Hepatobiliary Pancreat Dis Int

	2022 Vol. 21 No. 2
	Published: 2022-04-15


	Pages 103-204
	EDITORIAL REVIEW ARTICLES ORIGINAL ARTICLES/Liver ORIGINAL ARTICLES/Biliary ORIGINAL ARTICLES/Pancreas NEW TECHNIQUES LETTERS TO THE EDITOR STUDY PROTOCOL

EDITORIAL

	103	Tarantino G
		NAFLD or MAFLD: That is the conundrum ^Hot!
		Where do we stand and where are we going? This question is of paramount importance in the light of the necessity of shedding light on the novel, controversial issue that is changing the acronym of nonalcoholic fatty liver disease (NAFLD) to metabolic dysfunction-associated fatty liver disease (MAFLD). The debate is deeply rooted in a multitude of unknown, or at the best scarcely understood, factors/phenomena involving various pieces of research and throwing up a range of different questions that need to be explored independently. Dealing with the NAFLD/MAFLD epidemiology, Zeng et al. should be praised for approaching a complex topic concerning this multifaceted disease that bears a noteworthy impact on health care system. They carried out an intriguing cross-sectional study published in this issue [1]. A large sample size population consisting of 9927 Chinese individuals were included in that clinical investigation. The authors, interestingly, found that the prevalence of MAFLD was significantly higher than that of NAFLD (40.3% vs. 36.9%). MAFLD was highly represented in patients affected by glucose dysmetabolism, specifically in those with type 2 diabetes mellitus (53.8%) and pre-diabetes, the latter including patients with impaired fasting glucose (35.7%) or impaired glucose tolerance (40.9%). High risk of advanced fibrosis based on fibrosis-4 (FIB-4) determination (one of the most interesting tests that we will discuss further) was detected in 14.7% of lean (body mass index, BMI < 23 kg/m2, Asian criterion) MAFLD subjects with type 2 diabetes mellitus. Among the whole population, 3481 (35.1%) subjects fulfilled the diagnostic criteria for MAFLD and NAFLD (MAFLD+NAFLD+), 521 individuals (5.2%) were labelled as MAFLD+NAFLD-, and 181 patients (1.8%) were identified as MAFLD-NAFLD+. The MAFLD+NAFLD- group showed more significant metabolic disorders than the MAFLD+NAFLD+ group. Among MAFLD-NAFLD+ subjects, 82.9% had metabolic disorders, emphasising that the NAFLD diagnosis, even though comprehending some criteria of the metabolic syndrome, does not always overlap the diagnosis of MAFLD. Anyway, these results clearly highlight the importance of tackling the metabolic syndrome presence in NAFLD patients, but with the clear evidence that a relatively few (nearly 2%) percentage of NAFLD patients does not fulfil the criteria of MAFLD. As pointed out by the authors of this study, over 82% of these previously mentioned patients (the so called MAFLD-NAFLD+) had one metabolic disorder.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 103-105 . [Abstract] ( 99 ) [HTML 1KB] [PDF 0KB] ( 84 )

STUDY PROTOCOL

	106	Su RY, Ling SB, Shan QN, Wei XY, Wang R, Jia CK, Zhuang L, Shen T, Ding LM, Xu ZD, Luo LB, Sun LB, Li GM, Fang TS, Jiang N, Zhang K, Su ZJ, Peng ZH, Lang R, Jiang T, He Q, Ye LS, Zheng SS, Xu X
		Efficacy and safety of sirolimus early conversion protocol in liver transplant patients with hepatocellular carcinoma: A single-arm, multicenter, prospective study ^Hot!
		Mammalian target of rapamycin (mTOR) inhibitor as an attractive drug target with promising antitumor effects has been widely investigated. High quality clinical trial has been conducted in liver transplant (LT) recipients in Western countries. However, the pertinent studies in Eastern world are paucity. Therefore, we designed a clinical trial to test whether sirolimus can improve recurrence-free survival (RFS) in hepatocellular carcinoma (HCC) patients beyond the Milan criteria after LT. This is an open-labeled, single-arm, prospective, multicenter, and real-world study aiming to evaluate the clinical outcomes of early switch to sirolimus-based regimens in HCC patients after LT. Patients with a histologically proven HCC and beyond the Milan criteria will be enrolled. The initial immunosuppressant regimens are center-specific for the first 4-6 weeks. The following regimens integrated sirolimus into the regimens as a combination therapy with reduced calcineurin inhibitors based on the condition of patients and centers. The study is planned for 4 years in total with a 2-year enrollment period and a 2-year follow-up. We predict that sirolimus conversion regimen will provide survival benefits for patients particular in the key indicator RFS as well as better quality of life. If the trial is conducted successfully, we will have a continued monitoring over a longer follow-up time to estimate indicator of overall survival. We hope that the outcome will provide better evidence for clinical decision-making and revising treatment guidelines based on Chinese population data.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 106-112 . [Abstract] ( 136 ) [HTML 1KB] [PDF 0KB] ( 98 )

REVIEW ARTICLES

	113	Papamichail M, Pizanias M, Heaton ND
		Minimizing the risk of small-for-size syndrome after liver surgery ^Hot!
		Background: Primary and secondary liver tumors are not always amenable to resection due to location and size. Inadequate future liver remnant (FLR) may prevent patients from having a curative resection or may result in increased postoperative morbidity and mortality from complications related to small-for- size syndrome (SFSS). Data sources: This comprehensive review analyzed the principles, mechanism and risk factors associated with SFSS and presented current available options in the evaluation of FLR when planning liver surgery. In addition, it provided a detailed description of specific modalities that can be used before, during or after surgery, in order to optimize the conditions for a safe resection and minimize the risk of SFSS. Results: Several methods which aim to reduce tumor burden, preserve healthy liver parenchyma, induce hypertrophy of FLR or prevent postoperative complications help minimize the risk of SFSS. Conclusions: With those techniques the indications of radical treatment for patients with liver tumors have significantly expanded. The successful outcome depends on appropriate patient selection, the individualization and modification of interventions and the right timing of surgery.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 113-133 . [Abstract] ( 91 ) [HTML 1KB] [PDF 0KB] ( 90 )

	134	Tao ZW, Cheng BQ, Zhou T, Gao YJ
		Management of hepatocellular carcinoma patients with portal vein tumor thrombosis: A narrative review
		Background: Hepatocellular carcinoma (HCC) is one of the main reasons for malignancy-related death. Portal vein tumor thrombosis (PVTT) is the most common form of macrovascular invasion related to HCC occurring in 10%-60% of patients. HCC with PVTT is usually characterized by worsening liver function, vulnerability to blood metastasis, higher incidence of complications associated with portal hypertension, and intolerance to treatment when compared with that without PVTT. If only treated with supportive care, the median survival of HCC with PVTT is about 2.7 months. In the past, sorafenib was the only recommended therapy by guidelines with limited effectiveness. This narrative review aimed to describe the current management options for HCC with PVTT. Data sources: We have reviewed literature from PubMed on the treatment of HCC with PVTT and compiled evidence-based facts on effective therapies available for different types of PVTT. Results: Sorafenib monotherapy is not much effective, but combining it with other methods can improve survival. Each type of PVTT can benefit from the combination of transarterial chemoembolization and sorafenib than sorafenib monotherapy. The tumor downstaging can be realized possibly after transarterial chemoembolization, but tumor invasion into the main trunk of the portal vein greatly impairs efficacy. Although surgery is a curative approach, it is often not recommended for Vp4 PVTT. Some new methods can broaden the indication, but further explorations are needed. Radiotherapy can decrease the possibility of Vp3 progression to Vp4, but building a forecast model of best radiation dose and response is necessary. Systemic chemotherapy, hepatic arterial infusion chemotherapy, radiofrequency ablation, portal stenting, and traditional Chinese medicine are also beneficial in Vp3-4 PVTT. The accurate diagnosis of PVTT can be made by radiomics, and prognostic classification models can be used to design personalized treatments. The application of new treatment methods such as the atezolizumab plus bevacizumab scheme may increase survival. Conclusions: HCC with PVTT is still a thorny problem, and effective therapeutics need to be explored.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 134-144 . [Abstract] ( 96 ) [HTML 1KB] [PDF 0KB] ( 90 )

	145	Georgiou K, Sandblom G, Alexakis N, Enochsson L
		Intraoperative cholangiography 2020: Quo vadis? A systematic review of the literature ^Hot!
		Background: There are few randomized controlled trials with sufficient statistical power to assess the effectiveness of intraoperative cholangiography (IOC) in the detection and treatment of common bile duct injury (BDI) or retained stones during cholecystectomy. The best evidence so far regarding IOC and re- duced morbidity related to BDI and retained common bile duct stones was derived from large population-based cohort studies. Population-based studies also have the advantage of reflecting the outcome of the procedure as it is practiced in the community at large. However, the outcomes of these population-based studies are conflicting. Data sources: A systematic literature search was conducted in 2020 to search for articles that contained the terms “bile duct injury”, “critical view of safety”, “bile duct imaging”or “retained stones”in combi- nation with IOC. All identified references were screened to select population-based studies and observa- tional studies from large centers where socioeconomic or geographical selections were assumed not to cause selection bias. Results: The search revealed 273 references. A total of 30 articles fulfilled the criteria for a large observational study with minimal risk for selection bias. The majority suggested that IOC reduces morbidity associated with BDI and retained common bile duct stones. In the short term, IOC increases the cost of surgery. However, this is offset by reduced costs in the long run since BDI or retained stones detected during surgery are managed immediately. Conclusions: IOC reduces morbidity associated with BDI and retained common bile duct stones. The reports reviewed are derived from large, unselected populations, thereby providing a high external validity. However, more studies on routine and selective IOC with well-defined outcome measures and sufficient statistical power are needed.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 145-153 . [Abstract] ( 85 ) [HTML 1KB] [PDF 0KB] ( 96 )

ORIGINAL ARTICLES/Liver

	154	Zeng J, Qin L, Jin Q, Yang RX, Ning G, Su Q, Yang Z, Fan JG
		Prevalence and characteristics of MAFLD in Chinese adults aged 40 years or older: A community-based study ^Hot!
		Background: Nonalcoholic fatty liver disease (NAFLD) was recently proposed to be renamed metabolic dysfunction-associated fatty liver disease (MAFLD) with the diagnostic criteria revised. We investigated the similarities and differences in the prevalence and clinical characteristics of MAFLD and NAFLD in Chinese adults. Methods: A cross-sectional study of 9980 Chinese individuals aged 40 years or older was performed between 2011 and 2012 using randomized, stratified cluster sampling in Shanghai, China. A detailed questionnaire and the results of abdominal ultrasonography, a standardized 2-h 75-g oral glucose tolerance test and blood biochemical examinations were collected. Results: A total of 9927 subjects were included in this study. The prevalence of MAFLD (40.3%) was significantly higher than that of NAFLD (36.9%) ( P < 0.05). MAFLD was highly prevalent in type 2 diabetes mellitus (T2DM) (53.8%), impaired fasting glucose (35.7%) and impaired glucose tolerance (40.9%). High risk of advanced fibrosis based on fibrosis-4 was highly prevalent (14.7%) in lean MAFLD with T2DM. Among 9927 subjects, 3481 (35.1%) fulfilled the diagnostic criteria for MAFLD and NAFLD (MAFLD+NAFLD+), 521 (5.2%) MAFLD+NAFLD-, and 181 (1.8%) MAFLD-NAFLD+. The MAFLD+NAFLD- group had more significant metabolic disorders than those in the MAFLD+NAFLD+ group (all P < 0.05). Among MAFLD-NAFLD+ subjects, 82.9% had metabolic disorders. Conclusions: The new definition of MAFLD may better reflect the pathogenesis related to metabolism. Future research should focus on studying the natural history, pathogenesis and treatment effectivity of the overlap and non-overlap of NAFLD and MAFLD subjects.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 154-161 . [Abstract] ( 107 ) [HTML 1KB] [PDF 0KB] ( 65 )

	162	Costa PF, Coelho FF, Jeismann VB, Kruger JAP, Fonseca GM, Cecconello I, Herman P
		Repeat hepatectomy for recurrent colorectal liver metastases: A comparative analysis of short- and long-term results
		Background: Liver recurrence after resection of colorectal liver metastases (CRLM) is frequent. Repeat hepatectomy has been shown to have satisfactory perioperative results. However, the long-term outcomes and the benefits for patients with early recurrence have not been clarified. The aim of this study was to compare the short- and long-term outcomes of patients undergoing single hepatectomy and repeat hepatectomy for CRLM. Additionally, the oncological outcomes of patients with early ( ≤ 6 months) and late recurrence who underwent repeat hepatectomy were compared. Methods: Consecutive adult patients undergoing hepatectomy for CRLM between June 2000 and February 2020 were included and divided into two groups: single hepatectomy and repeat hepatectomy. Results: A total of 709 patients were included: 649 in the single hepatectomy group and 60 in the repeat hepatectomy group. Patients in the repeat hepatectomy group underwent more cycles of preoperative chemotherapy [4 (3-6) vs. 3 (2-4), P = 0.003]. Patients in the single hepatectomy group more frequently underwent major hepatectomies (34.5% vs. 16.7%, P = 0.004) and had a greater number of lesions re- sected (2.9 ± 3.6 vs. 1.9 ± 1.8, P = 0.011). There was no increase in operative time, estimated blood loss, length of hospital stay, complications, or mortality in the repeat hepatectomy group. There were no differences in overall survival ( P = 0.626) and disease-free survival ( P = 0.579) between the two groups. Similarly, for patients underwent repeat hepatectomy, no difference was observed between the early and late recurrence groups in terms of overall survival ( P = 0.771) or disease-free survival (P = 0.350). Conclusions: Repeat hepatectomy is feasible and safe, with similar short- and long-term outcomes when compared to single hepatectomy. Surgical treatment of early liver recurrence offers similar oncological outcomes to those obtained for late recurrence.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 162-167 . [Abstract] ( 64 ) [HTML 1KB] [PDF 0KB] ( 70 )

ORIGINAL ARTICLES/Biliary

	168	Gupta V, Chandra A, Gupta V, Patel R, Dangi A, Pai A
		Gallbladder perforation: A single-center experience in north India and a step-up approach for management
		Background: Spontaneous gallbladder perforation (GBP) is an uncommon diagnosis. This study presented the experience of managing spontaneous GBP over nine years at a large, tertiary care university hospital in north India and investigated the outcomes and treatment strategies. Methods: A retrospective review of prospectively maintained digital database of consecutive patients was performed. All patients received medical and/or surgical treatment for spontaneous GBP in our department between January 2010 and June 2018. Results: We identified 151 patients (81 females and 70 males) with mean age of 53 years. Most common presenting features were pain (96.7%), fever (54.3%) and jaundice (31.1%). Most common cause was gall- bladder stones (84.8%) followed by common bile duct stones (30.5%), xanthogranulomatous cholecystitis (17.9%) and malignancy (11.9%). As per Niemeier classification, 8.6% had type 1 GBP (free perforation in peritoneal cavity), 76.2% had type 2 GBP (localized perforation) and 13.2% had type 3 GBP (cholecysto- enteric fistula). About 60% of the perforations were diagnosed preoperatively. Type 1 was more com- mon in patients with diabetes and also had the worst prognosis. Surgery was performed in 109 patients (72.2%). Seven patients (4.6%) had a postoperative morbidity of Clavien-Dindo III or higher. There were three mortalities in patients who underwent surgery. Conclusions: High index of suspicion is required for preoperative diagnosis of GBP, especially in types 2 and 3. Laparoscopic cholecystectomy can be difficult in these patients and patients may require open or partial cholecystectomy. Early diagnosis and step-up approach for the treatment of GBP is critical.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 168-174 . [Abstract] ( 69 ) [HTML 1KB] [PDF 0KB] ( 89 )

ORIGINAL ARTICLES/Pancreas

	175	Fernandes J, Canena J, Moreira M, Alexandrino G, Figueiredo L, Araujo T, Lourenco L, Horta D, Lopes L
		Needle knife fistulotomy in flat and diverticular papillae: Is it time for redemption?
		Background: European Society of Gastrointestinal Endoscopy ( ESGE) recommends needle-knife fistulotomy (NKF) as the preferred precut technique in cases when standard cannulation techniques fail. Despite scarce scientific evidence, flat and diverticular papillae are thought not to be ideal for NKF, as they are associated with poor outcomes. The present study aimed to determine the outcomes of the use of NKF in relation to flat and intradiverticular papillae. Methods: This prospective multicenter study enrolled consecutive patients, evidencing naïve flat (group A, n = 49) or diverticular papilla (group B, n = 28), who underwent NKF after failure of standard cannulation techniques. Diverticular morphology was subdivided into intradiverticular (group B1, n = 14) and diverticular border papillae (group B2, n = 14), using a previously validated endoscopic classification of the major papilla. The success of biliary cannulation at initial endoscopic retrograde cholangiopancreatography (ERCP), overall biliary cannulation, overall cannulation time, and the rate of adverse events were assessed in the study. Results: The initial cannulation rates were 93.9%, 64.3% and 71.4% for group A, B1, and B2, respectively ( P = 0.005); overall cannulation rates after a second ERCP were 98.0%, 92.9% and 85.7%, respectively ( P = 0.134). Adverse events occurred in 11.7% of patients, with post-ERCP pancreatitis (PEP) being the most common adverse event (10.4%). Although there was a trend towards a higher incidence of PEP in flat papillae, univariate and multivariate analyses did not show any significant relationship between pancreatitis and trainee involvement, papillary morphology, nor overall cannulation time. Conclusions: Although flat papillae are associated with high success rates of biliary cannulation using NKF, the rate of PEP is not negligible. NKF is feasible in diverticular papillae, but it is associated with a modest success rate in the initial ERCP.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 175-181 . [Abstract] ( 69 ) [HTML 1KB] [PDF 0KB] ( 98 )

NEW TECHNIQUES

	182	Lin GL, Xiao M, Zhuang L, Yang Y, Li QY, Lu JF, Li MX, Zheng SS
		Combination of renoportal anastomosis and inferior mesenteric vein-portal anastomosis in liver transplantation: A new portal reconstruction technique
		Liver transplantation (LT) is the only way to cure end-stage liver disease with or without tumors in the last few decades [1]. However, critical issues such as how to rebuild portal flow in patients with portal vein thrombosis (PVT) or superior mesenteric vein (SMV) thrombosis have been challenging for surgeons. Adequate portal flow is critical in LT because more than 75% of the liver’s blood supply comes from the portal vein and the rest comes from the hepatic artery. PVT is a universal problem in LT. PVT was divided into grades I-IV by Yerdel et al. in 2000 [2]. For patients with grade I-III PVT, they could be managed through thrombectomy or reconstruction. The most severe grade IV PVT is defined as complete portal vein and entire SMV thrombosis [2–4]. For grade IV PVT, direct anastomosis of the donor’s portal vein to the recipient’s portal vein is not feasible even if vascular allograft is used.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 182-185 . [Abstract] ( 75 ) [HTML 1KB] [PDF 0KB] ( 83 )

	186	Tang JC, Suolang WJ, Yang C, Wang Y, Tian MW, Zhang Y
		Monosegmental ALPPS combined with ante-situm liver resection: A novel strategy for end-stage hepatic alveolar echinococcosis
		Hepatic alveolar echinococcosis (HAE) is a lethal infectious disease caused by the larval stage of Echinococcus multilocularis. To date, radical resection combined with albendazole is considered the major treatment for patients with HAE. However, many patients miss the best time for diagnosis and resection due to patient delay, doctor delay, or long distances to specialized centers. Allogeneic liver transplantation is an important method for the treatment of end-stage HAE, but its application is limited due to the shortage of organ donors, long-term use of immunosuppressive agents and high recurrence rates [1]. Recently, ex vivo liver resection and autotransplantation has been used for end-stage HAE with invasion of multiple intrahepatic structures that could not be reconstructed in vivo [2,3]. However, the insufficient future liver remnant (FLR), which may cause posthepatectomy liver failure, makes ex vivo liver resection and autotransplantation unfeasible for some patients. For patients suffering from end-stage HAE with insufficient FLR and infiltration of the hepatocaval confluence or the retrohepatic vena cava, we developed a novel strategy that consists of monosegmental associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) and ante-situm liver resection.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 186-189 . [Abstract] ( 64 ) [HTML 1KB] [PDF 0KB] ( 69 )

LETTERS TO THE EDITOR

	190	Vasques ER, Figueira ERR, Rocha-Filho JA, Lanchotte C, Ximenes JLS, Nader HB, Tersariol ILS, Lima MA, Rodrigues T, Cunha JEM, Chaib E, D’Albuquerque LAC, Galvao FHF
		A new heparin fragment decreases liver ischemia-reperfusion injury
		Ischemia-reperfusion injury following surgery and transplantation can lead to irreversible multiorgan failure. Intracellular calcium overload is associated to cellular death during ischemiareperfusion. A recently discovered heparin fragment (HF), trisulfated disaccharide (TD), that acts on sodium-calcium exchanger (NCX) decreasing intracellular Ca2+ , showed effectiveness on protecting hepatocytes from ischemia-reperfusion injury [1], such as protection during cardiac arrhythmias [2]. HF of different molecular weights and origins have TD in their basic unit; however, calcium dynamics is heterogeneous due to differences in molecular weight and structural conformation [3,4]. We evaluated a new bovine HF (BHF001) of ~8000 kDa, presenting similarity to fragments of porcine and synthetic origin; however, without anticoagulation properties [5]. We designed a model to study the intracellular Ca2+ behavior with administration of BHF001 in cell culture and in vivo experiments to analyze its cellular and systemic protection in rats submitted to liver ischemia-reperfusion injury.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 190-192 . [Abstract] ( 75 ) [HTML 1KB] [PDF 0KB] ( 72 )

	193	Barrios O, Mils K, Llado L, Lopez-Dominguez J, Ramos E
		A complicated peribiliary cyst: An unusual hilar cholangiocarcinoma mimic
		Peribiliary cysts are cystic dilatations of the extramural peribiliary glands that appears in the connective tissue around the hepatic hilum. They can affect up to the fourth order intrahepatic bile ducts and do not communicate with the bile lumen. It is a rare entity first described in 1984 by Nakanuma et al. [1]. Its diagnosis is usually an incidental discovery in patients with advanced liver disease, portal thrombosis, and portal hypertension [2].
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 193-195 . [Abstract] ( 80 ) [HTML 1KB] [PDF 0KB] ( 75 )

	196	Ishikawa-Kakiya Y, Maruyama H, Tanoue K, Fukunaga S, Nagami Y, Fujiwara Y
		Isolated pancreatic metastasis from a malignant pleural mesothelioma diagnosed using endoscopic ultrasonography-guided fine needle aspiration biopsy
		Malignant pleural mesothelioma is a rare and aggressive form of cancer with a poor prognosis [1]. Its progression is mainly a direct invasion from the primary lesion, and metastasis to distant regions rarely occurs. It was found that metastasis of malignant pleural mesothelioma may occur in the liver, adrenal glands, and kidneys in autopsy cases [2]. However, isolated pancreatic metastasis is extremely rare, even in advanced malignant pleural mesothelioma; there are few cases diagnosed by surgery or autopsy. Herein, we report the first case in which endoscopic ultrasonography (EUS) and EUS-guided fine needle aspiration biopsy (EUS-FNAB) were useful in a case of isolated pancreatic metastasis caused by malignant pleural mesothelioma.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 196-198 . [Abstract] ( 80 ) [HTML 1KB] [PDF 0KB] ( 69 )

	199	Hu S, Zhu Y, Chen Y, Cheng P, Wang GR, Wang LQ, Chen XM
		Nanosecond pulsed electric field interrupts the glycogen metabolism in hepatocellular carcinoma by modifying the osteopontin pathway
		Hepatocellular carcinoma (HCC) is one of the most common lethal cancers and is the leading cause of cancer mortality worldwide [1]. In recent years, developments in locoregional therapies have provided new options for the treatment of HCC, which are recommended by the international guidelines including the Barcelona Clinic Liver Cancer (BCLC) and the American Joint Committee on Cancer (AJCC) [2]. For locoregional therapies, radiofrequency ablation (RFA) is the most commonly used method which is based on thermal ablation. Although RFA is a minimal invasive treatment, the damage of adjacent normal tissues caused by the thermal effect occasionally occurs during treatment. Research has also revealed that the heat might promote tumor dissemination [3]. Thus, there is urgent need to find new non-thermal ablation method for HCC treatment. Unlike RFA, the temperature rise caused by nanosecond pulsed electric field (nsPEF) does not exceed 3 °C [4], which greatly reduces thermal damage to surrounding tissues. In addition, nsPEF has great capability to initiate antitumor immune reaction [5] . The current study aimed to investigate the therapeutic effect of nsPEF and the possible molecular mechanism on glycogen metabolism of nsPEF in HCC.
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 199-201 . [Abstract] ( 83 ) [HTML 1KB] [PDF 0KB] ( 71 )

	202	Dong B, Wu RR
		Neutrophil-to-lymphocyte ratio or platelet-to-lymphocyte ratio is a predictive factor of pancreatic cancer patients with type 2 diabetes
		Pancreatic cancer (PC) is one of the most deadly cancers due to the difficulty of its early diagnosis. Most patients have developed an unresectable PC when diagnosed [1]. According to GLOBOCAN 2018 estimates, PC ranked the 11th most common cancer in the world counting 458918 new cases and causing 432 242 deaths (4.5% of all deaths caused by cancer) in 2018 [2].
		Hepatobiliary Pancreat Dis Int. 2022; 21(2): 202-204 . [Abstract] ( 77 ) [HTML 1KB] [PDF 0KB] ( 69 )

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