中华外科杂志最新文献

{"title":"[Research advances in perineural invasion of pancreatic cancer].","authors":"G H Xue, G Jin, Y J Zhang, P Cheng","doi":"10.3760/cma.j.cn112139-20241208-00561","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20241208-00561","url":null,"abstract":"<p><p>Perineural invasion (PNI) in pancreatic cancer,as an important clinical pathological feature,not only participates in various biological processes such as development,growth,invasion,and metastasis of pancreatic cancer,but also is closely associated with poor prognosis in pancreatic cancer. This article systematically reviews the latest research advancements in the field of PNI in pancreatic cancer,providing a multidimensional analysis of its anatomical basis,cytokine regulatory networks,metabolic reprogramming mechanisms,vesicle-mediated molecular transport,immune-neural interactions,pain-inducing pathomechanism,quantitative assessment frameworks,experimental model construction,cutting-edge technological applications,and innovations in surgical strategies. In the surgical domain,precision techniques combining targeted nerve plexus resection with molecular-targeted probes have significantly improved the R0 resection rate,while surgical navigation strategies based on single-cell spatial transcriptomics offer novel insights for optimizing therapeutic paradigms. Future research should prioritize the discovery of PNI-specific molecular targets,multidimensional exploration of the neural-immune-metabolic axis,and addressing the challenges of integrating interdisciplinary technologies into clinical translation.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"761-766"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487265","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":"[The research progress on de-escalation and optimization strategies for the treatment of early-stage breast cancer].","authors":"X P Hao, S Wu, Z F Jiang","doi":"10.3760/cma.j.cn112139-20241012-00459","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20241012-00459","url":null,"abstract":"<p><p>With the advancement of precision medicine, the treatment of early-stage breast cancer is gradually moving toward standardized individualization. While ensuring therapeutic efficacy, increasing attention is being given to patients' quality of life. In recent years, as clinical research data on targeted therapies for HER2-positive breast cancer, CDK4/6 inhibitors for hormone receptor-positive breast cancer, and immune checkpoint inhibitors for triple-negative breast cancer have accumulated, the treatment of early-stage breast cancer has become more precise and personalized. Furthermore, the growing body of clinical research on breast-conserving surgery, axillary preservation, and even the omission of primary tumor resection has significantly improved patients' quality of life. These more effective drugs and advanced technologies provide the foundation for de-escalation treatment strategies in early-stage breast cancer, driving the development of a more refined, patient-centered treatment approach.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"682-689"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487269","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 advocating the use of graphic surgical records(2025 edition)].","authors":"","doi":"10.3760/cma.j.cn112139-20250423-00216","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20250423-00216","url":null,"abstract":"<p><p>Surgical records are the core components of medical documents in clinical centers of surgery. Standardization of surgical records contributes to standardizing surgical procedures, improving the quality of surgery, and ensuring patient safety. To ensure that surgical records more objectively, visually, and comprehensively reflect the actual surgical process, numerous high-level university hospitals' surgical centers have long adhered to the good tradition of documenting surgical records in a \"combination of text and images\" format. Graphic surgical records not only benefit postoperative review and structured data collection but also facilitate the implementation of high-quality clinical research and surgical training. As early as 2015, Group of Operative Surgery, Chinese Society of Surgery, Chinese Medical Association already formulated the \"Expert Consensus on Advocating the use of graphic surgical records\".In recent years, rapid development of information technology has provided technical support for the further promotion of graphical surgical records. After extensive and multiple rounds of professional discussions and investigations, and based on a thorough consideration of relevant national policy requirements, information standards, the 2025 edition of the \"Expert Consensus\" is intended to be revised, aiming to enhance the standardization of graphical surgical records, improve the quality of surgery and training system, as well as clinical researches, thereby contributing to the development of Healthy China.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"653-659"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487260","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":"[Implementation of personalized T-cell therapy in the treatment of pancreatic cancer].","authors":"Rienk Offringa, Z B Meng, H K Cai, X Y Shi, H Mei, H S Wu","doi":"10.3760/cma.j.cn112139-20250328-00164","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20250328-00164","url":null,"abstract":"<p><p>Pancreatic ductal adenocarcinoma is profoundly treatment-resistant, due to intrinsic properties of the tumor cells and the complex tumor microenvironment. Consequently, surgical resection of the primary tumor is still the only intervention that significantly prolongs patient survival. This points at an urgent need for more effective (neo)adjuvant strategies to increase the fraction of patients eligible to surgery and to counter post-surgery disease recurrence. The advent of single-cell RNA-sequencing has created an opportunity for the development of a highly potent, patient-tailored adjuvant treatment that is based on the infusion of genetically engineered autologous T-cells armed with tumor-reactive T-cell receptors as identified in the patient's own tumor sample.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"666-671"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487261","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 opportunities of minimally invasive pancreatic surgery].","authors":"S T Pan, H Zhang, R Y Qin","doi":"10.3760/cma.j.cn112139-20250228-00101","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20250228-00101","url":null,"abstract":"<p><p>With the advancement of contemporary science and technology,minimally invasive surgery has assumed an increasingly indispensable role in the management of pancreatic diseases. In comparison to traditional open methods,minimally invasive pancreatic surgery is frequently associated with shorter hospital stays,reduced intraoperative blood loss,and decreased rates of general and pancreas-specific complications,albeit with longer operation times. However,additional research is required to elucidate the differences between minimally invasive and open surgical methods concerning overall survival and disease-free survival. The implementation of minimally invasive pancreatic surgery demands sophisticated equipment and necessitates extensive training for surgeons to surmount the procedural learning curve. To fully exploit the benefits of minimally invasive surgery in the treatment of pancreatic diseases,it is imperative to integrate cutting-edge scientific technologies,innovate perioperative management pathways,develop multidisciplinary collaborative models,and establish a standardized training system.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"690-694"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487256","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":"[Management strategies and research progress in pancreatic fistula after pancreaticoduodenectomy].","authors":"C Qin, B B Zhao, W B Wang","doi":"10.3760/cma.j.cn112139-20250228-00097","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20250228-00097","url":null,"abstract":"<p><p>Pancreaticoduodenectomy is the standard surgical procedure for treating malignant tumors in the head and neck of the pancreas, the uncinate process, the ampulla of Vater, and the lower segment of the bile duct. The operation involves multi-organ resection and complex gastrointestinal reconstruction. Pancreatic fistula is a common complication after pancreaticoduodenectomy, often leading to infections, bleeding, and other complications, which can result in perioperative mortality. In recent years, with advancements in surgical techniques and concepts, as well as close collaboration among multidisciplinary teams, the management of pancreatic fistulas following pancreaticoduodenectomy has become increasingly optimized. Key aspects such as early identification, adequate drainage, nutritional support, inhibition of exocrine pancreatic secretion, infection control, and timely reoperation are all crucial in managing postoperative pancreatic fistulas. However, the current strategies for managing pancreatic fistulas, while clinically applied, are essentially symptomatic supportive treatments. There is currently no definitive treatment that can heal pancreatic fistulas within a short period. Therefore, there is an urgent need for significant progress in basic research and the translation of new materials to provide new strategies for managing pancreatic fistulas after pancreaticoduodenectomy.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"766-771"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487263","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":"[The application of artificial intelligence in enhancing the safety of pancreatic surgeries].","authors":"M X Li, R S Deng, C H Yuan","doi":"10.3760/cma.j.cn112139-20241129-00538","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20241129-00538","url":null,"abstract":"<p><p>Pancreatic surgeries have long been considered as challenging procedures due to its complex surgical characteristics. Establishing a surgical safety system is crucial for improving patients' prognosis. In recent years, artificial intelligence(AI) has developed rapidly, showing great potential in preoperative diagnosis, surgical planning, intraoperative navigation, postoperative management, and training of young surgeons. By analyzing preoperative imaging and biopsy results, AI can assist in evaluating the nature of the lesion and its relationship with surrounding tissues, which are critical for the surgical treatment planning; during the operation, it can achieve real-time recognition of anatomical structures and assist in intraoperative decision-making; in postoperative management, AI can provide detailed management based on individual characteristics, facilitating rapid recovery. Additionally, the combination of AI and virtual reality can assist in the training of young surgeons. However, the application of AI still faces issues such as data quality, algorithmic universality, and ethical concerns, calling for standardized data annotation and multi-center collaboration and supervision.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"756-760"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487267","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":"[The influence of preoperative CT image characteristics on the outcome of thoracoscopic surgery for chronic tuberculous empyema].","authors":"C Y Ding, Y H Jiang, S B Wu, L Yao, S Y Chen","doi":"10.3760/cma.j.cn112139-20241025-00474","DOIUrl":"https://doi.org/10.3760/cma.j.cn112139-20241025-00474","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;b&gt;Objective:&lt;/b&gt; To investigate the influence of four preoperative CT image characteristics on the outcome of thoracoscopic surgery for chronic tuberculous empyema. &lt;b&gt;Methods:&lt;/b&gt; This is a retrospective cohort study. Two hundred and eleven patients of tuberculous empyema who underwent video-assisted thoracic surgery(VATS) decortication at the First Department of Surgery&lt;i&gt;,&lt;/i&gt; Wuhan Pulmonary Hospital from June 2020 to June 2023 were retrospectively analyzed. There were 162 male cases and 49 female cases, with an age of (&lt;i&gt;M&lt;/i&gt; (IQR)) 33 (27) years (range: 8 to 76 years). Patients were divided into two groups according to whether low-density lines, mass-patchy density, pleural fusion were observed, and the lesion size. Compare the clinical indicators of two groups of cases. Using the rapeutic efficacy as the dependent variable and four CT features as covariates, cases with cure or improve were included in Logistic regression analysis to calculate &lt;i&gt;OR&lt;/i&gt; (95%&lt;i&gt;CI&lt;/i&gt;) values. &lt;b&gt;Results:&lt;/b&gt; Preoperative chest CT images showed that 127 cases (60.2%) had low-density lines, 102 cases (48.3%) had mass-patchy density, and 88 cases (47.7%) had pleural fusion. The lesions spanned 2 to 11 intercostal spaces, with a median of 7 intercostal spaces. The lesion size was divided into two groups according to &lt;7 intercostal spaces and ≥7 intercostal spaces, with 101 cases (47.9%) and 110 cases (52.1%), respectively. In the intra-group comparison, there were no difference in age, lesion location and pulmonary tuberculosis. In the comparison of gender, except that the proportion of female patients in the group with lesion size &lt;7 intercostal spaces (&lt;i&gt;χ&lt;/i&gt;&lt;sup&gt;2&lt;/sup&gt;=6.064, &lt;i&gt;P&lt;/i&gt;=0.010) was higher than ≥7 intercostal spaces, there were no significant difference between other groups. In low-density lines group, there was no difference in the incidence of anemia and hypoproteinemia between the two groups. Compared with the non low-density line group, patients with low-density line group exhibited fewer cases of abnormal elevation in ESR and CRP was lower(all &lt;i&gt;P&lt;/i&gt;&lt;0.01), the period of preoperative treatment (&lt;i&gt;U&lt;/i&gt;=7 281.00, &lt;i&gt;P&lt;/i&gt;&lt;0.01) was longer than the non low-density line group, while the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours, postoperative drainage duration, lung re-expansion duration, and therapeutic efficacy were all better than the non low-density line group(all &lt;i&gt;P&lt;/i&gt;&lt;0.05). In the comparison between the mass-patchy density group, there were fewer cases of anemia, hypoproteinemia, abnormal elevation of ESR and CRP in the without mass-patchy density group(all &lt;i&gt;P&lt;/i&gt;&lt;0.05), and the period of preoperative treatmentwas shorter (&lt;i&gt;U&lt;/i&gt;=4 581.50, &lt;i&gt;P&lt;/i&gt;=0.003), and the operation time, intraoperative hemorrhage, postoperative drainage at 72 hours, postoperative drainage duration, lung re-expansion duration and therapeutic effect were better too(all &lt;i&gt;P&lt;/i&gt;&lt;0.05). In the grouping compa","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 8","pages":"739-747"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144487268","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 and pathological features and prognostic analysis of early-onset intrahepatic cholangiocarcinoma].","authors":"D L Qin, Y Tang, Z L Li, J L Chen, Z M Geng, C D Sun, H Wu, Y H Qiu, T Q Song, X H Mao, Y He, Z J Cheng, W L Zhai, J D Li, X Liang, R X Lin, D Tang, Z H Tang, Z W Quan","doi":"10.3760/cma.j.cn112139-20250122-00041","DOIUrl":"10.3760/cma.j.cn112139-20250122-00041","url":null,"abstract":"<p><p><b>Objective:</b> To explore the clinical and pathological features and survival outcomes of patients with early-onset intrahepatic cholangiocarcinoma (EOICC). <b>Methods:</b> This is a multicenter, retrospective cohort study. Data of 1 160 intrahepatic cholangiocarcinoma patients undergoing radical resection in 14 tertiary Grade A hospitals in China from January 2010 to November 2021 were retrospectively collected. The cohort included 632 males and 528 females, aged(<i>M</i> (IQR)) 61 (14) years (range: 22 to 93 years). ICC aged ≤50 years at the time of diagnosis was defined as EOICC and >50 years as late-onset intrahepatic cholangiocarcinoma (LOICC). Of these, there were 247 cases in the EOICC group and 913 cases in the LOICC. The clinical and pathological characteristics of both groups were analyzed and compared using the independent sample <i>t</i>-test, Mann-Whitney <i>U</i> test or Kaplan-Meier method. Univariate and multivariate Cox regression models for patient outcomes were constructed and forest graphed. <b>Results:</b> Compared with the patients in the LOICC group, patients in the EOICC group had lower carcinoembryonic antigen levels (2.5(4.0) μg/L <i>vs.</i> 3.1(5.2)μg/L, <i>U</i>=124 899, <i>P</i>=0.009) and CA19-9 level (63.4(524.7)U/ml <i>vs.</i> 77.9(611.3)U/ml,<i>U</i>=120 320,<i>P</i>=0.013), higher levels of ALT (29(35)U/L <i>vs.</i> 24(26)U/L,<i>U</i>=101 214, <i>P</i>=0.013), a lower score of the Eastern US Cooperative Oncology Group (0 score patients: 54.7% <i>vs.</i> 44.1%, <i>χ²</i>=12.472, <i>P</i>=0.014), higher TNM stage (<i>χ²</i>=11.807, <i>P</i>=0.038), and proportion of lymph node dissection (62.3% <i>vs.</i> 54.1%, <i>χ²</i>=5.355, <i>P</i>=0.021). Patients in the two groups in sex, first diagnosis symptoms, intrahepatic bile duct stone history, nail protein, albumin, total bilirubin, transaminase, liver function Child-Pugh grade, T stage, stage, N stage, preoperative laparoscopic exploration proportion, tumor diameter, vascular invasion proportion, differentiation, margin, intraoperative bleeding, postoperative complications, postoperative hospital days were no statistical significance (all <i>P</i>>0.05). Patients in the EOICC group had better outcomes than the LOICC group (median survival time: 29.7 months <i>vs.</i> 25.0 months, 3-year overall survival: 45.1% <i>vs.</i> 37.8%, <i>P</i>=0.027). <b>Conclusion:</b> EOICC patients are better than LOICC patients in carcinoembryonic antigen, CA19-9, ALT, physical strength status and TNM stage, and the long-term prognosis is also better than LOICC patients.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 6","pages":"500-507"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043053","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 treatment status and future perspectives of advanced gallbladder cancer].","authors":"S T He, Z Y Yang, X S Wu, W Gong","doi":"10.3760/cma.j.cn112139-20250115-00028","DOIUrl":"10.3760/cma.j.cn112139-20250115-00028","url":null,"abstract":"<p><p>Gallbladder cancer has an insidious onset,and most of the cases are in advanced stage at the time of diagnosis,with unfavorable prognosis. Radical surgery is the only potential curative method for gallbladder cancer at present,but radical surgery of advanced gallbladder cancer is difficult and the postoperative recurrence rate is high. Neoadjuvant therapy and conversion therapeutic modalities are of great significance to improve the rate of radical resection of advanced gallbladder cancer and reducing the risk of postoperative recurrence. The application and research of minimally invasive approach surgery in gallbladder cancer are increasing; organoid technology provides a new platform for precise and individualized treatment and new drug development, and the application of artificial intelligence combined with big data shows great potential in tumor diagnosis, surgical assistance and prognosis evaluation. Although these techniques provide more means to improve the therapeutic effect of advanced gallbladder cancer, there are still challenges in clinical practice and more high-quality clinical studies.</p>","PeriodicalId":60685,"journal":{"name":"中华外科杂志","volume":"63 6","pages":"486-490"},"PeriodicalIF":0.0,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143993455","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}