In recent years, significant progress has been made in the field of colorectal cancer surgery in China. With innovations in techniques such as transanal total mesorectal excision and robotic surgery, as well as the exploration of comprehensive neoadjuvant therapy and neoadjuvant immunotherapy, the application of watch-and-wait and local resection strategies, colorectal surgery is gradually achieving minimally invasive surgical operations, more efficient tumor treatments, and individualized organ preservation. In light of these hotspots and innovations, many high-quality evidence-based medical studies have emerged in recent years. This article will review and summarize these developments.

Laparoscopic surgical treatment for colorectal cancer has undergone groundbreaking advancements and development. From the proposition and updating of minimally invasive theories to the standardization and refinement of laparoscopic surgical techniques, coupled with advancements in equipment and the integration of new technologies such as artificial intelligence and remote surgery, laparoscopic surgical treatment for colorectal cancer has become the primary modality for treating this disease. Currently, laparoscopic colorectal cancer surgery has been widely adopted across various levels of hospitals in China, profoundly impacting the surgical treatment of colorectal cancer. Simultaneously, we must align with the rapidly evolving shift towards comprehensive treatment modalities, adapt to multidisciplinary diagnostic and therapeutic systems, and continue to provide patients with safer and more efficient surgical treatment plans guided by high-quality clinical research results.

Despite the widespread use of laparoscopic techniques in right hemicolectomy for colon cancer in China and the significant progress made, key challenges remain. These include the complex anatomical structures, variable vascular variations, standardized lymphadenectomy ranges, and the selection of gastrointestinal reconstruction methods, all of which continue to limit the improvement and promotion of surgical quality. This article systematically elaborates on the critical difficulties and optimization strategies in laparoscopic right hemicolectomy, combining the latest research advancements, expert consensus, and the practical experience of our center. The aim is to provide a reference for standardizing surgical procedures, improving surgical safety, and enhancing oncological outcomes.

The surgical procedure and scope of lymph node dissection for colonic hepatic flexure cancer differ from those for ascending colon and ileal cancers because of the specificity of its location and biological behavior. Whether to clear lymph nodes in groups No.206 and No.204 and ligate vessels at the root remains controversial. We adopted a centralized and prioritized approach by first peeling away the dorsal lobe of the right hemicolonic mesentery from its attachment to the posterior peritoneum and then expanding Toldt’s space on the right side and crossing the fusion fascial space anterior to the pancreaticoduodenum. The surgical trunk was fully exposed, and the ileocolic, right colonic, accessory right colonic, and mesocolic vessels were sequentially ligated and transected, with careful attention paid to protecting Henle’s trunk to avoid hemorrhage during retraction. The lymph nodes in groups No.204 and No.206 were cleared medially from the lateral vascular arch of the greater curvature of the stomach on the cranial side, and the right vessels of the gastric omentum were ligated and transected at their roots. After severing the end of the left branch of the mesocolon vessel and the marginal vessel of the transverse colon, the transverse colon was transected with a linear stapler, the end of the ileum was transected with the same linear stapler approximately 15-20cm from the ileocecal side, and the specimen was removed en bloc. An intracorporeal overlap anastomosis between the ileum and the left part of the transverse colon with peristalsis was performed, and the common hole was closed with continuous 3-0 barbed sutures. the same 3-0 barbed sutures were used to close the mesenteric defect using continuous sutures. This procedure is suitable for resectable colorectal hepatic flexure cancer, and is safe and convenient surgical procedure is appropriate for future implementation.

The 3D fluorescence reverse staining technique is contrary to the traditional ICG "positive staining" (tumor visualization). The reverse staining method involves targeted injection of indocyanine green (ICG) through the peripheral vein, which makes healthy liver tissue visible, while the tumor area shows "negative staining" due to the interruption of the portal vein branches and the lack of normal liver cells and biliary excretion function, thus precisely defining the boundaries of liver segments. Moreover, this technique has undergone three major innovations: precise visualization of anatomical boundaries, real-time intraoperative navigation, and ultra-minimally invasive operations, and has become a key support for radical liver cancer surgery. The team has independently developed an ultra-minimally invasive instrument that can be assembled and disassembled outside the body, solving the current problem that the small clamp heads of minimally invasive instruments less than 2 mm cannot meet clinical needs. Moreover, it leaves only a 2mm incision on the skin after the operation, and the postoperative cosmetic effect is consistent with that of conventional single-port laparoscopy, but it significantly reduces the operation time and operational difficulty. In this operation, two SY19-1.98B type ultra-minimally invasive instruments developed by the team and T-shaped sutures were used. Except for the umbilical wound, the single wound was less than 2mm. This video shows the operation process of 3D fluorescence reverse staining ultra-minimally invasive laparoscopic anatomical resection of right liver cancer assisted by this instrument.

To explore the impact of preserving the left colic artery during laparoscopic low anterior resection (Dixon) in elderly patients with low rectal cancer.

A total of 136 elderly patients with low rectal cancer who underwent laparoscopic Dixon surgery from December 2021 to December 2024 were selected. They were divided into a study group and a control group using a random lottery method, with 68 cases in each group. The study group underwent preservation of the left colic artery, while the control group did not. Data were analyzed using SPSS 26.0 statistical software. Perioperative indicators, tumor diameter, and other measurement data that conformed to a normal distribution were expressed as (±s), and intergroup comparisons were performed using independent samples t test. Count data such as TNM staging were expressed as [cases(%)] and analyzed using the χ² test; Fisher’s exact test was used when the theoretical frequency was <5. P<0.05 was considered statistically significant.

Compared with the control group, the study group had a longer operation time, but shorter time to first postoperative defecation, first postoperative flatus, and postoperative hospital stay, as well as a lower incidence of postoperative anastomotic leakage (P<0.05). There were no statistically significant differences between the two groups in the number of lymph nodes dissected, intraoperative blood loss, or the incidence of other postoperative complications (P>0.05). After surgery, serum inflammatory indicators [C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6)] increased in both groups, but the magnitude of the increase of these serum inflammatory indicators in the study group was smaller than that in the control group (P<0.05).

Although preserving the left colic artery during laparoscopic Dixon surgery for elderly patients with low rectal cancer prolongs the operation time, it promotes faster postoperative recovery, effectively controls the inflammatory response caused by surgical trauma, and prevents the occurrence of postoperative anastomotic leakage.

To explore the efficacy and safety of single-port plus one laparoscopic radical resection for colorectal cancer in patients with colorectal cancer.

A total of 78 patients with colorectal cancer admitted from January 2021 to December 2023 were selected as the research objects. They were divided into the observation group (n=39, undergoing single-port plus one laparoscopic radical resection for colorectal cancer) and the control group (n=39, undergoing conventional 5-port laparoscopic radical resection for colorectal cancer) using the random number table method. Statistical analysis was performed using SPSS 25.0 software. Enumeration data were expressed as percentages, and comparisons were made using the χ² test. Measurement data conforming to normal distribution were expressed as (±s); independent sample t test and paired sample t test were used for inter-group and intra-group comparisons, respectively. Rank sum test was used for ranked data. P<0.05 was considered statistically significant.

The incision length, time to first flatus, time to ambulation, gastrointestinal function recovery time, and hospital stay in the observation group were significantly shorter than those in the control group (P<0.05). There were no statistically significant differences between the two groups in terms of maximum tumor diameter, distance of proximal and distal tumor resection margins, or number of lymph nodes dissected (P>0.05). The Visual Analogue Scale (VAS) scores on the 1st and 3rd days after surgery in the observation group were lower than those in the control group (P<0.05). The levels of tumor necrosis factor-α (TNF-α), C-reactive protein (CRP), interleukin-6 (IL-6), interleukin-8 (IL-8), norepinephrine (NE), cortisol (COR), and adrenaline (AD) in the observation group were all lower than those in the control group (P<0.05). The incidence of complications such as incision infection, subcutaneous emphysema, anastomotic bleeding, urinary retention, and intestinal obstruction in the observation group was lower than that in the control group (P<0.05).

The implementation of SILS+1 laparoscopic radical resection for colorectal cancer in patients with colorectal cancer can effectively shorten the hospital stay, reduce postoperative pain, inflammatory response, and stress response. It achieves a definite tumor radical effect, reduces the incidence of complications, promotes postoperative recovery, and has high safety.

To introduce a new surgical technique for low anterior resection with anal sphincter preservation: coloanal intussusception anastomosis.

A descriptive study was conducted on two typical cases, using an optimized anastomotic method that integrates the advantages of Parks procedure and modified Bacon procedure.

Both patients underwent successful surgery without stoma. The average anastomosis time was 22 minutes. Ischemic intestinal loops completely sloughed off within 3 to 8 days. The anal appearance was favorable, with no anastomotic fistula. Both the surgeon’s operational convenience and the patients’ postoperative comfort (pain and perianal discomfort) were satisfactory.

Coloanal intussusception anastomosis is a feasible anastomotic technique, applicable to various anal-sphincter-preserving needs where double-stapling anastomosis is infeasible. It shows research prospects in reducing the incidence of anastomotic leakage and the utilization rate of protective stomas.

To investigate the risk factors associated with lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer.

A total of 218 patients with locally unresectable gastric cancer who underwent radical resection after conversion therapy with the SOX regimen (combined with PD-1 monoclonal antibody immunotherapy) from January 2019 to November 2024 were included. Clinical data of the patients were collected through the medical record system. Univariate analysis and Logistic regression model were used to analyze the risk factors for lymph node metastasis.

Univariate analysis showed that tumor size, depth of invasion, presence or absence of perineural invasion, presence or absence of vascular invasion, and Lauren classification were associated with lymph node metastasis (P<0.05). Multivariate analysis revealed that vascular invasion (OR=7.475, 95%CI: 2.839-19.680, P<0.001), depth of invasion (OR=2.656, 95%CI: 1.713-4.119, P<0.001), and Lauren classification (OR=1.814, 95%CI: 1.062-3.098, P=0.029) were independent risk factors for lymph node metastasis in gastric cancer patients. Among 86 patients with T_0-2 stage, perineural invasion (OR=22.776, 95%CI: 1.658-312.782, P=0.019) and vascular invasion (OR=10.078, 95%CI: 1.791-56.700, P=0.009) were independent risk factors for lymph node metastasis. Among 132 patients with T_3-4 stage, vascular invasion (OR=8.258, 95%CI: 2.404-28.364, P<0.001) and Lauren classification (OR=3.179, 95%CI: 1.310-7.713, P=0.011) were independent risk factors for lymph node metastasis.

Vascular invasion, depth of invasion, and Lauren classification are independent risk factors for lymph node metastasis after conversion therapy (combined with immunotherapy) for locally unresectable gastric cancer. Among them, perineural invasion and vascular invasion are independent risk factors for patients with T_0-2 stage, while vascular invasion and Lauren classification are independent risk factors for patients with T_3-4 stage. For these patients, radical lymph node dissection should be performed as much as possible to improve prognosis.

To study the therapeutic effect of dual-endoscope combined function-preserving gastrectomy (FPG) for early proximal gastric cancer.

A retrospective cohort study was conducted to analyze the clinical data of 120 patients with early proximal gastric cancer (EGC) from January 2021 to October 2023. According to different surgical methods, the patients were divided into the observation group (n=68) and the control group (n=52). Patients in the observation group underwent endoscopic submucosal dissection (ESD) combined with laparoscopic lymph node dissection (LLND); patients in the control group underwent laparoscopic proximal gastrectomy (LPG). Data were analyzed using SPSS 24.0 software. Perioperative indicators and other measurement data with normal distribution were expressed as (±s) and analyzed by independent samples t test; counting data such as the incidence of postoperative complications were expressed as [cases (%)] and compared by χ² test; TNM staging data were expressed as case numbers and compared by Rank Sum test; Kaplan-Meier method was used to draw curves, and Log-Rank test was used for survival analysis. P<0.05 was considered statistically significant.

There was no statistically significant difference in the total number of dissected lymph nodes between the two groups (P>0.05). Compared with the control group, the observation group had longer operation time, less intraoperative blood loss, lower pain level, shorter gastric tube indwelling time, fasting time, and hospital stay (P<0.05). The total incidence of postoperative complications in the control group was 28.9%, which was higher than 2.9% in the observation group. In terms of Clavien-Dindo complication classification, the observation group was significantly milder than the control group (observation group: 1 case of grade Ⅰ, 1 case of grade Ⅱ, 0 cases of grade Ⅲ; control group: 8 cases of grade Ⅰ, 5 cases of grade Ⅱ, 2 cases of grade Ⅲ) (P<0.05). There were no statistically significant differences in preoperative Gastrointestinal Quality of Life Index (GLQI) and Patient-Generated Subjective Global Assessment (PG-SGA) scores between the two groups (P>0.05). At 6 and 12 months after surgery, compared with the control group, the observation group had significantly higher GLQI scores and significantly lower PG-SGA scores (P<0.05). There was no statistically significant difference in disease-free survival rate between the control group and the observation group (Log-Rank χ²=0.367, P>0.05).

Compared with LPG, dual-endoscope radical gastrectomy with LLND shows more significant advantages in perioperative indicators, quality of life, and postoperative nutritional improvement in patients with proximal EGC. LLND surgery helps reduce intraoperative bleeding, shorten postoperative recovery time, and significantly improve patients’ postoperative quality of life.

To investigate the efficacy of the modified inverted hand-sutured Overlap anastomosis in laparoscopic total gastrectomy (LTG).

A prospective selection was made of 178 gastric cancer patients who underwent LTG at the Affiliated Hospital of Tangshan Vocational and Technical College from January 2020 to March 2022. The patients were divided into the modified group (undergoing modified inverted hand-sutured Overlap anastomosis) and the traditional group (undergoing traditional Overlap anastomosis) using a random number table method, with 89 patients in each group. Statistical analysis was performed using SPSS 22.0 software. Measurement data conforming to normal distribution, were expressed as (±s). Independent sample t test was used for comparison between the two groups, and paired sample t test was used for intragroup comparison. Count data were expressed as [cases (%)] and analyzed using the χ² test. Kaplan-Meier survival curves were plotted to evaluate the 3-year postoperative survival of patients in both groups, and the Log-Rank test was used to compare survival differences between groups. P<0.05 was considered statistically significant.

All patients in both groups successfully completed LTG, with no conversion to open surgery or perioperative deaths. The operation time and anastomosis time in the modified group were significantly shorter than those in the traditional group, with statistically significant differences (P<0.05). After surgery, the levels of D-lactate (D-LAC), endotoxin (ET), and diamine oxidase (DAO) in both groups were significantly higher than those before surgery, and the levels in the modified group were lower than those in the traditional group. Meanwhile, the postoperative decreases in intestinal villus height and crypt depth in the modified group were smaller than those in the traditional group, with statistically significant differences (P<0.05). The total incidence of postoperative complications in the modified group was significantly lower than that in the traditional group (4.5% vs. 15.2%), with a statistically significant difference (P<0.05). The overall survival rate was 61.8% in the modified group and 51.7% in the traditional group. The comparison of overall survival rates between the two groups (Log-Rank χ²=6.052, P=0.014) showed a statistically significant difference (P<0.05).

The modified inverted hand-sutured Overlap anastomosis shows significant advantages in LTG. This anastomotic method not only reduces the difficulty of anastomotic operation, simplifies the surgical process, and significantly shortens the operation time but also causes less damage to the intestinal mucosal barrier function and effectively reduces the incidence of postoperative complications. Overall, the modified inverted hand-sutured Overlap anastomosis is an ideal anastomotic method in LTG with clinical application value.

To compare the clinical efficacy of proximal gastrectomy (PG) for upper gastric cancer (UGC) after neoadjuvant chemotherapy alone versus neoadjuvant chemotherapy combined with immunotherapy (nICT).

A retrospective collection was conducted on 257 UGC patients who underwent neoadjuvant therapy followed by surgery from January 2017 to March 2025. They were divided into two groups based on treatment modalities: the chemotherapy-alone group (n=114, receiving neoadjuvant chemotherapy) and the combined immunotherapy group (n=143, receiving neoadjuvant chemotherapy combined with PD-1 inhibitors). Data analysis was performed using SPSS 27.0 software. Measurement data with normal distribution were expressed as (±s) and analyzed by independent samples t test; measurement data with non-normal distribution were expressed as [M(Q₁, Q₃)] and analyzed by Mann-Whitney U test; counting data were expressed as [cases (%)] and analyzed by χ² test; ranked data were analyzed by Rank Sum test. P<0.05 was considered statistically significant.

There were no statistically significant differences between the two groups in terms of the number of dissected lymph nodes, tumor regression grade (TRG), vascular invasion, perineural invasion, operation time, estimated intraoperative blood loss, postoperative hospital stay, surgical complications, or the incidence of grade ≥3 complications (P>0.05). The combined immunotherapy group had higher rates of pathological complete response (pCR), major pathological response, and PG implementation; in contrast, it had lower rates of lymph node metastasis and open surgery implementation compared with the neoadjuvant chemotherapy group (P<0.05). Multivariate regression analysis showed that body mass index (BMI) >24.0 kg/m², neoadjuvant immunotherapy combined with chemotherapy regimen, and maximum tumor diameter ≤5 cm were independent influencing factors for choosing PG after neoadjuvant therapy (P<0.05).

For locally advanced UGC, nICT achieves better tumor primary lesion regression and regional lymph node control without increasing surgical risks.

To investigate the impact of different anastomotic methods on postoperative recovery and complication rates in patients undergoing laparoscopy-assisted distal gastrectomy for gastric cancer.

Clinical data of 102 gastric cancer patients who underwent laparoscopy-assisted distal gastrectomy from March 2023 to March 2025 were collected retrospectively. Patients were grouped based on the digestive tract reconstruction method: Group A (n=52, underwent BillrothⅡanastomosis + Braun anastomosis) and Group B (n=50, underwent uncut Roux-en-Y anastomosis). Data were analyzed using SPSS 26.0 software. Categorical data were expressed as [cases (%)] and analyzed using the χ² test, Fisher’s exact test, or continuity-corrected χ² test. Measurement data, which were confirmed to follow a normal distribution by the Shapiro-Wilk test, were expressed as (±s) and analyzed using the independent samples t test. P<0.05 was considered statistically significant.

Compared with Group A, patients in Group B had significantly shorter durations of operation, bowel sound recovery, first flatus, first oral intake, and first defecation (P<0.05). At 7 days postoperatively, hemoglobin, serum albumin, and serum transferrin levels decreased in both groups, but these levels were significantly higher in Group B than in Group A (P<0.05). There was no statistically significant difference in the total incidence of postoperative complications between the two groups (P>0.05).

Compared with Billroth Ⅱ+ Braun anastomosis, uncut Roux-en-Y anastomosis is more beneficial for shortening operation time, promoting gastrointestinal function recovery and postoperative recovery, and improving early postoperative nutritional status.

To investigate the short-term efficacy of skin-sparing mastectomy (SSM) combined with breast reconstruction in the treatment of early breast cancer.

Clinical data of 74 patients with early breast cancer admitted from January 2019 to September 2023 were collected and divided into the control group (n=40 cases, modified radical mastectomy combined with breast reconstruction) and the study group (n=34 cases, SSM combined with breast reconstruction) according to different surgical methods. All patients in both groups were followed up for 12 months. Statistical software SPSS 25.0 was used for data processing. Perioperative indicators, breast aesthetics, and scores of Breast Cancer Patient-Reported Outcomes Measurement System were compared between the two groups by t test. Tumor markers were compared by general linear repeated measures analysis of variance. Postoperative complications and recurrence were compared by χ² test. P<0.05 was considered statistically significant.

There were no statistically significant differences in perioperative indicators between the two groups (P>0.05). At 1 month and 12 months after surgery, the levels of carcinoembryonic antigen (CEA) and carbohydrate antigen 15-3 (CA15-3) in both groups were significantly lower than those before surgery (P<0.05), but there were no statistically significant differences in CEA and CA15-3 levels between the study group and the control group at 1 month and 12 months after surgery (P>0.05). No recurrence was observed in both groups within 12 months after surgery. At 1 month after surgery, the study group had higher scores in bilateral breast symmetry, breast shape, breast skin elasticity and texture than the control group (P<0.05). The study group had significantly higher scores in mental health, sexual health, and breast satisfaction than the control group at 1 month after surgery (P<0.05). There was no statistically significant difference in postoperative complications between the two groups (P>0.05).

SSM combined with breast reconstruction for early breast cancer can ensure good oncological efficacy, while improving breast aesthetics, mental health, sexual health, and breast satisfaction of patients.

To explore the efficacy of platelet-to-lymphocyte ratio (PLR) in predicting the response to neoadjuvant chemotherapy in breast cancer patients.

A total of 93 breast cancer patients who received neoadjuvant chemotherapy from March 2021 to February 2023 were selected. SPSS 23.0 software was used for statistical analysis. Enumeration data were described as [cases (%)] and analyzed by the χ² test. Receiver operating characteristic (ROC) curve was used to evaluate the predictive efficacy. Multivariate Logistic regression analysis was applied to explore the influencing factors. A two-tailed test with α=0.05 was considered statistically significant.

The ROC curve showed that the area under the curve (AUC) of PLR for predicting the response to neoadjuvant chemotherapy in breast cancer patients was 0.861 (95% CI: 0.850-0.913), with a cut-off value of 124.5, a specificity of 64.8%, and a sensitivity of 91.1%. According to the PLR cut-off value, patients were divided into the low PLR group (PLR<124.5, n=59) and the high PLR group (PLR ≥ 124.5, n=34). The proportions of clinical stageⅢ, tumor diameter>5 cm, and positive lymph node status in the high PLR group were significantly higher than those in the low PLR group (P<0.05). Univariate analysis showed that clinical stageⅢ, tumor diameter > 5 cm, PLR ≥ 124.5, and positive lymph node status were correlated with the response to neoadjuvant chemotherapy in breast cancer patients (P<0.05). Binary Logistic stepwise regression analysis revealed that tumor diameter > 5 cm, positive lymph node status, and PLR ≥ 124.5 were influencing factors for the response to neoadjuvant chemotherapy in breast cancer patients (P<0.05).

PLR can serve as an important marker for predicting the response to neoadjuvant chemotherapy in breast cancer patients. A higher PLR level is associated with a poorer response to neoadjuvant chemotherapy and a lower pathological complete response (pCR) rate.

To explore the efficacy of simple primary suture of the common bile duct during laparoscopic common bile duct exploration (LCBDE) for the treatment of common bile duct stones.

A retrospective analysis was conducted on the clinical data of 81 patients with common bile duct stones who underwent laparoscopic common bile duct exploration from August 2018 to March 2024. They were divided into the observation group (n=48, simple primary suture group) and the control group (n=33, T-tube drainage group) according to the common bile duct closure method. Data were processed using SPSS 27.0 software. Measurement data were expressed as (±s) and analyzed by independent samples t test; counting data were expressed as [cases (%)] and analyzed by χ² test. P<0.05 was considered statistically significant.

There were no statistically significant differences between the two groups in terms of intraoperative blood loss, total hospitalization cost, pain score on the 1st day after surgery, pain score on the 3rd day after surgery, Activities of Daily Living (ADL) score on the 1st day after surgery, ADL score on the 3rd day after surgery, or the incidence of postoperative bile leakage and bile duct stricture (P>0.05). The operation time and hospital stay in the observation group were shorter than those in the control group, with statistically significant differences (P<0.05). The pain score on the 7th day after surgery in the observation group was significantly lower than that in the control group, and the ADL score on the 7th day after surgery was significantly higher than that in the control group, with statistically significant differences (P<0.05).

Under the premise of strictly grasping the indications, both simple primary suture of the common bile duct and T-tube drainage during LCBDE are safe and feasible minimally invasive treatment methods. Simple primary suture of the common bile duct has the advantages of shorter operation time and shorter postoperative hospital stay, which can promote patients’ early recovery of daily life after surgery.

To investigate the efficacy of laparoscopic ultrasound-assisted guidewire-guided duodenoscopy via the cystic duct in the treatment of gallbladder stones combined with non-dilated common bile duct stones.

A retrospective analysis was performed on the clinical data of 139 patients with gallbladder stones and non-dilated common bile duct stones admitted from October 2020 to March 2023. According to different surgical methods, the patients were divided into a study group (n=73 cases) and a control group (n=66 cases). The study group underwent laparoscopic ultrasound-assisted guidewire-guided duodenoscopy for common bile duct lithotomy via the cystic duct combined with laparoscopic cholecystectomy (LC), while the control group underwent endoscopic retrograde cholangiopancreatography (ERCP) combined with LC. Data were processed using SPSS 26.0 statistical software. Measurement data with skewed distribution were expressed as quartiles M(Q₁, Q₃), and intergroup comparisons were performed using the Mann-Whitney U Rank Sum test, while pre-and post-surgical comparisons were conducted using the Wilcoxon test. Enumeration data were expressed as [cases (%)], and intergroup comparisons were made by χ² test or Fisher’s exact probability method. P<0.05 was considered statistically significant.

The study group showed a higher surgical success rate and shorter guidewire intubation time than the control group (P<0.05), with lower incidences of postoperative hyperamylasemia and pancreatitis (P<0.05). There were no significant differences between the two groups in stone residue, bile leakage, or duodenal perforation (P>0.05). The serum amylase (AMY) level in the control group increased at 6 hours postoperatively compared with that before surgery (P<0.05), while no significant difference was observed in the study group (P>0.05). At 5 days postoperatively, serum total bilirubin, alanine aminotransferase (ALT), and aspartate aminotransferase (AST) levels in both groups significantly decreased compared with those before surgery (P<0.05), but no significant intergroup differences were found (P>0.05).

Under strict screening of indications, laparoscopic ultrasound-assisted guidewire-guided duodenoscopy via the cystic duct is safe and effective for the treatment of gallbladder stones combined with non-dilated common bile duct stones.

To investigate the impact of percutaneous transhepatic cholangioscopic lithotomy (PTCSL) and laparoscopic common bile duct exploration (LCBDE) on stress response and stone clearance rate in patients with intrahepatic biliary stones.

A retrospective analysis was conducted on 120 patients with intrahepatic biliary stones admitted from May 2021 to May 2024. They were divided into the PTCSL group (n=56, undergoing PTCSL) and the LCBDE group (n=64, undergoing LCBDE) according to the surgical method. Statistical analysis was performed using SPSS 28.0 software. Ranked data were analyzed by the rank-sum test; counting data were expressed as [cases (%)] and analyzed by the χ² test; measurement data conforming to normal distribution were expressed as (±s), with inter-group comparison using the independent samples t test and intra-group comparison using the paired samples t test. P<0.05 was considered statistically significant.

The total effective rate of stone clearance in the LCBDE group was 96.9%, which was higher than 85.7% in the PTCSL group (P<0.05). At 3 days after surgery, the levels of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), epinephrine (EP), and cortisol (Cor) in both groups were higher than those before surgery, while the levels of γ-glutamyl transferase (GGT), alanine aminotransferase (ALT), and total bilirubin (TBIL) were lower than those before surgery. Moreover, the postoperative levels in the LCBDE group were lower, with statistically significant differences between the two groups (P<0.05). There were no statistically significant differences in surgical-related indicators or the total incidence of postoperative complications between the two groups (P>0.05).

Compared with PTCSL, LCBDE achieves better stone clearance efficacy in patients with intrahepatic biliary stones and has a smaller impact on postoperative stress response and early liver function indicators.

To investigate the relationship between programmed cell death 4 (PDCD4) and disease progression after hepatectomy in patients with primary hepatocellular carcinoma (HCC).

A total of 130 HCC patients who underwent surgical resection from May 2022 to January 2024 were selected. The expression of PDCD4 in cancer tissues was detected by immunohistochemistry, and its relationship with clinicopathological characteristics of HCC patients was analyzed. Survival analysis was performed using the Kaplan-Meier method, and univariate and multivariate COX regression analyses were used to identify influencing factors of disease progression after hepatectomy in HCC patients.

The low expression rate of PDCD4 in HCC tissues was 60.0%, and the high expression rate was 40.0%. Low PDCD4 expression was correlated with CNLC stage, differentiation degree, and vascular invasion (P<0.05). The 1-year postoperative recurrence rate in the low PDCD4 expression group was 33.3%, which was higher than 9.6% in the high PDCD4 expression group (P<0.05). Kaplan-Meier analysis showed that the median 1-year postoperative progression-free survival (PFS) in the low PDCD4 expression group was 6 months, which was significantly shorter than 9 months in the high PDCD4 expression group (P<0.05). The 1-year postoperative PFS rate in the low PDCD4 expression group was 66.7%, which was lower than 90.4% in the high PDCD4 expression group (P<0.05). Univariate analysis showed that tumor diameter, CNLC stage, differentiation degree, vascular invasion, and PDCD4 expression were associated with postoperative PFS in HCC patients (P<0.05). Multivariate COX regression analysis revealed that CNLC stage Ⅲ (HR=1.923, 95%CI: 1.282-2.889), vascular invasion (HR=2.331, 95%CI: 1.254-4.358), and low PDCD4 expression (HR=3.454, 95%CI: 1.781-6.688) were independent risk factors for postoperative PFS in HCC patients (P<0.05).

Low PDCD4 expression is closely related to disease progression after hepatectomy in HCC patients and serves as a potential biomarker for evaluating the risk of disease progression after hepatectomy in HCC patients. Detecting the expression level of PDCD4 is expected to provide a reference for clinical treatment decision-making.

To compare the efficacy and safety of the anterior approach with hepatic suspension versus the traditional approach in right hepatectomy for primary hepatocellular carcinoma.

A retrospective analysis was performed on the clinical data of 93 patients with primary hepatocellular carcinoma who underwent right hepatectomy from February 2021 to February 2024. After propensity score matching, 84 patients were finally included. They were divided into the traditional approach group (treated with the traditional approach) and the anterior approach group (treated with the anterior approach with hepatic suspension) according to the surgical approach, with 42 patients in each group. Statistical analysis was performed using SPSS 26.0 software. Measurement data conforming to normal distribution were expressed as (±s), and independent sample t test was used for comparison between groups. Count data were expressed as rates (%), and the χ² test was used for comparison of rates between groups. Kaplan-Meier survival curves were plotted, and the Log-Rank test was used to analyze survival outcomes. A P value < 0.05 was considered statistically significant.

Compared with the traditional approach group, the anterior approach group had shorter operation time and hospital stay, less intraoperative blood loss, and a lower intraoperative transfusion rate (P<0.05). At 7 days after surgery, the serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), and total bilirubin (TBIL) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). At 7 days after surgery, the serum levels of tumor necrosis factor-α (TNF-α), interleukin-6, and C-reactive protein (CRP) in both groups were higher than those before surgery, but the levels in the anterior approach group were lower than those in the traditional approach group (P<0.05). There was no statistically significant difference in the total incidence of postoperative complications between the two groups (P>0.05). At 1 year after surgery, the cumulative disease-free survival rate in the traditional approach group was lower than that in the anterior approach group (P<0.05). There was no statistically significant difference in the overall survival rate between the traditional approach group and the anterior approach group (P>0.05).

Compared with the traditional approach, right hepatectomy via the anterior approach with hepatic suspension can significantly shorten the operation time and hospital stay, reduce intraoperative blood loss and transfusion requirements in patients with primary hepatocellular carcinoma, and also help alleviate postoperative inflammatory responses and liver function damage.

To compare the therapeutic effects of single-port laparoscopic breast-conserving surgery via axillary approach versus traditional open breast-conserving surgery for early breast cancer.

A retrospective analysis was performed on the clinical data of 102 patients with early breast cancer from February 2020 to February 2023. Based on different surgical protocols, they were divided into the open surgery group (n=51, receiving traditional open breast-conserving surgery) and the laparoscopic group (n=51, receiving single-port laparoscopic breast-conserving surgery via axillary approach). Data were processed using SPSS 25.0 software. measurement data with normal distribution were described as (±s) and analyzed by independent samples t test; counting data were analyzed by χ² test. P<0.05 was considered statistically significant.

The operation time in the laparoscopic group was longer than that in the open surgery group, while the intraoperative blood loss, surgical incision length, postoperative drainage volume, and hospital stay in the laparoscopic group were better than those in the open surgery group, and the consumable cost was higher in the laparoscopic group (P<0.05). The Visual Analogue Scale (VAS) scores of patients in the laparoscopic group at 2 hours and 24 hours after surgery were lower than those in the open surgery group (P<0.05). At 1 month after surgery, the scores of breast satisfaction, mental health, physical health (chest), and sexual health in the laparoscopic group were higher than those in the open surgery group (P<0.05); at 6 months after surgery, there were no statistically significant differences in the above scores between the two groups (P>0.05). There were no statistically significant differences between the two groups in postoperative complications, or in recurrence and survival rates at 2 years after surgery (P>0.05).

Traditional open breast-conserving surgery and single-port laparoscopic breast-conserving surgery via axillary approach can achieve comparable therapeutic effects. However, single-port laparoscopic breast-conserving surgery via axillary approach can effectively relieve early postoperative pain, reduce intraoperative blood loss and postoperative drainage volume, shorten surgical incision length and hospital stay, and improve early postoperative satisfaction, but its consumable cost is higher.

To analyze the predictive value of serum macrophage migration inhibitory factor (MMIF) combined with perioperative indicators [interleukin-6 (IL-6), parathyroid hormone (PTH)] for early postoperative hypoparathyroidism in patients undergoing total thyroidectomy.

A prospective study was conducted on 130 patients who underwent total thyroidectomy from January 2021 to January 2025. All patients were followed up postoperatively and divided into the hypoparathyroidism group (n=40, serum calcium level <2.1mmol/L) and the normal group (n=90, serum calcium level ≥2.1mmol/L) based on fasting serum calcium levels (referring to ionized calcium^[1]) at 1 month after surgery. A combined prediction model with MMIF, IL-6, and PTH as variables was constructed using Logistic regression analysis. Receiver operating characteristic (ROC) curves were used to analyze the predictive value of postoperative MMIF, IL-6, and PTH levels for early hypoparathyroidism.

The levels of postoperative MMIF and IL-6 in the hypoparathyroidism group were higher than those in the normal group, while the PTH level was lower (P<0.05). Logistic regression analysis showed that postoperative MMIF, IL-6, and PTH were predictive indicators of hypoparathyroidism, and the combined prediction model was Logit(P) = -4.440 + 2.178 × MMIF + 0.189 × IL-6 - 0.257 × PTH. ROC curve analysis revealed that the area under the curve (AUC) of the combined prediction of early postoperative hypoparathyroidism by MMIF, IL-6, and PTH was 0.892, with a sensitivity of 82.5% and a specificity of 92.2%. The combined prediction efficacy was superior to that of each indicator alone (P<0.05).

Postoperative MMIF, IL-6, and PTH levels in patients undergoing total thyroidectomy have certain predictive value for early postoperative hypoparathyroidism, and the combined detection of the three can improve the predictive efficacy. Clinically, early postoperative screening of these indicators may be considered, and timely prevention and treatment measures can be taken to reduce parathyroid function damage.

To explore the high-risk factors for linezolid-induced thrombocytopenia in patients with postoperative surgical infections, and to provide a basis for the safety of clinical medication.

A retrospective analysis was conducted on the data of 164 patients who received linezolid for postoperative surgical infections from January 2021 to December 2021. Univariate and multivariate Logistic regression analyses were used to identify the high-risk factors for linezolid-induced thrombocytopenia in these patients.

The incidence of thrombocytopenia was 13.4% (22/164). In the 22 patients with thrombocytopenia, the platelet count decreased from (184.0±54.1)×10⁹/L before medication to (75.2±19.1)×10⁹/L after medication, with a statistically significant difference (P<0.05). Multivariate analysis showed that age ≥65 years (OR=3.432, 95%CI: 1.234-9.654), medication duration >14 days (OR=4.798, 95%CI: 1.321-17.456), combined use of ≥2 antimicrobial agents (OR=3.072, 95%CI: 1.178-8.032), glomerular filtration rate (GFR) <30ml/min (OR=6.623, 95%CI: 1.478-29.876), and Charlson Comorbidity Index (CCI) ≥4 (OR=5.998, 95%CI: 1.654-21.789) were high-risk factors for linezolid-induced thrombocytopenia in patients with postoperative surgical infections (all P<0.05).

In clinical practice, for patients with postoperative surgical infections who have characteristics such as advanced age, long-term medication, severe renal impairment, high CCI, and combined use of multiple drugs, high vigilance is required when using linezolid. Strengthened monitoring and intervention should be implemented to reduce the risk of thrombocytopenia and improve the safety and effectiveness of clinical treatment.

To compare the short-and mid-term efficacy of laparoscopic radical resection for right-sided colon cancer using the hybrid approach versus the medial-to-lateral approach.

A retrospective analysis was performed on data from 103 patients with colon cancer who underwent laparoscopic radical resection for right-sided colon cancer from June 2018 to June 2024. Based on the surgical approach, 52 patients who underwent the hybrid approach were assigned to the hybrid approach group, and 51 patients who underwent the medial-to-lateral approach were assigned to the medial-to-lateral approach group. From the total sample, 44 obese patients (BMI ≥28kg/m²) were selected (23 in the hybrid approach group and 21 in the medial-to-lateral approach group) to form the obese subgroup; 41 patients with tumors located in the hepatic flexure were selected (21 in the hybrid approach group and 20 in the medial-to-lateral approach group) to form the hepatic flexure subgroup for subsequent subgroup analyses. Data were analyzed using SPSS 25.0 statistical software. Perioperative indicators and other measurement data with normal distribution were expressed as (±s), and inter-group comparisons were performed using independent samples t test; counting data such as postoperative complications and tumor recurrence-free rate were analyzed using χ² test. P<0.05 was considered statistically significant.

Compared with the medial-to-lateral approach group, the hybrid approach group had shorter operation time and less intraoperative blood loss (P<0.05). In the obese subgroup or the subgroup with tumors located in the hepatic flexure, the hybrid approach group showed shorter operation time, shorter postoperative exhaust time, and less intraoperative blood loss (P<0.05). There were no statistically significant differences between the two groups in the total incidence of postoperative complications or the 1-year and 3-year disease-free survival rates (P>0.05).

Both the hybrid approach and the medial-to-lateral approach are safe and feasible for laparoscopic radical resection of right-sided colon cancer. However, compared with the medial-to-lateral approach, the hybrid approach is associated with shorter operation time and less intraoperative blood loss. Additionally, the hybrid approach facilitates early postoperative gastrointestinal function recovery in patients with obesity or tumors located in the hepatic flexure.

To analyze the risk factors for acute hepatic function deterioration after conventional transcatheter arterial chemoembolization (TACE) in elderly patients with Barcelona Clinic Liver Cancer (BCLC) stage B hepatocellular carcinoma.

A retrospective analysis was performed on the clinical data of 136 elderly patients with BCLC stage B hepatocellular carcinoma who underwent conventional TACE from January 2022 to January 2025. According to the occurrence of acute hepatic function deterioration after surgery, the patients were divided into the deterioration group (n=32) and the non-deterioration group (n=104). Their clinical data were analyzed, and univariate analysis and Logistic multivariate regression analysis were used to identify the risk factors for acute hepatic function deterioration after TACE. P<0.05 was considered statistically significant.

Univariate analysis showed that the deterioration group had a significantly higher proportion of Child-Pugh class B, higher rates of complicated liver cirrhosis and portal vein tumor thrombus, larger tumor invasion range (>50%), and higher preoperative levels of neutrophil-to-lymphocyte ratio (NLR), aspartate aminotransferase-to-platelet ratio index (APRI), and γ-glutamyl transpeptidase-to-platelet ratio index (GPRI) compared with the non-deterioration group (P<0.05). Logistic multivariate regression analysis revealed that Child-Pugh class B, complicated liver cirrhosis, portal vein tumor thrombus, tumor invasion range >50%, and high preoperative levels of NLR, APRI, and GPRI were independent risk factors for acute hepatic function deterioration after conventional TACE in elderly patients with BCLC stage B hepatocellular carcinoma. However, this study had limitations in sample size, especially the relatively small number of hepatic function deterioration events, and the above multivariate analysis results need to be validated in larger samples.

Acute hepatic function deterioration after conventional TACE in elderly patients with BCLC stage B hepatocellular carcinoma is influenced by factors such as Child-Pugh classification, liver cirrhosis, portal vein tumor thrombus, tumor invasion range, and preoperative levels of NLR, APRI, and GPRI.

To comprehensively evaluate the research status and development trends of enteral immunonutrition support in patients with gastrointestinal malignant tumors through bibliometric methods, and to provide a reference basis for clinical practice and further research.

Literatures related to enteral immunonutrition in patients with gastrointestinal malignant tumors were retrieved from the Web of Science Core Collection database, and visualized analysis was performed using VOSviewer and CiteSpace.

A total of 373 studies were included in this paper, and the number of publications showed an increasing trend. There were 2 041 authors involved in research in the field of enteral immunonutrition for gastrointestinal tumors, among whom the authors with the most publications were Braga M (14 articles) and Gianotti L (14 articles) from Italy. China (81 articles, 21.7%), the United States (57 articles, 15.3%), and Japan (49 articles, 13.1%) were the leading countries in publishing research in this field. The main research institutions included the University of Milan, Jagiellonian University, and Nanjing University. Clinical Nutrition was the journal with the most published literatures in this field. Keyword analysis showed a total of 4 clusters, and the hot research fields included "supplementation of ω-3 fatty acids", "enteral immunonutrition and complications", "surgical resection and early enteral nutrition supplementation", and "use of immunonutrition in patients with gastrointestinal tumors". On this basis, studies on the effect of immunonutrition support in improving the nutritional status, clinical outcomes, and quality of life of patients with gastrointestinal tumors have received more extensive attention.

The field of enteral immunonutrition support in patients with gastrointestinal malignant tumors is in a stage of development. Future research should focus on exploring the potential role of enteral immunonutrition in improving the clinical outcomes and quality of life of such patients, so as to provide a more solid scientific basis for clinical practice.

Transanal Endoscopic Microsurgery (TEM) is a commonly used surgical procedure for the treatment of rectal tumors. It primarily achieves en bloc resection through a multi-functional surgical operating system of rectoscopes and has been widely applied in surgeries for benign lesions such as rectal adenomas, early-stage rectal cancer, and various rare rectal diseases. Compared with open transabdominal surgery or laparoscopic surgery, TEM offers higher precision, less trauma and pain, shorter recovery time, and better functional preservation. In recent years, neoadjuvant chemoradiotherapy combined with local resection has provided a new direction for the comprehensive treatment of advanced rectal cancer. However, the effectiveness of neoadjuvant chemoradiotherapy combined with TEM remains controversial. This study analyzes and summarizes the research progress of TEM in the treatment of rectal tumors in recent years, aiming to provide a reference for future clinical treatment.

In recent years, significant achievements have been made in the research on surgical treatment of low rectal cancer, especially the application of function-preserving surgery, which has further improved tumor prognosis and patients’ quality of life. This article introduces the latest progress in function-preserving surgery for low rectal cancer, summarizes the evaluation and monitoring methods for anal sphincter function and urogenital function, and discusses the surgery-related factors affecting tumor prognosis. Future research directions should focus on optimizing the comprehensive strategies of function-preserving surgery and individualized precision treatment, verifying the short-term and long-term efficacy of different surgical methods through multi-center prospective randomized controlled trials, and finding a balance between tumor radical cure and function preservation, so as to further improve the treatment effect and patients’ quality of life.

Unresectable hepatocellular carcinoma refers to a type of liver cancer that cannot be radically resected through surgery due to tumor characteristics or limitations in the patient’s physical condition. Traditional transcatheter arterial chemoembolization (TACE) therapy has limitations in efficacy and a high risk of complications. In contrast, hepatic arterial infusion chemotherapy (HAIC) has demonstrated superior safety profiles, with more significant survival benefits compared to TACE. This study reviews the application of HAIC in unresectable hepatocellular carcinoma.

Foreign body in the common bile duct refers to a disease where iatrogenic or non-iatrogenic foreign bodies enter the common bile duct and cause clinical symptoms. This article reports the treatment process of one case of foreign body in the common bile duct. The patient had a history of common bile duct exploration and lithotomy, with the main symptom of upper abdominal pain. Upon admission, abdominal CT examination suggested intrahepatic and extrahepatic bile duct stones as well as a foreign body in the common bile duct. The patient underwent common bile duct exploration to remove the fishbone-like foreign body in the common bile duct, and the intrahepatic and extrahepatic bile duct stones were also removed simultaneously. This case is reported herein, and its possible pathogenesis is discussed to improve the understanding of such diseases and avoid misdiagnosis and missed diagnosis.