The complex pelvic anatomy of rectal cancer poses high demands on minimally invasive surgery in terms of precise dissection, radical tumor resection, and functional preservation. In recent years, laparoscopic, robotic, transanal, and ultra-low anterior resection techniques have continuously expanded the boundaries of minimally invasive surgery for rectal cancer. Meanwhile, digital artificial intelligence (AI) is being increasingly applied to preoperative imaging analysis, 3D reconstruction, surgical risk assessment, and personalized treatment planning. By enabling intraoperative anatomical recognition, real-time navigation, and risk alerts, AI is driving the evolution of minimally invasive surgery from mechanical assistance toward intelligent, integrated development. However, challenges remain, including insufficient data standardization, limited model generalizability, and a lack of high-level clinical evidence. In the future, with advances in multimodal data integration and intelligent robotics, digital AI is expected to further enhance the precision, safety, and consistency of quality in minimally invasive rectal cancer surgery.

Significant progress has been made in the application of intelligent technologies in the diagnosis and treatment of rectal cancer, particularly in robot-assisted surgical systems, artificial intelligence-assisted diagnosis, and intraoperative navigation technologies. These technologies not only enhance the safety of surgeries, effectively reduce postoperative complications, but also significantly improve the clinical prognosis of patients. However, China still faces many challenges in the popularization and application of intelligent technologies. This article systematically summarizes the current application status of intelligent technologies in minimally invasive surgery for rectal cancer, deeply analyzes their clinical value and existing deficiencies, and, in combination with the characteristics of domestic medical resources, looks forward to the future development direction of intelligent technologies, aiming to provide references for clinical practice.

Rectal cancer is one of the most common malignant tumors of the digestive tract. Its treatment modalities are gradually shifting from traditional open surgery to minimally invasive surgery, and from standardized therapy to individualized precision treatment. The rapid development of artificial intelligence, robotic surgical systems, intraoperative image navigation, and multi-omics technologies has provided crucial support for individualized treatment in minimally invasive surgery for rectal cancer. This article systematically reviews the current applications of intelligent and individualized technologies in minimally invasive surgery for rectal cancer, encompassing three main aspects: preoperative precise assessment, intraoperative intelligent navigation, and perioperative individualized management, while also discussing the challenges faced by current technologies and future directions for development.

With the advancement of minimally invasive surgical techniques, natural orifice specimen extraction surgery (NOSES) has been increasingly applied in the treatment of colorectal cancer. The NOSES-Ⅰ procedure for rectal cancer enables specimen extraction through the anus while adhering to the principles of radical oncologic resection and tumor-free technique, thereby avoiding an auxiliary abdominal incision. This approach offers advantages including reduced surgical trauma, less postoperative pain, fewer incision-related complications, and improved cosmetic outcomes. The robotic surgical system provides high-definition three-dimensional visualization and a flexible, stable operative platform, facilitating precise total mesorectal excision (TME) and gastrointestinal reconstruction within the narrow pelvis. However, this procedure requires careful patient selection, strict adherence to aseptic and tumor-free principles, and reliable anastomotic safety. This video demonstrates a case of robot-assisted NOSES-I surgery for rectal cancer, highlighting the minimally invasive advantages of combining robotic technology with the NOSES concept.

To explore the key operative technical points and clinical value of robot-assisted radical resection for low rectal cancer. With reference to the surgical video, we fully demonstrated the core operative steps of robot-assisted radical resection for low rectal cancer, including abdominal exploration, dissection and ligation of the inferior mesenteric vessels, preservation of pelvic autonomic nerves, total mesorectal excision, mobilization of the low rectum, and gastrointestinal reconstruction. This procedure confers particular technical advantages in addressing clinical challenges such as a narrow pelvis and low-lying tumors.The robotic system delivers magnified three-dimensional visualization and flexible robotic wrists, which facilitate meticulous dissection within the confined pelvic cavity. Standardized total mesorectal excision can be achieved with preservation of pelvic autonomic nerves and secure surgical resection margins. The approach reduces the technical difficulty of pelvic-floor manipulation and facilitates low sphincter-preserving surgery.The robotic surgical platform enables safe and standardized surgical management of low rectal cancer, with distinct advantages for meticulous deep-pelvic dissection. Proficiency in operative workflows and technical skills is essential to guarantee surgical quality. This procedure is suitable for implementation and popularization in well-equipped medical centers.

To investigate the sensitizing effect of the high-chloride salt of the traditional Chinese medicine monomer derivative, dihydroperiplanarol (DP), in reversing the acquired resistance of colorectal cancer to oxaliplatin (L-OHP), and to elucidate its potential molecular mechanism based on the PI3K/Akt signaling pathway and the anti-apoptotic network.

The human colorectal cancer L-OHP-resistant cell line (SW480/L-OHP) was established by a stepwise concentration increment method. The synergistic sensitizing effect of low-toxicity DP combined with L-OHP was evaluated by the CCK-8 method and CompuSyn software, and the effect on the long-term proliferation potential of the cells was assessed by the plate colony formation experiment. The apoptosis level was detected by Annexin V-FITC/PI double staining flow cytometry. The expression changes of PI3K/Akt signaling pathway targets and downstream apoptosis-related proteins were detected by Western blot. Statistical analysis was performed using GraphPad Prism 9.0 software. Quantitative data were expressed as (

The resistant cell line SW480/L-OHP with epithelial-mesenchymal transition (EMT) characteristics and anti-apoptotic phenotype was successfully constructed. The CCK-8 and colony formation experiments showed that the combination of 10 μmol/L low-toxicity DP and L-OHP exhibited significant synergy (CI<1), and the half inhibitory concentration (IC50) of L-OHP for the resistant cells decreased from 40.9 μmol/L to 3.8 μmol/L, with a reversal ratio of 10.7, and effectively inhibited the colony formation ability (P<0.000 1). Flow cytometry indicated that the combination treatment overcame the apoptosis resistance of the resistant cells, and the total apoptosis rate increased to 21.1% (P<0.000 1). Mechanism analysis showed that the combination treatment effectively inhibited the phosphorylation levels of PI3K and Akt in the resistant cells, thereby down-regulating the anti-apoptotic protein Bcl-2 and up-regulating the expression of pro-apoptotic protein Bax, and reshaping the apoptosis protein homeostasis of the resistant cells.

Dihydroperiplanarol high-chloride salt is a clinically promising chemotherapy sensitizing agent for oxaliplatin. It can effectively reverse the acquired resistance phenotype of colorectal cancer cells by synergistically targeting and blocking the PI3K/Akt signaling pathway and reshaping the anti-apoptotic network, providing a new combined traditional Chinese and Western medicine treatment strategy to overcome clinical chemotherapy resistance.

To investigate the expression of microRNA (miRNA)-381-3p in colon cancer tissues and analyze its relationship with postoperative recurrence.

This was a retrospective study. Clinical data of 156 colon cancer patients who underwent surgery and had preserved colon cancer tissues and adjacent tissues in wax blocks from December 2021 to May 2024 were collected. The expression of miR-381-3p was detected by real-time fluorescence quantitative PCR. Independent sample t test and paired sample t test were used to compare the relative expression levels of miR-381-3p between groups and within groups. Chi-square test or Fisher's exact probability method was used to compare count data. Multivariate Logistic regression analysis was used to analyze the influencing factors of postoperative recurrence. The receiver operating characteristic (ROC) curve was used to evaluate the predictive value of miR-381-3p for recurrence.

The relative expression level of miR-381-3p in cancer tissues was significantly lower than that in adjacent tissues (P<0.05). The relative expression level of miR-381-3p in cancer tissues of the recurrence group was lower than that of the non-recurrence group. The proportions of patients with lymph node metastasis, low differentiation of tissue, and TNM stage of Ⅲ were higher than those of the non-recurrence group (P<0.05). Multivariate Logistic regression model analysis showed that tissue differentiation and the relative expression level of miR-381-3p in cancer tissues were the influencing factors of postoperative recurrence (P<0.05). The ROC curve showed that the area under the curve (AUC) of miR-381-3p relative expression level for predicting postoperative recurrence was 0.907 (95%CI: 0.858~0.955), with a specificity of 83.3% and a sensitivity of 87.0%.

miR-381-3p is lowly expressed in colon cancer tissues. Its expression level is an independent risk factor for predicting postoperative recurrence. The AUC is 0.907, which has a high predictive value.

To explore the safety and feasibility of using T-tubes in the surgery for locally advanced right-sided colon cancer invading the duodenum.

The clinical data of 31 patients with locally advanced right-sided colon cancer invading the duodenum admitted from January 2021 to June 2024 were retrospectively analyzed. The perioperative conditions and postoperative complications of the patients were recorded and analyzed. The 1-year overall survival rate and disease-free survival rate were estimated using the Kaplan-Meier method, and the 95% confidence interval was calculated using the Greenwood formula.

Continuous variables were expressed as (

The average operation time was (200 ± 14.2) minutes, the intraoperative blood loss was (100.6 ± 14.1) ml, 2 patients underwent liver resection simultaneously, and 3 patients received blood transfusion during the operation. Postoperatively, 1 case of delayed gastric emptying occurred, 2 cases of intestinal obstruction, and 1 case of incision infection. All were cured and discharged after conservative treatment. The median postoperative T-tube removal time was 18 (16, 23) days, the median postoperative first rectal gas passage time was 4 (3, 5) days, the median postoperative recovery time for liquid diet was 15 (13, 20) days, the median postoperative hospital stay was 21 (18, 26) days, and the hospitalization cost was (103 791.5 ± 6 817.2) yuan.

In strict patient selection, this technique is safe and feasible, providing an effective option for preventing duodenal fistula.

To investigate the relationship between the maturity of tertiary lymphoid structures (TLS) in colon cancer tissues and clinical pathological features as well as prognosis.

The clinical data of 162 patients with colon cancer from January 2022 to January 2024 were retrospectively analyzed. The patients were divided into the TLS-positive group (n=124) and the TLS-negative group (n=38) based on the presence or absence of TLS in the tumor stroma. The TLS-positive group was further divided into the mature TLS (SFL-TLS) group (n=65) and the immature TLS (non-SFL-TLS) group (n=59) according to the histological morphology and functional structure integrity of TLS. Baseline data of the patients were collected, and the TLS structure was evaluated by histopathology and immunohistochemistry. Survival differences were analyzed using the Kaplan-Meier method and Log-Rank test. Independent factors affecting overall survival (OS) were analyzed using multivariate Cox proportional hazards regression.

Before surgery, there was a statistically significant difference in the preoperative carcinoembryonic antigen (CEA) levels between the TLS-positive group and the TLS-negative group (P<0.05); there were statistically significant differences in microsatellite instability (MSI) status and extranodal lymph node invasion between the SFL-TLS group and the non-SFL-TLS group (P<0.05). The effector immune cells (CD8+ T cells, NK cells, CD8+ cytotoxic T cells, CD20+ B cells) and CXCL13 chemokine levels in the SFL-TLS group were significantly higher than those in the non-SFL-TLS group, while the inhibitory Treg cell levels were significantly lower than those in the non-SFL-TLS group (P<0.001); the 3-year OS of the TLS-positive group was 63.7% (79/124), and that of the TLS-negative group was 42.1% (16/38), with a statistically significant difference between the two groups (Log-Rank χ²=6.785, P=0.009); the 3-year OS of the SFL-TLS group was 76.9% (50/65), and that of the non-SFL-TLS group was 49.2% (29/59), with a statistically significant difference (Log-Rank χ²=10.422, P=0.001); Cox univariate analysis showed that the preoperative cancer antigen (CEA) level and extranodal lymph node invasion were risk factors for OS; the MSI status and maturity of TLS were protective factors for the overall survival of patients; multivariate Cox analysis further indicated that the preoperative CEA level (HR: 1.027, 95%CI: 1.000~1.055), extranodal lymph node invasion (HR: 2.583, 95%CI: 1.382~4.825) were independent risk factors for OS; the MSI status (HR: 0.452, 95%CI: 0.239~0.853), TLS maturity (HR: 0.372, 95%CI: 0.192~0.713) were independent protective factors for OS, while the TLS presence status did not show an independent prognostic impact.

The maturity of TLS is related to the high microsatellite instability status and is an independent protective factor for OS in patients with colon cancer, and it can be used as a potential biomarker for evaluating the prognosis of colon cancer patients.

To explore the influencing factors of the prognosis of patients with left-sided colon cancer treated by laparoscopic natural orifice transmural specimen extraction surgery (NOSES).

The clinical data of 113 patients with left-sided colon cancer who underwent laparoscopic NOSES treatment from October 2021 to October 2024 were retrospectively analyzed. The patients were divided into the poor prognosis group (n=33) and the good prognosis group (n=80) based on the postoperative follow-up results. Multivariate Logistic regression analysis was used to identify the independent factors related to the prognosis of patients after laparoscopic NOSES treatment.

The poor prognosis group had a lower degree of differentiation, TNM stage of Ⅲ~Ⅳ, lymph node metastasis, vascular invasion, nerve invasion, and no postoperative adjuvant chemotherapy, which were all higher than those in the good prognosis group (P<0.05). After multivariate Logistic regression analysis, tumor differentiation degree of low differentiation (OR=4.983, 95%CI: 1.510~16.440), lymph node metastasis (OR=5.051, 95%CI: 1.332~19.157), vascular invasion (OR=5.396, 95%CI: 1.456~20.000), and nerve invasion (OR=6.048, 95%CI: 1.849~19.782) were all independent risk factors for poor prognosis in patients with left-sided colon cancer after laparoscopic NOSES treatment.

The prognosis of left-sided colon cancer patients treated by laparoscopic NOSES is influenced by multiple factors. Patients with low tumor differentiation, lymph node metastasis, vascular invasion, and nerve invasion have a worse prognosis. Clinicians need to formulate individualized intervention plans, strengthen perioperative management and postoperative follow-up, and standardize postoperative adjuvant therapy to improve the prognosis of patients.

To investigate the clinical efficacy and safety of laparoscopic distal gastrectomy with D2 resection combined with total mesorectal excision (TME) in patients with advanced gastric cancer.

A retrospective cohort study was conducted on 253 cases of advanced gastric cancer admitted to our hospital from March 2019 to March 2023. The patients were grouped according to the surgical method. 121 patients underwent laparoscopic distal gastrectomy with D2 resection combined with TME and were included in group A, while 132 patients underwent laparoscopic distal gastrectomy and were included in group B. The data of the two groups were matched by propensity score, and finally 106 pairs of matched cases were obtained. Quantitative data that followed a normal distribution were expressed as (

Compared with group B, group A had shorter operation time, less intraoperative blood loss, and more regional lymph node dissections (P<0.05); there was no statistically significant difference in R0 resection rate between the two groups (P>0.05). The time to anal exhaust, first meal intake, abdominal drainage, and postoperative hospital stay in group A were shorter than those in group B (P<0.05). Stratified analysis of reconstruction methods showed that there was no statistically significant difference in the incidence of complications among different reconstruction methods within groups A and B (P>0.05). The incidence of incision infection, abdominal infection, and gastrointestinal dysfunction in group A was lower than that in group B (P<0.05). There was no statistically significant difference in the incidence of anastomotic leakage, anastomotic bleeding, and intestinal obstruction between the two groups (P>0.05). The 1-year and 3-year disease-free survival rate and overall survival rate of group A were higher than those of group B, and the disease-free survival period and overall survival period of group A were also longer than those of group B (P<0.05). The recurrence rate of group A was lower than that of group B at 1 year and 3 years (P<0.05).

For patients with advanced gastric cancer, laparoscopic distal gastrectomy with D2 resection combined with TME can optimize perioperative indicators, accelerate the postoperative recovery process, reduce the risk of some complications, and improve survival prognosis.

To explore the short-term efficacy of pancreatic enzyme enteric-coated capsules on digestive tract symptoms, pancreatic function indicators, and quality of life in patients with pancreatic exocrine insufficiency (PEI) after gastric cancer surgery.

A total of 45 patients diagnosed with PEI after gastric cancer surgery were prospectively included. They were treated with pancreatic enzyme enteric-coated capsules orally for 4 weeks. The efficacy was evaluated, and the observation indicators included fecal elastase-1 (FE-1) concentration before and after treatment, pancreatic exocrine function-specific questionnaire (PEI-Q) score, daily defecation frequency, body weight, body mass index (BMI), and total score and dimensions of gastrointestinal quality of life index (GIQLI). Data were analyzed using SPSS 21.0 statistical software. Count data were expressed as [cases (%)] and analyzed by χ² test; continuous variables with normal distribution were expressed as(

After treatment, the main endpoint FE-1 concentration significantly increased from baseline (412.7±108.7) µg/g to (792.7±149.2) µg/g (P<0.001), the secondary endpoint PEI-Q score significantly decreased compared with baseline (P<0.001), daily defecation frequency significantly decreased (P<0.001), and the total score and four sub-dimensions of GIQLI (gastrointestinal symptoms, psychological state, social function, and health status) significantly improved (all P<0.05); while there was no statistically significant difference in body weight and BMI before and after treatment (P>0.05).

Pancreatic enzyme enteric-coated capsules can effectively alleviate the digestive tract symptoms of patients with PEI after gastric cancer surgery, improve pancreatic exocrine function and overall quality of life, but their intervention effects on short-term body weight and BMI are limited.

To explore the clinical efficacy of laparoscopic breast-conserving surgery combined with radiofrequency ablation (RFA) in the treatment of breast cancer.

From June 2016 to December 2020, 124 female patients with early-stage breast cancer were selected and randomly divided into the study group (treated with laparoscopic breast-conserving surgery combined with RFA) and the control group (treated with laparoscopic breast-conserving surgery alone), with 62 cases in each group. The levels of serum inflammatory factors before and 1 week, 1 month, and 3 months after surgery, the occurrence of upper limb lymphedema after surgery, and the aesthetic effect of the breast were compared between the two groups using the χ² test or t test.

One week after surgery, the levels of interleukin-6 (IL-6), interleukin-8 (IL-8), tumor necrosis factor-α (TNF-α), and C-reactive protein (CRP) in the study group were higher than those in the control group, and the levels of these inflammatory factors in the study group were lower than those in the control group at 1 month and 3 months after surgery (P<0.05); the incidence of upper limb lymphedema in the study group (21.0%) was lower than that in the control group (38.7%), and the normal rate of indocyanine green lymphography indicating normal lymphatic return in the study group was significantly higher than that in the control group (P<0.05); the total clinical effective rate (79.0%) and FACT-B score of breast cancer patients in the study group were higher than those in the control group, and the recurrence rate (8.1%) was lower than that in the control group (all P<0.05); there was no statistically significant difference in aesthetic effect and postoperative complication rate between the two groups (P>0.05).

Laparoscopic breast-conserving surgery combined with RFA has clinical application value for the treatment of early-stage breast cancer. Although the early postoperative inflammatory response was slightly more significant, the long-term anti-inflammatory effect was better, which could improve lymphatic return function, reduce the incidence of upper limb lymphedema, improve clinical efficacy, reduce recurrence rate, improve patient quality of life, and have good safety.

To investigate the predictive value of red cell distribution width/albumin ratio (RAR), platelet/lymphocyte ratio (PLR), and ALDH1A2 gene methylation for the prognosis of female breast cancer patients.

The clinical data of 242 female breast cancer patients who underwent modified radical mastectomy from January 2020 to December 2024 were retrospectively collected. The patients were divided into a favorable prognosis group (n=179) and an unfavorable prognosis group (n=63) based on whether they experienced recurrence or distant metastasis after surgery. The methylation status of the ALDH1A2 gene in cancer tissues and adjacent normal tissues was detected by methylation-specific PCR (MSP), and the differences in RAR, PLR, and ALDH1A2 methylation between the two groups were compared. Kaplan-Meier survival curves, Logistic regression, and receiver operating characteristic curves were used to analyze the prognostic predictive value.

The positive rate of ALDH1A2 methylation in cancer tissues of 242 female breast cancer patients was 36.4% (88/242), which was higher than 10.3% (25/242) in adjacent normal tissues (χ²=45.822, P<0.001). The levels of RAR, PLR, and the positive rate of ALDH1A2 methylation in the unfavorable prognosis group were higher than those in the favorable prognosis group (all P<0.05). ALDH1A2 methylation was related to pTNM stage, histological grade, lymph node metastasis, and estrogen receptor (ER) status (all P<0.05). ALDH1A2 methylation positive patients had a lower cumulative disease-free survival rate than those with negative methylation (47.7% vs. 89.0%, Log-Rank χ²=57.063, P<0.001). Logistic regression analysis showed that histological grade Ⅱ~Ⅲ, lymph node metastasis, RAR≥0.5 %·L/g, PLR≥123.2, and positive ALDH1A2 methylation were independent risk factors for unfavorable events in female breast cancer patients (all P<0.05). The AUC of ALDH1A2 methylation, RAR, PLR, and their combination for predicting unfavorable prognosis in female breast cancer patients were 0.748, 0.801, 0.776, and 0.914, respectively, with the highest combined predictive efficacy (all P<0.05).

Positive ALDH1A2 gene methylation, elevated RAR, and elevated PLR are closely related to the unfavorable prognosis of female breast cancer patients. Combined detection of ALDH1A2 methylation, RAR elevation, and PLR elevation can improve the efficacy of prognostic risk assessment for female breast cancer patients.

To construct a predictive model for acute pancreatitis (AP) secondary to persistent organ failure (POF) based on clinical characteristics and serological indicators using machine learning.

A total of 350 AP patients from October 2019 to December 2024 were retrospectively collected and divided into a training set (n=245) and an internal validation set (n=105) in a 7∶3 ratio. Another 82 patients from Xincheng Hospital during the same period were included as the test set. Quantitative data with normal distribution were described as (

The AP secondary POF-related variables selected by LASSO regression included body mass index, Acute Physiology and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) score, random blood glucose, interleukin 6 (IL-6), C-reactive protein (CRP), lactate dehydrogenase (LDH), and neutrophil count/lymphocyte count (NLR). The AUC of the LR, RF, and SVM models based on clinical characteristics were 0.700, 0.862, and 0.707, respectively; the AUC of the LR, RF, and SVM models based on clinical characteristics and serological indicators were 0.805, 0.904, and 0.840, respectively. The AUC of the serological indicators-based models in the three machine learning models were all better than those of the clinical characteristics alone (P < 0.05). The AUC of the RF model based on clinical characteristics and serological indicators in the internal validation set for predicting AP secondary POF was 0.899. The ROC curve was plotted using the test set data, and the results showed that the AUC value of the RF model based on clinical characteristics and serological indicators for predicting AP secondary POF was 0.896, with a sensitivity of 80.7%, specificity of 87.8%, accuracy of 85.7%, precision of 73.5%, and F₁ of 0.831.

The RF model based on the combination of clinical characteristics (body mass index, APACHE II score, random blood glucose) and serological indicators has excellent performance and reliable generalization ability for predicting AP secondary POF, and can be used for early identification of high-risk patients and risk stratification.

To explore the clinical safety, feasibility and application value of single-port laparoscopic cholecystectomy based on Laennec's membrane space.

The medical records of 88 patients with benign gallbladder diseases admitted from January to December 2025 were retrospectively analyzed. All patients underwent single-port laparoscopic cholecystectomy based on Laennec's membrane space. The completion of the surgery, operation time, intraoperative blood loss, postoperative hospital stay and occurrence of complications were recorded. Data were analyzed using SPSS 21.0 statistical software. Quantitative data that followed a normal distribution were expressed as (

87 patients successfully completed the single-port surgery, and 1 patient was unable to complete the operation due to insufficient operating space caused by obesity and had to add an additional auxiliary port under the xiphoid process. The operation time was 23 to 75 minutes, and the intraoperative blood loss was 5 to 20 ml. All patients were discharged smoothly within 2 to 3 days after surgery, without serious complications such as bile duct injury, biliary fistula, massive bleeding, or abdominal infection.

Single-port laparoscopic cholecystectomy based on Laennec's membrane space has clear anatomical layers, is safe and reliable to operate, and has significant minimally invasive effects. It can significantly improve patient satisfaction and has clinical application value for promotion.

To compare the short-term recovery trajectories and short-term prognosis differences between endoscopic sphincterotomy (EST) combined with endoscopic papillary balloon dilation (EPBD) and laparoscopic common bile duct exploration (LCBDE) combined with laparoscopic cholecystectomy (LC) in the treatment of common bile duct stones, and to provide evidence-based medical evidence for the individualized selection of treatment plans in clinical practice.

From December 2023 to December 2025, 306 patients with common bile duct stones and gallbladder stones were selected as the research subjects. The patients were divided into the endoscopic group (EST combined with EPBD + elective LC, n=120) and the laparoscopic group (LCBDE combined with LC, n=186). The propensity score matching (PSM) was used to balance the differences between the groups and reduce potential confounding factors. Then, t tests or χ² tests were used to compare the general information, efficacy-related indicators, perioperative indicators, and postoperative complication rates of the two groups of patients. Cox proportional hazards regression analysis was used to investigate the impact of treatment methods on the prognosis of patients.

There was no statistically significant difference in the one-stage stone clearance rate between the two groups (P>0.05). There were statistically significant differences in the operation time, intraoperative blood loss, postoperative bed rest time, postoperative hospital stay, postoperative eating recovery time, visual analog scale (VAS) scores at 1, 3, and 7 days after surgery, serum amylase (AMS) levels at 1, 3, and 7 days after surgery, and C-reactive protein (CRP) levels at 1 d, 3 d, and 7 days after surgery between the two groups (P<0.05). Cox regression analysis showed that laparoscopic treatment was a protective factor for the short-term prognosis of patients with common bile duct stones (P<0.05). The stratified analysis results showed that in subgroups of age < 60 years, multiple stones, and the maximum stone diameter ≥ 10 mm, the prognosis of patients in the laparoscopic group was better than that in the endoscopic group (all P<0.05).

EST combined with EPBD has more advantages in reducing postoperative pain and reducing inflammatory response, but the short-term prognosis is poorer; LCBDE combined with LC has more advantages in protecting pancreatic function and improving short-term prognosis. Clinical decision-making should be based on the individual circumstances of patients and select the best treatment plan.

To summarize the issues that are easily overlooked during the perioperative management of patients with thyroid hyperfunction in general surgery, and to analyze the corresponding countermeasures based on the actual handling process of 3 cases.

The clinical data of 3 patients with thyroid hyperfunction during the perioperative period from September 2023 to June 2025 were retrospectively analyzed. The cases of delayed thyroid crisis after surgery, pre-crisis manifestations, and cases of hyperthyroidism detected during preoperative screening were combined to analyze the perioperative risks and handling process.

The clinical conditions of the 3 patients were different. Case 1: Due to delayed recovery of intestinal function and continuous fasting after surgery, the anti-thyroid drugs (ATD) were interrupted. Thyroid crisis occurred 16 days after surgery; the free thyroxine (FT4) level was 16.11 pmol/L on the day of crisis, and the Burch-Wartofsky score (BWPS) was 55 points. After treatment with propylthiouracil (PTU) nasal feeding, hydrocortisone, and propranolol, the heart rate decreased from 145 beats/min to 110 beats/min within 48 hours, and the hospital stay was 28 days. Case 2: The preoperative hyperthyroidism control was poor, with an FT4 level of 41.6 pmol/L. The heart rate increased to 125 beats/min on the 1st day after emergency surgery, and the BWPS was 25 points. After treatment with PTU, propranolol, and prednisone, the symptoms were relieved on the 2nd day after surgery, and the patient was discharged on the 5th day. Case 3: Hidden hyperthyroidism was detected during preoperative screening, and the white blood cell count increased to 17.3×10⁹/L on the 1st day after surgery, while procalcitonin (PCT) and C-reactive protein (CRP) were normal, and there were no clear signs of infection. After continuous anti-thyroid treatment, the white blood cell count decreased to 10.6×10⁹/L 24 hours later, and the patient was discharged on the 3rd day after surgery. All 3 patients successfully completed the surgery, and no serious delayed surgical complications were observed during the 3-month follow-up.

The risks of perioperative hyperthyroidism in general surgery are related to the control of hyperthyroidism, surgical stress, and the continuity of postoperative medication. Timely assessment of the alternative administration method of ATD should be conducted when fasting is continued; patients with poor preoperative hyperthyroidism control and emergency surgery should be closely monitored; when there is an increase in white blood cells but no evidence of infection, a comprehensive judgment should be made based on PCT, CRP, and clinical manifestations.

Deep vein thrombosis (DVT) of the lower extremities is a common yet preventable perioperative complication in patients undergoing gastrointestinal surgery, which may progress to life-threatening pulmonary embolism (PTE). Gastrointestinal surgical patients often present with complex disease profiles, frequently complicated by malignancy, intestinal obstruction, intra-abdominal infection, inflammatory bowel disease, malnutrition, preoperative bowel preparation, perioperative fasting, postoperative mobility limitations, and risks of gastrointestinal or anastomotic bleeding. These factors result in a prolonged coexistence of both thrombotic and bleeding risks. In recent years, advances in enhanced recovery after surgery, laparoscopic and robotic techniques, electronic risk assessment systems, machine learning prediction models, and novel anticoagulants have gradually shifted management of venous thromboembolism (VTE) in gastrointestinal surgery from empirical prevention toward stratified, dynamic, and individualized approaches. This review focuses on the epidemiological characteristics, specialized pathogenesis, risk factors, risk assessment tools, preventive strategies, diagnostic-treatment integration, and quality management of perioperative DVT in gastrointestinal surgery, with particular emphasis on controversies such as the "ceiling effect" of the Caprini score, the safety of direct oral anticoagulants following gastrointestinal cancer surgery, and the appropriate patient populations for extended prophylaxis. The authors argue that perioperative DVT management in gastrointestinal surgery should not rely solely on single scoring systems or fixed anticoagulation protocols, but instead adopt a closed-loop model integrating baseline scoring, specialty-specific variables, bleeding risk, dynamic reassessment, and post-discharge follow-up, aiming to provide guidance for standardized clinical prevention and treatment.

Pancreatic cancer is a highly malignant and extremely unfavorable prognosis solid tumor of the digestive system. Radical surgical resection remains the main treatment method for it, while underestimation of staging, positive surgical margins, and high recurrence rate are important factors affecting its clinical efficacy. Traditional imaging examinations still have deficiencies in detecting small lesions, precise staging, and intraoperative margin assessment. Near-infrared (NIR) fluorescence imaging, as a new molecular imaging technology, has advantages such as real-time, sensitivity, no ionizing radiation, and easy integration with laparoscopic/surgical robot platforms. It has been recommended for application in the surgical treatment of many benign and malignant tumors of the digestive system. Among them, the second near-infrared window (NIR-Ⅱ, 1000-1700 nm) can provide a new technical path for precise diagnosis and intraoperative navigation of pancreatic cancer due to its advantages such as deep tissue penetration depth, high spatial resolution, excellent signal-to-noise ratio, and real-time visualization. In addition, near-infrared fluorescence molecular probes, as the key core of near-infrared imaging technology, their performance directly determines the imaging effect and application prospects. This article will review the design strategies, imaging targets, and their application in the construction of a diagnosis and treatment integrated platform of near-infrared fluorescence molecular probes in pancreatic cancer molecular imaging.

Post-cholecystectomy syndrome (PCS) is a persistent digestive disorder that persists after cholecystectomy surgery. Due to its complex etiology, difficult diagnosis, and diverse treatment options, PCS has long been a clinical challenge in the field of biliary surgery. This article reviews the multifactorial etiology of PCS, covering the latest progress in the pathogenesis of biliary factors, extrahepatic factors, and changes in the intestinal microbiota; analyzes the stratified application strategies of diagnostic techniques such as endoscopic ultrasound (EUS), SeHCAT scanning, and Oddi sphincter pressure measurement; summarizes various treatment strategies including dietary control, drug therapy, endoscopic intervention, and traditional Chinese medicine treatment; and assesses the application potential of the SECURE trial, the SUCCESS prediction model, and the PERFECT trial in preoperative patient screening, emphasizing the significance of precisely selecting surgical indications in reducing the risk of PCS occurrence.