One of the best-known sayings of Sir William Osler, the Father of Modern Medicine, is “To have striven, to have made the effort, to have been true to certain ideals—this alone is worth the struggle”. Indeed, to concern what patients think and strive to make changes are where the core value of medicine lies in. To fulfill that ideal and make practical efforts, Hepatocellular Carcinoma—20 years after the Milan Criteria—Legacy and Future and Academic Skills Workshop was held on September 16–17 in Beijing. It’s jointly convened by Peking Union Medical College Hospital, AME Publishing Company, University of Chicago Center in Beijing, Department of Radiology and Transplant Center of University of Chicago. This series meeting has been successfully held for the fifth time and was an excellent platform for physicians and experts from all over the world to exchange their experiences and learn from each other.
Milan criteria witnessed development and breakthrough in treating hepatocellular carcinoma (HCC) in the past two decades. To mark its 20th anniversary since it’s been put forward in 1996, Milan criteria was one of the keywords in this symposium, including its significance and progress. In addition, the symposium also focused on updates about HCC management in Asia and the US, and academic skills for writing as well as publishing scientific articles.
Importance of Milan criteria and HCC management in China
The symposium started in a speech of Professor Yilei Mao, deputy chair in Chinese Society of Liver Surgeons and professor of PUMC, who extended his warm welcome and greetings to all speakers and audiences. Then, Prof. Shusen Zheng, academician of Chinese Academy of Engineering and vice president of China Medical Doctor Association, gave a keynote speech in the matter of historical legacy of Milan criteria and current options for HCC treatment. Prof. Zheng is a pioneer in organ transplantation in China. His team in Department of Hepatopancreatobiliary Surgery, First Affiliated Hospital, Zhejiang University is the first to propose Hangzhou criteria in liver transplantation for HCC in 2008. In the symposium, Prof. Zheng showed some data collected from 6,900 clinical cases to prove that Hangzhou criteria are applicable. His speech was informative and evoked great interest in attendees.
After a precise and detailed introduction of current options for HCC treatment by Prof. Zheng, Prof. Haibo Wang, director of China Organ Transplant Response System (COTRS), brought up another topic that transplantation for HCC in the national organ donation and transplantation network. During the last 12 years, Prof. Wang dedicated himself to building a transparent and equitable deceased organ allocation system in China, which is crucial for the success of the new national deceased organ donation program. With much experience in conducting in-depth researches and analyzing big data in medicine, he used much data and figures to show the current situation in Chinese organ donation system and pointed out the achievements and deficiencies in HCC transplantation network.
Afterwards, Prof. Zhijun Zhu, chairman of Department of Liver of Transplantation in Friendship Hospital gave a speech about a creative technique, auxiliary liver transplantation. Participants felt so excited about what he said. Prof. Zhu presented some successful clinical cases and believed auxiliary liver transplantation is applicable to treat metabolic liver diseases and portal hypertension (Figure 1).
HCC management in Japan and the US
The first session of symposium mainly elucidated HCC treatment in China while the second session highlighted HCC management and interventional therapy in Japan and America. This session was hosted by Dr. J. Michael Millis, professor of surgery in University of Chicago Medicine. The first speaker of this session is Dr. Yasuhiko Sugawara, associate professor in Kumamoto University. Prof. Sugawara briefly introduced the current situation of transplantation for HCC in Japan. He also put forth that Milan criteria may be expanded in living donor liver transplantation (LDLT) for HCC.
Then Prof. David C. Cronin from Porter Adventist Hospital focused his speech on LDLT for HCC in the US. He indicated that there’s still no strong evidence to support performing LDLT for patients with HCC beyond the Milan criteria, though adult-to-adult LDLT has been performed for almost 20 years. Hence, both donors and recipients should be informed of the increased risk of HCC recurrence before LDLT is performed in patients with HCC beyond the Milan criteria. In aspect of moral, he advocated that when using innovative technology in surgery, the surgeon has a moral obligation to exercise caution and judgement beyond patient autonomy.
The last speaker of this session is Dr. Thuong Van Ha, professor of radiology in University of Chicago Medicine. His speech paid attention to interventional radiology treatment. Prof. Van Ha introduced two approaches of interventional treatment, including transhepatic arterial chemotherapy and embolization (TACE) and radiofrequency ablation (RFA), and shared his understandings about the crucial role of interventional radiology therapy in treating HCC (Figure 2).
Diagnosis, management and prevention
The second day symposium started with a speech by Dr. Adam S. Bodzin from University of Chicago Medicine. Dr. Bodzin’s topic was about his research and suggestions for HCC recurrence after liver transplantation. Following Dr. Bodzin, Prof. Simon C. Robson from Harvard Medical School and Beth Israel Deaconess Medical Center shared with the attendees his new opinions about CD39 and purinergic singalong’s relationship with the condition of biological responses in liver cancer. In the aspect of intrahepatic cholangiocarcinoma (ICC), Timothy Pawlik, professor of surgery and oncology in Ohio State University gave his speech via Skype, focusing on some practical directions to do researches in the field of ICC in the future. Assistant professor of ShanghaiTech University, Dr. Pengyu Huang, provided some new information about his study that perivenous IGF-2 may promote chronic injury induced liver regeneration (Figure 3).
Academic skills—making an impact—sharing your ideas
This section encompassed speeches about scientific manuscript writing, academic skills and peer review. Prof. Timothy Pawlik offered a few advices about manuscript writing while Prof. Adam Bodzin emphasized the significance of mentorship in leading a student or a young physician to a brighter future. Prof. David Cronin gave an overview of the peer review process. He also listed some dos and don’ts when writing a paper. Meanwhile, Prof. Thuong Van Ha talked about his own ideas about how to write clear and high quality review comments. As a non-English speaker, Prof. Yasuhiko Sugawara shared his own experience in writing English paper. He believed that for non-English speakers, an effective way to publish scientific articles is to revise their papers diligently and consider more profoundly.
Apart from the academic aspect, this section also covered some sharing of new technologies. Prof. Yilei Mao vividly described the history of 3D printing technology and introduced the initial 3D bioprinting human liver. Prof. Hong Li, chairman of Li Huili Hospital in Ningbo Medical Centre, shared his surgical video about total laparoscopic pancreaticoduodenectomy as well as his breathtaking experience of mountaineering to Mount Everest (Figure 4).
Legacy and future
As widely applied criteria in the world, Milan criteria have made great contribution to improving five-year survival rate after liver transplantation for HCC and reducing HCC recurrence rate. It’s delightful and thrilling that during the 20 years since Milan criteria was put forward, a series of related criteria such as UCSF criteria, Toronto criteria and Hangzhou criteria were came up with. The emergence of these criteria not only extends and complements the Milan criteria, but more importantly, brings hope and good news to patients. Hopefully, physicians and researchers can bring more criteria and new therapies for HCC in the future. The symposium is short, but we believe its impact will go on and lead to future progress in treating HCC. We gave our heartfelt thanks to all the speakers and organizers for their great support and contribution to this symposium (Figure 5).
As a series meeting, this symposium will continue to be held in 2017. We warmly welcome your participation. You may contact us via email of Hepatobiliary Surgery and Nutrition (HBSN) journal. Let’s look forward to our next gathering!
We would like to thank Cecilia Jiang, senior editor of HBSN, for her guidance and polishing this news.
Conflicts of Interest: The authors have no conflicts of interest to declare.