The incidence and mortality of gastric cancer are among the top of malignant tumors in China. Over the past three decades, laparoscopic surgery for gastric cancer in China has undergone a transformative evolution—from exploratory application to standardized innovation. Surgical techniques have progressively matured and been standardized, leading to the establishment of clinical consensus. Multiple high-quality clinical studies from China have demonstrated the safety and efficacy of laparoscopic gastric cancer surgery, providing robust evidence-based support and enhancing the country’s academic influence in international gastric cancer research. Concurrently, structured training programs in laparoscopic gastric cancer surgery are gradually being implemented. Looking ahead, further advancements are anticipated in function-preserving gastrectomy, navigation surgery, and single-incision laparoscopic techniques. Drawing upon both domestic and international studies, this review aims to comprehensively summarize the latest developments in laparoscopic gastric cancer surgery in China, with the goal of systematically elucidating its current status and future directions.

Laparoscopic radical gastrectomy for gastric cancer is an important method of minimally invasive surgical treatment for gastric cancer. The technical standards and quality control of this procedure directly affect the prognosis and quality of life of patients. This article systematically reviews the development process of key technologies and quality control systems for laparoscopic radical gastrectomy in China. The key technologies of laparoscopic radical gastrectomy for gastric cancer include preoperative precise assessment, standardized operation during the procedure, and handling of surgical specimens. The quality control system for laparoscopic radical gastrectomy in China covers the entire process from preoperative, intraoperative to postoperative management, and has been continuously improved with the accumulation of high-level evidence such as the CLASS series studies. Establishing a gastric cancer surgery quality database and a quality evaluation system centered on patient outcomes is the key path to achieving surgical homogeneity. In the future, the application of new technologies such as artificial intelligence will further improve surgical quality and promote laparoscopic surgery to develop towards greater precision, individualization, and intelligence.

This article provides an overview of the complications and related management of laparoscopic radical gastrectomy in China, drawing from both literature and current domestic clinical research progress. Laparoscopic radical gastrectomy in China has undergone vigorous development and continuous innovation over the past 30 years, achieving remarkable results. However, the uneven development across regions remains a current challenge. The overall complication rate and mortality rate of laparoscopic radical gastrectomy for early-staging gastric cancer in China are comparable to those of open surgery. The main complications include intraoperative bleeding, anastomotic leakage, stenosis, postoperative emptying disorders, and so on. Data show that laparoscopic surgery has advantages in reducing some systemic complications. Current research indicates that neoadjuvant therapy, especially chemotherapy combined with immunotherapy (NAIC), can improve the pathological complete response rate (pCR) and radical resection rate (R0) without increasing the risk of postoperative complications. The author believes that continuously promoting the standardization and modularization of laparoscopic radical gastrectomy, emphasizing the concept of mesenteric anatomy, and correctly and reasonably using energy devices can shorten the learning curve of surgeons, reduce the rate of surgical complications, and further improve the overall level of laparoscopic radical gastrectomy in China.

Laparoscopic distal radical gastrectomy has become one of the standard surgical procedures for early gastric cancer, with advantages such as minimal trauma and fast recovery. Standardized operation emphasizes the clearance of D2 lymph nodes in the "five regions" with the pancreas as the main anatomical landmark and safe reconstruction of the internal digestive tract. Common reconstruction methods include Billroth-I (such as Delta, triangulation), Billroth-Ⅱ, and Roux-en-Y anastomosis. In recent years, the combination of Billroth Ⅱ and Braun anastomosis has gradually gained attention due to its effective reduction of alkaline reflux gastritis, duodenal stump fistula, anastomotic inflammation, and gastroparesis syndrome, and improvement of patients’ quality of life. During the operation, attention should be paid to the tension of the anastomotic site, blood supply, and cross-over of the closure line. It is recommended to have an experienced team carry out the operation and use preoperative endoscopic submucosal injection of nano carbon to locate the tumor and improve surgical accuracy. More high-level evidence is still needed to support the long-term efficacy of oncology.

In cases of Siewert type II esophagogastric junction cancer with esophageal invasion measuring less than 2 cm, the transhiatal approach facilitates the performance of lower mediastinal lymphadenectomy in conjunction with D2 perigastric lymph node dissection. We present the inaugural instances of reduced-port laparoscopic surgery conducted without an assistant for Siewert type II esophagogastric junction cancer. The diaphragmatic esophageal fascia was initially incised along the attachment of the dorsal mesogastrium. Subsequently, the right infracardiac bursa was meticulously dissected into the dorsal side of the mesoesophagus, exposed, and incised. By mobilizing the infracardiac bursa cranially, the No.110 and No.112 lymph node groups, along with the periesophageal adipose tissue, were systematically dissected en bloc, thereby completing the lower mediastinal lymph node dissection. The surgical procedure commenced with the mobilization of the greater omentum from its attachment to the transverse colon. Upon reaching the infra-pyloric region, the right gastroepiploic ligament was retracted with care, allowing for meticulous dissection along its root to enable en bloc removal. A comprehensive lymph node dissection was then conducted in the infra-pyloric and supra-pancreatic regions, as well as the No.4sb group, facilitating communication with the lower mediastinum. Subsequently, the surgeon independently performed a side-to-side jejunojejunostomy and esophagojejunostomy utilizing the overlap technique.

To explore the application effects of the intermediate approach and the left anterior approach in laparoscopic radical resection for advanced gastric cancer (AGC) in middle-aged and elderly patients.

The data of 91 middle-aged and elderly patients with localized AGC who underwent laparoscopic radical resection from January to December 2022 were retrospectively analyzed. The patients were grouped according to the surgical approach. 46 patients in the intermediate group received the intermediate approach; 45 patients in the left anterior group received the left anterior approach. Data were analyzed using SPSS 25.0 software. Quantitative data were expressed as (±s), and independent sample t test were used; count data were expressed as [cases (%)], and χ² tests or Fisher’s exact tests were performed; survival analysis was conducted using the Kaplan-Meier method. P<0.05 was considered statistically significant.

There were no statistically significant differences in the number of lymph node dissections during the operation, 24-hour postoperative serum C-reactive protein (CRP), superoxide dismutase (SOD) levels, and complication rates between the two groups (P>0.05); the operation time and intraoperative blood loss of the intermediate group were less than those of the left anterior group (P<0.05). Before closure, the serum dopa decarboxylase (DDC) and carcinoembryonic antigen (CEA) levels of the intermediate group were lower than those of the left anterior group (P<0.05); the 3-year recurrence rate of the intermediate group was lower than that of the left anterior group (P<0.05). The 3-year overall survival rate of the intermediate group was 87.0%, which was higher than that of the left anterior group (68.9%), and the disease-free survival period and overall survival period were longer than those of the left anterior group (P<0.05).

The intermediate approach and the left anterior approach laparoscopic radical resection for AGC in middle-aged and elderly patients have no statistically significant differences in the number of lymph node dissections during the operation, postoperative stress response, and complications. However, compared with the left anterior approach, the intermediate approach has shorter operation time, less intraoperative blood loss, lower 3-year recurrence rate, and longer disease-free survival period and overall survival period.

To investigate the clinical efficacy of complete laparoscopic transabdominal transdiaphragmatic hiatus approach for radical resection of Siewert typeⅡadenocarcinoma of the esophagogastric junction.

A total of 78 patients with Siewert typeⅡadenocarcinoma of the esophagogastric junction (AEG) admitted from January 2021 to December 2023 were prospectively selected as the research subjects. The patients were divided into the control group and the study group by the digital table method, with 39 cases in each group. The control group underwent surgery through the left thoracic-abdominal combined approach, while the study group underwent surgery through the transabdominal transdiaphragmatic hiatus approach. Data were analyzed using SPSS 25.0 statistical software. The surgical time, postoperative complications, cardiac and pulmonary functions, and survival status of the two groups were compared.

The operation time, blood loss, time to first ambulation, time to first defecation, and postoperative hospital stay of the study group were significantly shorter than those of the control group (P<0.05). The total incidence of postoperative complications in the study group (12.8%) was significantly lower than that in the control group (33.3%), and the difference was statistically significant (P<0.05). The levels of SV, LVEF, FVC, and FEV1 of the two groups after surgery were significantly lower than those before surgery, and the levels of each index in the study group were significantly higher than those in the control group (P<0.05). There was no statistically significant difference in the cumulative disease-free survival rate (71.8% vs. 69.2%) and cumulative overall survival rate (76.9% vs. 71.8%) between the two groups (Log-Rank χ²=0.013, 0.063, P=0.909, 0.802).

The complete laparoscopic transabdominal transdiaphragmatic hiatus approach for radical resection of Siewert typeⅡAEG has significant short-term efficacy, does not affect the effect of lymph node dissection and prognosis, can shorten the operation time, reduce intraoperative injury, lower the incidence of postoperative complications, promote postoperative recovery, and has high promotion value.

To explore the feasibility and effectiveness of a standardized parenteral nutrition (PN) treatment process constructed based on an informatized whole-process nutrition management system, evaluate its value in optimizing the rationality of PN prescriptions, improving treatment efficacy, and reducing adverse reactions, and provide a reference for establishing a safer and more effective informatized whole-process nutrition management system for standardized PN treatment processes.

A single-center prospective randomized cluster-controlled study was conducted. A total of 210 patients who required PN support after gastric cancer resection from May to October 2022 were enrolled. A randomized block design was adopted, with the ward medical team as the blocking factor. One group was randomly selected as the intervention group (n=105), and the other groups served as the control group (n=105). In the intervention group, clinical pharmacists formulated PN regimens in accordance with the established standardized PN treatment process; in the control group, clinical physicians formulated PN regimens based on conventional experience. Statistical analysis of data was performed using SPSS 26.0 software. Data were expressed as (±s) or [cases (%)], and independent samples t test or χ² test was used for comparison. P<0.05 was considered statistically significant.

After PN treatment: In the control group, levels of creatinine, hemoglobin, and blood potassium decreased, while levels of estimated glomerular filtration rate (eGFR), triglycerides, platelets, blood sodium, and blood calcium increased (all P<0.05). The intervention group showed the same changing trend of the above indicators as the control group; additionally, levels of aspartate aminotransferase (AST) and total bilirubin decreased, and albumin level increased (all P<0.05). Inter-group comparison showed that levels of albumin, blood phosphorus, and blood potassium in the intervention group were higher than those in the control group (all P<0.05). Compared with the control group, the intervention group had significantly better outcomes in terms of average blood glucose level, daily maximum blood glucose value, and blood glucose fluctuation range (all P<0.05). The incidence of hyponatremia, hypophosphatemia, and hyperglycemia in the intervention group was lower (all P<0.05). There were no cases of unreasonable energy and fluid volume in the intervention group, which was significantly better than the control group (P<0.05). The intervention group had earlier times of first postoperative flatus and defecation, and fewer hospital stays, but the differences were not statistically significant (all P>0.05).

The standardized PN formulation process constructed based on the informatized whole-process nutrition management system significantly improves the rationality of PN prescriptions and enhances the control of patients’ blood glucose and electrolytes, providing a reference for the implementation of a more standardized and comprehensive informatized whole-process nutrition management.

To explore the clinical efficacy of laparoscopic radical resection assisted by a preoperative small incision in the treatment of advanced distal gastric cancer.

The clinical data of 115 patients with advanced distal gastric cancer who underwent surgery from February 2022 to November 2023 were collected retrospectively. According to the different surgical methods, the patients were divided into two groups: Routine Group: 56 patients who underwent conventional laparoscopic radical resection; study Group: 59 patients who underwent laparoscopic radical resection assisted by a preoperative small incision. Data were processed using SPSS 25.0 statistical software. Measurement data conforming to a normal distribution were expressed as (±s) and analyzed by independent samples t test. Postoperative Visual Analogue Scale (VAS) scores were tested by general linear repeated-measures analysis of variance (ANOVA). Recurrence time was analyzed using Kaplan-Meier statistics. Categorical data were expressed as [cases (%)] and analyzed by the χ² test. P<0.05 was considered statistically significant.

The operation time of the Study Group was shorter than that of the Routine Group, and the number of intraoperative lymph node dissections was greater than that of the Routine Group (both P<0.05). There were no statistically significant differences between the two groups in terms of postoperative time to get out of bed, time to first flatus, or length of hospital stay (all P>0.05). At 6h, 12h, 24h, and 48h postoperatively, the VAS scores of both groups decreased gradually (all P<0.05); however, there were no statistically significant differences in VAS scores between the two groups at each postoperative time point (all P>0.05). There were no statistically significant differences between the two groups in the total incidence of postoperative complications or the 12-month postoperative recurrence rate (all P>0.05). The recurrence time of patients with recurrence in the Study Group was longer than that in the Routine Group (P<0.05).

Laparoscopic radical resection assisted by a preoperative small incision can shorten the operation time of advanced distal gastric cancer, increase the number of intraoperative lymph node dissections, without increasing postoperative pain and complications, and can ensure good oncological efficacy. It has value for popularization and application.

To compare the therapeutic effects of different laparoscopic surgical methods for cT₁N₀M₀ gastric cancer.

Clinical data of 81 patients with cT₁N₀M₀ gastric cancer who underwent laparoscopic gastrectomy from January 2021 to January 2024 were collected. According to the surgical method, patients were divided into the LADG group (n=41, laparoscopic distal gastrectomy) and the LAPPG group (n=40, laparoscopic pylorus-preserving gastrectomy). Data were processed using SPSS 25.0 software, and t test or χ² test was used for comparison. P<0.05 was considered statistically significant.

Compared with the LADG group, the LAPPG group had lower hospitalization costs, higher levels of total protein, albumin, and hemoglobin at 3 months postoperatively, a higher incidence of gastric emptying disorders, and a lower incidence of bile reflux gastritis (P<0.05). There were no significant differences in recurrence rate, survival rate, disease-free survival, or overall survival between the two groups during the 12-month postoperative follow-up (P>0.05).

LADG and LAPPG have comparable therapeutic effects for cT₁N₀M₀ gastric cancer. However, compared with LADG, LAPPG is more conducive to improving the postoperative nutritional status of patients, reducing the occurrence of bile reflux gastritis, and has lower hospitalization costs, but it may increase the risk of postoperative gastric emptying disorders.

To explore the effect of 3D laparoscopy in the lymph node dissection for low-stage advanced rectal cancer under three-dimensional reconstruction, and to analyze its impact on postoperative micro-inflammation and intestinal mucosal function of patients.

A total of 120 patients with low-stage advanced rectal cancer from our hospital from January 2019 to January 2023 were retrospectively selected as the research subjects. The patients were divided into the observation group (n=56, who received pelvic structure MRI three-dimensional reconstruction before surgery) and the control group (n=64, who received MRI scan before surgery but did not undergo three-dimensional reconstruction). Data were analyzed using SPSS20.0 statistical software. Quantitative data with normal distribution were analyzed using the independent sample t test; count data were analyzed using the χ² test. P<0.05 was considered statistically significant.

Compared with the control group, the operation time, hospital stay, and intestinal function recovery time of the observation group were shorter, the intraoperative blood loss was less, and the number of resected lymph nodes and positive lymph nodes was higher (P<0.05). There was no statistically significant difference in preoperative micro-inflammatory indicators and intestinal mucosal function indicators between the two groups (P>0.05). Postoperative levels of C-reactive protein (CRP), tumor necrosis factor (TNF)-α, interleukin (IL)-6, diamine oxidase (DAO), D-lactic acid (D-LA), and endotoxin (ET) in both groups increased, while the level of IL-10 decreased. There was no statistically significant difference in ET levels between the two groups (P>0.05), but the levels of CRP, TNF-α, IL-6, DAO, and D-LA in the observation group were lower than those in the control group, and the level of IL-10 was higher in the observation group (P<0.05).

Three-dimensional reconstruction under 3D laparoscopy can improve the effect of lymph node dissection for low-stage advanced rectal cancer, and can also alleviate postoperative micro-inflammation and improve intestinal mucosal function of patients.

To explore the clinical efficacy of emergency laparoscopic resection and stent placement versus definitive laparoscopic resection for obstructive colorectal cancer.

112 patients with obstructive colorectal cancer were divided into the observation group (receiving emergency stent placement followed by definitive laparoscopic resection) and the control group (undergoing emergency laparoscopic surgery) by a 1:1 matching method, with 56 patients in each group. t test or χ² test was used to compare the perioperative indicators, inflammatory indicators, immune function indicators, quality of life, and complication rates between the two groups. P<0.05 was considered statistically significant.

Compared with the control group, the observation group had significantly less intraoperative blood loss, significantly higher primary anastomosis rate, significantly shorter first defecation time, significantly higher total hospitalization cost (P<0.05), and significantly lower positive rate of circumferential resection source. Postoperative levels of C-reactive protein (CRP), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in both groups significantly decreased, and the observation group was significantly lower than the control group (P<0.05); CD3⁺, CD4⁺, and CD4⁺/CD8⁺ were significantly lower than before treatment, but the observation group was significantly higher than the control group (P<0.05). The core quality of life scale (EORTC QLQ-C30) of cancer patients in both groups showed significantly lower fatigue symptoms after surgery, and the observation group was significantly lower than the control group (P<0.05); the scores of role function, physical function, and overall health status after surgery were significantly higher in the observation group than in the control group (P<0.05). The total incidence of complications in the observation group was significantly lower than that in the control group (P<0.05).

Emergency stent placement followed by definitive laparoscopic resection for patients with obstructive colorectal cancer can significantly reduce intraoperative trauma, promote postoperative recovery, reduce the body's inflammatory response and protect immune function, improve the quality of life of patients, and effectively reduce the occurrence of complications.

To compare the clinical effects of transvaginal and transanal natural orifice specimen extraction surgery (NOSE) in laparoscopic radical resection of colorectal cancer (CRC) in women.

The clinical data of 112 female CRC patients from June 2023 to May 2025 were retrospectively analyzed. They were divided into the vaginal group (n=41, specimens removed through the vagina) and the anal group (n=71, specimens removed through the anus) based on different NOSE methods. The measurement data conforming to normal distribution were expressed as (±s), and independent sample t test was used; the count data were analyzed by χ² test. P<0.05 was considered statistically significant.

The operation time, postoperative hospital stay, time to first flatus, time to first defecation, and time to start liquid diet in the vaginal group were all shorter than those in the anal group (P<0.05). There were no statistically significant differences in intraoperative blood loss, lengths of proximal and distal resected intestinal segments, number of lymph nodes dissected, and complication rates between the two groups (P>0.05). Three months after surgery, the Female Sexual Function Index (FSFI) of both groups increased compared with that before surgery, and the Pelvic Floor Impact Questionnaire 7 (PFIQ-7) score and Pelvic Floor Distress Inventory 20 (PFID-20) score decreased compared with those before surgery (P<0.05), but there were no statistically significant differences in these indicators between the two groups (P>0.05).

Transvaginal specimen extraction during laparoscopic CRC resection can significantly simplify the surgical procedure, accelerate postoperative gastrointestinal function and physical recovery, without increasing the risk of pelvic floor dysfunction or complications, under the premise of ensuring the radical effect and surgical safety. It can be used as an efficient and safe specimen extraction method in laparoscopic surgery for female CRC patients.

To investigate the effects of different approaches of intersphincteric resection (ISR) on patients with low rectal cancer.

A total of 114 patients with low rectal cancer admitted from April 2022 to April 2025 were selected as the research subjects. They were randomly divided into the transanal group and the transabdominal group, with 57 cases in each group. Patients undergoing transanal ISR were included in the transanal group, and those undergoing transabdominal ISR were included in the transabdominal group. Statistical analysis was performed using SPSS25.0. Quantitative data were expressed as (±s), and independent sample t tests were used for group comparisons, while paired sample t tests were used for within-group comparisons; qualitative data were expressed as [cases (%)], and χ² tests were used for group comparisons. A difference was considered statistically significant if P<0.05.

The operation time of the transanal group was significantly higher than that of the transabdominal group (P<0.05); the time to first semi-liquid diet was significantly lower in the transanal group (P<0.05). One month after surgery, the Wexner score of the transanal group was significantly higher than that of the transabdominal group (P<0.05). Three months after surgery, the total complication rate of the transanal group was significantly lower than that of the transabdominal group (P<0.05). There were no significant differences in hospital stay, distance of the far resection margin, and total number of lymph node dissections between the two groups (P>0.05).

The treatment effects of transabdominal and transanal ISR on patients with low rectal cancer are similar. The transanal approach is more conducive to promoting the recovery of intestinal function compared to the transabdominal approach, but it has a lower risk of complications. However, compared with the transabdominal approach, the transanal approach is not conducive to the recovery of anal function.

To explore the safety, feasibility and clinical application value of "three-port method" laparoscopic surgery in the treatment of acute sigmoid colon perforation.

The clinical data of 46 patients with sigmoid colon perforation from September 2016 to March 2025 were retrospectively analyzed. The patients were divided into the control group (n=23) and the observation group (n=23) according to different surgical methods. The observation group underwent "three-port method" laparoscopic partial sigmoid colon resection + colostomy, while the control group underwent open surgery for partial sigmoid colon resection + colostomy. Data were processed using SPSS 22.0 statistical software. Quantitative data such as perioperative indicators were expressed as (±s), and t tests were performed. The incidence of postoperative complications was expressed as [cases (%)], and chi-square tests were conducted. P<0.05 was considered statistically significant.

There was no statistically significant difference in intraoperative blood loss and operation time between the two groups (P>0.05). In terms of postoperative time, postoperative hospital stay, postoperative standing time, incision infection and postoperative analgesia, the observation group was significantly better than the control group, and the differences between the two groups were statistically significant (P<0.05). There was no statistically significant difference in preoperative CRP index values between the two groups (P>0.05), but there was a statistically significant difference in CRP index values 3 days after surgery (P<0.05).

Compared with traditional open surgery, the "three-port method" laparoscopic surgery also has safety and operability, and has obvious advantages in postoperative recovery, postoperative pain and incision healing. It is worthy of clinical application and promotion.

To explore the application value of neural monitoring technology in assisting the identification and protection of pelvic autonomic nerves (PAN) and Denonvilliers’ fascia during total mesorectal excision (TME) for male patients with middle and low rectal cancer, and to re-examine the relevant anatomical structures.

A retrospective study was conducted. A total of 78 male patients with middle and low rectal cancer who underwent TME from October 2021 to December 2022 were selected as the observation group (intraoperative pelvic autonomic nerve monitoring was performed). Meanwhile, 80 patients who underwent TME during the same period were included as the control group (intraoperative PAN protection was conducted without neural monitoring). SPSS 27.0 software was used for data analysis. Measurement data conforming to a normal distribution were expressed as (mean±standard deviation). Independent samples t test was used for inter-group comparison, and paired samples t test was used for comparison of data at different time points within the same group. Categorical data were analyzed using the χ² test. P<0.05 was considered statistically significant.

After tumor resection, there were no statistically significant differences in the potential changes of effector organs such as the prostate, seminal vesicles, bladder, and internal/external anal sphincters compared with those before tumor resection (P>0.05). At 6 months postoperatively, the International Prostate Symptom Score (IPSS) of patients in both groups was higher than that before surgery, and the International Index of Erectile Function-5 (IIEF-5) score was lower than that before surgery. Moreover, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group, with statistically significant differences (P<0.05). At 12 months postoperatively, the IPSS score of the control group was still higher than that before surgery, and the IIEF-5 score was still lower than that before surgery (P<0.05); however, there were no statistically significant differences between the above scores of the observation group and those before surgery (P>0.05). Additionally, the IPSS score of the observation group was lower than that of the control group, and the IIEF-5 score was higher than that of the control group (P<0.05). There was a statistically significant difference in the total incidence of postoperative complications between the two groups (P<0.05).

Implementing pelvic autonomic nerve monitoring during TME for male patients with middle and low rectal cancer can accurately identify and preserve PAN and their branches during surgery, reduce PAN injury to ensure the integrity of their functions, and improve patients’ postoperative urogenital function. Meanwhile, correct identification of Denonvilliers’ fascia during surgery and mastery of its anatomical techniques are helpful for maintaining the correct surgical anatomical plane, better protecting PAN, thereby further improving patients’ prognosis and promoting the standardized implementation of TME surgery.

To study the value of computed tomography angiography (CTA) in evaluating the classification of the inferior mesenteric artery (IMA) and guiding laparoscopic rectal cancer surgery.

The clinical data of 195 patients with rectal cancer who underwent laparoscopic radical resection of rectal cancer from December 2021 to January 2024 were analyzed retrospectively. The patients were divided into two groups according to the examination method: Observation Group: 107 patients who underwent CTA examination; Control Group: 88 patients who underwent conventional CT examination. Data were analyzed using SPSS 22.0 software. Data were expressed as (±s), [M(IQR)] (median and interquartile range), or [cases (%)] (number of cases and percentage). Statistical tests including t test, nonparametric Rank-Sum test, χ² test, or Fisher’s exact test were used as appropriate. P<0.05 was considered statistically significant.

The operation time, intraoperative blood loss, length of hospital stay, and time to first ambulation after surgery in the Observation Group were significantly better than those in the Control Group, with Cohen’s |d|>0.8 for all indicators, and the differences were statistically significant (all P<0.05). The total incidence of postoperative complications in the Observation Group was lower than that in the Control Group, with a statistically significant difference (P<0.05). The coincidence rate between the intraoperative findings of mesenteric blood vessels and their branches and the preoperative multi-slice spiral computed tomography angiography (MSCTA) results in the Observation Group was significantly higher than that in the Control Group (100% vs. 90.9%, P<0.05). Among patients with IMA classification of Type Ⅰ–Ⅲ, the operation time and intraoperative blood loss in the Observation Group were lower than those in the Control Group, and the differences were statistically significant (all P<0.05).

Performing CTA before radical resection of rectal cancer can assist surgeons in efficiently planning the operation and significantly shortening the operation time; it helps clarify the vascular distribution preoperatively and enables precise intraoperative operation to reduce blood loss; it optimizes the surgical plan, reduces the incidence of postoperative complications, and strongly promotes the postoperative recovery of patients.

Effect of Laparoscopic Radical Resection via Cranial-Caudal Combined Approach for Right-Sided Colon Cancer Objective To explore the short-and medium-term effects of laparoscopic radical resection via the cranial-caudal combined approach versus the complete cranial approach in the treatment of right-sided colon cancer.

Clinical data of 127 patients with right-sided colon cancer admitted from March 2019 to March 2023 were collected. According to the surgical approach, patients were divided into the combined group (n=65, cranial-caudal combined approach) and the cranial group (n=62, complete cranial approach). Data were analyzed using SPSS 25.0 statistical software. Measurement data conforming to normal distribution were expressed as (±s) and compared by independent sample t test; enumeration data were expressed as cases or percentages and compared by χ² test. A two-tailed test with α=0.05 was used for statistical significance.

Compared with the cranial group, the combined group had shorter operation time, less intraoperative blood loss, more dissected lymph nodes, earlier first extubation time, and shorter hospital stay (P<0.05). After surgery, the serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 125 (CA125), and carbohydrate antigen 19-9 (CA19-9) in both groups were lower than those before surgery (P<0.05), but there was no significant difference between the two groups (P>0.05). There were no statistically significant differences in the total incidence of complications within 30 days after surgery or the recurrence rate within 2 years after surgery between the two groups (P>0.05).

Laparoscopic D3 radical resection for right-sided colon cancer via the cranial-caudal combined approach and the complete cranial approach achieves comparable oncological efficacy. However, the cranial-caudal combined approach can increase the number of dissected lymph nodes, shorten operation time and reduce intraoperative blood loss, and enable earlier extubation and hospital discharge.

Disruption of circadian rhythms is closely associated with tumor occurrence and development. This study aims to explore the association between core circadian rhythm genes and the malignant progression of colorectal cancer.

Multiple database resources such as TCGA, Kaplan-Meier Plotter, GEPIA 2.0, TIMER 2.0, cBioPortal, and Methsurv were integrated to systematically analyze the correlation between circadian rhythm genes and the progression of colorectal cancer. Statistical analysis was performed using R 4.3.2 software. Quantitative data that met normal distribution were expressed as (±s), and comparisons between groups were conducted using t tests; quantitative data that did not meet normal distribution or had unequal variances were analyzed using the Wilcoxon rank sum test; count data were expressed as [cases (%)], and were analyzed using the χ² test or Fisher’s exact probability method. P<0.05 indicated statistically significant differences.

Core circadian rhythm genes showed significant differential expression in colorectal cancer and adjacent tissues. Among them, BMAL1, CLOCK, CRY1, NPAS2, NR1D1, and PER1/3 were highly expressed and significantly correlated with poor prognosis in patients (P<0.05). These genes were strongly correlated with APC, and had a weaker association with oncogenes such as MYC, PTEN, and TP53. Additionally, BMAL1/2, CLOCK, CRY1/2, and RORC could affect the infiltration status of immune cells in the tumor microenvironment. High methylation of CRY1, NPAS2, NR1D1, and PER1 indicated poor prognosis, while demethylation of CLOCK and CRY2 had protective effects. Notably, the regulatory role of circadian rhythm genes in colon cancer was more significant than that in rectal cancer, suggesting the existence of tissue-specific regulatory mechanisms.

Circadian rhythm genes can affect the malignant progression of colorectal cancer by regulating proto-oncogenes, immune microenvironment, and DNA methylation status. Moreover, the regulatory role of circadian rhythm genes in the occurrence and development of colon cancer is more significant than that in rectal cancer. Targeted regulation of key genes of circadian rhythm may provide more promising therapeutic strategies for patients with colon cancer.

To analyze the influencing factors of bile fistula after laparoscopic cholecystectomy (LC) and to construct a risk prediction model.

24 patients who underwent LC and developed bile fistula within 30 days after surgery were included in the bile fistula group; another 122 patients who underwent LC and did not develop bile fistula during the follow-up period were included in the non-bile fistula group. Multivariate Logistic regression analysis was used to analyze the influencing factors of bile fistula. A nomogram model was constructed, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive value of the nomogram model for bile fistula after LC.

The patients in the bile fistula group had a higher prevalence of smoking history, hypertension history, diabetes history, ASA-PS grade III-IV, gallbladder wall thickness ≥ 5 mm, local anatomical variation, gallbladder and surrounding organ adhesion, and Calot triangle adhesion compared with the non-bile fistula group (P<0.05). Multivariate Logistic regression analysis showed that ASA-PS grade III-IV (OR=3.025, 95% CI: 1.985-4.611), local anatomical variation (OR=2.784, 95% CI: 1.487-5.213), gallbladder wall thickness ≥ 5mm (OR=2.550, 95% CI: 1.517-4.286), Calot triangle adhesion (OR=3.089, 95% CI: 1.364-6.996), and gallbladder and surrounding organ adhesion (OR=2.835, 95% CI: 1.470-5.466) were risk factors for bile fistula after LC (P<0.05). The nomogram model showed a consistency index (C-index) of 0.862 (95% CI: 0.810-0.913). The area under the curve (AUC) of the nomogram model for predicting bile fistula after LC was 0.876 (95% CI: 0.828-0.921), with a specificity of 67.1% and a sensitivity of 93.2%.

The risk factors for bile fistula after LC include local anatomical variation, gallbladder wall thickness, ASA-PS grade, Calot triangle adhesion, and gallbladder and surrounding organ adhesion. The constructed nomogram model has a high predictive value for bile fistula after LC.

To explore the feasibility and safety of performing common bile duct exploration and stone removal through the cystic duct surgical approach under laparoscopy.

The clinical data of 54 patients with common bile duct stones and gallbladder stones from November 2020 to October 2024 were retrospectively analyzed. Among them, 30 were male and 24 were female, with an average age of (66.9±9.7) years. The patients were divided into two groups based on different surgical methods: 24 cases underwent indocyanine green (ICG) fluorescence laparoscopic cystic duct common bile duct exploration and stone removal (LTCBDE), and 30 cases underwent ICG fluorescence laparoscopic common bile duct incision and stone removal (LCBDE). The comparison included the time for identifying the cystic duct, common bile duct, and common duct, the time for common bile duct exploration and stone removal, the operation time, intraoperative blood loss; the success rate of the operation, stone clearance rate, postoperative hospital stay, hospitalization cost, and complications. Data were analyzed using SPSS 26.0 statistical software. Quantitative data with normal distribution were expressed as (±s), and comparisons between the two groups were performed using independent sample t tests. Count data were expressed as [cases (%)], and comparisons were conducted using the χ² test or Fisher’s exact probability method. P<0.05 was considered statistically significant.

Both groups successfully underwent the surgery. There were no statistically significant differences in the time for identifying the cystic duct, intraoperative blood loss, and operation success rate between the two groups (all P>0.05); however, the observation group had shorter time for common bile duct exploration and stone removal, and shorter operation time compared with the control group (all P<0.05). There was no statistically significant difference in the incidence of surgical complications and total hospitalization cost between the two groups (P>0.05), but there were statistically significant differences in the postoperative hospital stay and the duration of negative pressure drainage tube placement (all P<0.05).

For patients with gallbladder stones and common bile duct stones or those with indications for common bile duct exploration, performing common bile duct exploration and stone removal through the cystic duct is a safe and feasible surgical method, which avoids common bile duct incision and can avoid the impact of T-tube placement on the patient’s quality of life after surgery, reduces the postoperative hospital stay and the duration of negative pressure drainage tube placement, and is worthy of clinical promotion and implementation.

To explore the optimal timing for elective laparoscopic cholecystectomy (LC) after percutaneous transhepatic gallbladder drainage (PTGD) in patients with high-risk acute suppurative cholecystitis (ASC).

A retrospective study was conducted on 206 patients with high-risk ASC who were treated in our hospital from September 2016 to March 2022. According to the interval between PTGD and LC (PTGD-LC interval), the patients were divided into the early LC group (4 weeks≤PTGD-LC interval<6 weeks, n=96 cases) and the late LC group (6 weeks≤PTGD-LC interval<8 weeks, n=110 cases). Statistical software SPSS 21.0 was used for data analysis. The 36-Item Short Form Health Survey (SF-36) scores (before and after surgery), operation time, blood loss, postoperative time to first flatus, postoperative time to oral intake, drainage tube removal time, and length of hospital stay in the two groups were expressed as (±s) and analyzed by t test. The rates of partial cholecystectomy, severe pericholecystic adhesion, conversion to open surgery, postoperative complication rate, and pain scores were compared between the two groups using the χ² test. A P-value<0.05 was considered statistically significant.

The operation time, postoperative time to first flatus, postoperative time to oral intake, drainage tube removal time, and length of hospital stay in the early LC group were longer than those in the late LC group (all P<0.05). The intraoperative blood loss, conversion rate to open surgery, and rate of severe pericholecystic adhesion in the early LC group were higher than those in the late LC group (all P<0.05). The SF-36 score in the early LC group was worse than that in the late LC group, with a statistically significant difference (P<0.05). There were no significant differences in the rate of partial cholecystectomy, postoperative complication rate, or postoperative pain score between the two groups (all P>0.05).

Performing LC 6–8 weeks after PTGD can shorten the operation time and length of hospital stay, and is conducive to improving the quality of life of patients with high-risk ASC.

To investigate the clinical efficacy of percutaneous ablation and laparoscopic hepatectomy in the treatment of early intrahepatic cholangiocarcinoma (ICC) with single lesion ≤3 cm.

A total of 68 patients with early ICC admitted from January 2020 to December 2023 were prospectively enrolled and randomly divided into the laparoscopic hepatectomy (LH) group and radiofrequency ablation (RFA) group using a random number table, with 34 cases in each group. The LH group received laparoscopic hepatectomy, while the RFA group underwent percutaneous radiofrequency ablation. Data were analyzed using SPSS 27.0 statistical software. Measurement data such as operation time and intraoperative blood loss were expressed as (±s) and compared using independent sample t tests. Enumeration data such as postoperative complication grades and overall survival rate were expressed as percentages and analyzed using χ² test or Z test. Survival curves were drawn by Kaplan-Meier method, and intergroup survival relationships were tested by Log-Rank test.

The operation time, intraoperative blood loss, time to first feeding, time to ambulation, hospital stay, and hospitalization cost in the RFA group were all lower than those in the LH group (P<0.05). The total incidence of postoperative complications in the RFA group was lower than that in the LH group (11.8% vs. 44.1%, P>0.05). There were no statistically significant differences in disease-free survival rate and overall survival rate between the two groups within 3 years after surgery (Log-Rank χ² disease-free=0.110, P disease-free=0.947; Log-Rank χ² overall survival=0.042, P overall survival=0.979).

For patients with early ICC, RFA treatment ensures comparable disease-free survival and overall survival rates, with shorter operation time, less intraoperative blood loss, faster postoperative recovery, lower surgical cost, and a lower incidence of postoperative complications.

To evaluate the clinical feasibility, safety, and long-term prognosis of totally implantable venous access ports (TIAP) in non-tumor patients aged ≥ 80 years, identify the risk factors for unplanned removal of the port, and provide a basis for clinical decision-making.

The clinical data of 52 non-tumor patients aged ≥ 80 years who received TIAP from January 2018 to December 2023 were retrospectively analyzed. Univariate and multivariate COX regression analyses were conducted to identify the independent risk factors for unplanned removal of the port.

Demographic characteristics and surgical-related factors did not significantly affect the retention of the catheter. In patients with a cardiac pacemaker, 75.0% achieved lifelong retention of the TIAP.

TIAP is safe and feasible for use in elderly non-tumor patients. Even in patients with a cardiac pacemaker, it can be used as a long-term venous access option; it has a high lifelong retention rate and a low complication rate, which can effectively reduce the pain of repeated punctures for patients and is worthy of clinical promotion.

To explore the impact of gasless subclavian approach endoscopic thyroid cancer radical surgery on perioperative indicators and thyroid function in patients with papillary thyroid carcinoma (PTC).

The clinical data of 106 PTC patients from April 2023 to April 2025 were retrospectively analyzed. The patients were divided into the endoscopic surgery group (n=55, undergoing gasless subclavian approach endoscopic unilateral thyroid cancer radical surgery) and the traditional surgery group (n=51, undergoing traditional open approach unilateral thyroid cancer radical surgery). χ² test or t test was used to compare perioperative indicators, thyroid function, pain degree, aesthetic effect, and complications between the two groups. P<0.05 was considered statistically significant.

The endoscopic surgery group had less intraoperative blood loss and longer operation time than the traditional surgery group (P<0.05). On the third day after surgery, the free triiodothyronine (FT₃) and free thyroxine (FT₄) levels in the endoscopic surgery group were higher than those in the traditional surgery group, while the thyroid stimulating hormone (TSH) level was lower (P<0.05). On the first, third, seventh day after surgery and one month after surgery, the visual analogue scale (VAS) scores in the endoscopic surgery group were lower than those in the traditional surgery group (P<0.05). Three months after surgery, there was no statistically significant difference in VAS scores between the two groups (P>0.05). Three months after surgery, the scar assessment scale (PSAS) scores and Vancouver Scar Scale (VSS) in the endoscopic surgery group were lower than those in the traditional surgery group (P<0.05). The postoperative complication rates in the endoscopic surgery group and the traditional surgery group were 7.3% (4/55) and 11.8% (6/51), respectively, with no statistically significant difference (P>0.05).

Gasless subclavian approach endoscopic thyroid cancer radical surgery is more conducive to the early recovery of thyroid function in PTC patients, with less postoperative pain and good aesthetic effect of the incision.