Digital intelligent diagnosis and treatment integrates digital medicine, big data, and artificial intelligence into a novel high-technology paradigm for healthcare delivery. In minimally invasive pancreatic surgery, digital intelligence has enabled end-to-end support across the perioperative pathway, including early detection and differential diagnosis, preoperative assessment of resectability and procedure planning, intraoperative navigation and bleeding-risk prediction, and postoperative complication management. Digital intelligence and minimally invasive surgery are “natural symbionts”: by leveraging inherently digital signals generated during laparoscopic and robotic procedures, Digital intelligence is shifting pancreatic minimally invasive surgery from experience-driven practice toward data-driven decision-making, becoming a key engine for improving surgical precision, safety, and reproducibility. Looking ahead, advances in multicenter standardized research and explainable AI will further accelerate the digital-intelligent transformation of minimally invasive pancreatic surgery. This review systematically summarizes the developmental trajectory, representative clinical applications, key challenges, and future directions of digital intelligence in minimally invasive pancreatic cancer surgery.

Laparoscopic pancreaticoduodenectomy (LPD) is regarded as a highly demanding procedure in pancreatic surgery due to its complexity and high risk of bleeding. Its safe implementation relies on precise preoperative evaluation, meticulous intraoperative manipulation, and standardized perioperative management. This paper systematically analyzes the key technical difficulties and surgical quality control points of LPD in China, and explores strategies for improvement. Preoperative evaluation generally includes resectability assessment and oncological evaluation. In addition to routine and accurate contrast-enhanced abdominal computed tomography (CT) and three-dimensional vascular reconstruction for assessing resectability and formulating surgical plans, rigorous monitoring of tumor marker levels is also of great significance for improving patient prognosis.

Furthermore, an appropriate surgical approach should be selected according to the tumor location and its relationship with major blood vessels; if necessary, a combination of multiple approaches can be adopted to complete the operation. Indications for vascular resection and reconstruction as well as arterial sheath dissection must be strictly followed, and these procedures should be performed by an experienced pancreatic surgery team. In addition, the method of pancreaticojejunostomy should be individualized based on the diameter of the pancreatic duct and the texture of the pancreatic parenchyma, with the placement of a pancreatic stent to reduce the risk of pancreatic fistula. Postoperative management involves monitoring of drainage fluid, precise treatment of complications such as pancreatic fistula and bleeding, and early removal of drainage tubes when conditions permit, in line with the concept of enhanced recovery after surgery (ERAS).

In the future, with the continuous development of intraoperative navigation technology and artificial intelligence, LPD is expected to achieve standardized and modularized operations, further improving its safety. Surgical robotics will also be one of the directions for the reform and development of pancreatic surgery in China in the next generation.

Laparoscopic pancreaticoduodenectomy (LPD) is a complex minimally invasive surgery for treating periampullary and pancreatic head lesions. Although it has advantages such as less trauma and faster recovery, the incidence of postoperative complications is relatively high, which seriously affects the prognosis of patients. From a commentary perspective, this article analyzes the pathogenesis, clinical characteristics and treatment strategies of major complications such as pancreatic fistula, bleeding, biliary fistula and delayed gastric emptying after LPD, and discusses the controversies and progress in current diagnosis and treatment combined with 15 Chinese and English literatures,so as to provide reference for clinical practice.

An elderly female patient was admitted to the hospital for "abdominal pain accompanied by jaundice of the skin and sclera for 2 weeks." Two weeks before admission, she experienced epigastric pain of unknown cause, which manifested as intermittent dull pain and worsened after meals. Associated symptoms included anorexia, darkened urine, skin and scleral jaundice with pruritus. She denied having a fever and reported an unintentional weight loss of approximately 10 kg. Her past medical history included a 6-year history of diabetes mellitus (controlled with oral metformin, with fasting blood glucose levels around 7.0 mmol/L), a history of chronic cerebral infarction, and a history of appendectomy.Diagnostic procedures such as gastroscopy, contrast-enhanced computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) were crucial in confirming the diagnosis of a duodenal papillary carcinoma, as emphasized in a comparative study of imaging techniques for such tumors. The tumor was deemed resectable with no contraindications to surgery, as indicated by the high success rates and low complication rates observed in similar cases, such as those detailed in the provided references. The patient then underwent laparoscopic radical pancreaticoduodenectomy under general anesthesia.The operation lasted 260 minutes, and the intraoperative blood loss was 50 ml. Postoperatively, the patient recovered smoothly and was discharged on the 13 th day with all drainage tubes removed.

R0 resection and lymphadenectomy are crucial components of radical surgery for pancreatic cancer. In patients with locally advanced pancreatic cancer who respond well to chemotherapy, dissection of the Heidelberg Triangle and total mesopancreatic excision can also improve the R0 resection rate. We categorize the peripancreatic lymph nodes around the pancreatic head into three regions: posterior, superior, and inferior. Through total mesopancreatic excision and a superior mesenteric artery-first approach, modular resection of the specimen along with all regional lymphatic and neural tissues can be achieved, contributing to a higher R0 resection rate.During mobilization of the pancreatic head and duodenum, lymph node stations 16b1 and 16a2 are dissected first. Subsequently, lymphadenectomy of the superior pancreatic region is performed, with the left gastric artery and vein as the left boundary, the common hepatic artery as the inferior boundary, and the portal vein along with the left hepatic artery as the right boundary. Lymph nodes in the superior region (stations 7, 8, 12a, 12p, 12b) can be removed en bloc together with those in the posterior region. Finally, dissection of the inferior region is carried out using the total mesopancreatic excision and superior mesenteric artery-first approach: the superior mesenteric artery is skeletonized, the inferior pancreaticoduodenal artery (IPDA) is ligated, and the inferior pancreaticoduodenal vein (IPDV) is divided. Lymph node stations 14a, 14b, 14c, and 14d can thus be excised en bloc.

Duodenal papillary adenoma is a rare benign tumor. If left untreated, the tumor may undergo malignant transformation and threaten the patient's life. Currently, available surgical approaches include pancreaticoduodenectomy, endoscopic resection, and transduodenal local resection of the tumor. Although conventional pancreaticoduodenectomy has evolved over time, it is still associated with high perioperative morbidity and mortality, representing a relatively high-risk procedure that is no longer the first-choice approach. Endoscopic resection is suitable for small tumors but has limitations for large or extensively invasive lesions and may lead to severe complications such as bleeding and perforation.In contrast, function-preserving laparoscopic resection of duodenal papillary tumors avoids extensive resection of adjacent organs and digestive tract reconstruction, resulting in lower surgical risk and better preservation of the patient's digestive function. Using a combined strategy of preoperative pancreatic duct/biliary stent placement followed by function-preserving laparoscopic resection of duodenal papillary tumors, we successfully resected a duodenal papillary adenoma that was not amenable to endoscopic resection. The patient recovered uneventfully postoperatively without severe complications. The brief surgical steps are as follows: (1) Preoperative placement of pancreatic duct and/or biliary stents; (2) Patient positioning in the supine split-leg position, 30° reverse Trendelenburg and left tilt, followed by trocar insertion; (3) Adequate mobilization of the descending duodenum via Kocher maneuver; (4) Longitudinal incision of the anterolateral duodenal wall to fully expose the duodenal papilla and tumor;(5) Incision along the tumor margin to expose the duodenal mucosa and submucosa; after identifying the muscularis mucosae, complete tumor resection is performed from the tumor base under the guidance of the pancreatic duct/biliary stent; (6) Nasointestinal tube placement after intraoperative frozen-section pathology confirms a benign tumor; (7) Repair and reconstruction of the duodenal papilla and suture closure of the medial duodenal wall; (8) Duodenal wall repair and seromuscular imbrication; (9) Drainage tube placement.

To investigate the application value of preoperative endoscopic biliary and pancreatic stenting in local resection of pancreatic head and neck tumors.

A retrospective descriptive study was conducted. Clinical data of 26 patients who underwent local resection of pancreatic head and neck tumors from January 2019 to December 2022 were collected, including 10 males and 16 females, with a median age of 54 years (range, 17~72 years). All patients received preoperative endoscopic stent placement. Observation indicators: (1) perioperative conditions; (2) postoperative conditions. Measurement data were expressed as absolute numbers.

(1) Perioperative conditions: All patients underwent endoscopic retrograde cholangiopancreatography (ERCP) for stent placement before surgery, among whom 20 received stent placement on the day of surgery. A pancreatic duct stent was placed in all patients, and a biliary stent was additionally placed in 21 patients. Two patients with multiple lesions in the pancreatic head and tail underwent distal pancreatectomy plus local resection of the pancreatic head, while the others with single lesions underwent local resection of pancreatic tumors only. Eleven patients underwent Roux-en-Y pancreaticojejunostomy during local tumor resection. (2) Postoperative conditions: No surgery-related death occurred in the 26 patients, with a mean hospital stay of 20.8 days. Grade B pancreatic fistula occurred in 13 patients, biochemical fistula in 7, and no grade C fistula was observed. Delayed gastric emptying occurred in 3 patients (grade C in 2, grade A in 1). Postoperative hemorrhage occurred in 4 patients (grade A in 1, grade B in 3). Biliary fistula occurred in 1 patient. Five patients had intra-abdominal encapsulated effusion.

Preoperative endoscopic biliary and pancreatic stenting is safe and feasible in local resection of pancreatic tumors. It extends the indications of local resection, helps protect the biliary and pancreatic ducts, reduces surgical difficulty, improves surgical success rate, accelerates postoperative recovery, and reduces the incidence of postoperative pancreatic fistula and biliary fistula.

Compare the prognostic effects of laparoscopic common bile duct exploration with "T" tube drainage (LCBDE) and laparoscopic common bile duct exploration and stone extraction via cystic duct (LTCBDE) in patients with secondary common bile duct stones.

A total of 116 patients with secondary common bile duct stones admitted to our hospital from February 2020 to February 2023 were selected as the research subjects. According to the surgical methods, the patients were categorized into the LTCBDE group (n=57) and the LCBDE group (n=59). The propensity score matching method was used to balance the differences between the two groups. After reducing the potential confounding factors, the basic data, perioperative indicators, stress indicators and complications of the two groups of patients were analyzed by t test, χ² test or Fisher's exact probability test. P<0.05 was considered statistically significant.

After matching, there were statistically significant differences between the two groups in postoperative drainage time, postoperative 24 h visual analogue scale score, postoperative fluid infusion volume, incision length, postoperative hospital stay, gastrointestinal function recovery time, intraoperative blood loss, return to normal life time, operation time, anal exhaust recovery time (P<0.05). Three days after surgery, the levels of interleukin-6 (IL-6) in the two groups were lower than those before surgery (P<0.05), and the levels of adrenocorticotropic hormone (ACTH), cortisol (Cor), natural killer cell (NK) and norepinephrine (NE) in the two groups were higher than those before surgery (P<0.05). However, the levels of IL-6, ACTH, Cor, NK and NE in LTCBDE group were lower than those in LCBDE group (P<0.05). The total incidence of complications in LCBDE group was higher than that in LTCBDE group, and the difference was statistically significant (P< 0.05). There was no significant difference in recurrence rate between LTCBDE group and LCBDE group (25.0% vs. 27.8%) (χ²=0.071, P=0.789).

Compared with LCBDE, LTCBDE has advantages such as low stress response and low complication rate. This study more strongly recommends LTCBDE for the treatment of secondary common bile duct stones.

To investigate the efficacy and safety of laparoscopic cholecystectomy in elderly patients.

Clinical data of 621 patients who underwent cholecystectomy for acute cholecystitis from January 2023 to December 2024 were retrospectively analyzed. Patients were divided into an elderly group (n=82, age ≥70 years) and a control group (n=539, age <70 years). Statistical analysis was performed using SPSS 22.0 software. Categorical data were analyzed using the χ² test or exact test. Normally distributed continuous data were presented as (

There were significant differences between the two groups in age, body mass index (BMI), ASA classification, comorbidities [cardiovascular disease, diabetes mellitus, chronic obstructive pulmonary disease (COPD), renal insufficiency], operation time, and length of hospital stay (P<0.05). The elderly group had higher incidences of postoperative pulmonary infection, intra-abdominal infection, and overall complications, as well as a longer postoperative hospital stay (P<0.05). The higher proportion of comorbidities (e.g., cardiovascular disease, diabetes mellitus) and poorer ASA classification in the elderly group may be important contributors to the increased incidence of postoperative pulmonary and intra-abdominal infections. Multivariate analysis showed that diabetes mellitus, ASA grade Ⅲ, and operation duration >80 minutes were independent risk factors for increased postoperative morbidity. Cardiovascular disease, chronic renal insufficiency, and length of hospital stay were factors independently associated with discharge rate.

Laparoscopic cholecystectomy is relatively safe in elderly patients under the premise of adequate evaluation of comorbidities and optimized perioperative management (such as blood glucose control and shortening operation time by an experienced surgical team). The risk of postoperative complications is acceptable.

To investigate the efficacy of laparoscopic common bile duct exploration (LCBDE) and endoscopic retrograde cholangiopancreatography combined with endoscopic sphincterotomy and stone extraction (ERCP+EST), each combined with laparoscopic cholecystectomy (LC), in the treatment of cholecystolithiasis complicated with choledocholithiasis.

Clinical data of patients with cholecystolithiasis and choledocholithiasis admitted from January 2022 to January 2025 were retrospectively analyzed. Patients were divided into the LCBDE group (treated with LCBDE combined with LC) and the ERCP+EST group (treated with ERCP+EST combined with LC) according to different surgical procedures. Propensity score matching was used to eliminate confounding factors of baseline data, with 45 cases in each group. Data were analyzed using SPSS 24.0 software. Enumeration data were expressed as [cases (%)] and analyzed by the χ² test or Fisher's exact test. Measurement data conforming to normal distribution were expressed as (

There were no significant differences in the one-time stone clearance rate, stone residual rate, and recurrence rate within half a year between the LCBDE group and the ERCP+EST group (P>0.05). The drainage tube indwelling time in the LCBDE group was significantly longer than that in the ERCP+EST group (P<0.05), while the hospital stay was significantly shorter (P<0.05). There were no significant differences in operation time, blood loss, or conversion rate to laparotomy between the two groups (P>0.05). At 2 days after operation, the levels of CRP and TBIL in both groups were significantly increased (P<0.05), while CRP in the LCBDE group was significantly lower than that in the ERCP+EST group (P<0.05). There was no significant difference in TBIL between the two groups (P>0.05). The incidence of pancreatitis in the LCBDE group was significantly lower than that in the ERCP+EST group (P<0.05), and the incidence of biliary fistula was significantly higher (P<0.05). There were no significant differences in the rates of abdominal infection or biliary stricture between the two groups (P>0.05).

Both LCBDE and ERCP+EST combined with LC are effective in the treatment of cholecystolithiasis complicated with choledocholithiasis. LCBDE is more advantageous in postoperative recovery and is suitable for young patients or those with large stones. ERCP+EST is relatively difficult to perform and carries a risk of pancreatitis, but is suitable for patients who cannot tolerate general anesthesia and pneumoperitoneum, or those with severe obstructive jaundice. The appropriate surgical procedure can be selected clinically according to individual patient conditions.

To investigate the expression and clinical significance of pyruvate kinase M2 (PKM2) and heat shock protein 90α (HSP90α) in cholangiocarcinoma.

The expression of PKM2 and HSP90α was detected in 54 cholangiocarcinoma tissues and 20 adjacent normal tissues using the EliVision^TM plus two-step method of immunohistochemistry (IHC). Serum concentrations of PKM2 and HSP90α were measured by enzyme-linked immunosorbent assay (ELISA) in 54 cholangiocarcinoma patients, 32 choledocholithiasis patients, and 25 healthy individuals. The correlations between the two markers and clinicopathological parameters were statistically analyzed. Data were processed using SPSS 22.0. Measurement data conforming to a normal distribution were expressed as (

The positive rates of PKM2 and HSP90α expression in cholangiocarcinoma tissues were significantly higher than those in adjacent normal tissues (P<0.05). PKM2 expression was significantly correlated with lymph node metastasis and TNM stage (P<0.05). HSP90α expression was significantly correlated with tumor differentiation, lymph node metastasis, and TNM stage (P<0.05). At 3 days preoperatively, serum levels of PKM2 and HSP90α in cholangiocarcinoma patients were significantly higher than those in choledocholithiasis patients and healthy individuals. At 10 days postoperatively, both were significantly lower than the preoperative levels (P<0.05). There was no significant difference in PKM2 between cholangiocarcinoma patients and choledocholithiasis or healthy individuals (P>0.05), whereas HSP90α remained higher in cholangiocarcinoma patients (P<0.05). At 3 days preoperatively, serum PKM2 and HSP90α levels in choledocholithiasis patients were higher than those in healthy individuals (P<0.05). Diagnostic accuracy analysis of serum PKM2 and HSP90α in cholangiocarcinoma showed that the combined detection had a sensitivity of 85.2% and a specificity of 72.0%. The Kappa test showed consistent expression between IHC and ELISA.

PKM2 and HSP90α levels are elevated in both tumor tissues and serum of cholangiocarcinoma patients, and their upregulation is closely associated with the malignant progression of cholangiocarcinoma. Combined detection of the two markers is valuable for the early diagnosis, therapeutic effect evaluation, and prognosis assessment of cholangiocarcinoma.

To compare the clinical efficacy of laparoscopic precise hepatic pedicle dissection resection and conventional resection in the treatment of primary hepatocellular carcinoma (HCC).

The data of 113 patients with primary HCC who underwent laparoscopic liver cancer resection from May 2021 to May 2024 in our hospital were retrospectively analyzed. According to the different surgical methods, the patients were divided into the observation group (n=55, underwent laparoscopic precise hepatic pedicle dissection resection) and the control group (n=58, underwent laparoscopic conventional liver resection). Data were processed and analyzed using SPSS 27.0 software. Quantitative data were expressed as (

Compared with the control group, patients in the observation group had less intraoperative blood loss, less postoperative drainage volume, shorter postoperative extubation time, and shorter hospital stay (P<0.05). At 24 hours after surgery, the levels of serum C-reactive protein (CRP), interleukin-6 (IL-6), cortisol (Cor), and norepinephrine (NE) in both groups were higher than those before surgery; at 7 days after surgery, the levels of each indicator in both groups were lower than those at 24 hours after surgery, and the levels in the observation group at 24 hours and 7 days after surgery were lower than those in the control group (P<0.05). At 24 hours after surgery, the levels of serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin (TBIL) in both groups were higher than those before surgery; at 7 days after surgery, the levels of each indicator in both groups were lower than those at 24 hours after surgery, and the levels in the observation group at 24 hours and 7 days after surgery were lower than those in the control group (P<0.05). At 3 months after surgery, the levels of serum alpha-fetoprotein (AFP), carbohydrate antigen 19-9 (CA19-9), and soluble intercellular adhesion molecule-1 (sICAM-1) in both groups were lower than those before treatment, and the levels in the observation group were lower than those in the control group (P<0.05). The incidence of postoperative complications in the observation group was 5.5%, which was lower than 19. 0% in the control group (P<0.05). At 1 year after surgery, the disease-free survival rate of patients in the observation group was 74. 6%, which was higher than 55.2% in the control group (P<0.05).

Compared with traditional laparoscopic conventional liver resection, laparoscopic precise hepatic pedicle dissection resection for primary HCC has the advantages of less intraoperative bleeding and less surgical trauma, which can reduce postoperative inflammatory stress and liver function damage, significantly inhibit the expression of tumor factors, and improve the postoperative disease- free survival rate.

To explore the types, risk factors, prevention strategies and clinical management methods of common complications after laparoscopic radical resection of colorectal cancer, and to provide theoretical basis and practical guidance for reducing the incidence of complications and improving patient prognosis in clinical practice.

A retrospective analysis was conducted on relevant research literature from domestic and international sources (a total of 24 eligible studies were included in this study). The literature was analyzed using the methods of literature research, induction analysis, and comparative analysis to summarize the characteristics of complication occurrence, analyze risk factors, and summarize prevention and management plans. The quality of the included literature was evaluated, and the clinical effects of different prevention methods were compared.

The overall incidence of complications after laparoscopic radical resection of colorectal cancer ranged from 13.9% to 23.4%, significantly lower than that of open surgery (23.4% to 45.76%). Common complications included infection, anastomotic leakage, and intestinal obstruction, among others. There were also specific complications unique to laparoscopy, such as hypercapnia. The GPS2 score was an independent risk factor for total and severe complications after surgery. Age, operation time, and nursing intervention were also closely related to the occurrence of complications. Through comprehensive prevention measures throughout the entire process, such as preoperative rehabilitation, standardized operation during surgery, and personalized postoperative care, the incidence of complications can be significantly reduced, and the rehabilitation outcome can be improved.

Complications after laparoscopic radical resection of colorectal cancer are influenced by multiple factors. Clinically, a comprehensive prevention management system throughout the entire process needs to be established. High-risk patients can be screened using predictive models and targeted interventions can be implemented. Strengthening multidisciplinary cooperation is a key means to improve surgical safety and patient prognosis.

The optimal adjuvant therapy for patients with microvascular invasion (MVI)-positive hepatocellular carcinoma (HCC) after radical resection remains highly controversial. This study aimed to investigate the clinical efficacy of postoperative transcatheter arterial chemoembolization (TACE) in patients with MVI-positive HCC.

Clinical data of 130 patients who underwent radical resection for HCC and were pathologically confirmed as M-positive between March 2019 and May 2024 were retrospectively analyzed. Among them, 77 patients were included in the postoperative TACE group and 53 in the control group. Statistical analyses were performed using SPSS 26.0 and R Studio 4.4.3. Normally distributed continuous data were presented as (mean ± standard deviation) and analyzed by independent samples t test; non-normally distributed continuous data were analyzed by Mann-Whitney U test. Categorical data were analyzed by chi-square test. Univariate and multivariate COX regression analyses were used to identify risk factors affecting disease-free survival (DFS) after surgery in MVI-positive HCC patients. The Kaplan-Meier method was used to plot DFS curves, and differences between groups were analyzed by the Log-Rank test. A P-value <0.05 was considered statistically significant.

Univariate COX regression analysis showed that tumor diameter >5 cm (P=0.001), MVI grade 2 (P<0.001), AFP >400 ng/ml (P=0.001), satellite nodules (P<0.05), vascular tumor thrombus (P<0.05), and BCLC stage B (P<0.05) were potential risk factors for DFS. Multivariate COX regression analysis demonstrated that MVI grade 2, tumor diameter >5 cm, AFP >400 ng/ml, and vascular tumor thrombus were independent risk factors for DFS in MVI-positive HCC patients, whereas postoperative adjuvant TACE was an independent protective factor for DFS. Kaplan-Meier analysis showed that the median DFS was 19.8 months in the TACE group (95%CI: 13.4-26.8 months) and 10.5 months in the control group (95%CI: 9.0-16.6 months). The median DFS was significantly better in the TACE group than in the control group (P<0.05).

Postoperative adjuvant TACE can improve DFS in patients with MVI-positive HCC after radical resection.

To investigate the efficacy and prognostic impact of preserving the left colic artery during laparoscopic radical resection for rectal cancer.

A total of 108 patients with rectal cancer admitted from January 2021 to December 2021 were enrolled and randomly divided into an observation group (n=54) and a control group (n=54). All patients underwent laparoscopic radical resection for rectal cancer. The left colic artery was preserved in the observation group but not in the control group. Perioperative indicators, incidence of postoperative complications, gastrointestinal function, anal function, recurrence rate, and liver metastasis rate were compared between the two groups. Statistical analysis was performed using SPSS 22.0 software. Enumeration data were expressed as rates (%) and analyzed by the χ² test. Measurement data conforming or approximately conforming to a normal distribution were expressed as (

The length of hospital stay was significantly shorter in the observation group than in the control group (t=3.638, P<0.001). At 1 month after surgery, the complication rate in the observation group was 7.4% (4/54), which was significantly lower than 22.2% (12/54) in the control group (χ²=4.696, P=0.030<0.05). The levels of gastrointestinal function and anal function indexes in the observation group were significantly higher than those in the control group (t=5.017, 4.208, 3.424, 3.287, P<0.05). At 2 years after surgery, there were no significant differences in the recurrence rate and liver metastasis rate between the two groups (χ²=2.080, 0.101; P=0.149, 0.750>0.05).

Preserving the left colic artery during laparoscopic radical resection for rectal cancer can reduce the incidence of complications and promote postoperative recovery.

To investigate the learning curve and short-term outcomes of two minimally invasive procedures for low rectal cancer: transanal total mesorectal excision (TaTME) versus laparoscopic radical resection for middle and low rectal cancer.

A total of 149 patients with low rectal cancer were prospectively enrolled from January 2022 to January 2025. They were randomly divided into the observation group (n=75, treated with TaTME) and the control group (n=74, treated with laparoscopic radical resection for middle and low rectal cancer) using a random number table method. The χ² test or t test was used to compare baseline characteristics and learning curves between the two groups, as well as perioperative indicators, short-term outcomes, and postoperative complication rates at different learning stages.

The inflection point of the learning curve appeared later in the observation group (at the 40th case) and earlier in the control group (at the 20th case). The learning curve of TaTME showed a steeper slope during the learning phase (before the inflection point), with a more excessive increase in operative time. In contrast, the learning curve of laparoscopic radical resection rose more gently. In the observation group, operative time, extubation time, and hospital stay were significantly shorter in the plateau phase than in the ascending phase; intraoperative blood loss and intraoperative drainage volume were also significantly reduced (P<0.05). During the ascending phase, operative time was significantly longer, and intraoperative blood loss and drainage volume were significantly higher in the observation group than in the control group (P<0.05). In the plateau phase, operative time remained significantly longer in the observation group, but intraoperative blood loss and drainage volume were significantly lower than those in the control group (P<0.05).In the observation group, time to first ambulation and time to first flatus were significantly shorter in the plateau phase than in the ascending phase. The complete mesorectal excision rate was significantly higher in the plateau phase, while the positive circumferential resection margin rate and anal function score were significantly lower (P<0.05). The incidence of anastomotic leakage and overall complications in the observation group was significantly higher in the ascending phase than in the plateau phase, and also significantly higher than that in the control group at the same stage (P<0.05).

TaTME has a longer learning curve and greater technical difficulty in the early phase, with longer operative time and significantly higher complication risk during the ascending phase. However, the plateau phase is associated with significantly better intraoperative hemostasis, postoperative recovery, and oncological quality compared with the ascending phase, and is partially superior to the laparoscopic procedure. These findings indicate that TaTME has favorable clinical value and safety after proficient mastery.

To compare the clinical efficacy and safety of retro-peristaltic and pro- peristaltic intracavitary ileocolic-cecal anastomosis in total laparoscopic right hemicolectomy (TLRC).

A retrospective cohort design was adopted to collect the clinical data of 94 patients with right- sided colon cancer from January 2020 to December 2024. All patients underwent TLRC and intracavitary ileocolic-cecal side-to-side anastomosis (ⅡA-SS) for digestive tract reconstruction. The patients were divided into two groups based on different ⅡA-SS anastomosis methods: Anti-Peristaltic group (n=47, retro-peristaltic ileocolic-cecal anastomosis) and Overlap group (n=47, pro-peristaltic ileocolic-cecal anastomosis). Data were analyzed using statistical software SPSS 27. 0. Continuous variables were expressed as (

There were no statistically significant differences in intraoperative blood loss, operation time, hospital stay, Clavien-Dindo grade Ⅰ-Ⅲ complications, and postoperative complications (infection, chronic diarrhea, intestinal obstruction, etc.) between the two groups, as well as in the preoperative EORTC QLQ-C30 scores of the four dimensions (function, overall health, symptoms, and trauma), and the postoperative 6-month scores of the functional and overall health dimensions. Compared with the Overlap group, the Anti-Peristaltic group had a longer digestive tract reconstruction time, shorter ventilation time, and shorter defecation time (P<0.05). There was no interaction effect between time and method in the GIQLI score (P>0.05), the main effect of time on the GIQLI score was significant (P<0.05), the main effect of the method on the GIQLI score was significant (P<0.05); at 6 months postoperatively, the symptom and trauma scores of the EORTC QLQ-C30 scale in the Anti-Peristaltic group were lower than those in the Overlap group (P<0.05).

Anti-Peristaltic anastomosis can promote the recovery of intestinal function after TLRC and improve long-term quality of life, but caution should be exercised regarding the risk of anastomotic leakage. It is recommended to apply under strict operational control.

To clarify the impact of postoperative complications on quality of life in patients undergoing gastric cancer surgery.

Clinical data of 200 patients who underwent gastric cancer surgery from January 2021 to December 2024 were collected, and a follow-up database including clinical information and the Functional Assessment of Cancer Therapy-General (Chinese version, FACT-G) scale was established. The FACT-G scale consists of four domains: physical well-being (7 items), social/family well-being (7 items), emotional well-being (6 items), and functional well-being (7 items). Statistical analysis was performed using SPSS 27.0 software. Measurement data were expressed as (mean ± standard deviation) and analyzed using the t test; enumeration data were expressed as rates and analyzed using the chi-square test. Binary Logistic regression was used to analyze risk factors affecting quality of life. A P-value < 0.05 was considered statistically significant.

Among the 200 patients, 22.5% (45/200) had no postoperative complications and 77.5% (155/200) had complications, who were assigned to the non-complication group (n=45) and complication group (n=155), respectively. There were statistically significant differences in all domain scores of quality of life at 3, 6, and 12 months postoperatively between the two groups (P<0.05). Logistic regression analysis showed that postoperative complications, pathological classification of gastric cancer, surgical approach, number of tumors, tumor size, and length of hospital stay were independent risk factors for postoperative quality of life (P<0.05).

Postoperative complications in gastric cancer patients adversely affect postoperative quality of life, leading to prolonged hospital stay and increased medical costs. Postoperative quality of life is influenced by multiple factors, including postoperative complications, pathological classification of gastric cancer, surgical approach, number of tumors, tumor size, and length of hospital stay. The main complications affecting quality of life include anastomotic leakage, malnutrition, intra-abdominal infection, delayed gastric emptying, and intestinal obstruction.

To investigate the clinical value of one-stage suture following double-endoscopy combined common bile duct exploration and stone extraction in the treatment of choledocholithiasis.

Clinical data of 121 patients who underwent double-endoscopy combined common bile duct exploration and stone extraction from January 2023 to April 2025 were retrospectively analyzed. Before matching, patients were divided into an observation group (n=59, treated with one-stage suture of the common bile duct) and a control group (n=62, treated with T-tube drainage) according to different management methods of the bile duct incision after stone extraction. After 1∶1 propensity score matching, a total of 116 patients were successfully matched, with 58 patients in each group. Data were processed and analyzed using SPSS 23.0 software. Measurement data conforming to normal distribution were expressed as (

Compared with the control group, the time to first postoperative flatus and length of hospital stay were significantly shorter in the observation group (P<0.05). At 3 days after surgery, serum levels of C reactive protein (CRP), high-sensitivity C-reactive protein (hs-CRP), serum amyloid A (SAA), total bilirubin (TBIL), aspartate aminotransferase (AST), and alanine aminotransferase (ALT) were significantly lower than those before surgery in both groups (P<0.05). There were no statistically significant differences in proinflammatory factors and liver function indexes between the two groups before surgery and at 3 days after surgery (P>0.05). The total incidence of postoperative complications was significantly lower in the observation group than in the control group (P<0.05). During a median follow-up of 12 months, no common bile duct stenosis or recurrence of choledocholithiasis occurred in either group.

Compared with conventional postoperative T-tube drainage, double-endoscopy combined common bile duct exploration with stone extraction and one-stage suture shows equivalent efficacy in relieving biliary obstruction and improving liver function in the treatment of choledocholithiasis. However, the latter can shorten the time to first flatus and hospital stay, and reduce the incidence of postoperative complications.

To investigate the correlation between peripheral blood neutrophil percentage-albumin ratio (NPAR) and breast cancer, and to evaluate its clinical predictive efficacy for breast cancer.

A total of 109 patients with malignant breast tumors (malignant group), 94 patients with benign breast tumors (benign group) from January to December 2016 were enrolled, and 100 healthy women during the same period were included as the control group. Peripheral blood neutrophil percentage and serum albumin level were measured in the three groups, and NPAR was calculated. Intergroup differences in the indicators were analyzed by statistical methods. Binary Logistic regression was used to explore the correlation between NPAR and the risk of breast cancer, and ROC curve was applied to assess its diagnostic value.

NPAR and neutrophil percentage in the malignant group were significantly higher than those in the benign group and healthy group, while serum albumin level was significantly lower than that in the latter two groups. The difference in NPAR among the three groups was statistically significant (P<0.05). In the malignant group, there were no statistically significant differences in NPAR among subgroups with different clinical characteristics, including molecular subtypes, axillary lymph node metastasis status, and histological grade (P>0.05). Multivariate Logistic regression analysis showed that NPAR was a significant risk factor for breast cancer before adjustment for age (P<0.05), but the correlation disappeared after age adjustment (P=0.820), whereas age was an independent risk factor for breast cancer (OR=1.077, 95%CI: 1.043-1.113, P<0.001). Peripheral blood neutrophil percentage and serum albumin showed no significant statistical correlation with the incidence of breast cancer (all P>0.05). ROC curve analysis revealed that the AUC of age for differentiating breast cancer from benign breast tumors was 0.747 (95%CI: 0.680-0.815), with an optimal cutoff value of 45.5 years, a sensitivity of 61.5% and a specificity of 76.6%. The area under the curve (AUC) of NPAR for distinguishing breast cancer from benign breast tumors was 0.732 (95%CI: 0.667-0.797), with an optimal cutoff value of 11.88, a sensitivity of 75.2% and a specificity of 61.7%. The combined use of age and NPAR for differentiating breast cancer from benign breast tumors yielded an AUC of 0.799 (95%CI: 0.739-0.859), with a sensitivity of 75.2% and a specificity of 74.5%.

NPAR differs significantly among patients with malignant breast tumors, benign breast tumors and healthy individuals. It is associated with breast cancer risk before age adjustment, but its effect is confounded or modulated by age. Age is a definite independent risk factor for breast cancer, while the evidence supporting NPAR as an independent risk factor for breast cancer is insufficient. Detection of NPAR can assist in the clinical identification of breast cancer, but its clinical application value still needs to be further verified by large-sample and multicenter studies.

To evaluate the value of preoperative residual breast calcifications in predicting residual tumor after neoadjuvant chemotherapy (NAC).

A retrospective study was conducted on breast cancer patients who received NAC from January 2020 to December 2024 and showed suspicious microcalcifications within or near the tumor bed on mammography. Residual microcalcifications and residual lesions were analyzed by magnetic resonance imaging (MRI), and correlated with histopathological findings of residual tumors and immunohistochemical markers. Statistical analysis was performed using SPSS 28.0, with Fisher's exact test, Pearson's chi-square test, and intraclass correlation coefficient (ICC). P<0.05 was considered statistically significant.

A total of 96 patients were enrolled, including 10 who achieved pathological complete response (pCR). Suspicious microcalcifications were associated with benign pathology in 10.4% (10/96) of patients. Among the remaining 86 patients without pCR, residual microcalcifications were associated with invasive or in-situ carcinoma in 61.5% (59/96) and with benign pathology in 28.1% (27/96). The proportion of residual malignant microcalcifications was highest in hormone receptor-positive (HR+) patients compared with HR-negative (HR-) patients (48.9% vs. 13.5%, respectively; P=0.019). MRI was superior to residual microcalcifications on mammography in predicting residual tumor extent across all subtypes (ICC=0.709 vs. 0.365). MRI showed higher correlation with residual tumor size for HR/HER2+ and HR/HER2- subtypes (ICC=0.925 and 0.876, respectively).

After NAC, the extent of microcalcifications on mammography does not correlate with the extent of residual cancer in 38.5% of women. Regardless of the extent of microcalcifications, microcalcifications, residual tumor extent on post-chemotherapy MRI, and molecular subtype may serve as accurate tools for evaluating post-chemotherapy residual cancer.

To investigate the carrier rate of PALB2 gene germline mutations in Chinese female breast cancer patients, assess their pathogenic risk, and explore the correlation between these mutations and clinical pathological characteristics.

Systematic searches were conducted in both Chinese and English databases to collect studies on PALB2 gene mutations in the Chinese population published before 2024. A total of 12 studies were included, involving 15 824 female Chinese breast cancer patients and 13 505 female control subjects. The literature data were subjected to meta-analysis to calculate the pooled mutation carrier rate, risk ratio, and the strength of association with clinical characteristics. The primary effect indicators were the PALB2 mutation carrier rate and its risk ratio, both of which were calculated with 95%CI. The I² statistic was used to evaluate the heterogeneity among studies. P<0.05 was considered statistically significant

The pooled analysis showed that the total carrier rate of pathogenic/likely pathogenic mutations (PV/LPV) of PALB2 in Chinese female breast cancer patients was 1.3% (95%CI: 1.09%-1.44%), significantly higher than that of the control group of healthy individuals (0.2% (95%CI: 0.15%-0.32%)), and the combined risk ratio for developing breast cancer among carriers was as high as 6.8 (95%CI: 4.210-11.120, P<0.001). In the familial/early-onset breast cancer subgroup, the carrier rate increased to 2.2%. Compared with non-carriers, the proportions of grade 11 histological grading and high Ki-67 expression (>20%) were significantly higher in PALB2 mutation carriers (P<0.05); the average diagnosis age was significantly lower than that of non-carriers and the proportion of first-degree relatives with a history of breast cancer was higher (P<0.05); in PALB2 mutation carriers, there was a trend of higher proportion of triple-negative breast cancer compared to non-carriers, but the difference was not statistically significant (P>0.05).

PALB2 is an important breast cancer susceptibility gene with a high penetrance in Chinese women. Its germline mutations can significantly increase the risk of breast cancer and are associated with some invasive clinical pathological features.

To analyze the risk factors for complications after endovascular aortic repair of abdominal aortic aneurysm, and to construct and evaluate the predictive efficiency of a prediction model for postoperative complications based on these risk factors.

Clinical data of 270 patients who underwent endovascular aortic repair for abdominal aortic aneurysm from August 2022 to August 2024 were retrospectively collected. Patients were divided into a complication group (n=80) and a non-complication group (n=190) according to the occurrence of postoperative complications. Measurement data conforming to normal distribution were expressed as (

The proportions of hypertension, liver disease, bilateral internal iliac artery embolization during operation, and maximum difference of intraoperative mean arterial pressure (MAP) in the complication group were higher than those in the non-complication group, while the preoperative hemoglobin level was lower (P<0.05). Logistic regression analysis showed that hypertension (OR=4.740, 95%CI: 1.828-12.287), liver disease (OR=1.357, 95%CI: 1.021-1.803), bilateral internal iliac artery embolization during operation (OR=3.607, 95%CI: 1.733-7.509), and maximum difference of intraoperative MAP (OR=2.881, 95%CI: 1.572-5.278) were risk factors for postoperative complications. Preoperative hemoglobin level was a protective factor (OR=0.641, 95%CI: 0.426-0.963), all P<0.05. The combined prediction model was logit (P) = -0.279 + 1.556 × hypertension + 0.305 × liver disease + 1.283 × bilateral internal iliac artery embolization + 1.058 × maximum difference of intraoperative MAP -0.445× preoperative hemoglobin. ROC curve showed that the area under the curve (AUC) of the model for predicting postoperative complications was 0.867, with a sensitivity of 72.5% and a specificity of 89.0%, which was superior to individual index prediction (Z=6.865, 12.302, 8.200, 1.976, 5.742, P<0.05).

The occurrence of complications after endovascular aortic repair of abdominal aortic aneurysm is closely related to hypertension, liver disease, bilateral internal iliac artery embolization during operation, maximum difference of intraoperative MAP, and preoperative hemoglobin level. The prediction model constructed based on the above indicators shows significant predictive efficiency for postoperative complications.

hormone (PTH) and calcium (Ca) levels], prognosis, and postoperative complications were compared between the two groups.

Retrospective cohort study. The clinical data of 86 patients with cN0 unilateral paramedian isthmus-type PTC admitted to our hospital from March 2022 to February 2024 were analyzed. They were divided into the observation group (single-sided adenoma lobe + isthmus resection, n=39) and the control group (total thyroidectomy, n=47) according to the surgical method. The perioperative conditions, parathyroid function [serum parathyroid hormone (PTH), calcium (Ca) levels], prognosis and surgery outcomes of the two groups were compared using the χ² test or t test.

The incision length, operation time, and hospital stay in the observation group [(6.3±1.2) cm, (75.5±15.6) min, (4.9±1.1) d, respectively] were shorter than those in the control group [(7.7±1.5) cm, (118.4±22.5) min, (6.7±1.7) d, respectively], and intraoperative blood loss (45.4±12.5) ml was less than that in the control group (72.1±14.3) ml (P<0.05). Serum PTH and Ca levels at 7 days after operation were decreased compared with preoperative levels in both groups. The PTH and Ca levels in the observation group at 7 days after operation [(34.2±6.6) pg/ml, (2.2±0.2) mmol/L, respectively] were higher than those in the control group [(23.2±5.4) pg/ml, (2.0±0.1) mmol/L, respectively] (P<0.05). There were no significant differences in distant metastasis rate (2.6% vs. 0.0%) or recurrence rate (7.7% vs. 4.3%) between the two groups (P>0.05). The complication rate in the observation group (12.8%) was lower than that in the control group (40.4%) (P<0.05).

For carefully selected patients with cN0 low-risk PTC adjacent to the isthmus, unilateral lobectomy plus isthmusectomy has advantages in reducing perioperative trauma, preserving parathyroid function, and lowering complications, while achieving similar short-term tumor control to total thyroidectomy.