China is a large country with liver cancer, and according to the World Health Organization, about 55% of the world’s liver cancer patients occur in China; and half of the new cases of liver cancer each year are in our country. This phenomenon is mainly attributed to the large number of hepatitis B virus carriers and hepatitis B patients in China. According to the data released by the Ministry of Health in April 2008, the number of hepatitis B virus carriers in China has decreased significantly, but still remains at 7.18%, which means that there are about 94-95 million people carrying the hepatitis B virus in China. Nearly 10% of these hepatitis B carriers will eventually develop liver fibrosis and cirrhosis over the course of their lives, with a proportion of these patients progressing to liver cancer. A 10-year World Bank-funded survey on the top 10 chronic diseases in China shows that liver cancer is the disease that accounts for the largest economic and medical burden on society, while hepatitis B ranks fourth, and if you add the two together, it is clear that hepatitis-cirrhosis-liver cancer has become a major problem in the medical field in China. This state of affairs brings a great challenge to the medical workers in China, but also an opportunity to make contributions. 1. The significance of liver cancer treatment and perioperative liver function protection: At present, the first choice for liver cancer treatment is still surgery (including surgical resection and liver transplantation), which has become the consensus of the industry. It has been clearly pointed out in the world’s major guidelines on the standardized diagnosis and treatment of liver cancer, including those of the American Association for the Study of Liver Diseases (AASLD), the National Comprehensive Cancer Network (NCCN), the European Association for the Study of Liver Diseases (EASL), and the Ministry of Health of the People’s Republic of China, that if the liver If a malignant tumor can be surgically removed, surgical resection is the first option. However, the problem is that most patients with hepatocellular carcinoma also have varying degrees of hepatic impairment, including acute and chronic hepatitis, liver fibrosis, and cirrhosis of varying degrees, making surgery a clear risk, and the determination of resection is not limited to the resectability of the tumor, but also includes the function of the liver, especially whether the remaining liver function can withstand such liver resection after surgery. The hepatic surgeon, unlike surgeons in any other specialty such as gastrointestinal surgery, is the only surgeon who must remove a tumor from an organ that is already compromised. Domestic clinical hepatobiliary surgeons are used to pay particular attention to the operation and surgical technique, which is in fact important and not exaggerated for the success or failure of the operation and the result. At present, the liver surgery skills of large domestic hepatobiliary surgery centers should rank among the top in the world. From the figures published by AASLD, the percentage of liver cancer patients who undergo surgical resection in western countries is 5%, while in northeast Asian countries, the percentage is 40%. This difference in resection rate reflects that the scope and skills of liver cancer resection in China are at least as good as those in western countries such as the United States. However, frankly speaking, the emphasis on perioperative liver function protection by our surgeons, especially primary care physicians, is still lacking and there is obvious room for improvement. This phenomenon often prevents an effective and smooth recovery after our hepatectomy, and sometimes good surgical skills are not reflected in a smooth postoperative recovery. Therefore, the assessment and protection of liver function in the perioperative period has become a crucial topic. 2. Routine measures for perioperative liver function protection in hepatocellular carcinoma surgery: Accurate and reasonable liver function assessment may determine the safety and prognosis of surgery; and effective liver function protection before, during and especially after surgery is often a crucial measure to save patients’ lives and enhance the effect of surgical treatment. Hepatobiliary surgeons need to first focus on or pay attention to the protection of liver function in perioperative hepatocellular carcinoma patients. Such protection is generally reflected in the comprehensive hepatoprotective treatment for patients with cirrhosis starting before surgery, giving necessary and sufficient energy support and protein supplementation to make patients more tolerant of surgical trauma; delicate operation during surgery, avoiding unnecessary liver tissue damage, preserving the intact blood supply of the remaining liver as much as possible, minimizing unnecessary and excessive intraoperative bleeding, and shortening or eliminating intraoperative liver The preservation of residual liver function after surgery is an obvious and important process, which involves a broader field, including rational and precisely calculated postoperative fluid therapy, the use of available hepatoprotective drugs, and the control of excessive inflammatory responses in the remaining liver after major liver surgery. In patients undergoing marginal liver function surgery, the effectiveness of pharmacological liver function protection measures is actually quite limited. Lack of accurate preoperative estimation and negligent intraoperative manipulation often make postoperative hepatoprotective measures unable to restore the impaired liver function. In case of progressive postoperative liver failure, the application of artificial liver can also be considered for support, but the results are not seen to be satisfactory at present. When postoperative fulminant liver failure (FLF) occurs, the mortality rate will exceed 90%. 3, the role of counteracting excessive inflammatory response in postoperative liver function protection: inflammatory response is a set of fine and complex defense functions actively selected by human beings during the long evolutionary process, which is inextricably linked with the immune function of the whole body, and the lack of a reasonable inflammatory response process will make us lose our defense and resistance to diseases and various bacterial and microbial erosion, the reason why we, a human This delicate inflammatory response process has played an absolutely crucial role in the survival of our human race through repeated elimination and screening to the present day. In the last decade or so, more attention has been paid to the damage caused by an excessive inflammatory response, and young surgeons and researchers often mention the word “inflammatory response” and immediately get a “negative” impression, as if all pro-inflammatory cytokines such as What we need is a rational regulation of the inflammatory response in the disease state. However, in some cases of severe trauma and serious diseases, the inflammatory cascade in the body is over-mobilized and a large amount of inflammatory factors and cytokines are released, which can indeed bring serious damage to the body, sometimes even causing fatal consequences, as shown most clearly in many ICU patients. In patients undergoing surgical trauma or major surgery, this excessive inflammatory response can often result in serious complications and even cost lives if not controlled in a timely manner, so it is crucial to regulate the excessive inflammatory response appropriately and skillfully. In the case of liver resection, is this excessive inflammatory response also present in the remaining liver with an underlying liver disease after surgery? This question was not very clear until a few years ago. The Department of Liver Surgery at Peking Union Medical College Hospital conducted a study in this regard. The group first applied a lethal model of 90% liver resection in an animal experiment, in which all rats died within 24h after surgery without treatment, because the remaining 10% of the liver could not afford to recover after surgery. We tried to apply a statin (Atovastatin) to partially suppress inflammation in the remaining liver, which significantly prolonged the survival time of the laboratory animals to 72 h, but the final result was still 100% death; then we chose a complete blocker of inflammatory channels, AG490, which blocks the phosphorylation of JAK2 kinase in the cytokine signaling pathway, thereby blocking the phosphorylation of the signaling protein STAT. thereby blocking the phosphorylation level of the signaling protein STAT and clearly inhibiting the release of inflammatory factors. After applying AG490, not only the survival time of the experimental animals was prolonged, but also one fourth of them survived for a long time. In fact, this result was somewhat surprising to us, since simply blocking the excessive inflammatory response in the liver remaining after surgery could have such a positive effect. The next study showed that AG490 clearly protected the hepatic function of the limited remaining liver, making it sufficient to support the emergence of effective hepatocyte proliferation; and this effect was indeed produced by reducing the phosphorylation of JAK2 and STAT3, blocking the secretion of pro-inflammatory cytokines, and increasing the secretion of anti-inflammatory cytokines. This result we presented internationally at the AASLD Congress in the USA. With this theoretical basis and findings, we began to try to apply the results of this study against the excessive inflammatory response in the remaining liver to the clinic by designing a prospective, randomized, controlled clinical study in which a parthenogenic anti-inflammatory drug (ustekin) was applied intravenously at the time of surgery and 3 d postoperatively, resulting in a significant reduction in the patient’s postoperative liver enzyme and bilirubin levels and an effective modulation of The clinical end results showed a significant reduction in the length of hospital stay and hospital-related costs. Interestingly, this effect in patients against excessive inflammatory responses in the remaining liver was mainly seen in larger scale (three or more hepatic halves) liver resections, which may indicate that excessive inflammatory responses in the remaining liver also occur in patients with small scale liver resections, but their overall negative postoperative impact may not be very significant; whereas excessive inflammatory responses in the remaining liver of large scale liver resections can significantly affect the patient’s postoperative recovery, and can even be fatal. Therefore, we recommend the application of anti-inflammatory agents for a short period of time after surgery to further protect liver function and adequately improve the patient’s prognosis, in addition to routine liver function protection measures for patients undergoing major hepatectomy. In conclusion, the hepatobiliary surgeon should go far beyond the level of a “surgeon” and pay more attention to and gain more detailed insight into the mechanisms and conditions of the disease and the patient, pay attention to the protection of liver function before, during and after surgery in patients with underlying liver disease, and constantly propose new ideas and develop new methods in order to achieve the best surgical results with good surgical techniques to achieve the best surgical results.