Chinese expert consensus on conversion therapy for hepatocellular carcinoma(2021 edition)

Recent advances in systemic and locoregional treatments for patients with unresectable or advanced hepatocellular carcinoma(HCC)have resulted in improved response rates.This has provided an opportunity for selected patients with initially unresectable HCC to achieve adequate tumor downstaging to undergo surgical resection,a‘conversion therapy’strategy.However,conversion therapy is a new approach to the treatment of HCC and its practice and treatment protocols are still being developed.Review the evidence for conversion therapy in HCC and develop consensus statements to guide clinical practice.Evidence review:Many research centers in China have accumulated significant experience implementing HCC conversion therapy.Preliminary findings and data have shown that conversion therapy represents an important strategy to maximize the survival of selected patients with intermediate stage to advanced HCC;however,there are still many urgent clinical and scientific challenges for this therapeutic strategy and its related fields.In order to summarize and learn from past experience and review current challenges,the Chinese Expert Consensus on Conversion Therapy for Hepatocellular Carcinoma(2021 Edition)was developed based on a review of preliminary experience and clinical data from Chinese and non-Chinese studies in this field and combined with recommendations for clinical practice.Sixteen consensus statements on the implementation of conversion therapy for HCC were developed.The statements generated in this review are based on a review of clinical evidence and real clinical experience and will help guide future progress in conversion therapy for patients with HCC.

The APR triangle:A practical zone in the Glissonean approach to laparoscopic anatomical right hepatectomy

Background:An understanding of vascular anatomy is crucial for the safe performance of laparoscopic anatomical liver excision.We discovered a triangular zone during the laparoscopic right liver surgery and termed this zone the APR triangle.The purpose of this study was to determine the probability of the existence of the APR triangle and elucidate its various forms.Methods:Analyzed three-dimensional image reconstructions of 66 individuals who underwent liver surgery and calculated the statistics for various types of APR triangles under various grouping settings.Results:The APR triangle was present in the majority of cases,with right hepatic vein trunk type in 68%and right hepatic vein branch type in 21%,respectively.The angle between the right anterior and right posterior hepatic pedicles(AP&PP)was at most between 45 and 90°(74%).There was a 35%chance that at least one of the AP&PP was longer than 2 cm,and a 39%chance that both were.The right posterior pedicle first branch would appear at the bifurcation of AP&PP in 13%only.Conclusions:The APR triangle is objectively present and may represent a practical zone for performing laparoscopic right hepatic anatomical resection more simply and safely.

Is HPB robotic-assisted surgery an evolution or a revolution in laparoscopy?

Robotic-assisted surgery technology demonstrates a new prospect for surgery.Its advantages are particularly prominent in specific surgery divisions or for specific surgical procedures,which has set off a new wave of surgical technology following laparoscopic surgery.Looking back at the history of surgical development over the past century,there have been many technological waves,some of which have become classics and standards,some of which are constantly evolving,and some of which have been gradually abandoned in practice.In the context of the increasingly mature and accurate laparoscopic surgery,which has become a standard operation of many types of surgery,the government,medical institutions and surgeons should carefully consider the role and future development of robotic-assisted surgery.