中华胃肠外科杂志最新文献

{"title":"[Artificial intelligence-enabled advances in gastric cancer imaging: current status, challenges, and prospective strategies].","authors":"K Shen, W J Chen, X D Cheng","doi":"10.3760/cma.j.cn441530-20260511-00194","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260511-00194","url":null,"abstract":"<p><p>Gastric cancer remains one of the most common malignancies in China, and early diagnosis and accurate staging are critical for improving patient prognosis. Conventional imaging-based diagnosis of gastric cancer is limited by physician experience, equipment variability, and subjective interpretation, resulting in insufficient detection of early lesions and inconsistent staging assessment. Artificial intelligence (AI), powered by deep learning, radiomics, and related technologies, has demonstrated substantial potential in lesion detection, staging assessment, treatment response evaluation, and prognostic prediction for gastric cancer. These advances may improve diagnostic performance and promote more homogeneous clinical practice. However, clinical translation remains challenged by data heterogeneity and data silos, limited model generalizability, insufficient interpretability, inadequate prospective clinical evidence and regulatory frameworks, and variable acceptance among clinicians. This article reviews the current applications and technical advances of AI in gastric cancer imaging, analyzes the key barriers to clinical implementation, and proposes practical strategies from four perspectives: data governance, technological innovation, clinical translation, and physician-AI collaboration. The aim is to provide a reference for promoting standardized, accessible, and clinically meaningful implementation of AI in precision diagnosis and treatment of gastric cancer.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"979-984"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907203","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":"[A prospective randomized controlled trial of the effect of sleeve gastrectomy combined with His angle reconstruction on postoperative gastroesophageal reflux after surgery].","authors":"X Y Shi, K Cao, Z Q Zhan, Z W Zhai, C X Ye, Y S Li, J Wang, M Y Sun, Z J Wang, J G Han","doi":"10.3760/cma.j.cn441530-20251013-00380","DOIUrl":"10.3760/cma.j.cn441530-20251013-00380","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To compare the incidence of gastroesophageal reflux disease (GERD) following sleeve gastrectomy (SG) alone versus SG with reestablishment of the acute angle of His (SG-His), and to evaluate the safety and clinical efficacy of the latter approach. &lt;b&gt;Methods:&lt;/b&gt; A total of 124 obese patients admitted to Beijing Chaoyang Hospital, Capital Medical University from January 2023 to December 2023 were enrolled in this randomized controlled study and assigned to either the study group (SG-His, &lt;i&gt;n&lt;/i&gt;=64) or the control group (SG, &lt;i&gt;n&lt;/i&gt;=60). Surgical duration, postoperative complications and postoperative pain were recorded. Reflux symptoms were assessed using the Reflux Disease Questionnaire (RDQ) and Gastroesophageal Reflux Disease Questionnaire (GerdQ) scores preoperatively and at 1, 3, 6, and 12 months postoperatively. Weight loss outcomes were evaluated at 12 months post-surgery. &lt;b&gt;Results:&lt;/b&gt; Twelve months Follow-up was completed by 56 patients in the SG-His group and 55 in the SG group, yielding a dropout rate of 10.5%. No significant differences were observed between groups in baseline characteristics, including reflux scores, body weight, BMI, and comorbidities (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). Operative time, postoperative complication rates, and pain-related metrics were comparable between groups (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). With regard to reflux outcomes in the per protocol set, the SG-His group exhibited significantly lower RDQ scores than the SG group at 1 month [1.0 (0.0-7.0) vs. 5.0 (1.0-9.0), &lt;i&gt;P&lt;/i&gt;=0.015], 3 months [0.0 (0.0-4.0) vs. 6.0 (0.5-9.0), &lt;i&gt;P&lt;/i&gt;&lt;0.001], 6 months [0.0 (0.0-2.0) vs. 4.0 (0.0-9.0), &lt;i&gt;P&lt;/i&gt;&lt;0.001], and 12 months [0.0 (0.0-4.0) vs. 2.0 (0.0-7.0), &lt;i&gt;P&lt;/i&gt;=0.020] postoperatively. In the per protocol set, the GerdQ score was also significantly lower in the SG-His group at 6 months [6.0 (6.0-6.8) vs. 6.0 (6.0-8.0), &lt;i&gt;P&lt;/i&gt;=0.014], although no significant differences were found at 1, 3, or 12 months (all &lt;i&gt;P&lt;/i&gt;&gt;0.05). According to RDQ criteria, the proportion of patients diagnosed with GERD was significantly lower in the SG-His group at 1 month [8.2% (5/61) vs. 21.1% (12/57), &lt;i&gt;P&lt;/i&gt;=0.047], 3 months [3.5% (2/57) vs. 19.6% (11/56), &lt;i&gt;P&lt;/i&gt;=0.007], 6 months [1.8% (1/56) vs. 17.9% (10/56), &lt;i&gt;P&lt;/i&gt;=0.004], and 12 months [1.8% (1/56) vs. 14.5% (8/55), &lt;i&gt;P&lt;/i&gt;=0.034]. Similarly, based on GerdQ criteria, GERD diagnosis rates were significantly reduced in the SG-His group at 3 months [21.1% (12/57) vs. 41.1% (23/56), &lt;i&gt;P&lt;/i&gt;=0.021], 6 months [10.7% (6/56) vs. 30.4% (17/56), &lt;i&gt;P&lt;/i&gt;=0.010], and 12 months [14.3% (8/56) vs. 36.4% (20/55), &lt;i&gt;P&lt;/i&gt;=0.007]. There were no significant differences in weight loss between the two groups at 12 months post-surgery (&lt;i&gt;P&lt;/i&gt;&gt;0.05). &lt;b&gt;Conclusions:&lt;/b&gt; Sleeve gastrectomy with reestablishment of the acute angle of His significantly reduces the incidence and severity of postoperative gastroesophageal reflux, effectively mitigates GERD symptoms, and maintains equivalen","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1040-1048"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906686","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":"[2025 Annual data report on bariatric and metabolic surgery in Guangdong Province].","authors":"Z Y Dong, X J Dai, X W Zhao, Y Wang, T F Chen, M L Zhao, S W Xiong, X G Zhang, J J Liang, S Han, W X Hu, J J Wang, Y Li, C C Wang","doi":"10.3760/cma.j.cn441530-20260617-00240","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260617-00240","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To analyze the implementation status of bariatric and metabolic surgery and the provincial resource distribution characteristics in Guangdong Province in 2025. &lt;b&gt;Methods:&lt;/b&gt; Descriptive analysis was performed based on the aggregated data of bariatric and metabolic surgeries reported by 39 hospitals in Guangdong Province in 2025. Using the 2024 provincial data as annual control, we analyzed the total surgical volume, surgical procedure composition, distribution of performing hospitals, urban distribution, and application of novel procedures, with comparative analysis combined with external data (national, Shanghai, and international public databases). External reference materials included the 2024 Annual Report of China Obesity and Metabolic Surgery Database, the 2024 Annual Report of Greater China Bariatric and Metabolic Surgery Database, the Analysis of Quality Control Data of Bariatric and Metabolic Surgery in Shanghai from 2012 to 2023, the global registry report of the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), and public data released by the American Society for Metabolic and Bariatric Surgery (ASMBS)/Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP). National and Shanghai data were used for horizontal regional comparison, while US data served as a reference for international industry trends. &lt;b&gt;Results:&lt;/b&gt; A total of 1611 bariatric and metabolic surgeries were completed in Guangdong Province in 2025, representing an 18.3% increase compared with 1362 cases in 2024; the number of hospitals performing such surgeries rose from 22 to 39. Procedure composition: conventional laparoscopic sleeve gastrectomy (SG) accounted for 1,086 cases (67.4%); Roux-en-Y gastric bypass (RYGB) for 142 cases (8.8%); sleeve gastrectomy with transit bipartition (SG-TB) for 82 cases (5.1%); single-port SG for 87 cases (5.4%); one-anastomosis gastric bypass (OAGB) for 61 cases (3.8%); revisional bariatric surgery for 59 cases (3.7%); bypass stent for 73 cases (4.5%), and robot-assisted SG for 4 cases (0.2%). No cases of hydrogel balloon therapy or endoscopic sleeve gastroplasty (ESG) were reported. The top 10 hospitals ranked by surgical volume in Guangdong Province in 2025 showed an obvious hierarchical distribution. The cumulative volume proportions of the top 3, top 5 and top 10 hospitals reached 71.8%, 81.8% and 90.6%, respectively. In terms of urban distribution, Guangzhou, Shenzhen and Zhongshan contributed 95.8% (1543 cases) of the provincial total. The total number of bariatric surgeries nationwide in China reached 32 342 in 2024, while Shanghai recorded 1430 cases in 2023. Sleeve gastrectomy (SG) accounted for 75.6% of all national procedures in 2024 versus 87.9% in Shanghai in 2023. Roux-en-Y gastric bypass (RYGB) made up 4.7% of national surgeries in 2024 and 7.7% in Shanghai in 2023. There were 1234 one-anastomosis gastric bypass (OAGB) procedures natio","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1049-1057"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148906457","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 artificial intelligence in gastric cancer surgery].","authors":"B Yu, Y K Wang, F Shan, J F Ji, Z Y Li","doi":"10.3760/cma.j.cn441530-20260617-00241","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260617-00241","url":null,"abstract":"<p><p>Artificial intelligence has rapidly advanced in recent years and is increasingly being incorporated into preoperative assessment, intraoperative assistance, and postoperative quality control in gastric cancer surgery. Radical gastrectomy is characterized by complex anatomical planes, frequent vascular variations, extensive lymph node dissection, and multiple intraoperative decision points. Artificial intelligence may provide surgeons with more intuitive, continuous, and quantifiable assistance through image recognition, multimodal prediction, three-dimensional navigation, and surgical video analysis. This review summarizes recent progress and potential clinical value of artificial intelligence in gastric cancer surgery from four aspects: anatomical recognition, metastasis risk assessment and intraoperative staging assistance, surgical navigation and decision support, and surgical quality control. Current studies suggest that artificial intelligence can help identify the pancreas, perigastric vessels, loose connective tissue, peritoneal metastases, surgical phases, and instrument movements. It may also contribute to risk stratification, preoperative planning, intraoperative warning, surgical training, and standardized quality assessment. However, clinical translation remains limited by insufficient high-quality annotated data, limited cross-center robustness, inadequate validation in real-world operative settings, and unresolved ethical and responsibility issues. Future multicenter prospective studies are needed to determine whether artificial intelligence can reliably improve surgical quality, oncological safety, and patient outcomes.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"972-978"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907047","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 artificial intelligence in multidisciplinary team of colorectal cancer liver metastasis: status, challenges and prospects].","authors":"Y E Liao, Y B Liao, R R Wang, S Wang, Y T Situ, X Y Wan, Z Z Pan, J Z Lin, J H Peng","doi":"10.3760/cma.j.cn441530-20260512-00195","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260512-00195","url":null,"abstract":"<p><p>Colorectal cancer liver metastasis (CRLM) has high diagnostic and therapeutic complexity, and multidisciplinary team (MDT) has become its core diagnostic and therapeutic path. However, traditional MDT is faced with problems such as uneven distribution of expert resources and inefficient information integration. The rapid development of artificial intelligence (AI) technology provides a new path for the intellectualization of CRLM-MDT. This article systematically reviews the application status of AI in the whole process of CRLM-MDT, including AI-assisted disease assessment, prognostic risk stratification and efficacy prediction, clinical decision-making, intraoperative imaging and quality control, and automatic case follow-up. It also analyzes the current bottlenecks of AI application, such as insufficient multimodal integration, clinical transformation barriers, ambiguous decision-making boundaries and lack of evaluation system, and looks forward to the development direction of human-machine collaborative MDT 2.0. Studies have shown that AI can improve the accuracy and efficiency of CRLM diagnosis and treatment, but it is necessary to break through the reviews of technology and clinical integration to truly realize the transformation from technical feasibility to clinical applicability, and provide more high-quality personalized diagnosis and treatment services for CRLM patients.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"992-997"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907100","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":"[Esophagojejunostomy after laparoscopic total gastrectomy: the 'negation of negation' from linear stapling to circular stapling].","authors":"Y G Zhang, Z Li, Y W Qian, L J Wang, Z K Xu","doi":"10.3760/cma.j.cn441530-20260616-00236","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260616-00236","url":null,"abstract":"<p><p>Esophagojejunostomy remains the most technically demanding step in laparoscopic total gastrectomy. This review systematically traces the spiral evolution of esophagojejunal anastomotic techniques from open circular stapling and laparoscopy-assisted circular stapling, to totally laparoscopic linear stapling (Overlap and π-shaped methods), and subsequently to the resurgence of circular stapling under totally laparoscopic and robotic-assisted platforms. Linear stapling achieves complete minimally invasive surgery by eliminating the auxiliary incision; however, it faces technical bottlenecks including limited applicability for high anastomosis, difficulty in common opening closure, and compromised anti-reflux mechanisms. Conversely, circular stapling has regained vitality on the totally laparoscopic platform through hand-sewn purse-string sutures, modified anvil insertion techniques, and robotic assistance, preserving the anatomical and physiological advantages of end-to-side anastomosis, particularly for advanced esophagogastric junction tumors. Based on domestic and international evidence together with our institutional experience, this article proposes an individualized selection framework from the dimensions of tumor location, patient body habitus, and surgeon expertise, and outlines future directions in instrument innovation, technical integration, and high-quality evidence generation, aiming to provide practical guidance for surgeons in selecting esophagojejunostomy approaches.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1014-1020"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907364","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":"[Expert consensus on evaluation standards for artificial intelligence applications in colorectal cancer (2026 edition)].","authors":"","doi":"10.3760/cma.j.cn441530-20260612-00234","DOIUrl":"10.3760/cma.j.cn441530-20260612-00234","url":null,"abstract":"<p><p>Artificial intelligence (AI) technologies are rapidly being applied across all segments of colorectal cancer management, including cancer screening, endoscopic diagnosis and treatment, imaging and pathological analysis, therapeutic decision-making, intraoperative assistance, and follow-up management. Nevertheless, substantial disparities exist among various AI systems in terms of task definition, data sources, validation methodologies, performance metrics, safety thresholds, and real-world clinical practicability. There is an urgent need to establish a dedicated evaluation framework tailored to clinical scenarios specific to colorectal cancer. To address this demand, the Colorectal Surgery Group of the Chinese Society of Surgery (Chinese Medical Association), the Colorectal Cancer Committee of China Anti-Cancer Association, and the Colorectal Surgeon Expert Group of the Surgeon Branch (Chinese Medical Doctor Association) jointly assembled a working group composed of specialists covering colorectal surgery, digestive endoscopy, medical imaging, pathology, medical oncology, radiation oncology, artificial intelligence, medical statistics, medical informatization, medical ethics, and regulations. Through systematic literature retrieval, collation of existing clinical guidelines and regulatory documents, expert letter consultations, and panel discussions, the working group formulated 13 recommendations graded by levels of evidence and strength of recommendation, and developed the <i>Expert Consensus on Evaluation Standards for Artificial Intelligence Applications in Colorectal Cancer (2026 Edition)</i>. This consensus establishes a tiered evaluation framework centered on seven core dimensions: algorithmic performance, clinical safety, clinical efficacy, user experience, model interpretability, ethical compliance, and continuous supervision. It further clarifies targeted evaluation requirements for key AI application scenarios, including AI-assisted lesion detection during endoscopy, AI-aided diagnosis via imaging and pathological slides, generative AI and clinical decision support, intraoperative AI assistance, and real-world surveillance of AI systems.The consensus underscores that AI systems shall only serve as auxiliary clinical tools and must not replace clinicians to independently render diagnostic, therapeutic or surgical decisions. Prior to clinical deployment, all AI systems for colorectal cancer shall undergo rigorous validation commensurate with their risk classification, implement disease-specific safety red lines, mandate mandatory clinician review, and enforce full-lifecycle supervision throughout clinical use.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"961-971"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907345","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 transformer in intelligent diagnosis and treatment of peritoneal metastasis: current status and prospects].","authors":"P R Zou, Q F Lin, Z T Zhang, Y H Jie, T Li, T Y Xu, X J Zou, Q Ye, Z Q Li, W Wang, Y B Zhao, H Wang, Z X Yuan","doi":"10.3760/cma.j.cn441530-20260508-00189-1","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260508-00189-1","url":null,"abstract":"<p><p>Peritoneal metastasis is a common manifestation of advanced malignant tumors. Traditional imaging and cytology have insufficient sensitivity for detecting subcentimeter lesions, whereas Transformer models, leveraging self-attention mechanisms, exhibit unique advantages in global context modeling and multimodal fusion. These models have shown preliminary potential in the fields of imaging, pathological and molecular diagnosis, and prognosis prediction. However, existing studies are generally constrained by single-center, small-sample designs, limited cross-center generalizability, and a lack of prospective validation; model interpretability and the computational complexity of clinical deployment also constitute critical bottlenecks. In the future, adopting the pretraining-fine-tuning paradigm of large-scale medical foundation models, advancing pan-omics fusion and dynamic temporal modeling, and conducting prospective interventional clinical validation will be key pathways to propel Transformers from assistive tools toward core components of intelligent diagnosis and treatment for peritoneal metastasis. This paper summarizes and analyzes currently available research data, reviews the applications of Transformers in three major scenarios-imaging diagnosis, pathological and molecular subtyping, and prognosis prediction-focuses on analyzing translational bottlenecks such as data scarcity, model interpretability, and clinical deployment, and proposes corresponding solutions and future directions.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1077-1082"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907193","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 of a multidisciplinary intelligent nexus for decision support in digestive malignancies and its application to comprehensive perioperative management in older patients].","authors":"Y M Zhou, Y W Zang, H T Sun, L Lu, M W Zhou, Y Yang, Y Zhu, L Y Yang, H Huang, Q Zhang, D Tang, Z Q Lu, Z T Yue, J B Xiang, L X Qin","doi":"10.3760/cma.j.cn441530-20260529-00214","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20260529-00214","url":null,"abstract":"<p><p>We describe the technical architecture of the Huashan Multidisciplinary Intelligent Nexus for Decision Support in Digestive Malignancies (HS-MIND), developed using a reasoning-augmented large language model (ReAG-LLM) and a multi-agent system (MAS). We also summarize our approach to implementing the system at a single center and our experience using it in the perioperative management of older patients with digestive system malignancies. Built on a general-purpose medical AI platform, HS-MIND was customized for the management of digestive system malignancies and deployed on premises. Its core architecture comprises four layers: the data and knowledge layer, the reasoning augmentation and tool-use layer, the multi-agent collaboration layer, and the clinical application layer, with safety governance integrated throughout the workflow. By combining retrieval-augmented generation (RAG), controlled chain-of-thought (CoT) reasoning, tool-augmented reasoning, and multi-agent collaboration, the system grounds its outputs in evidence, integrates information across specialties, ranks alternative management pathways, and provides prompts for clinician review. In representative high-risk scenarios, HS-MIND can proactively identify perioperative risk factors, integrate information across specialties, and generate structured, evidence-grounded recommendations. HS-MIND has been used to synthesize clinical information and review risks before multidisciplinary discussions in 25 older patients with digestive system malignancies and multiple comorbidities. A module designed to detect conflicts involving cardiovascular risk or antithrombotic therapy was triggered in 5 cases. In 23 cases, the system's ranking of alternative treatment pathways was reviewed during multidisciplinary discussions and used to inform decision-making. Two cases were flagged for further review because of insufficient evidence or unresolved conflicts, with final adjudication by senior physicians. Using de-identified data from a previously treated 76-year-old patient with low rectal cancer and severe coronary artery disease, we illustrate the system's longitudinal reasoning while preserving the actual chronology of clinical events, thereby showing how it operates in a high-risk scenario involving competing clinical priorities. We also characterize the system's early clinical use across this single-center series of 25 cases, with the aim of informing clinical decision-making.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1004-1013"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907291","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":"[Intestinal microbiota alterations after digestive tract reconstruction surgery and their impacts on host physiology].","authors":"Z K Wang, J C Guo, K Cao, X M Yang, D Li, Y M Sha, L Zhang, Q Lu","doi":"10.3760/cma.j.cn441530-20251029-00406","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20251029-00406","url":null,"abstract":"<p><p>The gut microbiota, acknowledged as the human body's 'second genome', plays a pivotal role in maintaining health. Digestive tract reconstruction surgery profoundly alters the anatomical structure and physiological environment of the gastrointestinal tract, thereby inducing significant shifts in the intestinal microbiota. These microbial changes subsequently influence host physiological functions through metabolic, immune, neuroendocrine, and other pathways. For instance, Roux-en-Y gastric bypass surgery enriches short-chain fatty acid(SCFA)-producing <i>Bacteroides</i>, improving systemic insulin sensitivity. Conversely, pancreaticoduodenectomy leads to a marked enrichment of potential pathobionts such as <i>Klebsiella</i> and <i>Clostridium</i>, which may elevate the risk of infections and tumor recurrence. This review comprehensively summarizes the characteristic changes in the gut microbiota following various digestive tract reconstruction procedures and discusses their multifaceted impacts on host physiology, aiming to provide insights for future experimental research and clinical practice.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"29 8","pages":"1083-1090"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148907384","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}