Anatomical resection of hepatocellular carcinoma: A critical review of the procedure and its benefits on survival

Hepatocellular carcinoma(HCC) is the sixth most common type of cancer and the third most frequent cause of cancer-related death. Advances in preoperative assessment of HCC(e.g., imaging studies and liver function tests), surgical techniques, and postoperative care have improved the surgical outcomes and survival of patients who undergo hepatic resection for HCC. However, in the last 20 years, the long-term survival after hepatectomy has remained unsatisfactory owing to the high rates of local recurrence and multicentric occurrence. Anatomical liver resection(AR) was introduced in the 1980 s. Although several studies have revealed tangible benefits of AR for HCC, these benefits are still debated. Because most HCCs occur in patients with liver cirrhosis and poor hepatic function, there are many factors that affect survival, including the surgical method. Nevertheless, many studies have documented the perioperative and long-term benefits of AR in various conditions. In this article, we review the results of several recently published, well-designed comparative studies of AR, to investigate whether AR provides real benefits on survival outcomes. We also discuss the potential pitfalls associated with this approach.

Molecular heterogeneity in intrahepatic cholangiocarcinoma

Intrahepatic cholangiocarcinoma(iCCA)is a heterogeneous primary liver cancer,and currently there exist only a few options of targeted therapy.Histopathologically,iCCA is sub-classified according to morphology(mass forming type,periductal infiltrating type,and intraductal growing type)and histology(small duct type and large duct type).According to different histopathological types,clinical features such as risk factors and prognosis vary.Recent developments in genomic profiling have revealed several molecular markers for poor prognosis and activation of oncogenic pathways.Exploration of molecular characteristics of iCCA in each patient is a major challenge in a clinical setting,and there is no effective molecular-based targeted therapy.However,several recent studies suggested molecular-based subtypes with corresponding clinical and pathological features.Even though the subtypes have not yet been validated,it is possible that molecular features can be predicted based on clinicopathological characteristics and that this could be used for a more rational approach to integrative clinical and molecular subclassification and targeted therapy.In this review,we explored the genomic landscape of iCCA and attempted to find relevance between clinicopathologic and molecular features in molecular subtypes in several published studies.The results reveal future directions that may lead to a rational approach to the targeted therapy.

New Year’s greeting and overview of World Journal of Hepatology in 2021

The World Journal of Hepatology(WJH)was launched in October 2009.It mainly publishes articles reporting research findings in the field of hepatology,covering a wide range of topics,including viral hepatitis B and C,non-alcoholic fatty liver disease,alcoholic liver disease,autoimmune and chronic cholestatic liver disease,drug-induced liver injury,cirrhosis,liver failure,hepatocellular carcinoma,coronavirus disease 2019-related liver conditions,etc.As of December 31,2020,the WJH has published 1349 articles,among which,the total cites is 18995 and the average cites per article is 14.In celebrating the New Year,we are pleased to share with you special a New Year’s greeting from the WJH Editors-in-Chief,along with a detailed overview of the journal’s submission,peer review and publishing metrics from 2020.In all,we are appreciative for the substantive support and submissions from authors worldwide,and the dedicated efforts and expertise provided by our invited reviewers and editorial board members.

New-onset diabetes after adult liver transplantation in the Korean Organ Transplantation Registry (KOTRY) study

Background:New-onset diabetes after transplantation(NODAT)is a serious complication following liver transplantation(LT).The present study aimed to investigate the incidence of and risk factors for NODAT using the Korean Organ Transplantation Registry(KOTRY)database.Methods:Patients with history of pediatric transplantation(age≤18 years),re-transplantation,multi-organ transplantation,or pre-existing diabetes mellitus were excluded.A total of 1,919 non-diabetic adult patients who underwent a primary LT between May 2014 and December 2017 were included.Risk factors were identified using Cox regression analysis.Results:NODAT occurred in 19.7%(n=377)of adult liver transplant recipients.Multivariate analysis showed steroid use,increased age,and high body mass index(BMI)in recipients,and implantation of a left-side liver graft was closely associated with NODAT in adult LT.In living donor liver transplant(LDLT)patients(n=1,473),open donor hepatectomy in the living donors,steroid use,small for size liver graft(graft to recipient weight ratio≤0.8),increased age,and high BMI in the recipient were predictive factors for NODAT.The use of antimetabolite and basiliximab induction reduced the incidence of NODAT in adult LT and in adult LDLT.Conclusions:Basiliximab induction,early steroid withdrawal,and antimetabolite therapy may prevent NODAT after adult LT.High BMI or advanced age in liver recipients,open donor hepatectomy in living donors,and small size liver graft can predict the occurrence of NODAT after adult LT or LDLT.