference in age distribution, gender ratio and comorbidities among the three groups. The length of inferior vena cava protruding from the high type was significantly longer than that of the classical type[(3.1±0.8) cmvs. (1.6±1.0) cm,P<0.001), but significantly shorter in the low type[(-0.7±2.4) cmvs. (1.6±1.0) cm,P<0.001). The mean follow-up time was (18.0±7.0) months. The stent patency rate was 97.0% at 1 year and 92.8% at 2 years postoperation. The clinical symptoms of the three groups were significantly relieved. No thrombosis was found in right limbs.ConclusionsThere is a significant difference in the location of the stent tip between classical and non-classical compression types. Complete coverage of lesion by the stent should be the prerequisite for stent placement in treatment of all three types. Small sample, short-term follow-up data suggested that stents can also relieve clinical symptoms and have good patency rate in the high compression type and the low compression type. Figures and Tables|References|Related Articles|Metrics

Review

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Research progress on the immune microenvironment and immunotherapy of thyroid cancer LIAO Zhenyu, ZHU Wenxin, YAN Jiqi 2025, 30 (02): 165-170. DOI:10.16139/j.1007-9610.2025.02.12 Abstract( 187) HTML( 4) PDF(1255KB) ( 53) Thyroid cancer is the most common endocrine malignancy. Although most patients achieve good prognosis through surgery and conventional treatments, approximately 15%-20% of patients with papillary thyroid cancer and the anaplastic and medullary thyroid cancers still lack effective treatment options. The tumor immune microenvironment plays a critical role in the occurrence, progression, and drug resistance of thyroid cancer. This review focused on the key immune cells in thyroid cancer, including tumor-associated macrophages, myeloid-derived suppressor cells, mast cells, natural killer cells, and T lymphocytes, and explored their roles and mechanisms in tumor immune evasion. Immunotherapy has become an emerging treatment strategy for advanced thyroid cancer, we summarized the attempts and advances in immune checkpoint inhibitors, targeted macrophage therapy and tumor vaccines. Figures and Tables|References|Related Articles|Metrics

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Abnormalities in T cell subsets in the circulating immunity and tumor microenvironment in patients with pancreatic ductal adenocarcinoma SU Bingwei, SHEN Baiyong 2025, 30 (02): 171-175. DOI:10.16139/j.1007-9610.2025.02.13 Abstract( 118) HTML( 2) PDF(915KB) ( 34) Pancreatic ductal adenocarcinoma (PDAC) is a highly malignant solid tumor of digestive system, which can affect the immune system. The abnormalities of distribution, percentage, function, and activity of immune cells in both peripheral circulation and tumor microenvironment (TME) are detected in patients with PDAC. T cells are the main lymphocytes that participate in cell-mediated immunity and exert anti-tumor effects. According to the function and the cluster of differentiation, T cells can be divided into different subsets, such as CD4+, CD8+, CD4+CD25+, etc. The abnormalities of T cell subsets in the circulating immunity and TME of patients with PDAC may play an important role in cancer progress. References|Related Articles|Metrics

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Intraoperative margin assessment techniques in breast-conserving surgery: current status and advances JIN Xiaoding, ZOU Qiang, JIN Yiting 2025, 30 (02): 176-182. DOI:10.16139/j.1007-9610.2025.02.14 Abstract( 197) HTML( 5) PDF(899KB) ( 74) In breast-conserving surgery, timely and accurate intraoperative margin assessment is crucial for ensuring surgical success and reducing local recurrence rates. This review first outlined the current methods for intraoperative margin evaluation, including rapid pathological examination and specimen imaging techniques. According to the technical classification, this review systematically introduced emerging technologies that have advanced significantly in recent years, encompassing advanced microscopy, advancements in conventional imaging technologies, novel imaging technologies, and techniques based on biochemical and electrical property contrasts of tissues. Finally, the review summarized and compared these technologies horizontally, and proposed several assessment dimensions aligned with surgical clinical needs, aiming to support the optimization and clinical translation of intraoperative margin assessment techniques. Despite the vigorous development of new technologies, further clinical research and technical refinement remain necessary to achieve continuous improvement and innovation, ultimately providing better options for the patients. Figures and Tables|References|Related Articles|Metrics