中华胃肠外科杂志最新文献

{"title":"[Application and short-term efficacy of Da Vinci Xi robot-assisted transabdominal division of the rectourethralis muscle in ultra-low anastomosis surgery for low rectal cancer].","authors":"G Hu, Y H Wang, Z D Xing, J B Du, J Q Tang","doi":"10.3760/cma.j.cn441530-20260512-00196","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260512-00196","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the safety and short-term outcomes of Da Vinci Xi robot-assisted transabdominal division of the rectourethralis muscle (TaRUMD) in ultralow sphincter-preserving surgery for low rectal cancer. <b>Methods:</b> This was a retrospective observational study. The inclusion criteria were as follows: (1) male patients aged 18-75 years; (2) pathologically confirmed rectal adenocarcinoma without distant metastasis that could not be radically resected; (3) tumor located ≤3 cm from the anal verge, with the main tumor body on the anterior wall; (4) good preoperative anal function; (5) no invasion of the anal sphincter complex; and (6) American Society of Anesthesiologists (ASA) score ≤3. Exclusion criteria: (1) signet-ring cell carcinoma, mucinous adenocarcinoma, and other poorly differentiated tumors; (2) delayed anastomosis procedures, such as the modified Bacon procedure; (3) preoperative anal sphincter dysfunction; (4) tumor invasion into adjacent organs.The clinical data of 25 male patients with low rectal cancer who underwent Da Vinci Xi robot-assisted transabdominal division of the rectourethralis muscle for ultralow sphincter preservation performed by the same surgical team of the Department of Colorectal Surgery, National Cancer Center / Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between March and September 2025 were retrospectively collected. The patients had a mean age of (53.2±11.7) years, a mean body mass index (BMI) of (24.7±2.3) kg/m², and a mean distance from the tumor to the anal verge of (2.3±0.2) cm. Intraoperative and postoperative recovery, complications, and 3-month follow-up outcomes were analyzed. Surgical technique: All operations were completed with the Da Vinci Xi robotic system. After division of the main trunk or branches of the inferior mesenteric artery, the rectum was mobilized to the levator ani plane following the principle of total mesorectal excision (TME). The posterior intersphincteric space was exposed at the 4-5 o'clock and 7-8 o'clock positions in the lithotomy position, and the hiatal ligament at the 6 o'clock position was divided to expose the posterior half of the intersphincteric space. The intersphincteric space was then dissected anteriorly in a clockwise direction from the 9 o'clock position on the left side and counterclockwise from the 3 o'clock position on the right side to expose the rectourethralis muscle, which was divided close to the anterior rectal wall using Maryland bipolar forceps, thereby fully exposing the anterior half of the distal intersphincteric space with positive perineal transillumination. Depending on the tumor size and circumferential extent, the distal rectum was divided transabdominally or after eversion, followed by coloanal anastomosis. <b>Results:</b> All 25 male patients with anterior-wall low rectal cancer successfully underwent Da Vinci Xi robot-assisted TaRUMD, with no intraoperative complications s","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1245-1252"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274025","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interpretation of the 2025 annual report of the Chinese Obesity and Metabolic Surgery database: evolving procedures and multiple therapeutic approaches].","authors":"Y Liu, W H Chen, S W Jiang, R X Hu, S H Hu, C C Wang","doi":"10.3760/cma.j.cn441530-20260824-00319","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260824-00319","url":null,"abstract":"<p><p>Metabolic and bariatric surgery remains one of the most effective interventions for obesity, and the operative procedures continue to evolve. The 2025 annual report of the Chinese Obesity and Metabolic Surgery (COMES) database shows that an estimated 40 059 metabolic and bariatric procedures were performed in China in 2025, representing a 23.9% increase over 2024 and reaching an all-time high. Sleeve gastrectomy (SG) remained the predominant procedure, accounting for 81.1%. The number of sleeve gastrectomy with transit bipartition (SG-TB) procedures doubled, making it the second most commonly performed operation. Revisional surgery increased by 55.3%, and endoscopic bariatric therapies rose from 158 to 593 cases. The continued growth in surgical volume amid the rapid advances in anti-obesity pharmacotherapy indicates that medications and surgery are not mutually exclusive, zero-sum alternatives. Based on the annual report and the latest clinical evidence, this commentary addresses three topics: the synergy between pharmacotherapy and surgery, the evolution of SG-based combined procedures and revisional surgery, and the clinical positioning of endoscopic therapies and surgical approaches. We analyze the current trends and challenges in metabolic and bariatric surgery, aiming to inform individualized management and support the high-quality development of the field in China.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1189-1195"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy and safety of GLP-1 receptor agonists combined with bariatric surgery for obesity: a timing-stratified systematic review].","authors":"M C He, R Hua, Y K Shao, B Xu, Q W Shen, X J Fu, C W Zhan, X J Huang, Q Y Yao","doi":"10.3760/cma.j.cn441530-20260715-00287","DOIUrl":"10.3760/cma.j.cn441530-20260715-00287","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To systematically evaluate the efficacy and safety of GLP-1 receptor agonists applied at different stages before and after bariatric surgery, and to compare the clinical benefits of preoperative use, early postoperative use, and rescue use after insufficient weight loss or weight regain according to medication timing. &lt;b&gt;Methods:&lt;/b&gt; PubMed, Web of Science, and Embase via Ovid were searched from inception to June 20, 2026. A relatively strict three-concept search strategy was used, consisting of terms related to bariatric surgery, GLP-1 receptor agonists and specific drug names, and perioperative or weight-management scenarios. Searches were mainly restricted to title and abstract fields, and animal-only studies were excluded. Clinical studies involving patients who underwent metabolic and bariatric surgery and received GLP-1 receptor agonists before or after surgery were included. Studies were classified into three groups according to medication timing: preoperative use, early postoperative use, and rescue use after insufficient weight loss or weight regain. Mean difference or standardized mean difference was used for continuous variables, and odds ratio was used for categorical variables. Meta-analysis was performed using a random-effects model. &lt;b&gt;Results:&lt;/b&gt; A total of 27 studies were included in the systematic review, including 10 studies on preoperative use, 4 on early postoperative use, and 13 on rescue use after insufficient weight loss or weight regain. Among them, 13 studies were included in efficacy meta-analyses. Preoperative use of GLP-1 receptor agonists improved preoperative weight loss, with a pooled SMD of 0.52 (95%CI: 0.25-0.79, &lt;i&gt;I²&lt;/i&gt;=0%, &lt;i&gt;P&lt;/i&gt;&lt;0.05). However, when postoperative weight loss at 12 months was assessed using body weight at surgery as the baseline, the percentage of total body weight loss at 12 months was 2.85 percentage points lower in the preoperative medication group than in the non-medication group (95%CI: -4.35 to -1.36, &lt;i&gt;I²&lt;/i&gt;=37.7%, &lt;i&gt;P&lt;/i&gt;&lt;0.05). Active addition of GLP-1 receptor agonists around 1 month after surgery increased the percentage of total body weight loss at 6 months by an additional 3.62 percentage points (95%CI: 1.88-5.37, &lt;i&gt;I²&lt;/i&gt;=0%, &lt;i&gt;P&lt;/i&gt;&lt;0.05). Initiation of GLP-1 receptor agonists around 6 months after surgery resulted in an additional weight loss of 7.48 kg during subsequent follow-up compared with controls (95%CI: 5.35-9.60, &lt;i&gt;I²&lt;/i&gt;=34.6%, &lt;i&gt;P&lt;/i&gt;&lt;0.05). For rescue therapy, four randomized controlled trials showed that GLP-1 receptor agonists resulted in an additional 10.30 percentage points of endpoint percentage weight loss compared with placebo or usual care (95%CI: 6.40-14.20, &lt;i&gt;I²&lt;/i&gt;=89.2%, &lt;i&gt;P&lt;/i&gt;&lt;0.05). Regarding safety, among studies that clearly reported event numbers, the pooled incidences of nausea, constipation, diarrhea, and vomiting were 25.3%, 19.0%, 9.2%, and 8.6%, respectively. Serious adverse events were uncommon. &lt;b&gt;Conclus","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1253-1266"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274090","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Trends in the treatment of obesity: from single modality to combination therapy].","authors":"P Zhang, Z T Zhang","doi":"10.3760/cma.j.cn441530-20260827-00327","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260827-00327","url":null,"abstract":"<p><p>The medical treatment of obesity includes pharmacotherapy, interventional therapy with medical devices, and metabolic and bariatric surgery. With the advancement in understanding of obesity and its treatment goals, the combined application of multiple therapeutic modalities-particularly the combination of bariatric surgery and pharmacotherapy based on a foundation of healthy lifestyle and behavioral management for severe and extreme obesity-represents an effective future solution. This includes the use of anti-obesity medications before bariatric surgery to reduce surgical difficulty and perioperative risks, and the use of anti-obesity medications as adjunctive therapy after bariatric surgery to further improve both short- and long-term treatment outcomes. However, specific combination regimens, including the timing of medication initiation, drug selection, and duration of treatment, await further clinical investigation. Targeted therapy and immunotherapy for obesity should be future research hotspots and hold promise as breakthrough points in the clinical management of obesity.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1196-1199"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274104","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Effect of gastric cancer respiratory prehabilitation-based comprehensive management on postoperative pulmonary complications: a real-world prospective cohort study].","authors":"C L Yang, J D Liu, P L Jin, B T Ye, X Y Liu, B S Li, Z D Sun, J J Zhao, H J Li, Y H Sun, X F Wang","doi":"10.3760/cma.j.cn441530-20251025-00402","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20251025-00402","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the effect of respiratory prehabilitation-based comprehensive management on the prevention of postoperative pulmonary complications in patients with gastric cancer and to explore associated factors, thereby providing evidence for the design and implementation of prehabilitation programs. &lt;b&gt;Methods:&lt;/b&gt; This was a real-world prospective cohort study. Patients who underwent radical gastrectomy for gastric cancer at Zhongshan Hospital, Fudan University, between July and November 2021 were eligible if postoperative pathological examination confirmed gastric adenocarcinoma, no other malignancy was present, and written informed consent was obtained. Patients requiring combined organ resection other than cholecystectomy, those with a history of thoracic surgery, and those unable to complete pulmonary function assessment were excluded. A total of 582 patients were included, comprising 273 in the prehabilitation group and 309 in the non-prehabilitation group. Patients in the prehabilitation group underwent a respiratory management-centered prehabilitation program starting 2-4 weeks before surgery, including health education, breathing exercises, and effective coughing training, with airway clearance, optimization of respiratory medications, nutritional support, and psychological intervention provided as clinically indicated. Patients in the non-prehabilitation group received routine perioperative care. The primary outcome was the occurrence and Clavien-Dindo grade of pulmonary complications within 30 days after surgery, with grade II or higher pulmonary complications defined as the primary event for analysis. Secondary outcomes included overall postoperative complications and their Clavien-Dindo grades within 30 days, treatment and outcomes of pulmonary complications, as well as time to nasogastric tube removal and postoperative length of stay as recovery-related outcomes. &lt;b&gt;Results:&lt;/b&gt; Compared with the non-prehabilitation group, the prehabilitation group had earlier nasogastric tube removal [45 (28, 69) hours vs. 88 (43, 118) hours, &lt;i&gt;Z&lt;/i&gt;=-6.851, &lt;i&gt;P&lt;/i&gt;&lt;0.001], a lower incidence of postoperative complications of Clavien-Dindo grade II or higher [8.4% (23/273) vs. 17.8% (55/309), χ²=10.975, &lt;i&gt;P&lt;/i&gt;&lt;0.001], and lower Clavien-Dindo grades of overall postoperative complications (&lt;i&gt;Z&lt;/i&gt;=-3.306, &lt;i&gt;P&lt;/i&gt;&lt;0.001). The incidence of pulmonary complications of Clavien-Dindo grade II or higher was also lower in the prehabilitation group [7.7% (21/273) vs. 15.9% (49/309), &lt;i&gt;χ&lt;/i&gt;²=9.133, &lt;i&gt;P&lt;/i&gt;=0.003], as were the Clavien-Dindo grades of pulmonary complications (&lt;i&gt;Z&lt;/i&gt;=-3.018, &lt;i&gt;P&lt;/i&gt;=0.003). Multivariable logistic regression analysis showed that prehabilitation was independently associated with a lower risk of pulmonary complications of Clavien-Dindo grade II or higher (OR=0.416, 95%CI:0.237-0.730, &lt;i&gt;P&lt;/i&gt;=0.002). Compared with distal gastrectomy, total gastrectomy (OR=3.143, 95%CI:1.750-5.644, &lt;i&gt;P&lt;/i&gt;&lt;0.001) a","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1227-1236"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274129","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Efficacy and safety of endoscopic treatment for anastomotic leakage following colorectal surgery: a systematic review].","authors":"S Y Zheng, Y Wang, C M Zhang, S Y Li, L Q Ji, C Xin, Z Lou","doi":"10.3760/cma.j.cn441530-20251208-00469","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20251208-00469","url":null,"abstract":"<p><p><b>Objective:</b> This study aims to synthesize relevant literature on endoscopic treatment of anastomotic leakage after colorectal surgery, and evaluate the safety and efficacy of endoscopic therapies including over-the-scope clip (OTSC), endoscopic vacuum therapy (EVT) and covered stent for anastomotic leakage (AL) following colorectal surgery, so as to provide evidence-based support for clinical decision-making. <b>Methods:</b> Relevant studies on endoscopic treatment of AL after colorectal surgery were retrieved from Chinese and English databases. Two researchers independently screened the literature, extracted data, and assessed the risk of bias. Given the significant clinical and methodological heterogeneity among the included studies, a meta-analysis was not performed, and a narrative synthesis was adopted to summarize the results. <b>Results:</b> A total of 38 studies involving 679 patients were included.In the OTSC group (10 studies, 81 patients), the clinical cure rate ranged from 57.1% to 100%.In the EVT group (20 studies, 452 patients), the clinical cure rate was 55.3%-100%, with a wide variation in healing time (1-114 days). In the covered stent group (8 studies, 146 patients), the clinical cure rate was 71.4%-100%; however, the incidence of device-related complications such as stent migration was relatively high. <b>Conclusions:</b> Endoscopic treatment is a feasible minimally invasive strategy for AL after colorectal surgery. OTSC, EVT and covered stents each have their own indications and complication profiles. Clinical selection should be individualized based on the defect characteristics and patient condition.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1267-1274"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Application of the 'page-turning' technique for lateral lymph node dissection along the internal iliac vessels in middle and lower rectal cancer].","authors":"H P Tang, W W Xiong, W Wang, J Li, H S Tang, Y H Peng, J H Wang, Z J Zhang, L J Luo, F H Hong, H J Zhou, W Q Zou","doi":"10.3760/cma.j.cn441530-20260324-00129","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260324-00129","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the feasibility, safety, and short-term efficacy of the \"page-turning\" technique for lateral lymph node dissection (LLND) along the internal iliac vessels in middle and lower rectal cancer. &lt;b&gt;Methods:&lt;/b&gt; This study employed a descriptive case series research approach. A retrospective analysis was performed on the clinical data of 45 patients with middle and lower rectal cancer who underwent \"page-turning\" lateral lymph node dissection along the internal iliac vessels between January 2020 and November 2025. Surgical steps: 1) Establishing the medial boundary: The posterior peritoneum is opened along the ureter, and dissection is carried caudally to the superior vesical artery. The obturator internus muscle is exposed, the distal umbilical artery is divided, and the medial boundary is established. 2) Establishing the lateral boundary: Dissection proceeds along the medial border of the external iliac vessels, exposing the iliopsoas muscle and obturator internus as the lateral boundary, with Cooper's ligament and the obturator foramen identified caudally. 3) The lymphoadipose tissue in the obturator fossa is cleared with careful preservation of the obturator nerve. 4) \"Page-turning\" dissection of No. 263 lymph nodes: Beginning at the bifurcation of the common iliac artery, the lymphoadipose tissue is dissected en bloc from cephalad to caudad using a \"page-turning\" technique. The anterior trunk branches of the internal iliac artery are sequentially divided - the umbilical artery is addressed first, followed by ligation of the obturator artery - to expose the root of the superior vesical artery. Skeletonization continues along the root of the superior vesical artery, and a gauze is placed at the entry point of the internal pudendal artery into Alcock's canal as a landmark. Dissection then advances along three key anatomical landmarks: the ureter traced cephalad to the ureterovesical junction, the Retzius space developed caudally, and the entry of the internal pudendal artery into the pudendal canal serving as the inferior boundary. The vesical vessels are sequentially divided from anterior to posterior in close proximity to the bladder wall. The No. 263d and No. 263p lymph nodes are resected en bloc, completing thorough skeletonization of the No. 263 lymph nodes. Operative time, intraoperative blood loss, number of lymph nodes dissected, postoperative complications, functional recovery, and short-term oncological outcomes were evaluated. &lt;b&gt;Results:&lt;/b&gt; All 45 patients successfully completed the operation without conversion to open surgery or perioperative mortality. The total operative time was (320.8±82.1) minutes, the lateral dissection time was (70.8±34.2) minutes, and the intraoperative blood loss was 50 (20, 100) ml. The time to first flatus was (2.1±0.9) days, the time to pelvic drain removal was (5.2±2.7) days, and the median postoperative hospital stay was 8 (&lt;i&gt;Q1&lt;/i&gt;,&lt;i&gt;Q3&lt;/i&gt;: 6, 11) days. According ","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1237-1244"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274085","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Attention to the diagnosis and treatment of non-cirrhotic hyperammonemic encephalopathy after bariatric surgery].","authors":"S Lu, B Xu, Q Y Yao, Y K Shao","doi":"10.3760/cma.j.cn441530-20260512-00197","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260512-00197","url":null,"abstract":"<p><p>Bariatric and metabolic surgery has become an effective intervention for the treatment of severe obesity and type 2 diabetes mellitus, whose long-term efficacy and safety have been confirmed by substantial evidence-based medical data. However, with the annual increase in surgical volume, a series of rare but severe metabolic complications have been gradually recognized. Among them, non-cirrhotic hyperammonemia has attracted extensive attention due to its insidious onset, rapid progression and high mortality. Hyperammonemia after bariatric surgery is mainly characterized by significantly elevated blood ammonia and neuropsychiatric symptoms, with mostly normal liver function, and is easily misdiagnosed as cerebrovascular accident or psychiatric disorder. This article systematically reviews the clinical research progress of hyperammonemia after bariatric surgery in terms of epidemiology, clinical manifestations, pathogenesis, treatment and long-term management, aiming to improve clinicians' ability to identify and manage this disease, and reduce the risks of missed diagnosis, misdiagnosis and death.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1279-1282"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Renal function assessment and procedure selection in metabolic and bariatric surgery].","authors":"Z Yan, F Xiong, J Y Xu, F Xie, B Q Yang, Y Shen, H Qin, L Chen, S H Zhu","doi":"10.3760/cma.j.cn441530-20260720-00290","DOIUrl":"10.3760/cma.j.cn441530-20260720-00290","url":null,"abstract":"<p><p>Obesity is an important risk factor for the development and progression of chronic kidney disease (CKD), whereas CKD may increase perioperative risk in patients undergoing metabolic and bariatric surgery. Surgical procedures differ in their effects on acute kidney injury, volume depletion, nephrolithiasis, enteric hyperoxaluria, nutritional status, and immunosuppressant exposure; therefore, kidney function assessment is essential for risk stratification and procedure selection. In patients with obesity, serum creatinine and cystatin C may be affected by muscle mass, adiposity, and inflammation, while body surface area indexing and postoperative changes in body composition may further complicate the interpretation of estimated glomerular filtration rate. Preoperative evaluation should establish whether kidney abnormalities are chronic and should include creatinine-based estimated glomerular filtration rate and the urine albumin-to-creatinine ratio as initial assessments. Measurement of cystatin C, measured glomerular filtration rate, or 24-hour urine analysis may be added when clinically indicated. Procedure selection should integrate CKD stage, albuminuria category, the trajectory of kidney function, previous acute kidney injury, the risk of nephrolithiasis or hyperoxaluria, dialysis and kidney transplantation plans, and the need for metabolic and antireflux efficacy. Sleeve gastrectomy is generally favored in patients with advanced CKD, those receiving dialysis, kidney transplant candidates, and patients at high risk of hyperoxaluria. Roux-en-Y gastric bypass may be considered after multidisciplinary assessment in patients with stable kidney function, low stone risk, and a greater need for metabolic or antireflux effects. Postoperative kidney function should be evaluated in conjunction with changes in body composition, albuminuria, glomerular hyperfiltration, and kidney-related clinical events. This review summarizes kidney function assessment, procedure selection, and postoperative reassessment in patients undergoing metabolic and bariatric surgery.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1200-1206"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274093","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Evolution of later-line treatment strategies for advanced colorectal cancer: seeking balance between survival benefit and quality of life].","authors":"L Liu, X L Liu","doi":"10.3760/cma.j.cn441530-20260323-00127","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260323-00127","url":null,"abstract":"<p><p>Later-line treatment for metastatic colorectal cancer (mCRC) has shifted from purely pursuing survival prolongation to a chronic disease management model that balances survival with quality of life (QoL). Conventional line-by-line drug sequencing faces efficacy plateaus and tolerability challenges, necessitating an integrated precision framework combining biological stratification, dynamic monitoring, and multimodal therapy. This review synthesizes four evolving domains in later-line management. In systemic therapy, cross-line use of antiangiogenic agents (bevacizumab, anlotinib), trifluridine/tipiracil combination regimens, immunotherapy breakthroughs in MSI-H/dMMR populations, and targeted rechallenge strategies have demonstrated clinical value. Locoregional therapy integration offers salvage options for oligometastatic patients through selective internal radiation therapy (SIRT) of liver metastases, pressurized intraperitoneal aerosol chemotherapy (PIPAC), and stereotactic body radiotherapy (SBRT). Precision stratification builds an end-to-end care pathway via circulating tumor DNA (ctDNA) trajectory monitoring, body composition assessment, and molecular biomarkers. Special population management addresses individualized considerations for elderly frail patients and early-onset colorectal cancer. The review emphasizes that treatment decisions must balance survival benefit against toxicity burden, prioritizing patient-reported outcomes (PROs), toxicity management, and early integration of palliative support. Future paradigms should establish patient-centered, multidisciplinary continuum-of-care systems that coordinate three pillars: precision molecular profiling to guide therapy selection, rational de-escalation to avoid overtreatment, and supportive care to preserve dignity throughout the disease trajectory.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1283-1289"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}