中华外科杂志最新文献

{"title":"[Analysis of the prevalence rate and risk factors of gallstone in the elderly in Xuhui District of Shanghai].","authors":"T M Su, Q Song, L Shen, S Li, F Q Zhu, L Yao, G R Chen, J Su, N Wang, Y N Yang, Y X Xu, G Z Zeng, H Su, D Y Wu, Q Zhu, Z J Yu, F Ling, L Chen, X Z Gao, D M Jiang, J W Lyu, W Y Jiang, J X Lu, Y Liu, J Tang, Y Y Mao, S Q Yang, G X Yang, W Y Chen, J Zhu, Y Tao, C Y Wang, R Q Tu, B Wu, N J Shen, Y Wang, S L Zhang, H B Liu","doi":"10.3760/cma.j.cn112139-20251120-00538","DOIUrl":"10.3760/cma.j.cn112139-20251120-00538","url":null,"abstract":"<p><p><b>Objective:</b> To investigate the prevalence and the risk factors of gallstone in Xuhui District of Shanghai,providing a scientific basis for developing targeted prevention and control measures. <b>Methods:</b> This is a cross-sectional study,which was conducted on permanent resident elderly individuals aged 65 and above who had established health records and completed annual health examinations between January and December 2024,across 13 community health centers in Xuhui District,Shanghai. A total of 48 844 elderly participants were included in the study, including 21 483 males and 27 361 females, aged (72.0±6.1) years (range: 65 to 106 years). The gender, age, height, weight, results of fasting venous blood and ultrasound results were collected.The absolute standardized mean difference (<i>ASMD</i>) was calculated to assess the balance of covariates between groups.Based on the presence of gallbladder stones detected by ultrasonography, the participants were divided into the study group and the control group. Rank-sum test and <i>χ²</i> test were used for data analysis, and logistic regression analysis was performed to explore the risk factors for gallbladder stone formation. <b>Results:</b> The <i>ASMD</i> values of the total population and study sample were all≤0.2. The overall prevalence of gallstone in the study population was 14.44% (7 054/48 844), with a prevalence of 13.67% (3 741/27 361) in female and 15.42% (3 313/21 483) in males. The prevalence of gallbladder polyps was 5.50%(2 682/48 844).The proportion of fatty liver was 45.50%(22 224/48 844). Additionally, a statistically significant difference in total cholesterol levels was observed between the gallstone group (range:4.34 to 5.77 mmol/L) and the non-gallstone groups (range: 4.39 to 5.82 mmol/L)(<i>Z</i>=-2.093, <i>P</i><0.05). Multivariate Logistic regression analysis revealed that body mass index (BMI) ≥28 kg/m² (<i>OR</i>=1.19, 95%<i>CI</i>: 1.17 to 1.20) and fatty liver disease (<i>OR</i>=1.22, 95%<i>CI</i>: 1.05 to 1.41) were independent influencing factors for gallstone formation (both <i>P</i><0.05). Compared with the 65 to 69 years group, the risks of gallstones were significantly higher in the 70 to 74 years group (<i>OR</i>=1.25, 95%<i>CI</i>: 1.05 to 1.48) and the group aged 80 years and above (<i>OR</i>=1.28, 95%<i>CI</i>: 1.03 to 1.61). <b>Conclusions:</b> The prevalence of gallstone is relatively high among the elderly population in Xuhui District, Shanghai. BMI ≥28 kg/m² and fatty liver disease are independent risk factors for gallstones. Compared with people aged 65 to 69 years, those aged 70 to 74 years and ≥80 years have an increased risk of developing gallstones.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1114-1119"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860556","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 practice guideline for laparoscopic radical resection of intrahepatic cholangiocarcinoma(2026)].","authors":"","doi":"10.3760/cma.j.cn112139-20260727-00324","DOIUrl":"10.3760/cma.j.cn112139-20260727-00324","url":null,"abstract":"<p><p>Intrahepatic cholangiocarcinoma (ICC) is highly aggressive and prone to lymph node metastasis or invasion of adjacent bile ducts, blood vessels, and organs. In recent years, reports on laparoscopic radical resection for ICC have increased annually, demonstrating short-and long-term outcomes comparable to those of open surgery. However, further standardization is still required in areas such as surgical indications, major hepatectomy or resection in difficult anatomical locations, combined resection of bile ducts, blood vessels, or multiple organs, and surgery following conversion or downstaging therapy. To this end, the Branch of Biliary Surgery, Chinese Society of Surgery, Chinese Medical Association and the Biliary Surgery Expert Working Group of Surgical Branch, Chinese Medical Doctor Association convened domestic experts to formulate recommendations on key issues, encompassing surgical safety and efficacy, preoperative evaluation and indications, operative procedures, lymph node dissection and hepatectomy, combined resection of bile ducts, blood vessels, or organs, and conversion/downstaging surgery. This initiative aims to provide guidance for the standardized implementation of laparoscopic radical resection for ICC.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1013-1020"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860582","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":"[Optimal measurement time for evaluating gallbladder contraction function by oral protein bar combined with olive oil: a prospective, multicenter, single-blind, crossover trial].","authors":"L Deng, H Xin, D Wu, B D Zhang, H Xu, Y Y Sun, Y Y Lin, P Yue, J Q Yuan, W B Meng","doi":"10.3760/cma.j.cn112139-20260616-00264","DOIUrl":"10.3760/cma.j.cn112139-20260616-00264","url":null,"abstract":"<p><p><b>Objectives:</b> To explore the optimal time window for evaluating gallbladder contraction function by oral standardized protein bar combined with olive oil, and to verify the measurement stability of this novel method compared with the traditional fried egg test. <b>Methods:</b> This is a prospective, multicenter, single-blind, randomized crossover controlled trial. A total of 112 healthy volunteers from 4 centers (the First Hospital of Lanzhou University, the First Hospital of Qinhuangdao, the Liaoning Jinqiu Hospital, and the Honghui Hospital Affiliated to Xi'an Jiaotong University) were enrolled, with a 1-week washout period between two intervention cycles. Group A received oral fried egg intervention in the first cycle and oral standardized protein bar plus 50 ml extra virgin olive oil in the second cycle; while group B received the interventions in reverse order. Gallbladder ultrasound was performed at fasting state and 30, 50, 70, 90 and 110 min after intervention to measure the long diameter, wide diameter and anteroposterior diameter of the gallbladder, and calculate the gallbladder volume and gallbladder contraction rate. The changing trends of gallbladder contraction rate at each time point were compared between the two interventions, the coefficient of variation (CV) was used to evaluate the measurement stability of the two methods, and paired <i>t</i>-test, repeated measures analysis of variance, and Feltz-Miller asymptotic test were used for statistical analysis. <b>Results:</b> Among the 112 subjects, 47 were male and 65 were female, with an age of (30.6±7.1) years(range:19 to 62 years) and a fasting gallbladder volume of (20.0±7.1) ml. Under both interventions, the gallbladder contraction rate of the subjects began to increase at 30 min after intervention, reached the peak at 50 to 70 min, and then gradually decreased. There was no significant difference in the level of gallbladder contraction rate between the two groups at the peak time point (<i>t</i>=0.421,<i>P</i>=0.674). The intragroup CV of gallbladder contraction rate at each time point in the oral protein bar plus olive oil group was significantly lower than that in the fried egg group (all <i>P</i><0.05), indicating better measurement stability. No serious adverse events such as acute pancreatitis and gastrointestinal bleeding occurred in either group, and the incidence of mild gastrointestinal adverse events showed no significant difference between the two groups (<i>χ²</i>=0.269, <i>P</i>=0.604). <b>Conclusions:</b> The optimal measurement time window for evaluating gallbladder contraction function with oral protein bar combined with olive oil is 50-70 min after intervention. This method is easy to operate with favorable safety, and its measurement stability is significantly better than the traditional fried egg test, providing a new method option for standardized clinical evaluation of gallbladder contraction function.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1090-1097"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860588","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":"[New concepts in perioperative refined management of liver resection for hepatocellular carcinoma].","authors":"T Yuan, Z Y Huang","doi":"10.3760/cma.j.cn112139-20260409-00148","DOIUrl":"10.3760/cma.j.cn112139-20260409-00148","url":null,"abstract":"<p><p>Liver resection for hepatocellular carcinoma (HCC) still faces the dual challenges of operative safety and high postoperative recurrence. Traditional precision surgery mainly focuses on operative manipulation, whereas the concept of scientific hepatectomy incorporates cirrhosis background, tumor biological behavior, and coordination with systemic therapy into a unified decision-making framework. This article discusses perioperative refined management strategies guided by scientific hepatectomy. Preoperatively, the severity of cirrhosis should be evaluated to define the safe extent of resection. Intraoperatively, oncological radicality should be balanced against liver parenchymal preservation. During the perioperative period, neoadjuvant therapy, conversion therapy, and adjuvant therapy should be integrated to promote the transition of HCC surgery toward comprehensive treatment. The focus of scientific hepatectomy is not merely to improve operative precision, but to select a more appropriate resection timing, resection extent, and treatment coordination strategy according to cirrhosis severity, tumor biological risk, and the need for subsequent treatment.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1035-1039"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860596","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":"[Anatomical variations of peripancreatic veins and surgical strategies].","authors":"R X Wang, Z Y Fan, L J Zhang, H X Zhan","doi":"10.3760/cma.j.cn112139-20260105-00007","DOIUrl":"10.3760/cma.j.cn112139-20260105-00007","url":null,"abstract":"<p><p>The pancreas is deeply located anatomically and adjacent to important blood vessels, making pancreatic surgery technically challenging and high-risk. As an important tributary of the portal vein, the peripancreatic venous system exhibits complex and diverse anatomical variations. These variations are key factors leading to intraoperative vascular injury and postoperative complications. Currently, the clinical understanding of venous variations in this region remains insufficient, with a lack of targeted surgical strategy guidance. Based on existing anatomical and imaging studies, this article systematically analyzes the variation types and clinical impacts of structures such as the superior mesenteric vein, splenic vein, left gastric vein, Henle trunk, pancreaticoduodenal vein and jejunal vein. It focuses on discussing preoperative evaluation methods and intraoperative management strategies, aiming to provide a reference for improving the precision and safety of pancreatic surgery.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1056-1063"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860585","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 \"Guideline for quality control of laparoscopic radical resection for biliary tract cancer（2026 edition）\"].","authors":"A Q Zhai, T R Lyu, F Y Li","doi":"10.3760/cma.j.cn112139-20260526-00219","DOIUrl":"10.3760/cma.j.cn112139-20260526-00219","url":null,"abstract":"<p><p>The publication of \"Guideline for quality control of laparoscopic radical resection for biliary tract cancer（2026 edition）\" marks the transition of laparoscopic radical resection for biliary tract cancer from technical exploration to a developmental stage centered on stratified indications, team credentialing, and whole-process quality control. The clinical value of laparoscopic radical resection for biliary tract cancer should not be evaluated solely by minimally invasive benefits, but should be established on the basis of strict patient selection, standardized margin assessment, adequate regional lymphadenectomy, high-quality biliary or gastrointestinal reconstruction, and standardized postoperative quality feedback. Focusing on the core recommendations of the guideline across different biliary tract cancer subtypes, this article provides in-depth interpretation of indication selection and team credentialing criteria, quality assessment of intraoperative margin control and lymph node dissection, as well as controversial issues such as the timing of surgery after conversion therapy and the choice of surgical procedures for mid-bile duct cancer. The aim is to promote the standardized, cautious, and high-quality implementation of laparoscopic radical resection for biliary tract cancer.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1070-1076"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860591","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":"[Current status and future prospects of complex liver transplantation].","authors":"C W Li, Z Q Sun, Q Sun, Y Ding, W L Wang","doi":"10.3760/cma.j.cn112139-20260512-00194","DOIUrl":"10.3760/cma.j.cn112139-20260512-00194","url":null,"abstract":"<p><p>Liver transplantation is the most effective treatment for end-stage liver disease. This article presents a review focusing on the research progress of complex liver transplantation. First, it analyzes two core clinical challenges currently restricting the development of liver transplantation: the shortage of donor liver resources and the increasing complexity of recipient conditions. Second, it categorically reviews the current development status of various complex liver transplantation techniques, sequentially elaborating on the technical key points, domestic innovative achievements, and clinical bottlenecks of non-whole graft liver transplantation (including living donor, auxiliary, autologous, split, and reduced-size liver transplantation), domino multi-recipient liver transplantation, as well as cutting-edge new technologies such as combined organ transplantation, ischemia-free liver transplantation, and xenogeneic liver transplantation. The efficacy of each technique is summarized by integrating data from domestic and international literature. Finally, leveraging the advantage in the large volume of liver transplantation cases of China, the article summarizes multiple original technological breakthroughs in domestic complex liver transplantation and prospects the future development directions of the field from the perspectives of surgical technique optimization, individualized precise recipient management, donor liver resource coordination, and multidisciplinary collaboration, aiming to provide reference for the clinical diagnosis and treatment of complex liver transplantation and subsequent research.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1021-1026"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860544","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":"[Advances and prospects of hemostatic strategies in hepatic surgery].","authors":"T A Xie, S Y Peng, X T Hou, X J Cai","doi":"10.3760/cma.j.cn112139-20260604-00248","DOIUrl":"10.3760/cma.j.cn112139-20260604-00248","url":null,"abstract":"<p><p>The liver is characterized by abundant blood supply and intricate anatomical architecture,rendering intraoperative and postoperative hemorrhage a primary clinical challenge. Conventional compression and suture ligation fail to enable precise perioperative hemorrhage prediction. Driven by the integration of precision medicine,artificial intelligence,and biomaterials,hemostatic strategies are undergoing a paradigm shift from passive compression to precise targeted intervention. This paper systematically reviews advances and future perspectives in hemostatic strategies for hepatic surgery. Preoperative individualized intervention is achieved via tranexamic acid prophylaxis,portal vein embolization,and radiological assessment; intraoperatively,Peng's curettage-suction technique enhances hemorrhage control; postoperatively,tiered \"pharmacological-interventional-surgical\" management allows proactive whole-course hemostatic regulation. Looking ahead,nano-drug delivery systems coupled with artificial intelligence closed-loop frameworks will facilitate the integrated development of hemostasis,liver regeneration promotion,and postoperative recurrence inhibition.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1046-1050"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860565","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 JSGPM classification in pancreaticobiliary maljunction].","authors":"M Z Weng, H Weng, Y Wang, W J Wu, W Gong, X F Wang","doi":"10.3760/cma.j.cn112139-20260302-00083","DOIUrl":"10.3760/cma.j.cn112139-20260302-00083","url":null,"abstract":"<p><p><b>Objective:</b> To evaluate the clinical value of the Japanese Study Group on Pancreaticobiliary Maljunction(JSGPM) classification in the diagnosis and treatment of pancreaticobiliary maljunction (PBM). <b>Methods:</b> A retrospective cohort analysis was conducted on 103 patients diagnosed with PBM via endoscopic retrograde cholangiopancreatography at the Department of General Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine from January 2010 to September 2018. There were 32 male cases and 71 female cases; the age (<i>M</i>(IQR)) was 5.1 (39.0) years (range: 2.2 to 56.1 years), with 74 cases aged <12 years and 29 cases aged ≥12 years.The distribution characteristics, clinical manifestations, and treatment strategies of different JSGPM subtypes were compared between pediatric (<12 years) and adolescent/adult (≥12 years) patients. Normally distributed quantitative data were compared between two groups using the independent samples <i>t</i>-test, and among multiple groups using analysis of variance (ANOVA). Skewed quantitative data were compared using non-parametric tests. Categorical variables were compared using the <i>χ²</i> test or Fisher's exact test. <b>Results:</b> Among the 103 PBM patients, JSGPM classified 40 cases as type A (39.2%), 31 cases as type B (30.4%), 25 cases as type C (24.5%), and 6 cases as type D (5.9%), with no unclassifiable cases. Among patients aged ≥12 years, the incidence of type B PBM was higher than that in children <12 years (51.7% (15/29) <i>vs.</i> 21.6% (16/74); <i>χ</i>²=8.974<i>, P</i><0.01), and type B was the predominant subtype without concurrent common bile duct dilation (≥12 years <i>vs.</i> <12 years: 12/15 <i>vs.</i> 7/16). Among the 7 pediatric cases (7/16) and 12 adult patients (12/15) with type B PBM without concurrent common bile duct dilation, none underwent extrahepatic bile duct resection; instead, they received only endoscopic sphincterotomy plus cholecystectomy. All patients were followed up for (36±26) months (range: 6 to 96 months), with no recurrence of biliary tract infections, obstructive jaundice, or pancreatitis. <b>Conclusions:</b> The JSGPM classification is concise, practical, and highly correlated with clinical features and prognostic risks, providing clear guidance for individualized diagnosis and treatment. This classification helps identify high-risk type B PBM patients and guides the implementation of precise preventive strategies, avoiding undertreatment or overtreatment.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1120-1125"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860575","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":"[Impact of liver metastatic burden on prognosis of patients with pancreatic neuroendocrine tumor and liver metastases after radical resection].","authors":"L Li, M Yuan, Q Chen, S Q Ren, M Meng, J A Lei, J Lu, B Q Li, Y T Bing, C H Yuan","doi":"10.3760/cma.j.cn112139-20260311-00096","DOIUrl":"10.3760/cma.j.cn112139-20260311-00096","url":null,"abstract":"<p><p><b>Objectives:</b> To investigate the impact of liver metastatic burden on the prognosis of patients with pancreatic neuroendocrine tumor (pNET) complicated by synchronous liver metastases who undergo curative resection,and to evaluate the value of preoperative systemic therapy/postoperative adjuvant therapy in subgroups with different metastatic burdens. <b>Methods:</b> This is a retrospective case series study. A total of 54 patients with pNET and liver metastases who underwent synchronous curative resection at Peking University Third Hospital from January 2016 to December 2025 were enrolled. 26 males and 28 females; with an age (<i>M</i>(IQR)) of 52(38)years(range:17 to 78 years). A combined scoring system based on the number and maximum diameter of liver metastatic lesions was constructed, and patients were divided into a high-burden group (<i>n</i>=33) and a low-burden group (<i>n=</i>21) using X-tile software. Kaplan-Meier method,log-rank test, and Cox regression analysis were used to identify prognostic factors, and the value of different systemic therapy regimens was evaluated by stratification. <b>Results:</b> Liver metastatic burden was an independent adverse prognostic factor for recurrence-free survival (RFS) in patients with pNET and liver metastases after curative resection (<i>HR=</i>3.323,95%<i>CI</i>:1.455 to 7.594,<i>P=</i>0.001). Subgroup analysis showed that preoperative systemic therapy significantly affected RFS in the high-burden group (<i>P=</i>0.013). Among patients receiving preoperative systemic therapy,those treated with chemotherapy or targeted therapy achieved significantly superior RFS compared with patients receiving somatostatin analog (SSA) monotherapy (<i>HR</i>=10.27, 95%<i>CI</i>: 1.262 to 83.580, <i>P</i>=0.008) and patients without preoperative therapy (<i>HR</i>=6.537, 95%<i>CI</i>: 0.789 to 54.150, <i>P</i>=0.047). Preoperative systemic therapy exerted no significant difference in the impact on OS in either the high-or low-burden group (both <i>P</i>>0.05). Similarly, postoperative adjuvant therapy showed no significant difference in the impact on RFS or OS in both subgroups (all <i>P</i>>0.05). Preoperative chemotherapy or targeted therapy, preoperative SSA combined with chemotherapy or targeted therapy followed by postoperative SSA could significantly improve RFS in high-burden patients (<i>P</i><0.01). <b>Conclusions:</b> Liver metastatic burden is an independent prognostic factor for RFS after synchronous curative resection. Preoperative chemotherapy or targeted therapy can improve RFS in high-burden patients,and the sequential systemic therapy strategy based on chemotherapy or targeted therapy and SSA can further enhance RFS in this subgroup.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"64 10","pages":"1105-1113"},"PeriodicalIF":0.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148860536","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}