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This review explored recent advancements in organ preservation strategies for early rectal cancer. Although total mesorectal excision (TME) remains the standard treatment, there is a growing interest in organ preservation approaches due to the potential decline in quality of life associated with TME. We discussed precise staging methods for early rectal cancer and proposed specific organ preservation protocols for cT1N0M0 and cT2N0M0 patients. Additionally, immunotherapy has shown significant potential for patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) status. This review summarized current research findings and provided guidance for clinicians on organ preservation options when treating early rectal cancer.

Objective To analyze the influencing factors of delayed postoperative bleeding (DPPB) after endoscopic submucosal dissection (ESD) for early gastric cancer and construct a Nomogram model. Methods The clinical information of 234 patients who underwent ESD treatment at our hospital and pathologically diagnosed with early gastric cancer from April 2021 to April 2023 were collected. The patients were grouped based on the presence or absence of DPPB. Logistic regression analysis was applied to screen for risk factors affecting DPPB after ESD in early gastric cancer patients. R software was applied to construct a Nomogram model for predicting the risk of DPPB in early gastric cancer patients after ESD. Receiver operator characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness of fit test were plotted to evaluate the Nomogram model. Results A total of 23 (9.8%) of 234 early gastric cancer patients who underwent ESD treatment developed DPPB. Multivariate Logistic regression analysis showed that the number of biopsies ≥ 3 (95%CI: 2.482-20.424, P=0.000), the maximum diameter of lesions ≥ 3 cm (95%CI: 1.620-13.244, P=0.004), the depth of invasion to submucosa (95%CI: 1.421-10.536, P=0.008), and intraoperative bleeding (95%CI: 1.160-11.300, P=0.027) were independent risk factors for DPPB after ESD in early gastric cancer patients. The area under ROC curve (AUC) was 0.838 (95%CI: 0.743-0.932). The slope of the calibration curve was close to 1. Hosmer-Lemeshow goodness of fit test showed χ2=3.328, P=0.505. Conclusions The number of biopsies ≥ 3, the maximum diameter of lesion ≥ 3 cm, the depth of invasion to submucosa, and intraoperative bleeding are independent risk factors for DPPB after ESD in early gastric cancer patients. The Nomogram model based on these four independent risk factors can effectively predict the risk of DPPB after ESD in early gastric cancer patients.

The safety and efficacy of laparoscopic surgery for colorectal cancer has been confirmed by several large-scale clinical studies. Laparoscopy has become the main modality of surgical treatment for colorectal cancer in China. Based on evidence-based medicine and the experience accumulated in clinical practice, laparoscopic colorectal surgical techniques are still being continuously optimised and improved. The key techniques mainly revolve around the following three aspects:①complete surgical excision extension;②appropriate lymph node dissection area;③safe digestive tract reconstruction. Prioritizing the standardization of laparoscopic colorectal cancer surgery, promoting the consistent implementation of these procedures, establishing a scientific evaluation system, thoroughly assessing surgical outcomes, and conducting high-quality clinical research are essential for enhancing the standardization of laparoscopic colorectal cancer surgery in China.

Objective To investigate the application of synchronized immersion course (SIC) in teaching of clinical practice of surgery for eight-year program students. Methods A total of 94 eight-year program students in French class and 4+4 class who received SIC in the study of surgery in Ruijin Clinical School, Shanghai Jiao Tong University from September 2017 to June 2019 were selected as the pilot group. A total of 91 students in English class who were taught in the traditional way in the same period were selected as a horizontal control group. A total of 84 students in French class and 4+4 class who were studying from September 2015 to June 2017 were selected as the longitudinal control group. Teaching satisfaction evaluation, examination results and specialization choice were compared among students in each group to assess teaching effectiveness. Results The total score (3.8±0.3) and satisfaction rate (98.9%) of the questionnaire in the pilot group were better than those in the horizontal control group (3.6±0.4, 90.1%)（P=0.001，P=0.008）. For the case analysis station in objective structured clinical examination (OSCE), the mean score (86.2±6.9) and pass rate (97.9%) in the pilot group were better than those in the horizontal control group (79.7±11.4, 89.0%)（P=0.001，P=0.014）, as well as better than those in the longitudinal control group (79.5±13.5, 88.1%)（P=0.001，P=0.009）. For the history inquiry station, the mean score (86.3±10.7) and pass rate (96.8%) in the pilot group were better than those in the horizontal control group (81.4±11.6, 86.8%)（P=0.003，P=0.013）. The proportion of students choosing the surgical specialty was higher in the pilot group (55.3%) than in the horizontal control group (46.2%) and the longitudinal control group (44.0%) without statistically significant difference. Conclusions SIC can help eight-year program students strengthen their clinical thinking and practice skills. Meanwhile, SIC can increase students’ satisfaction with teaching and their interest in surgery.

Objective To explore the feasibility and rationality of advanced integrated two-stage laparoscopic simulation training course in standardized training of surgical residents. Methods From December 2019 to December 2021, the advanced integrated two-stage laparoscopic simulation training course was carried out among 2019—2020 surgical residents who received standardized training in our hospital. The course was divided into two stages. In the first stage, BEST (best essential surgical technology training) course, adopted Darwin® endoscopic training system, Tianyan® endoscopic training system, Microport® 3D laparoscopic training system and simple simulative models were used. The second stage, BEST PLUS course, same platform as that in BEST course and in vitro animal models were used. The questionnaire survey method (before and after class questionnaire) was adopted to evaluate the curriculum setting, such as curriculum form, simulators, teaching method, time arrangement, curriculum difficulty, training effect, curriculum satisfaction and so on. Results A total of 37 surgical residents completed the two-stage course training and the questionnaire survey. The overall satisfaction rate with the curriculum setting was 100%. There were 32 residents (86.5%) thought that first stage training course could significantly improve their clinical skills, 35 residents (94.6%) thought that second stage training course could significantly improve their clinical skills, and 36 resident (97.3%) thought that the first stage curriculum could significantly help them improve performance in the second stage curriculum. Conclusions The trainees had a high degree of recognition and satisfaction for the advanced integrated two-stage laparoscopic simulation training course. The overall design of course was reasonable and feasible, and was attractive to trainees.

The advancements in colorectal minimally invasive surgical techniques represent not merely technological innovation but also a significant leap in surgical philosophy. Over the past half-century, we have witnessed the historic transition from traditional open surgery to minimally invasive procedures, a change propelled by continuous innovations in surgical platforms and techniques. The innovations of platforms encompass developments in imaging platforms, energy platforms, instrumentation platforms. Furthermore, innovations in surgical techniques primarily focus on exploring variables within five key elements of surgical techniques: the approach, extent of bowel resection, lymph node dissection, reconstruction of the digestive tract, and specimen extraction. The progress in colorectal minimally invasive surgery has significantly reduced surgical trauma, and enhanced patients' postoperative quality of life and the overall safety of surgeries. This progress is underpinned by stringent quality control throughout the surgical process, ensuring standardized and homogeneous execution of procedures. Moving forward, the ongoing drive to innovate surgical techniques and philosophies will continue to improve the efficacy and safety of colorectal minimally invasive surgeries. This journey not only necessitates the relentless advancement of medical technologies, but also requires surgeons to continuously deepen and actively pursue surgical philosophies.

Objective To investigate the risk factors and preventive strategies of pancreaticoduodenectomy postoperative hemorrhage. Methods A total of 208 patients who underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of the 904th Hospital of Joint Logistics Support Force, PLA from January 2017 to December 2021 were enrolled. Twenty-one patients with postoperative hemorrhage were retrospectively analyzed. Results Univariate analysis indicated that postoperative hemorrhage was mainly associated with pancreatic leakage, biliary leakage, abdominal infection, hypoproteinemia, diabetes, improper use of ultrasound knife, skeletonization, intraoperative blood loss, preoperative jaundice, etc.(P0.05). Among the 21 patients with postoperative hemorrhage, 4 cases recovered after conservative treatment such as hemostasis and blood transfusion, 6 cases underwent interventional treatment, 11 cases underwent abdominal exploration, and 2 cases died of postoperative multiple organ failure. Pancreatic leakage (OR=3.963,95%CI: 1.120-14.025), biliary leakage (OR=4.013,95% CI: 1.173-13.734) and abdominal infection (OR=7.545,95%CI: 1.833-31.051) were independent risk factors for postoperative hemorrhage. Conclusions The improvement of anastomotic manipulation, reduction of anastomotic leakage, and control and prevention of abdominal infection are important to prevent postoperative hemorrhage of pancreaticoduodenectomy. Surgical treatment should be performed as soon as possible for the patients with poor conservative treatment effect.

Colorectal cancer(CRC) ranks in third place in terms of incidence but second in terms of mortality. Cancer vaccine, as a novel immunotherapy, presents tumor antigens to human immune system and further elicits anti-tumor immune response, leading to long-term immune memory. This review summarized representative research progress in both clinical and basic scenario of past five years, and prospected the future of CRC vaccine.

Objective To analyze the serum PD-L1 levels of gastric cancer patients and its relationship with tumor stage and prognosis. Methods Serum of sixty patients with pathological diagnosis of gastric cancer in our hospital from August 2018 to December 2019 were collected, and the serum of 15 healthy adults as a control. The serum PD-L1 levels was measured by enzyme linked immunosorbent assay(ELISA). The serum PD-L1 levels between gastric cancer patients and healthy adults were compared.The relationship between the serum PD-L1 levels and prognosis of gastric cancer patients with different stages was analyzed. Finally, the PD-L1 expression in tumor tissues was detected by immunohistochemical staining, and its correlation with serum PD-L1 levels was analyzed. Results The serum PD-L1 levels of gastric cancer group was significantly higher than that of the control group. The serum PD-L1 levels in patients with stage Ⅲ and Ⅳ gastric cancer was significantly higher than that in stage Ⅰ and Ⅱ. The serum PD-L1 levels in gastric cancer patients with peritoneal metastasis was significantly elevated, indicating poor prognosis. Kaplan-Meier survival analysis showed that the survival time of gastric cancer patients with higher level of serum PD-L1 was shorter than those with lower ones. We further evaluated the PD-L1 expression in tumor tissues. There was no significant correlation between the serum PD-L1 levels and that in tumor tissues. Conclusions The serum PD-L1 levels of gastric cancer patients was higher than that of healthy adults, and which gradually increased with the progression of the disease. Gastric cancer patients with peritoneal metastasis had a much higher serum PD-L1 levels, and there was no significant correlation between serum PD-L1 levels and PD-L1 expression in tumor tissues.

Early rectal cancer is defined as any size of rectal epithelial tumor with infiltration depth limited to the mucosa and submucosa, regardless of with or without lymph node metastasis. Local resection is one of the main treatment methods for early rectal cancer without local lymph node metastasis. The development of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) has brought more options for the treatment of early rectal cancer. About 8%-12% of early rectal cancer patients have local lymph node metastasis and therefore still require total mesorectal excision (TME). The current guidelines recommend that early rectal cancer with high-risk pathological features requires additional salvage radical surgery. Various minimally invasive and anal sphincter-preserving surgical techniques, such as natural orifice specimen extraction surgery (NOSES), transanal total mesorectal excision (TaTME), intersphincteric resection (ISR), and conformal sphincter-preserving operation (CSPO), have better achieved the goal of anal sphincter preservation and anal function preservation. The overall prognosis of early rectal cancer is good, but full-process surveillance is equally important. With the innovation of early diagnosis, early treatment and full-process surveillance, the development of endoscopic and surgical techniques will further improve the standardization of diagnosis and treatment for early rectal cancer.

For locally advanced rectal cancer (LARC), the standard treatment of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) leaded to limited tumor regression grade and organ preservation rate, and didn’t decrease the rate of distant metastasis. Radiotherapy can promote the immune response and has good synergistic effect with immunotherapy, which is likely to overcome the treatment difficulty of the microsatellite stable(MSS) colorectal cancer. Recently, multiple clinical trials are ongoing in terms of the combination of nCRT and immunotherapy in LARC. Most of them have achieved promising complete response rates, providing new treatment options for preservation of organ functions in mid-low MSS LARC. Large-scale randomized controlled trials are needed in the future to validate these findings and explore the benefit of organ preservation and long-term survival. In addition, studies are still needed on the optimal combination patterns of radiotherapy and immunotherapy and the precise efficacy evaluation, etc.

Locally advanced rectal cancer (LARC) is associated with a high risk of local recurrence and distant metastasis, making it difficult to be cured by surgery alone. Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for LARC, with reduced local recurrence rates. However, neoadjuvant chemoradiotherapy is associated with patients' urogenital and sexual dysfunction, which severely affecting their quality of life. Therefore, determining the optimal timing of surgery to balance oncologic and functional outcomes is crucial and challenging. We proposed that choosing the optimal timing of surgery based on preoperative risk assessment of LARC is an effective strategy. The patients with low to moderate risk of recurrence can be considered to perform surgery directly or have preoperative chemotherapy followed by radical surgery. Patients with high risk of recurrence should extend neoadjuvant therapy before surgery to improve oncologic outcomes. In this study we explored the optimal timing of radical surgery for LARC, providing a new idea for individualized and precise treatment of LARC.

In order to reduce intraoperative recurrent laryngeal nerve injury, intraoperative neural monitoring(IONM) is widely used in thyroid-related surgery, especially in reoperations. However, some incidental injuries have also been observed during IONM. This article reported a case suffered skin thermal injury at the site of hypodermic needle electrode placement during IONM in Shanghai International Medical Center. Combining relevant adverse event information and analyzing the causes was essential to understand and prevent potential risks, and prioritize patient safety.

Breast cancer is the most common malignant tumor in women. With the development of genomics technology and medical frontier technology, the systemic treatment of breast cancer has gradually entered the era of personalized medicine. However, the decision-making of adjuvant radiotherapy for breast cancer still mainly relies on traditional clinicopathological factors, and there is a lack of scientific and reliable tools to guide precise radiotherapy in different populations. Hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer is the most common molecular subtype of breast cancer. The 21-Gene recurrence score (RS) test (Oncotype Dx™, Genomic Health, Redwood City, CA) is a commercially available genomic test for breast cancer. In this article, we reviewed the current research evidence on the use of 21-Gene RS test for radiotherapy decision-making in HR-positive HER2-negative early breast cancer. Current clinical studies support the predictive value of 21-Gene RS test for adjuvant radiotherapy, and several large-scale prospective clinical studies in this area are underway.

The combination of anti-angiogenesis, immune checkpoint inhibitors(ICIs) and chemotherapy(target-immune-chemo) has achieved initial results in the comprehensive treatment of gastric cancer. Experimental studies have shown that among various determinants of tumor immunotherapy, tumor microenvironment (TME) plays a crucial role in affecting ICIs efficacy. The biological mechanism leading to immunosuppressive TME is multi-factorial and very complex, but one of clear and important mechanisms is the influence of abnormal neoangiogenesis in tumors. The use of low-dose targeted tumor angiogenesis drugs (such as anti-VEGF /VEGFR monoclonal antibody, etc.) is expected to make tumor vessels normalization and reverse immunosuppressive TME to immunesupportive TME, so as to play synergistic, complementary, anti-tumor effects with ICIs and chemotherapy drugs. Perioperative treatment of locally advanced gastric cancer (LAGC) has become an indispensable and important strategy in surgical comprehensive treatment of gastric cancer. In recent years, a therapeutic combination regimen of anti-angiogenesis, ICIs and chemotherapy (target-immune-chemo) has been clinically applied in the perioperative treatment of LAGC, and the preliminary efficacy [pathologic complete response(pCR), major pathological response(MPR), tumor regression grade(TRG) and treatment-related adverse events(TRAEs), etc.] has shown encouraging results. This article reviewed the relevant clinical research results and made a summary and analysis.

The National Comprehensive Cancer Network (NCCN), as the world's leading non-profit consortium in the field of oncology, continues to update clinical practice guidelines for multiple malignancies annually and has become a benchmark for clinical practice guidelines in oncology worldwide. Currently, the NCCN clinical practice guidelines for hepatocellular carcinoma have been updated to version 2.2023, as compared with version 1.2023 of its main updates for the content of the discussion section. The NCCN guidelines for hepatobiliary cancers have been reorganized to separate guidelines for biliary tract cancers and hepatocellular carcinoma since version 1.2023. The main updates focus on tumor screening, diagnosis, surgery, adjuvant therapy, locoregional therapy, systemic therapy, and so on. The molecular testing was added for the first time. Therefore, the updates of version 1.2023 were highlighted again in the new version 2.2023. This article interpreted the new guidelines and focused on the aspects of updates.

Biliary tract carcinoma exhibits high heterogeneity at the genomic, epigenetic, and molecular expression levels. The patients even with the same pathological morphology and clinical stage of biliary tract malignant tumors have substantial differences in the treatment response and prognosis. Traditional pathological histology and clinical classifications are no longer sufficient to meet the demands of the precision medicine era. Molecular subtyping has the potential to provide more personalized cancer treatment strategies. It not only helps to reveal the mechanisms of tumor development and accurately predict disease prognosis, but also plays a crucial role in guiding the development of novel targeted drugs and implementing targeted therapies for specific tumors. With the ongoing development of precision medicine, the role of molecular subtyping in cancer diagnosis, treatment option, and prognosis assessment is increasingly prominent. This paper systematically reviewed the recent progress in the molecular subtyping of biliary tract malignant tumors based on domestic and international clinical and basic research.

Progress in the systemic therapies, represented by the molecular target therapies and immune checkpoint inhibitors (ICIs), have significantly improved the prognosis of unresectable hepatocellular carcinoma (uHCC), but long term survial remains limitted. As one of the major combination of systemic and surgical therapies, conversion therapy provides potentially curative opportunity to some uHCC patients. It is widely reported from different domestic centers.The first Chinese expert consensus about it was released in 2021. Yet at the same time, there are many key issues in the practice and theory remains to be resolved. Actively thinking, exploring and finally resolving these issues are essential for establishing and promoting the standardized theoretical system of uHCC conversion therapy.

Objective To determine the expression and clinical significance of pseudogene FMO6P in gastric cancer, and explore its functions and underlying molecular mechanism in regulating the invasion and metastasis of gastric cancer cells. Methods The expression level of FMO6P in gastric cancer tissues and cell lines was detected by quantitative real time polymerase chain reaction(qRT-PCR). The migration and invasion abilities of gastric cancer cells were detected by transwell assay. The effect of FMO6P on the tumor formation and peritoneal dissemination of gastric cancer cells were evaluated by injecting FMO6P-overexpressing gastric cancer cells into the subcutaneous or peritoneal cavity of nude mice respectively. The expression levels of epithelial-mesenchymal transition(EMT) markers, including E-cadherin, N-cadherin, ZEB1, MMP2, and the activation of AKT/mTOR pathway in FMO6P-overexpressing or knockdown gastric cancer cells were measured by Western blot. Results The expression of FMO6P was significantly reduced in tumor tissues compared to its adjacent non-tumor tissues of gastric cancer, FMO6P expression level in tumor tissues was correlated with tumor size and TNM stage. Overexpression of FMO6P significantly inhibited the invasion and migration abilities of gastric cancer cells, while downregulation of FMO6P expression promoted the invasion and migration ability of gastric cancer cells. Overexpression of FMO6P in gastric cancer cells significantly inhibited the subcutaneous tumor formation and peritoneal dissemination of gastric cancer cells in nude mice. Moreover, overexpression of FMO6P promoted the expression of E-cadherin, and inhibited the expression of N-cadherin, ZEB1, and MMP2 in gastric cancer cells. The phosphorylation levels of AKT and mTOR were also downregulated in gastric cancer cells overexpressing FMO6P. Conclusion All these findings suggested that pseudogene FMO6P suppresses the invasion and migration potential of gastric cancer cells in vitro and in vivo, which is possibly through the inhibition of the AKT/mTOR signaling pathway.

The liver is the most common site of metastasis in patients with colorectal cancer(CRC). The liver microenvironment is a diverse assemblage of cells, which has their own unique biological characteristics and functions, supplemented by the interaction between cells, which jointly regulate the tumor microenvironment and play significant role in the occurrence and development of CRC liver metastasis. Consequently, a thorough investigation of the molecular mechanisms underlying CRC liver metastasis is imperative for comprehension of tumor progression, prediction of metastasis risk, and the development of innovative therapeutic strategy. This paper delved into the cellular constituents of the liver tumor microenvironment, elucidating the roles and influences of diverse cell types in the process of CRC liver metastasis, offering fresh insights and strategies for the diagnosis and management of CRC liver metastasis.

In recent years, benifit by the advancement of minimally invasive surgical techniques, laparoscopic living donor hepatectomy（LLDH） has experienced rapid development. Since this technology was first reported in 2002, major transplant centers have been continuously developing and accumulating experience. Compared with traditional open surgery, LLDH has advantages such as less trauma, less intraoperative bleeding, and lower incidence of postoperative complications. However, at the same time, there were certain difficulties in managing, such as, warm ischemia time, overcoming learning curves, avoiding biliary complications, and controlling bleeding, still needed to be solved. The application of some new technologies and surgical methods also made this technology more efficient and safer. This article discussed the development history, surgical difficulties and complications, and technical improvements of LLDH, and looked forward to the future prospects and development directions of this technology.

Objective To explore the effect of hyperlipidemia and lipid-lowering therapy on the prognosis of postoperative patients with hepatitis B related hepatocellular carcinoma. Methods The clinical data of the patients with hepatitis B related hepatocellular carcinoma who were operated in our hospital from January 2012 to January 2021 were retrospectively collected. The effect of blood lipid level and related lipid-lowering therapy on the prognosis of postoperative patients with hepatitis B related hepatocellular carcinoma was analyzed. Results Among 166 patients with hepatitis B related hepatocellular carcinoma, there were 63 cases had hyperlipidemia, of which 33 cases were treated by statins. The median postoperative disease free survival time in the hyperlipidemia group was significantly lower than that in the normal blood lipid group (24.8 months vs. 38.5 months, P

Objective To investigate the consistency between mismatch repair proyeins expressions detected by immunohistochemistry (IHC) and microsatellite instability(MSI) identified by next-generation sequencing (NGS), and evaluate the correlation of these results with the clinical characteristics of Chinese colorectal cancer (CRC). Methods Using IHC and NGS to identify mismatch repair (MMR) and MSI status in CRC, and assessing the consistency between these different detection methods. Results The concordance rate of MSI status detected by IHC and NGS was 98.36%, indicating good agreement (Kappa=0.856). Certain pathogenic or likely pathogenic germline variants were present in the pMMR/MSI-H subtype. The co-deficiency of MLH1 and PMS2 was most common in the dMMR/MSS subtype. Patients with inconsistent typing were more likely to have early-onset right-sided colon cancer (P

Objective To investigate the technique and dosage selection of indocyanine green(ICG) fluorescence staining in laparoscopic anatomical hemihepatectomy. Methods A retrospective cross-sectional study was conducted. The clinical date of the patients who underwent laparoscopic anatomical hemihepatectomy in the Cancer Hospital of the Chinese Academy of Medical Sciences from October 2020 to October 2023 was collected and analyzed, and the management of the Glissonean pedicle, the method and effect of ICG fluorescence staining during the operation, the dose of ICG injection, and the postoperative recovery were analyzed. Results A total of 91 laparoscopic anatomical hemihepatectomies were enrolled in this study, including 28 right hemihepatectomies and 63 left hemihepatectomies. The Glissonean pedicle was dissected intra-sheath in 9 cases and extra-sheath in 82 cases. ICG fluorescence staining was all performed using the negative staining method, of which 69 cases(75.8%) were successfully stained. The success rate of staining in the extra-sheath dissection and low-dose ICG group was higher than that in the intra-sheath dissection and high-dose ICG group. The average operation time was (168.5±32.2) minutes, the intraoperative bleeding volume was (152.4±56.3) ml, and the intraoperative blood transfusion rate was 6.6% (6/91), the average postoperative hospital stay was (8.5±2.6) days. One case was converted to laparotomy due to exophytic growth of the tumor compressing the Glissonean pedicle. Four cases had Clavien-Dindo Ⅰ-Ⅱ complications, all of which improved after treatment. There were 3 cases of grade Ⅲa complications, all of which were caused by bile leakage and abdominal cavity infection. They were cured by puncture and drainage. And there were no serious complications above grade Ⅲb. Conclusions In laparoscopic anatomical hemihepatectomy, the ICG fluorescence staining method was recommended to use the negative staining method of the extra-sheath dissection of the Glissonean pedicle, and a lower dose of ICG could help to increase the success rate of fluorescence staining.

Surgery is still the first choice for patients with hepatocellular carcinoma(HCC). However, about 70% of HCC patients in China are first diagnosed in the advanced stage and have lost the opportunity for surgery. Recently, the rapid development of systematic therapy has brought new hope for patients with advanced HCC. The combination of molecular targeted therapy and immunotherapy with or without local therapy significantly improves the survival of advanced HCC and alters the landscape of surgical treatment in advanced HCC. In addition, systemic therapy also brings new opportunities for perioperative treatment of HCC patients. Conversion therapy, neoadjuvant therapy, and postoperative adjuvant therapy can increase the chances of surgical treatment, reduce the risk of postoperative metastasis and recurrence, and prolong the overall survival of HCC patients. Systematic therapy based on molecular targeted therapy and immunotherapy has been applied through the whole process of HCC surgical treatment, and has completely altered the surgery paradigm of HCC. However, further research is needed to determine the optimal combination protocol, screen the sensitive populations, address drug resistance, and reduce systemic adverse events.

Objective To establish and validate a Nomogram model for predicting the overall survival (OS) of the patients with intrahepatic cholangiocarcinoma (ICC) based on domestic multicenter data, and screen the beneficiaries of adjuvant chemotherapy based on the prediction model. Methods From December 2011 to December 2017, the data of 278 patients with postoperative pathological diagnosis of ICC from 4 medical centers in our country were collected retrospectively COX regression model was used to screen the independent risk factors of OS and constructed a Nomogram model. This model was used to stratify the risk of OS for all patients and to screen the beneficiaries of adjuvant chemotherapy. Results A total of 278 patients were enrolled, and 23 cases(8.3%) received adjuvant chemotherapy. COX multivariate analysis showed that drinking history, ECOG score, method of hepatectomy, lymph node status, number of tumors, and tumor differentiation were independent risk factors for postoperative OS. The Nomogram model had a C-index of 0.690(95% CI: 0.646-0.734) in the training cohort and 0.740(95% CI: 0.863-0.617) in the validation cohort. According to risk stratification by Nomogram model, in the high-risk group there was a statistically significant difference in survival between adjuvant chemotherapy and non-adjuvant chemotherapy (P=0.033), whereas in the low-risk group, there was no significant difference in survival(P=0.59). Conclusion Nomogram model based on independent risk factors of OS demonstrated excellent predictive capability for survival and could be used to screen, and identify the patients with ICC who benefit from adjuvant chemotherapy.

Objective To explore the feasibility of ultrasonic measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance for predicting difficult laryngoscopy exposure in obstructive sleep apnea hypopnea syndrome(OSAHS) patients. Methods One hundred and fifty OSAHS patients with ASA Ⅰ-Ⅲ level, who underwent elective uvulopalatopharyngoplasty(UPPP) surgery under general anesthesia,were analyzed. Rountine airway assessment (Mallampati classification) and ultrasound measurement of the skin to hyoid bone distance, skin to epiglottis distance and skin to anterior commissure of vocal cords distance were performed before anesthesia. Intubation under direct laryngoscopy and the classification of laryngoscopy exposure was recorded. Cormack-Lehane classification Ⅲ-Ⅳ grade was defined as difficult laryngoscopy exposure. According to the classification results, patients were divided into two groups: non-difficult laryngoscopy exposure group and difficult laryngoscopy exposure group. We analyzed and compared the Malampati grading and ultrasound measurements between two groups. The receiver operating characteristic(ROC) curve and the optimal cut-off point of ultrasonic measurements were calculated. The effects of different methods for predicting difficult laryngoscopy exposure were analyzed. Results The proportion of cases whose Mallampati airway classification grade>Ⅱ in difficult laryngoscopy exposure group was significantly more than that in non-difficult laryngoscopy exposure group (P

The etiology of congenital biliary dilatation (CBD) is still unclear. Currently, abnormal pancreatico-bile duct confluence is the mainstream theory. In terms of classification, Todani classification is the most widely used. On the other hand, Dong's classification which proposed by Dong Jiahong and his colleagues has guiding significance for the selection of surgical methods. CBD is difficult to detect and diagnose because of the poor specificity of clinical symptoms, and it is often necessary to make a preliminary diagnosis based on the medical history, and it is also quite dependent on the assistance of imaging. Serological examination also plays a key role in the diagnosis of CBD because of its convenience and high acceptance. This article reviewed the etiology, classification and diagnosis of CBD.

In this paper we interpretated the background about Standardized surgical procedure of conformal sphincter-preservation operation (CSPO) for low rectal cancer (2023 edition), and several key issues need to be attention, for example, the definition of conformal resection, the clarity of relevant anatomical concepts, the functional advantages of CSPO, the main differences between CSPO and intersphincteric resection(ISR), the clinical value and indications, the principles and details of surgery, and the key issues of perioperative nursing.

Solitary cervical submental nodule is a relatively rare case in clinical procedure and prone to miss diagnosis. Differential diagnosis with various head and neck diseases is necessary. This article reported a case of solitary cervical submental metastasis of papillary thyroid carcinoma received in the department of surgery, Civil Aviation Shanghai Hospital, Ruijin Gubei Branch, Shanghai Jiao Tong University School of Medicine. The patient came to the outpatient clinic for treatment due to "consciously larger submental tubercle than before". Ultrasound examination revealed suspicious lesions in both the thyroid and submental regions. Ultrasound-guided final needle aspiration biopsy diagnosed as malignant tumor. Surgical resection was performed and the central group lymph nodes dissected Pathological examination confirmed papillary thyroid carcinoma with solitary submental metastasis. This article reported the clinical diagnosis and treatment of this case, in order to improve the disease recognition for clinicians, and make differential diagnosis with other rare neck diseases, and avoid missing diagnoses.

Objective To analyze the independent factors affecting the prognosis of pancreatic cancer and construct a prediction model based on surveillance, epidemiology, and end results (SEER) database. Methods The clinical data of 7 801 American pancreatic cancer patients from 2010 to 2015 were obtained from SEER database. They were randomly divided into training group and validation group in a ratio of 7:3. The nomogram was constructed after multivariate COX regression analysis of clinical variables in the training group. The accuracy of the model was verified by receiver operating characteristic(ROC) curve and calibration curve. Results Age, primary-site, grade, T-stage, N-stage, M-stage，surgery, radiotherapy and chemotherapy were related to the prognosis of the patients with pancreatic cancer. The area under curve(AUC) of overall survival(OS) ROC curve of 3- and 5-year were 0.90 and 0.91 respectively. The AUC of cancer specific survival(CSS) ROC curve were 0.91 and 0.91 respectively. The calibration curve showed a good consistency between the observed and predicted values. The selected clinical variables did have an impact on the prognosis of the patients with pancreatic cancer. Conclusions The model had good prediction accuracy and was helpful for clinical decision-making and personalized treatment of the patients with pancreatic cancer.

Objective To evaluate the efficacy of double U-stitch and modified “double U-stitch pancreaticojejunostomy” in pancreaticoduodenectomy. Methods We retrospectively analyzed the clinical information of 150 patients who underwent pancreaticoduodenectomy between January 2022 and September 2023 in Wang Wei’s team in department of pancreatic surgery, Fudan University Shanghai Cancer Center. The patients were divided into two groups according to the pancreaticojejunostomy method: the double U-stitch 1.0 group (70 cases before modification) and the double U-stitch 2.0 group (80 cases after modification). The postoperative complications of the two groups were compared. Results The overall postoperative complications were significantly lower in the double U-stitch 2.0 group as compared with the double U-stitch 1.0 group (13.8% vs. 38.6%, P=0.001). The incidence of clinically relevant pancreatic fistula was 18.6% in the double U-stitch 1.0 group, while this was significantly decreased in the double U-stitch 2.0 group (6.3%) (P=0.021). Postoperative extraluminal hemorrhage occurred in 5 patients in the double U-stitch 1.0 group, while in the double U-stitch 2.0 group, only one patient experienced postoperative intraluminal hemorrhage, the difference was statistically significant between two groups (P=0.007). The median postoperative length of hospital stay was significantly shorter in the double U-stitch 2.0 group than that in the double U-stitch 1.0 group (11 d vs. 14 d, P=0.001). Conclusions The modified “double U-stitch pancreaticojejunostomy” can significantly reduce the incidence of clinically relevant pancreatic fistula and other relevant severe complications, which helps improve the safety of the procedure.

Objective To construct and validate an effective prognostic nomogram for the patients with incidental gallbladder cancer(IGBC). Methods The clinical data of 161 patients with IGBC requiring radical surgery admitted to the First Affiliated Hospital of Xi’an Jiaotong University from May 2011 to October 2022 was analyzed retrospectively. COX proportional risk regression model was used to screen for influencing factors on overall survival(OS) of IGBC. Nomogram was constructed based on independent influencing factors that affected the prognosis of IGBC patients. The concordance index(C-index) and calibration curve were used to validate the performance of the model. Receiver operating characteristic (ROC) curve analysis and decision curve analysis (DCA) were used to validate the predictive accuracy and net benefit of the plotted column chart. Results Univariate COX regression analysis suggested that age, T stage, N stage, M stage, preoperative carcinoembryonic antigen(CEA), preoperative carbohydrate antigen19-9(CA19-9), preoperative red blood cell volume distribution on width coefficient of variation(RDW-CV), treatment method, and recurrence and metastasis were risk factors which affected the long-term survival of IGBC patients after radical surgery. Multivariate COX regression analysis suggested that T stage, N stage, preoperative CA19-9， preoperative RDW-CV, preoperative AST， treatment methods, and recurrence and metastasis were independent risk factors which affected the prognosis of IGBC patients. The C-index of the constructed prognostic model was 0.872. The calibration plot demonstrated good performance of the Nomogram. ROC curve analysis showed an area under the curve of 0.869, confirming a high sensitivity and specificity. A high net benefit was proven by DCA. Conclusions The constructed Nomogram can accurately and intuitively predict the survival probability of IGBC patients after radical surgery.

Pancreatic cancer has a very poor prognosis. Early diagnosis and treatment are especially critical for improving its prognosis. Nanotechnology has been widely used in the diagnosis and treatment of pancreatic cancer. Relying on the unique physicochemical properties of nanoparticles and their rich surface modifications, effective enrichment of tumor sites can be achieved. Magnetic iron oxide nanoparticles (MIONPs) is one of the commonly used nanomaterials in the diagnosis and treatment of pancreatic cancer, and has good biocompatibility. Through special surface modification, it can be used in targeted diagnosis and treatment of pancreatic cancer. MIONPs can be used as a contrast agent for MRI, and by modifying the surface, they also can be used in targeted imaging of pancreatic cancer. And they can also be modified as a drug delivery system to achieve targeted delivery of drugs and improve therapeutic effects. However, the application of MIONPs in pancreatic cancer diagnosis and treatment still faces some challenges, such as nanotoxicity and cost issues. With the development of technology, MIONPs are expected to play an important role in the personalized diagnosis and treatment of pancreatic cancer.

Pancreatic adenocarcinoma, a severe digestive malignancy, is characterized by its poor prognosis. The National Comprehensive Cancer Network (NCCN) persistently refines its guidelines, integrating cutting-edge evidence-based medical insights to standardize the diagnostic and therapeutic strategies of pancreatic adenocarcinoma. The NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma were updated twice on May 4 and June 19, 2023, respectively. Compared to the 2022 predecessor, these two updates placed a particular emphasis on immunotherapy/targeted therapy, the introduction of NALIRIFOX regimen, and supplementary treatment protocols for patients with intermediate performance status. This article provided an interpretation of the latest updates to the NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma, integrating relevant evidence-based medical findings.

This ENETS guidance for well-differentiated nonfunctioning pancreatic neuroendocrine tumours (NF-Pan-NET), which published on Journal of Neuroendocrinology (2023), has been developed by a multidisciplinary working group, and provides up-to-date and practical advice on the management of these tumours. In this guideline, the authors discussed 10 troublesome questions about clinical practice, and summarized the extensive experience of their centers treating patients with NF-Pan-NET, and suggested that multidisciplinary participation is an essential part of NF-Pan-NET diagnosis and treatment. This paper aims to interpret the key contents of the guidelines in order to provide standardized clinical diagnosis and treatment procedures in NF-Pan-NET.

Objective To explore the clinical application value of simple resection in the treatment of pancreatic solid pseudopapillary tumor(SPT). Methods Retrospective analysis of clinical and follow-up data of pancreatic SPT patients who underwent simple pancreatectomy and conventional pancreatectomy from January 2015 to December 2022 in the pancreatic cystic tumor database of Huashan Hospital, Fudan University. A total of 87 patients with pancreatic SPT, including 14 cases underwent simple resection and 73 cases underwent conventional resection, were included. The average age was (36.2±11.7) years old, and females accounting for 87.4%. Results The accuracy of preoperative imaging diagnosis reached 88.5%. Simple resection had a significant advantage over conventional resection in terms of surgical time [(138.3±56.4) min vs. (241.2±89.2) min, P

Objective To investigate the risk factors of early thromboembolism after pancreaticoduodenectomy with vein reconstruction. Methods The results of bedside ultrasonography and clinical data of 90 patients from Ruijin Hospital, Shanghai Jiao Tong University School of Medicine who underwent pancreaticoduodenectomy with vein reconstruction within 7 days after operation between Janurary 2018 and September 2021 were analyzed retrospectively. According to the results of bedside ultrasound examination of the patency of portal vein, the postoperative patients were divided into portal vein patency group and portal vein embolization group. The hemodynamic differences of bedside ultrasound and the influencing factors of postoperative portal vein thromboembolism were compared. Results Among 90 patients underwent bedside ultrasound, 8 patients had portal vein thromboembolism after pancreaticoduodenectomy with vein reconstruction, and the incidence rate was 8.89%. Bedside ultrasound showed that the velocity and flow of portal vein in patients with portal vein thromboembolism decreased significantly (P

Endoscopic resection (ER) and laparoscopic surgery are the main methods for treatment of early gastric cancer (EGC). Radical gastrectomy(RG) and lymph node dissection are required for the patients who don’t meet the indications of ER, but it may cause postoperative stomach dysfunction and reduce quality of life (QOL). Pylorus-preserving gastrectomy (PPG) is one of the function-preserving gastrectomy for EGC. The short-term complications of PPG are equal to that of RG and it is also beneficial to long-term nutritional status and QOL. The 5-year survival rate of PPG is similar to that of distal subtotal gastrectomy (DSG) according to a retrospective study of the matched cohort. But delayed gastric emptying (DGE) is a common problem in the short and long term after PPG. The limited lymph node dissection of PPG makes its application not widely promoted. Sentinel node navigation surgery (SNNS) may provide more personalized and minimally invasive surgery, in order to preserve the gastric function to the maximum extent.

Due to the characteristics of the insidious onset, difficult early diagnosis and high malignancy of pancrea-tic cancer, only a minority of patients still have the chance of surgical resection at the time of diagnosis. In recent years, chemotherapy-based preoperative neoadjuvant therapy has been increasingly applied to pancreatic cancer without distant metastases to help achieve tumor downstaging, increase R0 resection rate and improve patient survival. A large number of clinical trials have proven the advantages of neoadjuvant therapy for pancreatic cancer, but there are still many issues to be gradually addressed by further research to reach a consensus.

Pancreatic cancer is a high malignant tumor with insidious onset, early metastasis, and extremely poor prognosis. How to improve the early diagnosis and the prognosis of the patients is the current research focus. Although traditional surgical resection may improve the prognosis of some patients, the long-term effect is still poor. Biological benefit is the new mode of pancreatic cancer treatment, and it is crucial to do the whole process monitoring, precisely make the treatment plan and predict the effect under this mode. Artificial intelligence technology, with its powerful data processing and image recognition functions and high learning efficiency, can help to build relatively perfect prediction models with the cooperation of multidisciplinary experts, assist clinicians to make optimal plans, and make the pancreatic cancer patients benefit from precision medicine and individualized therapy.

As a systemic disease, pancreatic cancer is highly malignant and has a high rate of recurrence and metastasis, which makes it particularly difficult in diagnosis, treatment and management. In recent years, with the concept of neoadjuvant therapy deeply rooted in the hearts of the people, the treatment of pancreatic cancer has increasingly emphasized the development of comprehensive and individualized treatment schemes in the whole process and multi-dimensional management of pancreatic cancer patients. However, there still remain many controversies about the application of neoadjuvant therapy for resectable pancreatic cancer. This review intended to discuss the hot topics and related controversies in the implementation of neoadjuvant therapy for patients with resectable pancreatic cancer based on domestic and foreign guidelines and the latest research progress, which may vastly promote the standardized application of neoadjuvant therapy for resectable pancreatic cancer.

Intraductal papillary mucinous neoplasm (IPMN) of the pancreas is an important precancerous lesion to pancreatic ductal adenocarcinoma. Clinical decisions in the diagnosis and treatment of IPMN are foremost based on a profound understanding of the related pathology of IPMN. Systematic literature reviews were conducted around four aspects of macroscopic examination, microscopic examination, molecular detection and differential diagnosis of IPMN. This review provided updated perspectives on gross types, histological grades and differentiation subtypes, the composition pattern and histological classification of IPMN with invasive carcinoma, the molecular research of IPMN and important differential diagnosis. This analysis confirms the heterogeneity and heterochronous in IPMN, laying the foundation for finding new method to help clinicians developing appropriate diagnosis and treatment plans.

The incidence of colonic diverticular disease is increasing significantly and is showing a trend of youthfulness. The treatment of colonic diverticulum disease mainly involves drugs, including antibiotics, rifaximin, and mesalazine. In addition, probiotics and dietary fiber are believed to have a positive impact on the treatment of diverticular diseases. When it progresses to acute complicated diverticulitis, surgical treatment becomes a necessary means. Up to now, our country has not formulated standards and guidelines of the diagnosis and treatment for colonic diverticulitis.

Thyroid carcinoma in children and young adolescent is a special type of thyroid carcinoma, which has received more and more attention. In recent years, confusion and difficulties continue to emerge in understanding the disease. This article reviewed these clinical challenges and summarized recent research progress at home and abroad, with a view to identifying valuable opportunities to improve the diagnosis and treatment of thyroid carcinoma in children and young adolescents.

Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography (ERCP) through a network meta-analysis. Methods Randomized controlled trials (RCTs) that compared the efficacy of different adjunctive methods (early or late needle-knife technique, pancreatic guidewire-assisted technique, pancreatic stent-assisted technique, transpancreatic sphincterotomy, persistent standard cannulation technique) for difficult biliary cannulation with each other were identified. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA) for all methods were performed. Results Eighteen RCTs were identified according to selection criteria, and 2 033 patients were enrolled. The use of transpancreatic sphincterotomy over persistent standard cannulation technique (RR=1.34, 95% CI: 1.02-1.77) and over pancreatic guidewire-assisted technique（RR=1.26, 95% CI: 1.00-1.60）significantly increased the success rate of biliary cannulation. Based on SUCRA ranking, transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation. Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique (RR=0.53, 95％CI: 0.30-0.94), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR=0.41， 95％CI: 0.17-0.99; RR=0.49， 95％CI: 0.25-0.96; respectively). Based on SUCRA ranking, early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation. Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP; early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation.

The incidence of thyroid tumors has been increasing recent years, the importance of quality of life has been more concerned in addition to radical treatment. Traditional open surgery has been unable to meet the needs of all patients. In recent years, the continuous innovation and vigorous development of minimally invasive techniques, including endoscopy, ablation, and robotics, have expanded the range of available surgical options. In this review, we summarized the advancements in minimally invasive surgery for thyroid tumors, focusing on how to select the most appropriate surgical approach based on the patient's condition and develop personalized treatment plans.

Advanced differentiated thyroid carcinoma (ADTC) lacks effective treatment options, and has a poor prognosis, which is an urgent clinical problem to be resolved. Targeted multikinase inhibitor(MKI) has been approved for the treatment of radioiodine refractory differentiated thyroid carcinoma, and have recently been recommended as a preoperative neoadjuvant therapy agents for locally ADTC. Although radioiodine therapy is the standard postoperative treatment for ADTC, it has certain limitations. MKI combined with radioiodine therapy is expected to become a new strategy of treatment for ADTC.

Secondary hyperparathyroidism is one of common complications of long-term dialysis patients. Although medical treatment schemes such as calcimimetics and vitamin D analogues can be selected, patients refractory to drug treatment can still refer to parathyroidectomy as a treatment choice. At present, the surgical treatment include subtotal parathyroidectomy, total parathyroidectomy with or without auto-transplantation and purge parathyroidectomy. Because the etiology of this disease is related to hyperplasia of parathyroid tissue stimulated with metabolic disorder of calcium, phosphorus and vitamin D in dialysis patients, the course of disease and target indexes of surgical treatment might still be difficult to control, and there still lies controversies in surgical therapeutic strategy. However, with updating of clinical data, the emergence of new concepts and the introduction of new technologies, reasonable drug selection and appropriate timing of surgical intervention will further improve the treatment efficacy and safety.

Objective To evaluate the clinical efficacy of comprehensive treatment for synchronous primary advanced gastric and esophageal cancer by propensity score matching (PSM). Methods A total of 2 551 patients with advanced gastric cancer admitted to Jiangsu Province Hospital of Chinese Medicine from January 2013 to December 2022 were retrospectively analyzed. Among them, 45 patients with synchronous primary esophageal cancer were distributed to the observation group, and 2 506 patients without esophageal cancer were distributed to the control group. Through the PSM method, the control group was matched with the observation group and the equilibrium samples of covariates between two groups were obtained. The overall survival(OS) between the two groups were compared. Results Both observation and control group contained 45 patients in this study. According to the treatment regimen, the patients in the observation group was divided into radical resection treatment subgroup (n=22) and chemoradiotherapy (CRT) subgroup (n=23). In the radical resection subgroup, 4 patients underwent the simultaneous surgical resection of gastric and esophageal tumors through proximal gastrectomy with the Ivor Lewis operation. Eighteen patients underwent endoscopic submucosal dissection(ESD) of their esophageal tumors and gastric cancer radical resection. Radical resection of gastric cancer combined with preoperative chemoradiotherapy of esophageal cancer was performed in the CRT subgroup. Survival analysis showed that OS in the observation group was significantly shorter than that in the control group (P=0.042) and there was no significant difference in OS between the radical resection subgroup and the control group (P=0.799). The 1 -, 3 -, and 5-year survival rates of the patients in the CRT subgroup were significantly lower than those of the control group (P=0.003). While the 1 -, 3 -, and 5-year survival rates of the patients in the radical resection subgroup were not statistically significant, compared to those of the CRT subgroup (P=0.071).Conclusions Multidisciplinary and comprehensive treatment can significantly improve the prognosis of patients with synchronous primary advanced gastric and esophageal cancer. Radical resection of gastric cancer combined with ESD of esophageal cancer is an optional treatment for patients with gastric cancer complicated with early esophageal cancer. Radical resection of gastric cancer combined with CRT of esophageal cancer can improve the prognosis of patients with advanced gastric cancer complicated with unresectable esophageal cancer.