中华胃肠外科杂志最新文献

{"title":"[Clinical application analysis of remote robot-assisted sleeve gastrectomy and bariatric anti-reflux surgery].","authors":"Z Q Zhou, Aikebaier Aili, L Si, Maimaitijiang Kasimu, Saiyidan Nijiati, Z P Ma, Kelimu Abudureyimu","doi":"10.3760/cma.j.cn441530-20260622-00247","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260622-00247","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the safety and feasibility of remote robot-assisted sleeve gastrectomy with concomitant anti-reflux surgery. <b>Methods:</b> A descriptive case series study was conducted. We retrospectively enrolled 7 patients who underwent remote robot-assisted sleeve gastrectomy with concomitant anti-reflux surgery, which was collaboratively performed by Xinjiang Uygur Autonomous Region People's Hospital (operator side) and Aksu Prefectural First People's Hospital (patient side) from October 2025 to March 2026. Baseline characteristics, intraoperative parameters, intraoperative network performance, and 3 month postoperative followup data were collected. The outcomes analyzed included weight loss efficacy [percentage of excess weight loss (%EWL) and percentage of total weight loss (%TWL)], antireflux effect (GERDQ score), and incidence of complications. <b>Results:</b> A total of 7 patients undergoing remote bariatric surgery were enrolled, including 1 male and 6 females. Among them, 2 patients had a history of previous abdominal surgery, 2 had hypertension, 1 had diabetes mellitus, and 1 had reflux esophagitis. The mean age was (36.4±6.2) years. During remote surgery, the mean latency at the operator side and the patient side were (73.29±3.73) ms; the average packet loss rates were (0.06±0.03)% and (0.02±0.02)% respectively; the mean upload speed before and after master-slave operation were (190.89±81.98) Mbps and (71.22±10.28) Mbps;and the mean download speed before and after master-slave operation were (144.00±58.93) Mbps and (78.13±18.56) Mbps respectively. no operation lag or signal interruption occurred throughout the procedure. The mean preoperative body weight of the patients was (117.57±17.72) kg, and the mean body weight at 3 months postoperatively was (91.66±8.44) kg. The mean preoperative body mass index (BMI) was (41.74±4.48) kg/m², and the mean BMI at 3 months postoperatively was (32.67±2.64) kg/m². The median preoperative GERD-Q score was 8 (interquartile range, <i>Q1, Q3</i>: 6, 11), and the GERD-Q score at 3 months postoperatively was 6 (<i>Q1, Q3</i>: 6, 7). At 3 months after surgery, %TWL was (21.32±6.75)%, and %EWL was (53.47±13.89)%. In terms of postoperative complications, there were 2 cases of dysphagia (water swallowing test [WST] grade ≥ 2), 1 case of constipation, 2 cases of chest pain, 2 cases of alopecia, 2 cases of abdominal distension, and 1 case of vomiting. Among these patients, those with chest pain, abdominal distension, vomiting, and WST grade≥2 dysphagia achieved gradual and spontaneous resolution by 3 months postoperatively, while the symptoms of constipation and alopecia showed no significant improvement. <b>Conclusion:</b> Remote robot-assisted sleeve gastrectomy and sleeve gastrectomy with concomitant anti-reflux surgery are safe and feasible.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 10","pages":"1220-1226"},"PeriodicalIF":0.0,"publicationDate":"2026-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149274132","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":"[Preliminary outcomes of modified Bacon procedure combined with priority intersphincteric- plane dissection via the jack-knife transanal approach for special-type ultra-low rectal cancer].","authors":"K M Lei, J J Chen, J J Zhou, X H Ren, Q Qian, C Q Jiang, W H Chen","doi":"10.3760/cma.j.cn441530-20260211-00082","DOIUrl":"10.3760/cma.j.cn441530-20260211-00082","url":null,"abstract":"<p><p><b>Objective:</b> To explore the feasibility and short-term outcomes of the jackknife position transanal-priority intersphincteric space (ISS) dissection combined with the modified Bacon procedure for special types of ultra-low rectal cancer. <b>Methods:</b> A retrospective observational study was performed. Clinical data of 7 patients with ultra-low rectal cancer who underwent transanal-first ISS dissection combined with modified Bacon technique for staged reconstruction at Zhongnan Hospital of Wuhan University between September 2024 and August 2025 were retrospectively analyzed. The patients were aged (58.3±11.2) years with a body mass index of (23.0±2.9) kg/m². Based on preoperative pelvic MRI measurement, the median distance from the inferior tumor margin to the anal verge was 3.0 (2.4, 3.4) cm. Four patients received neoadjuvant chemoradiotherapy and achieved tumor regression. Among the 7 patients, preoperative imaging and digital rectal examination indicated anterior wall tumor involvement (partial or circumferential) in 6 cases, and tumor located at the right posterior wall in 1 case; one patient was complicated with drug-induced osteonecrosis of the femoral head and could not tolerate the conventional lithotomy position. Perioperative parameters and short-term oncological outcomes were analyzed. <b>Results:</b> All seven patients underwent successful laparoscopic surgery without conversion to open surgery or prophylactic stoma creation. The median operative time was 210 (180, 220) minutes, with intraoperative blood loss of 50 (50, 100) ml. Two perioperative complications occurred, both resolved conservatively. All cases achieved negative circumferential margins with a distal margin distance of 1.0 (0.5, 1.3) cm. Median follow-up was 18 (13, 19) months, with one case showing distant metastasis and no recurrence in the remaining patients. Overall, patients reported satisfactory anal function. <b>Conclusion:</b> The combination of the jackknife position transanal-priority ISS dissection and the modified Bacon procedure is a feasible and safe sphincter-preserving strategy for patients with ultra-low rectal cancer characterized by unfavorable tumor location, challenging anatomy, or high anastomotic risk. It serves as an effective supplementary option for managing such complex cases.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 9","pages":"1166-1172"},"PeriodicalIF":0.0,"publicationDate":"2026-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148991561","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":"[Development and prognostic value of sequential feature reconstruction-based multi-instance learning model for survival prediction of gastric cancer whole-slide images].","authors":"W Ba, C F Cai, B L Zhang, C R Lu, Z G Song, K C Zhang","doi":"10.3760/cma.j.cn441530-20260601-00217","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260601-00217","url":null,"abstract":"<p><p><b>Objective:</b> To construct a survival prognostic prediction model for whole-slide histopathological images (WSIs) of gastric cancer based on multi-instance learning with sequential feature reconstruction, and to explore its predictive value. <b>Methods:</b> Retrospectively collected hematoxylin-eosin stained WSIs and clinical prognostic data of gastric cancer patients treated at the 1st, 8th and 9th Medical Centers of Chinese PLA General Hospital from January 2015 to December 2022. The sample sizes of the three medical centers were 386, 284 and 216 cases, denoted as Dataset 1, Dataset 2 and Dataset 3 respectively. This study developed a multi-instance learning model based on sequential feature reconstruction, named sequence reordering and sparse autoencoder-based enhanced representation transformer for multiple instance learning (S²ERT-MIL). After extracting patch features of pathological images via a pre-trained model, the model reconstructed and optimized patch instance features through sequence reordering, regional feature enhancement, sparse autoencoding and cross-regional information fusion, and finally output patient-level survival risk scores. Five-fold cross-validation was adopted to evaluate model performance, and comparisons were conducted with representative MIL models including Attention-Based Multiple Instance Learning (ABMIL), Clustering-constrained Attention Multiple Instance Learning (CLAM), Dual-Scale Multiple Instance Learning (DSMIL), Dual-Tier Feature Distillation Multiple Instance Learning (DTFD-MIL) and Representation Refinement and Transformation Multiple Instance Learning (RRT-MIL). The concordance index (C-index) was used to assess the survival prediction performance of the model. Patients were divided into high-risk and low-risk groups according to the median risk score, and the Kaplan-Meier method with Log-rank test was applied to evaluate the risk stratification ability. Visualization analysis of high- and low-attention patches was also performed. <b>Results:</b> S²ERT-MIL achieved the highest C-index across all three datasets, with values of 0.7493±0.0486, 0.6758±0.0347 and 0.7232±0.0362 in Dataset 1, Dataset 2 and Dataset 3, respectively, all higher than those of the comparison models. Kaplan-Meier survival analysis showed that S²ERT-MIL stratified patients into high-risk and low-risk groups with significantly different survival outcomes in all three datasets. Attention-region visualization showed that high-attention patches were mainly derived from areas with dense tumor cells, complex tissue architecture or marked stromal reaction, whereas low-attention patches mostly represented low-information regions or areas relatively weakly associated with prognosis. <b>Conclusion:</b> S²ERT-MIL can predict patient survival prognosis based on H&E-stained gastric cancer WSIs and showed favorable risk discrimination and stratification performance across three datasets.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1021-1029"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907234","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 analysis of neoadjuvant avapritinib in patients with platelet-derived growth factor receptor α D842V-mutant gastrointestinal stromal tumors].","authors":"P Zhang, Y Zhou, J Li, H K Tian, Z D Gao, H B Qiu, X Y Wu, X L Jiao, K X Tao","doi":"10.3760/cma.j.cn441530-20250928-00367","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250928-00367","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To evaluate the efficacy of avapritinib as neoadjuvant therapy in gastrointestinal stromal tumor (GIST) with platelet-derived growth factor receptor α (&lt;i&gt;PDGFRA&lt;/i&gt;)- D842V mutation. &lt;b&gt;Methods:&lt;/b&gt; We conducted a retrospective analysis of patients with gastrointestinal stromal tumors harboring the &lt;i&gt;PDGFRA&lt;/i&gt;-D842V mutation who received neoadjuvant treatment with avapritinib. Clinical and pathological data were retrieved from 7 medical institutions [Union Hospital of Tongji Medical College, Huazhong University of Science and Technology (3 cases); Fudan University Shanghai Cancer Center (3 cases); Peking University Cancer Hospital & Institute (2 cases); Peking University People's Hospital (1 case); Sun Yat-sen University Cancer Center (1 case); the First Affiliated Hospital of Chongqing Medical University (1 case); the Affiliated Hospital of Qingdao University (1 case)] from October 2019 to March 2025, including the patients' demographic data, laboratory and imaging findings, neoadjuvant therapy history, operative details, pathologic and genetic testing results, as well as postoperative adjuvant treatment and follow-up information. &lt;b&gt;Results:&lt;/b&gt; After excluding 1 patient with concomitant gastric cancer, 7 patients presenting with distant metastasis at initial diagnosis or a prior history of GIST surgery, and 2 patients with incomplete clinical data, a total of 12 patients with &lt;i&gt;PDGFRA&lt;/i&gt;-D842V mutations who received avapritinib neoadjuvant therapy were enrolled in this study. There were 8 male patients and 4 female patients, with a mean age at diagnosis of (56.0±12.4) years. Among them, 5 cases received a dosage of 300 mg/day, 2 cases received 200 mg/day, 2 cases received 150 mg/day, and 3 cases received 100 mg/day. The maximum tumor diameter before and after neoadjuvant therapy was (15.7±4.9) cm vs. (10.1±4.1) cm, respectively (&lt;i&gt;t&lt;/i&gt;=5.998, &lt;i&gt;P&lt;/i&gt; &lt; 0.001), and the median time to best response was 4.5 (3.3,5.0) months. Among the 12 patients, 9 achieved partial response and 3 achieved stable disease, yielding an overall disease control rate of 100%. Common adverse events included anemia (8 cases), elevated bilirubin (6 cases), periorbital edema (5 cases), leukopenia (4 cases), and decreased neutrophil count (4 cases). Grade ≥3 adverse events occurred in eight patients, primarily anemia (2 cases), elevated bilirubin (2 cases), and leukopenia (1 case). All these adverse events resolved following appropriate supportive management. After achieving maximal response to neoadjuvant therapy, all 12 patients underwent surgical resection with curative intent. The median operative time was 95.0 (82.5, 120.0) minutes, and the median intraoperative blood loss was 50.0 (20.0, 175.0) ml. Among them, 7 patients underwent laparoscopic surgery, and 5 underwent open surgery. A total of 2 patients in the entire cohort underwent combined organ resection, including partial hepatectomy and partial transverse colectomy. The median po","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1067-1072"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907285","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":"[Challenges and strategies for the integration of artificial intelligence and endoscopy: focusing on colonoscopy practice].","authors":"X D Zhao, L Rong","doi":"10.3760/cma.j.cn441530-20260521-00204","DOIUrl":"10.3760/cma.j.cn441530-20260521-00204","url":null,"abstract":"<p><p>Artificial intelligence (AI) has witnessed rapid development in the field of digestive endoscopy, especially for colonoscopy, where its application is the most mature. Based on deep learning algorithms, three major technical systems have been established in clinical practice, including computer-aided detection (CADe), computer-aided diagnosis (CADx), and computer-aided quality assessment (CAQ). Numerous randomized controlled trials have verified its prominent advantages in improving adenoma detection rate, reducing missed diagnosis risks, and assisting pathological prediction. Nevertheless, such benefits have not been fully reproduced in real-world studies, highlighting practical challenges in translating AI efficacy \"validated in laboratories\" into \"usefulness in clinical settings\". Based on clinical practice of colonoscopy, this article systematically reviews the current applications of AI. From the perspectives of inherent technical limitations of AI models and subjective factors in human-machine collaboration, it analyzes the underlying causes limiting the clinical benefits of AI in real-world scenarios. Furthermore, this study proposes a dual strategy of \"exploring scenario-driven differentiated deployment\" and \"optimizing human-machine collaboration\". On one hand, the appropriate application scope of AI should be rationally defined, and differentiated deployment should be carried out according to clinicians' experience levels and clinical scenarios. On the other hand, systematic training is required to help clinicians form scientific understanding and reasonable expectations of AI and establish an efficient human-machine collaboration model, so as to facilitate in-depth integration of AI and endoscopic techniques and promote its wide clinical implementation.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"998-1003"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907225","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":"[Clinical applications and future perspectives of artificial intelligence-enabled surgical robots in gastrointestinal surgery].","authors":"Y Shi, C C Lu, J J Wu","doi":"10.3760/cma.j.cn441530-20260616-00238","DOIUrl":"10.3760/cma.j.cn441530-20260616-00238","url":null,"abstract":"<p><p>Relying on core technologies including deep learning, radiomics and large language models, artificial intelligence (AI) has covered the full workflow of diagnosis and treatment in gastrointestinal surgery. Meanwhile, continuous iteration and large-scale clinical adoption of surgical robots are driving gastrointestinal surgical procedures toward higher precision and minimal invasiveness. The deep integration of artificial intelligence and surgical robots has reshaped the paradigm of gastrointestinal surgical care, facilitating the disciplinary transformation from conventional minimally invasive surgery to digital, intelligent and precise surgery. This paper reviews cutting-edge advances in robot-assisted gastrointestinal surgery empowered by artificial intelligence, analyzes prevailing bottlenecks hindering clinical translation, including insufficient data standardization, algorithm trustworthiness, and incomplete supporting regulatory and ethical frameworks. Combined with the latest domestic and international research outcomes, it prospects future development pathways, providing references for formulating standards and standardized clinical implementation of intelligent technologies in gastrointestinal surgery. The profound combination of AI and surgical robots breaks through the technical limitations of traditional minimally invasive surgery, bringing revolutionary transformations to the advancement of precise and intelligent gastrointestinal surgery. Gastrointestinal surgeons will not be directly replaced by AI in the future; instead, they will be superseded by peers proficient in AI and robotic technologies, and the evolution of gastrointestinal surgery will inevitably be led by AI-competent clinicians. With joint efforts across multiple disciplines, robot-assisted surgery in the AI era will undoubtedly elevate gastrointestinal surgery to an advanced new level.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"985-991"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907266","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 of ripretinib in advanced gastrointestinal stromal tumor and treatment options after resistance: a retrospective real-world study​].","authors":"X N Yin, H X Yang, J Mao, Y H Han, L Y Sun, Y Yin, B Zhang","doi":"10.3760/cma.j.cn441530-20251021-00394","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20251021-00394","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the clinical efficacy, safety, and post-resistance treatment strategies of ripretinib in the treatment of advanced gastrointestinal stromal tumors (GIST), and to provide evidence-based references for optimizing individualized treatment of advanced GIST. &lt;b&gt;Methods:&lt;/b&gt; This is a single-center retrospective real-world study. Inclusion criteria: (1) GIST confirmed by histopathology; (2) disease progression after previous treatment with other targeted drugs including imatinib; (3) continuous administration of ripretinib for more than one month with at least one efficacy evaluation. Exclusion criteria: (1) Clinical data were seriously missing, and data such as patient dosage, efficacy evaluation results, and adverse reactions could not be obtained; (2) complicated with other serious underlying diseases, such as uncontrolled severe cardiovascular and cerebrovascular diseases, liver and kidney failure, etc.; (3) Allergic or severe drug intolerance to ripretinib. According to the above criteria, a total of 93 patients with advanced GIST treated in West China Hospital of Sichuan University from July 2021 to March 2025 were collected. In this study, evaluable patients were defined as those who met any of the following criteria: (1) baseline and follow-up imaging examinations were completed in our center with complete imaging data, and the long diameter of target lesions could be accurately measured and the efficacy could be evaluated; (2) The efficacy evaluation was completed in other hospitals, but the image data and report were complete, and the exact measurement data of target lesions could be obtained after review by the radiology department of our hospital. All patients with advanced GIST enrolled in the study initially received the standard dose of ripretinib (150 mg once daily). After disease progression (PD), the following treatment strategies could be selected after multi-disciplinary team (MDT) discussion: (1) the dose of ripretinib was increased from 150 mg once daily to 150 mg twice daily (ripretinib dose-escalation group); (2) The standard-dose ripretinib (150 mg, once daily) was combined with local treatment, including surgery, interventional therapy and radiotherapy (ripretinib combined with local treatment group); (3) standard-dose ripretinib combined with frontline TKI, including imatinib, sunitinib and regorafenib (ripretinib combined with frontline TKI group); (4) other TKI treatment, including imatinib, sunitinib, regorafenib and avapritinib (other TKI treatment group). The primary outcome was median progression-free survival (mPFS). Secondary outcomes included objective response rate [ORR, the proportion of patients with complete response (CR) or partial response (PR)], disease control rate [DCR, the proportion of patients with CR, PR, or stable disease (SD)], overall survival (OS), and adverse events. &lt;b&gt;Results:&lt;/b&gt; A total of 93 patients with advanced GIST were enrolled. Among 59 evaluable pat","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1058-1066"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907264","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":"[Single-center efficacy analysis of surgical treatment for para-aortic lymph nodes metastasis in colorectal cancer].","authors":"Y W Sun, X J Wang, Z F Chen, Z B Xu, S H Huang, W Z Jiang, H M Lin, Y Huang, P Chi","doi":"10.3760/cma.j.cn441530-20260604-00219","DOIUrl":"10.3760/cma.j.cn441530-20260604-00219","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To explore the feasibility, safety and oncologic value of para-aortic lymph node (PALN) dissection (including open, laparoscopic and robotic approaches) in colorectal cancer patients with clinically suspected PALN metastasis. &lt;b&gt;Methods:&lt;/b&gt; A retrospective observational study was performed. Clinical data of 202 colorectal cancer patients who underwent synchronous PALN dissection at Fujian Medical University Union Hospital between 2011 and 2025 were retrospectively reviewed, including 40 open surgeries, 148 laparoscopic surgeries and 14 robotic surgeries. Perioperative surgical data were collected; postoperative complications were graded by the Clavien-Dindo classification. The metastatic pattern of PALN involvement were analyzed. Logistic regression analysis was performed to identify its risk factors. Survival analysis was conducted using the Kaplan-Meier method, and independent prognostic factors for overall survival (OS) were identified via Cox proportional hazards regression model. &lt;b&gt;Results:&lt;/b&gt; Among all 202 patients, 106 (52.5%) had rectal tumors, 77 (38.1%) had sigmoid colon tumors, and 19 (9.4%) had descending colon tumors. All patients successfully completed PALN dissection. Postoperative complications occurred in 89 patients (44.1%), including 40 cases (19.8%) of chyle leak. According to the Clavien-Dindo classification: 4 cases (4.5%) were grade Ⅰ, 75 cases (84.3%) grade Ⅱ, 9 cases (10.1%) grade Ⅲ, and 1 case (1.1%) grade Ⅳ. No death occurred within 30 days after surgery. Postoperative pathology confirmed that the PALN positive rate was 33.7% (68/202). In the PALN-positive group, lymphovascular invasion was detected in 41 cases (60.3%, 41/68) and perineural invasion in 34 cases (50.0%, 34/68), which were significantly higher than those in the PALN-negative group [13.4% (18/134) and 25.4% (34/134), respectively], with statistically significant differences (all &lt;i&gt;P&lt;/i&gt;&lt;0.001). Multivariate Logistic regression analysis revealed that tumor N2 stage (OR=11.665, &lt;i&gt;P&lt;/i&gt;&lt;0.001), positive No.253 lymph nodes (OR=17.683, &lt;i&gt;P&lt;/i&gt;&lt;0.001), number of harvested regional lymph nodes (OR=0.946, &lt;i&gt;P&lt;/i&gt;=0.002), number of resected PALNs (OR=1.106, &lt;i&gt;P&lt;/i&gt;=0.002) and lymphovascular invasion (OR=4.522, &lt;i&gt;P&lt;/i&gt;=0.007) were independent risk factors for PALN metastasis. A total of 170 patients who underwent simultaneous para-aortic lymph node (PALN) dissection between 2011 and 2022 were enrolled, with a median follow-up of 43 months. Among them, the 5-year OS was 41.1% in 54 patients with positive PALN, versus 86.8% in 116 patients with negative PALN, and the difference was statistically significant (&lt;i&gt;P&lt;/i&gt;&lt;0.001). The 5-year OS in the laparoscopic and robotic minimally invasive surgery group was 78.4%, which was significantly higher than that in the open surgery group (52.2%), with a statistically significant difference (&lt;i&gt;P&lt;/i&gt;=0.003). Patients without postoperative complications had a 5-year OS of 77.1%, higher than those","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1030-1039"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907392","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":"[Laparoscopic transhiatal right thoracic approach for lower esophageal and inferior mediastinal lymphadenectomy with digestive reconstruction in adenocarcinoma of the esophagogastric junction].","authors":"Y H Chen, Y J Lin, X Y Wang, J J Liu, L Lian, J S Peng","doi":"10.3760/cma.j.cn441530-20251128-00452","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20251128-00452","url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinical application of totally laparoscopic lymph node dissection around the lower esophagus and in the inferior mediastinum combined with digestive tract reconstruction via the esophageal hiatus and right thoracic approach for adenocarcinoma of the esophagogastric junction (AEG). <b>Methods:</b> A retrospective analysis was performed on 4 patients with locally advanced Siewert type Ⅱ/Ⅲ AEG without distant metastasis. A combined exposure technique, including traction of the left diaphragmatic crus using barbed sutures and deliberate opening of the right pleura, was applied under laparoscopy to create an adequate operative space for lymph node dissection around the lower esophagus, inferior mediastinal lymphadenectomy and digestive tract reconstruction. <b>Results:</b> A total of 4 patients underwent this surgical procedure from November 2024 to September 2025, including 3 cases of Siewert type Ⅱ and 1 case of Siewert type Ⅲ. There were 3 patients with clinical T3 stage and 1 patient with clinical T4b stage, and the tumor diameter ranged from 1 cm to 10 cm. Two patients received neoadjuvant therapy preoperatively. All operations were completed totally laparoscopically without conversion to open laparotomy or thoracotomy. The operative time ranged from 243 to 340 minutes, and intraoperative blood loss was 50 to 100 ml. The number of harvested lymph nodes was 17 to 30. One patient developed right pleural effusion (Clavien-Dindo grade Ⅲa) postoperatively, which resolved after percutaneous puncture and drainage without thoracic infection. No other complications occurred in the remaining patients. <b>Conclusion:</b> The totally laparoscopic approach via the esophageal hiatus and right thorax serves as a novel alternative for minimally invasive radical resection of high-position AEG.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1073-1076"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907407","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}