中华胃肠外科杂志最新文献

{"title":"[Development process, current status, and future trends of acute care surgery].","authors":"H J Ren, J Wang, J A Ren","doi":"10.3760/cma.j.cn441530-20250325-00120","DOIUrl":"10.3760/cma.j.cn441530-20250325-00120","url":null,"abstract":"<p><p>Emergency surgery has always been an important component of general surgery, with major diseases including acute abdomen and trauma. With the differentiation and development of general surgery sub specialties, department of emergency surgery has begun to emerge, but its development faces various challenges, such as insufficient medical staff, inadequate treatment capabilities, and poor treatment outcomes. To change this situation, about 20 years ago, a new treatment model began to emerge in the United States, establishing a department of acute care surgery that integrates trauma, emergency general surgery, and surgical critical care. This model quickly spread worldwide and achieved remarkable achievements. In recent years, colleagues in the field of surgery in China have gradually recognized the advantages of this model and established acute care surgery. This article aims to elaborate on its development process, current situation, and future trends, providing reference for the prosperous development of acute care surgery in China.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"736-742"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709142","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":"[Research progress on biomarkers for proficient mismatch repair/microsatellite stable colorectal cancer in the immunotherapy era].","authors":"M X Yan, Y Q Wang, L J Shen, Z Zhang","doi":"10.3760/cma.j.cn441530-20250226-00072","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250226-00072","url":null,"abstract":"<p><p>Immunotherapy based on immune checkpoint inhibitor (ICI) has shown remarkable efficacy in the treatment of microsatellite instability (MSI)-high CRC. However, the monotherapy of ICI in microsatellite stable (MSS) CRC has not been satisfactory. Some patients with MSS CRC can benefit from various combination immunotherapy regimens. Identifying appropriate biomarkers to select MSS-type CRC patients who will benefit from ICI treatment prior to therapy initiation and dynamically monitoring treatment efficacy during the therapeutic course have become crucial components of precision medicine in clinical practice. This article reviews the current research status of traditional biomarkers such as tumor mutation burden (TMB) and PD-L1 expression. It also explores the latest research progress and clinical translation potential of emerging biomarkers, including <i>POLE/POLD1</i> mutations, immune score, circulating tumor DNA, and gut microbiome. Furthermore, it addresses the challenges in the clinical application of biomarkers, such as the controversy over TMB cutoff values and the heterogeneity of PD-L1 expression. Finally, it outlines future research directions with the aim of providing a basis for clinical decision-making in immunotherapy and facilitating the realization of precision medicine.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"796-803"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709196","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":"[Value and controversy of prophylactic hyperthermic intraperitoneal chemotherapy in locally advanced colorectal cancer].","authors":"B Lan, X S Qin, H Wang","doi":"10.3760/cma.j.cn441530-20241220-00414","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241220-00414","url":null,"abstract":"<p><p>Locally advanced colorectal cancer patients are characterized by poor prognosis and high recurrence rates, with peritoneal metastasis rates as high as 20%-30%. Despite curative resection and chemotherapy being the main treatment methods, challenges remain in preventing peritoneal metastasis. Neoadjuvant therapy and immunotherapy are hot topics of research, and hyperthermic intraperitoneal chemotherapy (HIPEC) is one of the new approaches for preventing peritoneal metastasis, yet its value and safety are still controversial. HIPEC can directly target free tumor cells in the abdominal cavity through hyperthermic effects and high concentrations of chemotherapeutic drugs, but its prophylactic use requires further exploration regarding effectiveness and risks. Early intervention and identification of high-risk factors are crucial for improving therapeutic outcomes, and tests such as circulating tumor DNA and free peritoneal cell DNA provide new avenues for early screening. The value of prophylactic HIPEC varies across different studies, and its complications and risks should not be overlooked. The selection of chemotherapy drugs, dosage, and personalized treatment plans are key factors affecting therapeutic efficacy. Other prevention strategies, such as pressurized intraperitoneal aerosol chemotherapy and neoadjuvant chemotherapy, are also being explored. In summary, prophylactic HIPEC shows some potential in controlling peritoneal metastasis, but its application requires individualized assessment and optimization.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"804-809"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709199","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":"[Comparison of short-term safety and efficacy among total laparoscopic, laparoscopy-assisted, and open radical total gastrectomy after neoadjuvant therapy: a multicenter retrospective study].","authors":"X P Gao, J Yuan, X H Mei, Z J Feng, X Guo, G Ji, Y Y Song, J P Wei","doi":"10.3760/cma.j.cn441530-20241029-00356","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20241029-00356","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the short-term safety and efficacy of total laparoscopic, laparoscopy-assisted, and open total gastrectomy in patients with gastric cancer who have undergone neoadjuvant therapy. <b>Methods:</b> In this retrospective cohort study, relevant clinical data on 243 patients who had undergone radical total gastrectomy after receiving neoadjuvant therapy were collected. These patients had been admitted to the First Affiliated Hospital of Air Force Medical University, Yuncheng Central Hospital of Shanxi Province, and Heji Hospital Affiliated to Changzhi Medical College between January 2020 and April 2024. Among them, 202 were male (83.1%) and 41 were female (16.9%), and their average age was 61.3±8.1 years. The patients were allocated to three groups according to surgical procedure: total laparoscopic (68 cases), laparoscopic- assisted (79 cases), and open surgery (96 cases). We compared relevant baseline characteristics, neoadjuvant treatment, intraoperative and postoperative conditions, postoperative histopathological findings, and related complications between these three groups. <b>Results:</b> There were no statistically significant differences in baseline characteristics or neoadjuvant treatment between the three groups (all <i>P</i>>0.05). The operative time was longer in the total laparoscopic group than in the laparoscopic-assisted and open surgery groups (267.7±37.9 minutes vs. 243.9±38.3 minutes vs. 219.7±41.2 minutes, respectively; <i>F</i>=7,112.278; <i>P</i><0.001). However, more lymph nodes were harvested in the total laparoscopic group than in the laparoscopic-assisted and open surgery groups (27.8±4.8 vs. 27.4±6.3 vs. 27.2±5.1, respectively; <i>F</i>=6.042;<i>P</i>=0.002). Additionally, the total laparoscopic group had shorter times to first postoperative flatus (2.3±0.7 days vs. 2.4±0.7 days vs. 2.6±0.6 days, respectively; <i>F</i>=5.094;<i>P</i>=0.006] and first postoperative bowel movement (2.9±0.5 days vs. 3.0±0.6 days vs. 3.0±0.6 days, respectively; <i>F</i>=3.929;<i>P</i>=0.020). There were no statistically significant differences in intraoperative blood loss, intraoperative transfusion rates, postoperative intensive care unit admission rates, maximum tumor diameter, number of positive lymph nodes dissected, TNM stage, time to first postoperative oral intake, time to drain removal, or length of hospital stay between the three groups (all <i>P</i>>0.05). Among the 243 patients, 22 developed postoperative complications, making the overall complication rate 9.1%. Six patients (8.8%) in the total laparoscopic group developed complications, comprising two (2.9%) Grade IIIa Clavien-Dindo complications. One of these patients (1.5%) was readmitted within 30 days due to complications. Seven patients (8.9%) in the laparoscopic-assisted group developed complications, comprising two (2.5%) Grade IIIa Clavien-Dindo complications. One of these patients was readmitted within 30 days and another was within 90 da","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"758-766"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709140","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":"[Pelvic radiation-associated angiosarcoma of the small bowel: a case report].","authors":"Y Cao, Q Y Qin, T H Ma","doi":"10.3760/cma.j.cn441530-20250215-00058","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250215-00058","url":null,"abstract":"","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 7","pages":"788-790"},"PeriodicalIF":0.0,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144709194","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 the whole-course nutritional management of colorectal cancer patients with enterostomy (version 2025)].","authors":"","doi":"10.3760/cma.j.cn441530-20250512-00183","DOIUrl":"https://doi.org/10.3760/cma.j.cn441530-20250512-00183","url":null,"abstract":"<p><p>Enterostomy is an important means of treating colorectal cancer disease, and the nutritional problems of colorectal cancer patients with enterostomy are getting more and more attention. Malnutrition not only prolongs the hospitalization time of the patients and increases their economic burden, but also increases the incidence of patients' complications and death rate. At present, the nutritional management of colorectal cancer patients with enterostomy in China has not yet formed a consensus. Launched by the Chinese Society for Oncological Nutrition, experts with relevant backgrounds from multiple disciplines in China were invited, based on relevant references, the latest evidence and experts' clinical experience, and after several rounds of expert correspondence and expert demonstration meetings, to write the expert consensus on the whole-course nutritional management of colorectal cancer patients with enterostomy. The expert consensus centers on the teamwork model for the whole-course management of colorectal cancer patients with enterostomy, nutritional tertiary diagnosis, principles of nutritional therapy, perioperative nutritional management, nutritional management of intestinal stoma complications, and post-discharge nutritional management, aiming to provide standardized guidance for the whole-course nutritional management of patients with intestinal stoma.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 6","pages":"599-608"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477052","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 30-year review of gastric cancer surgery: China has achieved leapfrog leadership].","authors":"H Liang","doi":"10.3760/cma.j.cn441530-20250522-00197","DOIUrl":"10.3760/cma.j.cn441530-20250522-00197","url":null,"abstract":"<p><p>Gastric cancer is one of the most common malignant tumors in China. Over the past 30 years, remarkable progress has been made in the diagnosis and treatment of gastric cancer in China. Especially in the era of minimally invasive surgery, perioperative treatment, and immunotherapy, clinical studies initiated by China rank first in the world in both quantity and quality. The mortality rate of gastric cancer surgery is lower than 1%,ranking among the global leaders. Clinical research related to laparoscopy/robotics ranks among the top globally. The first prospective, multicenter, randomized controlled phase 3 trial on conversion therapy for stage IV gastric cancer with peritoneal metastasis has been completed. First-line immunotherapy/double immunotherapy for advanced gastric cancer and perioperative immunotherapy clinical trial are international leading. The second edition of the Guidelines for Integrated Diagnosis and Treatment of Gastric Cancer by Chinese Anti-Cancer Association uses evidence predominantly from China. The era of China leading international diagnosis and treatment of gastric cancer had arrived.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 6","pages":"688-692"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476960","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":"[Pathogenesis and progress in diagnosis and treatment of diversion colitis after colorectal cancer surgery].","authors":"Z W Zhang, Y J Ye, Z L Shen","doi":"10.3760/cma.j.cn441530-20250326-00125","DOIUrl":"10.3760/cma.j.cn441530-20250326-00125","url":null,"abstract":"<p><p>Diversion colitis (DC) is a non-specific inflammation caused by the lack of fecal flow stimulation in the distal intestine after intestinal diversion surgery. It is mainly related to factors such as intestinal flora imbalance, deficiency of short-chain fatty acid (SCFA) and immune abnormalities. The clinical manifestations of diversion colitis include abdominal pain, mucus and bloody stools, diarrhea and other symptoms, but most patients may have no obvious symptoms. Diagnosis mainly relies on endoscopic examination and pathological characteristics. Common endoscopic findings include mucosal congestion, edema, and increased fragility, and the histological manifestation is mainly lymphoid follicle hyperplasia. Other intestinal inflammatory diseases need to be excluded. The treatment options include surgical and conservative medical therapies, among which stoma reversal is the most effective treatment to restore intestinal continuity. Conservative treatments such as SCFA, 5-aminosalicylic acid (5-ASA), steroid or cellulose solution enema, leukocyte removal therapy and fecal microbiota transplantation (FMT) can be used for those who cannot undergo surgery, combined with diet and lifestyle support to improve symptoms. This article summarized the pathogenesis, status, clinical features, diagnostic strategy and treatment progress of DC, hoping to provide reference for the diagnosis and treatment of DC.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 6","pages":"627-632"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476976","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 analysis of 8 cases of laparoscopic combined with colonoscopic transanal total mesorectal resection].","authors":"S H Yang, C Y Ma, Y Wang, W Cui","doi":"10.3760/cma.j.cn441530-20240402-00121","DOIUrl":"10.3760/cma.j.cn441530-20240402-00121","url":null,"abstract":"<p><p><b>Objective:</b> To explore the feasibility and safety of laparoscopic combined with colonoscopic transanal total mesorectal resection (laparoscopic combined with colonoscopic taTME) in the treatment of rectal cancer. <b>Methods:</b> The descriptive case series analysis method was adopted. From October 2023 to February 2024, the Department of Colorectal Surgery of Li Huili Hospital, Ningbo Medical Center, performed laparoscopic combined with colonoscopic taTME on 8 patients with rectal cancer. Among the 8 patients, there were 5 males and 3 females, aged from 56 to 74 years old, with a body mass index (BMI) of 20.3-26.7 kg/m². All patients were pathologically diagnosed with rectal adenocarcinoma. The long diameter of the tumors was 2.0-6.5 cm, the lower edge of the tumors was 3-5 cm away from the anal verge. In terms of tumor TNM staging, there were 2 cases in stage I, 3 cases in stage II, and 3 cases in stage III. The surgical conditions, postoperative curative effects, and the occurrence of complications were observed. <b>Results:</b> All 8 patients successfully completed laparoscopic combined with colonscopic taTME, and there was no conversion to laparotomy. The operative time was 260 to 335 minutes, the intraoperative blood loss was 50 to 100 milliliters, and the distance from the tumor to the anal margin was 0.8 to 2.0 centimeters. All patients in the group underwent protective end ileostomy, and none of them underwent permanent enterostomy. Specimens were removed from the right lower abdomen in 7 cases and through the anus in 1 case. There was no residual cancer cells at the pathological resection margins postoperatively. All patients ambulated on the first day after the operation, and began to eat on the 2nd to 3rd day after the operation. Anastomotic leakage occurred in 1 patient after the operation, and the condition improved after conservative treatment. The length of hospital stay was 21 days. The other 7 patients were discharged from the hospital 8 to 12 days after the operation. Two patients completed the ileostomy closure surgery 3 months after the operation and recovered well. The patients were followed up until April 2024, during which there were no cases of tumor recurrence or death. <b>Conclusion:</b> For appropriate cases, laparoscopic combined with colonoscopic taTME is safe and feasible.</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 6","pages":"684-687"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477047","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":"[Preoperative anal function assessment in sphincter-preserving surgery for rectal cancer: clinical significance and strategies].","authors":"F Liu, Y J Ye","doi":"10.3760/cma.j.cn441530-20250410-00152","DOIUrl":"10.3760/cma.j.cn441530-20250410-00152","url":null,"abstract":"<p><p>Sphincter-preserving surgery has become the mainstream approach for mid-to-low rectal cancer, yet postoperative anal dysfunction (low anterior resection syndrome, LARS) occurs in 30%-50% of patients, significantly impacting quality of life. This review systematically elaborates the clinical value of preoperative anal function assessment (mainly digital rectal examination), proposing a multidimensional evaluation system integrating anatomical (including high-resolution anorectal MRI, 3D transrectal ultrasound and dynamic contrast-enhanced ultrasound), physiological (anorectal amnometry and anal electromyography), and neurological assessments (including Parks scale, Wexner score, MSK-BFI scale and LARS score), alongside innovative strategies such as artificial intelligence and gut microbiome analysis. We advocate incorporating preoperative functional assessment into quality control standards for sphincter preservation, promoting a paradigm shift from \"anatomical preservation\" to \"functional preservation\".</p>","PeriodicalId":23959,"journal":{"name":"中华胃肠外科杂志","volume":"28 6","pages":"609-614"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476978","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}