Implant-based breast reconstruction（IBBR）can reduce or avoid donor site injury and scarring in autologous breast reconstruction. IBBR has become the most common approach in breast reconstruction after mastectomy in recent ten years. With the progress of materials science and the development of breast surgery，mesh-assisted techniques has been widely used in IBBR，for the patients who need to implant larger volume prostheses，artificial materials which combined with pectoral muscles can “extend” muscle tissue and cover the prostheses without tension，and remodeling the fuller sub mammary folds. Matrices have been more applied in China in recent years，further reducing the surgical trauma and increasing the aesthetic outcomes of breast reconstruction. The investigation on the application of matrices in IBBR in China showed that the regional economic conditions and the economic conditions of patients are the main factors for the choice of breast reconstruction and matrices application. In addition，due to the different morphological characteristics of Chinese women's breasts，which is smaller than European and American women，matrices are less used for breast reconstruction with small breasts. The application of matrices in IBBR in China is more individual and regional.

The long-term survival rate of patients with hilar cholangiocarcinoma could be improved by radical resection with negative histological margin. The key points to improve the radical resection is precise segmental resection of the liver, appropriate scope of lymphadenectomy and experienced vascular reconstruction skill. This article will introduce the options of radical operation and the measures to improve the radical resection rate of hilar cholangiocarcinoma.

The Trocars were laid out in a conventional five-port approach. A Kocher maneuver was performed at the beginning，the inferior margin of the pancreatic neck was then dissected and the tumor invasion to the superior mesenteric vein（SMV）was evaluated. The distal stomach was resected after assessment as resectable，and the common hepatic artery was dissected and suspended as No. 8 and 12 lymphadenectomy performed，and then the gastroduodenal artery（GDA）was isolated and ligated，the gallbladder was removed with the common bile duct divided. The proximal jejunum was divided distal to the ligament of Treitz and dissected. The pancreas was subsequently divided at the neck and the splenic vein was exposed and ligated. The proximal and distal ends of the invaded SMV segments were dissected and suspended. The uncinate process was freed from the right wall of superior mesenteric artery（SMA）（in arterial-first approach）. Finally，the specimen with the invaded SMV（approximately 3 cm in length）were removed during the blockage of both proximal and distal ends of the SMV. The proximal and distal ends of the SMV were then anastomosed and reconstructed using an artificial vessel with a diameter of 8 mm. The specimen was sent for pathological diagnosis. The pancreaticojejunostomy，choledochojejunostomy and gastrojejunostomy was preformed intracorporeally.

This is the first report about Ligation-free radical resection of colon cancer in hepatic flexure with priority dissection of No. 206 and No. 204 lymph nodes. Firstly，LigaSure（LF1937）forceps was used to peel off the right gastroepiploic mesentery with the right hemi-colon and its mesentery from the cranial side to the caudal side，and to expose the right Toldt's fascia plane. Therefore，the anterior fascial plane of the pancreatico-duodenum and the confluence of the Henle trunk into the superior mesenteric vein are revealed clearly. Secondly，the membrane bridge on the surface of the ileo-mesocolon was incised along the infravascular fossa of the ileocolon. The fascial space was extended between the dorsal layer of the right mesocolon and the right Toldt’s fascia，then converged the cranial side of the Toldt’s fascial space. The right mesocolon was peeled off at the right edge of the superior mesenteric artery，and the breakwater technique of LigaSure（LF1937）was applied to coagulate and transect vessels as followed：the ileocolic vessels，the right colic vessels，and the middle colic vessels. Meanwhile，the No.203，No.213 and No.223 groups of lymph nodes are dissected sequentially.

China has entered a period of rapid development of Bariatric and metabolic surgery. We continue to explore the specialized development of Bariatric and metabolic surgery，standardized surgery training，academic exchanges and scientific research，and more and more voices of Chinese bariatric and metabolic surgery are heard in the international community. How to achieve simultaneous development of quantity and quality is the question that every bariatric and metabolic surgeon should think about.

With the development of the concept of minimally invasive surgery and the innovation of endoscopic instruments，laparoscopic surgery for pancreatic cancer has continuously made great breakthroughs in China，in which it has achieved similar results in comparison to open surgery in terms of safety and feasibility. However，pancreatic cancer is often accompanied by the infiltration of surrounding tissue and the invasion of peripheral lymph node or blood vessel that significantly increases the difficulty of operation，for which it is still remains controversial in terms of the efficacy of minimally invasive surgery. Therefore，in order to promote the standardization of laparoscopic surgery for pancreatic cancer on the whole，the author put forward some viewpoints from the aspects of selection of operation indication，radical resection of tumor and long-term outcome et al.

To compare the clinical effects of continuous intraoperative neuromonitoring (c-ionm) and intermittent intraoperative neuromonitoring (i-ionm) in endoscopic assisted thyroid surgery.

Data of 59 patients undergoing endoscopic assisted thyroid surgery from May 2016 to December 2018 were retrospectively analyzed, and they were divided into the c-ionm group and the i-ionm group according to different intraoperative neuromonitoring methods. SPSS 21.0 statistical software was used for analysis. The function evaluation of vagus nerve and recurrent laryngeal nerve was expressed by(±s), and independent t test was performed. χ² test was performed for recurrent laryngeal nerve injury. P<0.05 indicated the difference was statistically significant.

There was no significant difference in intraoperative nerve monitoring time between the two groups (P>0.05). Among the 59 patients, 86 recurrent laryngeal nerves were dissected and exposed, among which 11 showed a decrease of EMG amplitude by >50% during the operation, and gradually recovered to more than 70% of the initial R1 signal level within 10 min after the operation was stopped, with an average recovery time of (6.7±2.5) min. There was no significant difference between the two groups in the injury and recovery of recurrent laryngeal nerves during the operation (P>0.05). There was no significant difference in EMG amplitude and latency between the two groups compared with the APS electrode stimulation at the beginning (P>0.05). Under the light microscope, the structure of the vagus nerve and recurrent laryngeal nerve in the two groups was normal, the fiber cells were complete, and there was no neurobundle edema and neurovascular injury.

The efficacy of c-ionm and i-ionm in endoscopic thyroid surgery is similar in reducing the injury of vagus and recurrent laryngeal nerve. The two neuromonitoring techniques have no effect on the neurological function of patients, and both are safe and reliable.

To investigate the clinical value of laparoscopic small bowel lithotomy combined with intraoperative small bowel blocking in the treatment of acute coprolitith small bowel obstruction.

The clinical data of 48 patients with acute bezoar-induced small bowel obstruction who were treated and operated from June 2017 to June 2020 were retrospectively analyzed. According to different operation methods，they were divided into two groups，laparoscopy group（n=26）and laparotomy group（n=22）. In the laparoscopic group，emergency laparoscopic enterotomy for stone removal was performed，and small intestinal obstruction was performed at the proximal end of the small intestine. Patients in the laparotomy group received emergency exploratory laparotomy and small bowel incision for stone extraction. SPSS 21.0 statistical software was used for data statistical analysis.The perioperative indicators and other measurement data were expressed as（

The operation time in laparoscopy group was longer than that of laparotomy group，and the difference was statistically significant（P<0.05）；Volume of blood loss，exhaust time and hospitalization time were significantly lower than those in the laparotomy group. The difference was statistically significant（P<0.05）. The complication rate in laparoscopy group was 3.8%，which was significantly lower than that of laparotomy group（18.2%，），and the difference was statistically significant（P<0.05）.

Compared with laparotomy，laparoscopic surgery combined with intraoperative small bowel obstruction can significantly reduce intraoperative bleeding，postoperative hospitalization time，and postoperative complications. It is a safe and effective treatment method.

Gastrointestinal stromal tumors（GIST），soft tissue tumors derived from Cajal stromal cells，are a common type of gastrointestinal sarcoma. The discovery of targeted drugs has greatly improved the survival rate of GIST，and imatinib，as a targeted drug，has become the first-line treatment for GIST. However，recent studies have found that most patients have developed resistance to imatinib. Recent studies have shown that immunotherapy，including combination therapy based on immune checkpoint inhibitors and imatinib，cytokines，anti-kit antibodies，bisspecific monoclonal antibody therapy，and other novel strategies，are also effective in treating gastrointestinal stromal tumors. In this review，the role of immunotherapy and other novel strategies in the treatment of gastrointestinal stromal tumors will be discussed.

Standardized clinical data is an important basis for high-quality clinical and fundamental research，a powerful guarantee for improving clinical practice，and a basis for clinical decision-making and medical policy formulation. The construction and management of a standardized clinical database can improve the quality of clinical data. Based on the Greater China Metabolic and Bariatric Surgery Database，this paper focuses on the establishment process and practical experience of the clinical database in five aspects：background and purpose，set-up process，quality improvement issues，clinical data protection，and prospects，in the hope of promoting high-quality clinical research and clinical practice in metabolic and bariatric surgery.

Radical antegrade modular pancreatosplenectomy（RAMPS），was thought to have more lymph node yield and higher negative margin rates. In this case，the patient was admitted due to adenocarcinoma，who received placement of pancreatic stent previously. After evaluation，a surgical plan of robotic assisted posterior RAMPS combined with bilateral pancreatic mesangectomy was made. Intraoperatively，the gastrocolic omentum was divided first，then the superior mesenteric artery，the superior mesenteric vein and the left renal vein was exposed successively after dissection of inferior margin of pancreas. Dissection then proceeds cranially and dorsally along the left renal vessels，after which pancreatic head，splenic vein and uncinate process were divided successively. The splenic artery and left gastric artery were dissection along celiac trunk，after which the splenic artery was divided. Left gastric vein，gastrosplenic ligament and gastropancreatic ligment was dissected leftwards along the greater curvature and lesser curvature，to resect distal pancreas and peri-pancreatic tissue. The instrument was docked again after removal of the specimen，then the ligation of vascular end was reinforced，the pancreatic stump was bundled，and the drainage was placed.

To study the immunotyping changes of HER2 positive breast cancer after neoadjuvant chemotherapy.

A retrospective analysis was made on 66 cases of breast cancer of HER2 positive treated with neoadjuvant chemotherapy from January 2012 to December 2017. All patients underwent ultrasound-guided core needle biopsy before chemotherapy, and pathological examination after surgery. SPSS19.0 statistical software was used to observe the changes of estrogen receptor (ER), progesterone receptor (PR), cell proliferation nuclear antigen Ki67 (Ki67) and HER2 levels in patients before and after adjuvant chemotherapy. Chi-square test was used to show that there was significant difference between patients before and after adjuvant chemotherapy with P<0.05.

After neoadjuvant chemotherapy in 66 HER2-positive breast cancer patients, PR up-regulated rate was 19.32%, and down-regulated rate was 25.57%. ER remained unchanged (74.43%). Ki67 down-regulated rate was 23.86%, which was significantly higher than the up-regulated rate of 12.50%, and the unchanged rate was 63.64%. 7 of 66 patients turned negative after neoadjuvant chemotherapy in HER2. The negative conversion rate was 10.61%.

ER and PR of some patients with HER2-positive breast cancer after neoadjuvant chemotherapy may be up-regulated or down-regulated. Ki-67 may be down-regulated in a certain proportion and HER2 may be negative. These changes will affect the classification of breast cancer and the choice of post-operative therapeutic drugs.

The Chinese Medical Association's Clinical Practice Guide for Breast Surgery（2022）added a new chapter of clinical practice guideline about postoperative lymphedema of breast cancer. According to the Evidence-Based Medical evidences of diagnosis and treatment of postoperative lymphedema of breast cancer，referring to the GRADE standard and following the principle of clinical diagnosis and treatment accessibility，this guideline present recommendations on the high-risk population，diagnosis，staging，treatment and postoperative rehabilitation of postoperative lymphedema of breast cancer in grades. In this paper，combined with practical clinical experience，the key contents of the guideline are interpreted for the reference of relevant people.

Postoperative recurrence and distant metastasis of gastrointestinal tumors often occur，which seriously affects the prognosis of patients and is an important problem to be solved urgently in surgery. Current studies have revealed the close relationship between inflammation and the occurrence and development of tumors. Inflammation is associated with the entire perioperative period，including preoperative tumor microenvironment-related inflammation，trauma-related inflammation，and postoperative infection-related inflammation. These inflammation can be both pro-tumor and anti-tumor. When pro-tumor inflammation becomes dominant，it can stimulate tumor recurrence in situ and reduce overall survival. Therefore，it is necessary to evaluate the tendency of perioperative inflammation. In this paper，the latest progress of basic and clinical research at home and abroad is reviewed，and the mechanism of inflammation and corresponding evaluation indexes are briefly described.

Parastomal hernia is one of the most common long-term complications after permanent enterostomy. Which is a type of parastomal abdominal incisional hernia. The incidence is increasing year by year. Although the majority of parastomal hernias are asymptomatic or only have a slight abdominal discomfort，which can be improved by conservative treatment，surgical treatment is often required when severe abdominal pain，intestinal obstruction and abdominal distension. The three major surgical approaches include suture repair，stoma translocation，and mesh repair. For patients with high risk factors，preventive placement of a mesh during an ostomy may be considered. This paper reviewed recent literatures，and summarize the research progress of surgical treatment of parastomal hernia.

China is a large country of liver cancer in the world，with more than half of the cases of morbidity and death in the world. At present，surgical resection is still the first choice for the treatment of liver cancer. In recent years，with the progress of surgical instruments and the improvement of operational proficiency，surgical resection of liver cancer gradually shows a minimally invasive trend. Laparoscopic liver cancer surgery has been widely recognized for its effectiveness and safety because of its small abdominal incision and rapid postoperative recovery. However，due to the variability and complexity of liver cancer surgery，there are still many contents to be further standardized in the specific clinical application of laparoscopic liver cancer surgery. The problems that should be paid attention to laparoscopic liver cancer surgery include indication selection，process selection，perioperative management and so on. For laparoscopic liver cancer surgery，we must comprehensively consider many factors，such as patients' physical condition，treatment trauma，safety，effectiveness and cost，so as to complete the operating specifications of laparoscopic liver cancer surgery，make the surgery more safe and effective，and maximize the benefits of patients.

Day surgery can save medical resources，reduce treatment related costs，which achieve a win-win result between hospital and patients. As a superficial organ，breast has particularly advantages to implement day surgery. Most of the breast surgical procedures are clean surgery and do not need complicated preparations. There is no significant interference on diet and activities after operation. However，there are still many problems in the day surgery for breast，such as indications，safety and surgical procedures. The consensus on the standardized management of day surgery for breast in China helps to guide the practice in this field. We intend to make a review on the point.

With the development of laparoscopic technology，laparoscopic surgery has been widely used in colon cancer surgery. Its high-resolution field of vision and magnification effect allow the surgeon to perform delicate dissection andmanipulation. After years of practice，laparoscopic surgery has been proved to be safe and effective，and is highly respected by surgical experts. For right colon cancer，there are various lymph node dissection methods and surgical plans such as D2 radical resection，D3 radical resection and CME resection，and various digestive tract reconstruction methods such as end-to-end anastomosis，end-to-side anastomosis and side-to-side anastomosis. it is very important to select appropriate lymph node dissection and digestive tract reconstruction in clinical practice. Also，standardized surgical operation is a crucial guarantee for surgical safety and good prognosis of patients.