Consideration on immunotherapy of liver metastases of malignant tumors

In this editorial,we comment on the article“Analysis of the impact of immuno-therapy efficacy and safety in patients with gastric cancer and liver metastasis”by Liu et al that was published in the recent issue of the World Journal of Gastroin-testinal Surgery.It has prompted us to think and summarize some thoughts on immunotherapy for malignant tumor liver metastasis.Immunotherapy plays a crucial role in the treatment of malignant tumors;however,the presence of liver metastases in advanced tumors may impact its efficacy.Although patients with liver metastases can still benefit from immunotherapy,multiple clinical studies have indicated that,compared to other sites of metastasis,liver metastases may diminish the effectiveness of immunotherapy.The efficacy of immune checkpoint inhibitors in patients with liver metastases often fails to reach the ideal level,primarily due to the liver metastases exploiting the host's peripheral immune to-lerance mechanisms to promote systemic CD8(+)T cell exhaustion,resulting in a systemic immune-tolerant environment.This article aims to summarize the reasons for the decreased efficacy of immunotherapy following liver metastasis in various malignant tumors and propose potential clinical strategies for manage-ment.

Timing of hepatectomy following the Omicron variant infection for vaccinated-patients:A retrospective cohort study

Many previous studies suggested that severe acute respiratory syndrome coronavirus 2(SARS-CoV-2) infection elevated the risk of morbidity and 90-day mortality after operation, especially pulmonary complications [1–7]. Uncertainty about perioperative safety puts off the progress of elective surgery [8]. The Omicron variant has recently become the dominant variant causing prevalence in several countries [9]. Although a high rate of patients with Omicron presented asymptomatic status [10], it is still unclear whether Omicron infection would raise the risk of postoperative complications.

Reconsideration of the clinical management of hepatic hemangioma

In this letter,we comment on the article by Zhou et al that was published in the recent issue of the World Journal of Gastrointestinal Surgery.This article proposes a new clinical grading system based on a multidisciplinary team,which prompts us to rethink the clinical management of hepatic hemangioma.Hepatic hemangioma is the most common benign solid liver tumor.In general,follow-up and obser-vation for the vast majority of hepatic hemangioma is reasonable.For those pa-tients with symptoms and severe complications,surgical intervention is ne-cessary.Specific surgical indications,however,are still not clear.An effective grading system is helpful in further guiding the clinical management of hepatic hemangioma.In this article,we review the recent literature,summarize the sur-gical indications and treatment of hepatic hemangioma,and evaluate the potential of this new clinical grading system.

Lymphoepithelioma-like hepatocellular carcinoma: Case report and review of the literature

Lymphoepithelioma-like hepatocellular carcinoma(LELHCC) is a rare form of undifferentiated carcinoma of the liver characterized by the presence of an abundant lymphoid infiltrate. Here,a case of LEL-HCC is described. An 81-year-old woman with a chronic hepatitis C infection was referred to the general surgery department of our hospital in August 2013 with a diagnosis of HCC. A past ultrasound examination had revealed a 60 mm-diameter nodular lesion in the third segment of the liver. After a needle biopsy,the lesion was diagnosed as HCC. The patient underwent surgery with a liver segmentectomy. Two additional nodes on the gastric wall were detected during the surgical operation. The histology of the removed specimen showed a poorly differentiated HCC with significant lymphoid stroma. Immunohistochemical studies revealed that the epithelial component was reactive for CK CAM5.2,CK8,CK18,CEA(polyclonal) and was focally positive for hepar-1 and that the lymphoid infiltrate was positive for CD3,CD4 and CD8. The tumor cells were negative for Epstein-Barr virus. The gastric nodes were ultimately determined to be two small gastrointestinal stromal tumors(GISTs).The synchronous occurrence of HCC and GIST is another very uncommon finding rarely described in the literature. Here,we report the clinicopathological features of our case,along with a review of the few cases present in the literature.

New insights in the metabolic function related to gut microbiota in the process of liver regeneration

Liver disease is a prominent cause of premature mortality globally(1).Many patients with liver diseases require therapeutic liver surgery,usually through hepatectomy(2).Due to the clinical demand for such practice,the study of liver regeneration following hepatectomy holds significant value.The gut microbiota,considered as a“new organ”due to its substantial influence on various physiological functions,has gained increasing attention from the scientific community,particularly in relation to the gut-liver axis.

The significance of severe postoperative complications on liver regeneration

The liver is an extraordinary organ known for its remarkable regenerative capacity(1).This regenerative ability lays the foundation for various therapeutic approaches,such as partial hepatectomy(PHx),split-liver transplantation,live-donor liver transplantation,and associated liver partition and portal vein ligation for staged hepatectomy(ALPPS).

Laparoscopic combined with thoracoscopic transdiaphragmatic hepatectomy for hepatitis B-related hepatocellular carcinoma located in segment VII or VIII

Laparoscopic hepatectomy(LH)is considered a safe and effective method of treating liver cancer because of its relatively low level of trauma,bleeding,pain,and short hospital stay as compared with traditional open surgery[1].However,this is not ideal for tumors located in segment VII or VIII of the liver as these tumors are difficult to be exposed during laparoscopy,and the conversion rate is relatively high[2].Although it has been reported that the thoracoscopic transdiaphragmatic segment VII or VIII hepatectomy can obtain better visual field and operation space[3]。

MDIG-mediated H3K9me3 demethylation upregulates Myc by activating OTX2 and facilitates liver regeneration

The mineral dust-induced gene(MDIG)comprises a conserved JmjC domain and has the ability to demethylate histone H3 lysine 9 trimethylation(H3K9me3),Previous studies have indicated the significance of MDIG in promoting cell proliferation by modulating cell-cycle transition.However,its involvement in liver regeneration has not been extensively investigated.In this study,we generated mice with liver-specific knockout of MDIG and applied partial hepatectomy or carbon tetrachloride mouse models to investigate the biological contribution of MDIG in liver regeneration.

A Case Report of Alloimmune Hepatitis after Direct-acting Antiviral Treatment in a Liver Transplant Patient

Direct-acting antiviral (DAA) therapy is often well-tolerated, and adverse events from DAA therapy are uncommon. We report a case of a woman who underwent orthotopic liver transplant for chronic hepatitis C infection and later devel-oped alloimmune hepatitis shortly after starting DAA therapy for recurrent hepatitis C infection. The patient developed acute alloimmune hepatitis approximately 2 weeks after starting treatment with sofosbuvir, velpatasvir, and voxilap-revir. This case report proposes a dysregulation of immune surveillance due to the DAA stimulation of host immunity and rapid elimination of hepatitis C viral load as a precipitating factor for the alloimmune process, leading to alloimmune hepatitis in a post-transplant patient who starts on DAA.

The role of all-trans retinoic acid in the biology of Foxp3＋ regulatory T cells

Regulatory T （Treg） cells are necessary for immune system homeostasis and the prevention of autoimmune diseases. Foxp3 is specifically expressed in Treg cells and plays a key role in their differentiation and function. Foxp3＋ Treg cells are consisted of naturally occurring, thymus-derived Treg （nTreg） and peripheral-induced Treg （iTreg） cells that may have different functional characteristics or synergistic roles. AII-trans retinoic acid （atRA）, a vitamin A metabolite, regulates a wide range of biological processes, including cell differentiation and proliferation. Recent studies demonstrated that atRA also regulates the differentiation of T helper （Th） cells and Treg cells. Moreover, atRA also sustains nTreg stability under inflammatory conditions. In this review, we summarize the significant progress of our understanding of the role（s） and mechanisms of atRA in Treg biology.