Abstract:Chronic constipation is a common functional bowel disorder that significantly impacts patients' quality of life and mental health. The Surgical Diagnosis and Treatment Guidelines for Constipation were first published in 2008 and revised in 2017, respectively, and have contributed to the growth of constipation surgery in China. With a deeper understanding of the underlying mechanisms and advancements in minimally invasive surgical techniques, the branch has again assembled multidisciplinary experts to enhance the diagnosis and treatment system. Based on the latest local and global evidence and utilizing the GRADE system to assess the quality of evidence and strength of recommendations, they have developed the Guidelines for Surgical treatment of constipation (2025 Edition). The new edition systematically updates information on causes, diagnostic methods, and non-surgical and surgical treatment options for constipation. It clearly defines surgical indications and principles for procedure selection, emphasizing personalized treatment and evidence-based decision-making. This guideline aims to standardize diagnosis and treatment, improve clinical decision-making, and promote consistency and effectiveness in surgical approaches for treating constipation.

Abstract:Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders, including hypertension and diabetes. In China, more than half of the adult population is overweight or obese. While anti-obesity pharmacotherapies (such as GLP-1 receptor agonists) and bariatric surgery have both advanced rapidly, strategies for integrating these two modalities remain unclear. In particular, controversies persist regarding surgical eligibility after drug discontinuation, and standardized clinical guidelines are lacking. In July 2025, the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on "metabolic bariatric surgery after pharmacotherapy-induced weight loss", which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery. This article interprets the statement from the perspectives of treatment strategies, surgical eligibility, and drug-surgery coordination, aiming to provide evidence-based reference for clinicians and to promote standardized, integrated obesity management.

Abstract:Complex rectal cancer often requires extended multivisceral resection beyond the total mesorectal excision plane or lateral lymph node dissection (LLND) beyond the conventional range. Owing to the deep pelvic location, limited operating space, and complex local anatomy, conventional open or laparoscopic surgery is associated with restricted visualization, technical difficulty, and increased surgical risk. With the advancement of robot-assisted surgical technology, its high-definition three-dimensional vision, articulated robotic arms with multiple degrees of freedom, and ergonomic improvements effectively overcome the limitations of traditional laparoscopy, allowing precise manipulation in narrow pelvic spaces. These advantages have made robotic surgery increasingly valuable in complex rectal cancer procedures such as LLND and multivisceral resection. This review summarizes recent literature and the authors' clinical experience to discuss the feasibility, advantages, and limitations of robotic-assisted rectal cancer surgery.

Abstract:Laparoscopic intersphincteric resection (ISR) represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer. Based on 400 cases of surgical experience, this study proposes a series of systematic strategies addressing some major technical challenges of ISR. To facilitate precise dissection of the intersphincteric space, a "knife-edge position transanal-priority" approach was adopted, improving exposure and reducing the risk of circumferential margin positivity. To prevent and reduce anastomotic leakage, ISR combined with the modified Bacon (Turnbull-Cutait) delayed anastomosis was introduced as a "stoma-free but safe" alternative. For large anastomotic disruptions, a stoma-therapist-involved management protocol with transanal "U-shaped" repair was implemented to promote healing. Furthermore, a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence. Our initial experience suggests that, these strategies contribute to optimizing the balance between oncological radicality and functional preservation, offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.

Abstract:Background and Aims Tumor deposits (TDs) may influence prognosis beyond the current 8th edition AJCC pTNM nodal classification in gastric cancer (GC). This study investigates the prognostic value of TD number and proposes an improved pN staging (mpN) that classifies patients with TD number >1 as pN3b. We validated the mpN staging against the 8th AJCC pN staging.Methods A dual-center retrospective cohort study was performed, including 1 327 patients who underwent radical gastrectomy at Sun Yat-sen University Cancer Center (2011-2015; test cohort) and 340 patients from Guangdong Provincial People's Hospital (2015-2022; validation cohort). Patients were dichotomized into low-TD (≤1) and high-TD (>1) groups. Outcomes were overall survival (OS) and disease-free survival (DFS). Survival analyses used Kaplan-Meier curves, IPTW, and Cox regression. Predictive performance of staging systems was assessed by time-dependent ROC (tROC)/tAUC, concordance index (C-index) and Akaike information criterion (AIC).Results TDs were present in 435/1 327 (32.7%) in the test cohort. Presence of TD was associated with worse OS (IPTW-adjusted HR=2.69, 95% CI=2.18-3.31, P<0.01) and DFS (HR=2.82, 95% CI=2.32-3.42, P<0.01). In multivariable models, TD remained an independent adverse factor for OS (HR=1.65, 95% CI=1.34-2.05; P<0.01) and DFS (HR=1.74, 95% CI=1.43-2.11, P<0.01). Increasing TD number correlated with progressively poorer survival; X-tile identified >1 as an optimal cutoff, with high-TD patients showing markedly worse outcomes (OS: adjusted HR=3.65, 95% CI=2.74-4.88; DFS: adjusted HR=3.74, 95% CI=2.85-4.91; both P<0.01). Incorporation of TD number into the mpN staging (assigning TD>1 to pN3b) improved prognostic discrimination: in the test cohort 5-year OS tAUC was 0.746 for mpN vs. 0.703 for AJCC pN (C-index 0.738 vs. 0.721, AIC 5 805.27 vs. 5 849.30); similar improvements were observed in the validation cohort.Conclusion TD presence and number exert significant negative prognostic impact in GC. Classifying patients with TD number >1 as pN3b enhances prognostic accuracy. Routine reporting of TD counts and further prospective multicenter validation of mpN staging are warranted.

Abstract:Background and Aims Microsatellite-stable (MSS) colorectal cancer (CRC) generally exhibits poor responsiveness to immune checkpoint inhibitors (ICIs), and effective immunotherapy strategies remain lacking. Anti-angiogenic agents such as bevacizumab (BEV) can improve the tumor immune microenvironment and act synergistically with ICIs. This multicenter real-world study compared the efficacy of different immunotherapy-based combination regimens in patients with MSS/MSI-L/pMMR advanced CRC, aiming to identify the optimal treatment strategy.Methods A total of 100 patients with MSS/MSI-L/pMMR advanced CRC who received systemic treatment between November 2019 and February 2025 at four tertiary hospitals in Hunan, China, were retrospectively enrolled. Patients were classified into six treatment groups: chemotherapy alone, chemotherapy + targeted therapy, immunotherapy alone, immunotherapy + chemotherapy, immunotherapy + targeted therapy, and immunotherapy + chemotherapy + targeted therapy. The primary endpoints were overall survival (OS) and progression-free survival (PFS), while secondary endpoints were objective response rate (ORR) and disease control rate (DCR). Additionally, among patients receiving immunotherapy, subgroup analysis was performed according to BEV administration.Results Among all 100 patients, the immunotherapy + chemotherapy + targeted therapy group achieved the highest ORR (32.0%) and DCR (76.0%) and was the only regimen yielding a complete response (CR). Compared with chemotherapy or immunotherapy alone, the triplet regimen significantly improved OS (P<0.05); although PFS improvement did not reach statistical significance, a clear late-stage separation of survival curves was observed. In the immunotherapy subgroup, BEV-containing regimens achieved markedly better outcomes than non-BEV regimens, with DCR of 75.0% vs. 48.8%, median OS of 18.9 vs. 11.5 months, and median PFS of 13.8 vs. 7.2 months (all P<0.001). Cox regression analysis showed that compared with chemotherapy alone, the triplet regimen significantly reduced the risk of death (HR=0.11) and disease progression (HR=0.25) (both P=0.002). Vascular invasion was identified as an adverse prognostic factor for PFS (HR=3.0, P=0.007).Conclusion This multicenter real-world study demonstrated that combining immunotherapy with chemotherapy and targeted therapy significantly improves DCR and survival outcomes in patients with MSS/MSI-L/pMMR advanced CRC, with BEV-containing triplet regimens providing the most pronounced benefit. BEV may enhance immune responsiveness by modulating the tumor microenvironment and promoting effector T-cell infiltration, offering a promising therapeutic direction for "immune-cold" CRC. Prospective randomized studies are warranted to further validate its clinical value and define appropriate patient populations.

Abstract:Background and Aims Mucinous adenocarcinoma of the colorectum (MAC) is a distinct histologic subtype of colorectal cancer characterized by high malignancy and low diagnostic accuracy of preoperative biopsy, posing challenges for clinical decision-making. Given the critical role of the inflammatory microenvironment in tumor progression, this study aimed to develop and validate a nomogram model integrating preoperative systemic inflammatory indicators and clinical features to improve the preoperative diagnosis of MAC.Methods Clinical data of 293 patients with colorectal cancer who underwent radical resection between June 2017 and June 2022 at the First Affiliated Hospital of the University of South China were retrospectively analyzed. Based on postoperative pathology, patients were classified into the mucinous adenocarcinoma (MAC) group and the non-specific adenocarcinoma (AC) group. Propensity score matching (PSM, 1∶1) was used to balance age, T stage, and N stage. Differences in preoperative inflammatory indices were compared between groups. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MAC, which were incorporated into a diagnostic nomogram. The model's discrimination, calibration, and clinical utility were evaluated using the area under the receiver operating characteristic curve (AUC), calibration plots, and decision curve analysis (DCA).Results Among the 293 patients, 46 had MAC and 247 had AC, with a preoperative colonoscopic diagnostic rate of 54% for MAC. After PSM (43 pairs), platelet count, platelet lymphocyte ratio (PLR), systemic immune inflammation index (SII), inflammation related prognostic index (IPI), and systemic inflammation score (SIS) were significantly higher in the MAC group, while lymphocyte monocyte ratio (LMR) was lower (all P<0.05). Multivariate analysis identified tumor location, maximum tumor diameter, and preoperative IPI as independent predictors. The AUCs of the nomogram in the training (n=206) and validation (n=87) cohorts were 0.759 (95% CI=0.662-0.856) and 0.776 (95% CI=0.649-0.903), respectively. Calibration plots showed good agreement between predicted and observed probabilities, and DCA demonstrated satisfactory clinical applicability.Conclusion A nomogram model integrating tumor location, tumor size, and preoperative IPI was successfully developed and validated for preoperative diagnosis of colorectal MAC. This model provides a practical, quantitative tool with good predictive performance to assist clinicians in individualized treatment planning, particularly for patients ineligible for surgical biopsy.

Abstract:Background and Aims Whether to close mesenteric fissures during laparoscopic radical resection of colorectal cancer remains controversial. Traditional suture closure is technically demanding and may injure mesenteric vessels. This study aimed to evaluate the safety and efficacy of using α-cyanoacrylate medical glue to close mesenteric fissures during laparoscopic colorectal cancer surgery.Methods A retrospective analysis was conducted on patients who underwent laparoscopic radical resection of colorectal cancer in the Department of Colorectal Surgery, the Sixth Affiliated Hospital of Sun Yat-sen University, from January 2022 to December 2023. Seventy-eight patients who received intraoperative α-cyanoacrylate glue closure of mesenteric fissures were included as the observation group, and 74 patients without fissure closure were selected as the control group using the propensity score matching method. Perioperative parameters, postoperative recovery, and complications were compared between the two groups.Results No significant differences were observed in baseline characteristics or main intraoperative variables between groups (all P>0.05). The observation group had significantly less ascitic drainage within 3 days after operation [(203.14±116.44) mL vs. (384.53±243.89) mL, P<0.01] and shorter postoperative gas passage, defecation, and drainage tube removal times (all P<0.01). The incidence of postoperative complications and intestinal obstruction was comparable between groups (all P>0.05). Multivariate analysis showed that intraoperative application of α-cyanoacrylate glue was an independent promoting factor for intestinal exhaust within 3 days after surgery (OR=5.739, P=0.000).Conclusion The use of α-cyanoacrylate medical glue for closing mesenteric fissures during laparoscopic radical resection of colorectal cancer is safe and feasible. It effectively reduces postoperative ascitic drainage and accelerates bowel recovery, offering a simple and reliable alternative to traditional suture closure.

Abstract:Background and Aims Colorectal cancer (CRC) has a complex pathogenesis, and current treatments remain limited in efficacy for advanced metastatic disease. Dasatinib is a multi-target tyrosine kinase inhibitor that has shown potential antitumor activity in various solid tumors. This study aimed to evaluate the causal relationships between dasatinib-related target genes and CRC based on genetic variation, and to explore the mediating role of immune cells, thereby providing genetic epidemiological evidence for the prevention and targeted therapy of CRC.Methods Dasatinib-related target genes were identified through DrugBank, and the corresponding eQTLs, GWAS data for CRC (ebi-a-GCST90018808), and 731 immune-cell traits were obtained from the IEU OpenGWAS database. A two-sample Mendelian randomization (MR) framework with a two-step mediation approach was applied: first, to assess the causal relationship between dasatinib target genes (as exposures) and CRC; second, to evaluate the causal effects between target genes and immune cells, as well as between immune cells and CRC; and finally, to calculate the proportion of mediated effects. Wald ratio, inverse-variance weighted (IVW), MR-Egger, MR-PRESSO, Cochran's Q, I2, and leave-one-out analyses were used to examine heterogeneity, horizontal pleiotropy, and robustness.Results MR results showed that dasatinib-associated inhibition of ABL1 was significantly associated with a reduced risk of CRC (OR=0.511 0, 95% CI=0.323 1-0.808 0, P=0.004 1). Inhibition of YES1 was also associated with decreased CRC risk (IVW OR=0.889 9, 95% CI=0.811 6-0.975 8, P=0.013 1), with no evident heterogeneity or horizontal pleiotropy among the corresponding SNPs. Further analysis revealed that dasatinib-related inhibition of YES1 significantly reduced the levels of IgD^-CD24^-AC level (OR=0.818 0, 95% CI=0.678 2-0.986 7, P=0.035 7), and this immune cell subset itself was identified as a risk factor for CRC (OR=1.105 7, 95% CI=1.029 6-1.187 5, P=0.005 7). Mediation analysis indicated that IgD^-CD24^-AC accounted for -9.89% and 17.31% of the mediation effects in the ABL1→CRC and YES1→CRC pathways, respectively.Conclusion Genetic evidence from MR suggests dasatinib-target genes ABL1 and YES1 are causally linked to reduced CRC risk, with IgD^-CD24^-AC partially mediating the YES1-related protective effect. These findings point to immune-mediated mechanisms underlying dasatinib's potential influence on CRC risk; further experimental validation and replication across populations are warranted.

Abstract:Background and Aims Colorectal cancer (CRC) has a complex pathogenesis, and current treatments remain limited in efficacy for advanced metastatic disease. Dasatinib is a multi-target tyrosine kinase inhibitor that has shown potential antitumor activity in various solid tumors. This study aimed to evaluate the causal relationships between dasatinib-related target genes and CRC based on genetic variation, and to explore the mediating role of immune cells, thereby providing genetic epidemiological evidence for the prevention and targeted therapy of CRC.Methods Dasatinib-related target genes were identified through DrugBank, and the corresponding eQTLs, GWAS data for CRC (ebi-a-GCST90018808), and 731 immune-cell traits were obtained from the IEU OpenGWAS database. A two-sample Mendelian randomization (MR) framework with a two-step mediation approach was applied: first, to assess the causal relationship between dasatinib target genes (as exposures) and CRC; second, to evaluate the causal effects between target genes and immune cells, as well as between immune cells and CRC; and finally, to calculate the proportion of mediated effects. Wald ratio, inverse-variance weighted (IVW), MR-Egger, MR-PRESSO, Cochran's Q, I2, and leave-one-out analyses were used to examine heterogeneity, horizontal pleiotropy, and robustness.Results MR results showed that dasatinib-associated inhibition of ABL1 was significantly associated with a reduced risk of CRC (OR=0.511 0, 95% CI=0.323 1-0.808 0, P=0.004 1). Inhibition of YES1 was also associated with decreased CRC risk (IVW OR=0.889 9, 95% CI=0.811 6-0.975 8, P=0.013 1), with no evident heterogeneity or horizontal pleiotropy among the corresponding SNPs. Further analysis revealed that dasatinib-related inhibition of YES1 significantly reduced the levels of IgD^-CD24^-AC level (OR=0.818 0, 95% CI=0.678 2-0.986 7, P=0.035 7), and this immune cell subset itself was identified as a risk factor for CRC (OR=1.105 7, 95% CI=1.029 6-1.187 5, P=0.005 7). Mediation analysis indicated that IgD^-CD24^-AC accounted for -9.89% and 17.31% of the mediation effects in the ABL1→CRC and YES1→CRC pathways, respectively.Conclusion Genetic evidence from MR suggests dasatinib-target genes ABL1 and YES1 are causally linked to reduced CRC risk, with IgD^-CD24^-AC partially mediating the YES1-related protective effect. These findings point to immune-mediated mechanisms underlying dasatinib's potential influence on CRC risk; further experimental validation and replication across populations are warranted.

Abstract:Background and Aims Rhabdoid carcinoma of the colon (RCC) is an exceptionally rare and highly aggressive malignancy characterized by early metastasis and poor prognosis, with no standardized treatment available. We report a case of ascending colon RCC and summarize previously published cases to improve understanding of its clinicopathologic and molecular features.Methods The clinical data, imaging, pathology, and immunohistochemistry of one patient treated at Xiangya Hospital were retrospectively analyzed. In addition, 36 published RCC cases were systematically reviewed. Clinical characteristics, tumor location, immunophenotype, molecular alterations, treatments, and survival outcomes were extracted and summarized.Results A 71-year-old man presented with abdominal distension, pain, and altered bowel habits. Imaging and colonoscopy indicated an obstructing ascending colon mass. Laparoscopic right hemicolectomy was performed. Pathology revealed poorly differentiated RCC infiltrating the serosa with 4/21 lymph-node metastases. Immunohistochemistry showed AE1/AE3 (+), vimentin (+), CDX2 (-), CK20 (-), and Ki-67 (80%+), with retained INI1 expression. Genetic testing indicated KRAS mutation and wild-type BRAF^V600E. The patient received no adjuvant therapy and died of peritoneal metastasis within 3 months. Including this case, 37 RCC patients (male to female ratio=1.3∶1; mean age 66 years) have been documented. Sixty-two percent of tumors were right-sided. Most exhibited rhabdoid morphology with diffuse vimentin positivity (97.06%) and AE1/AE3 positivity (100.00%), while CDX2 was negative in 85.71%. BRAF^V600E mutation was present in 65.00%, and KRAS mutation in 22.73% of tested cases. Among 28 patients with MMR data, 60.71% were pMMR and 39.29% dMMR. Although surgery was the primary treatment, 78.79% of patients died within 1 year (median survival 6.0 months), with only a few long-term survivors following adjuvant chemotherapy or immunotherapy.Conclusion RCC is a rapidly progressive colorectal malignancy with extremely poor prognosis and limited response to conventional chemotherapy. Tumor dedifferentiation, INI1 deficiency, and alterations in KRAS/BRAF-MAPK signaling may contribute to its pathogenesis. Surgery remains the mainstay of treatment, but incorporation of immunotherapy, targeted agents, and radiotherapy may offer potential benefits. Further studies are urgently needed to define effective therapeutic strategies.

Abstract:Background and Aims Sleeve gastrectomy (SG) has become the most widely performed bariatric procedure worldwide, but postoperative gastroesophageal reflux disease (GERD) remains a major concern. This multicenter study aimed to identify independent risk factors associated with GERD after SG to guide preoperative assessment and intraoperative management.Methods Clinical data of 672 patients who underwent SG between January 2020 and December 2022 in six bariatric centers and completed a 12-month follow-up were retrospectively analyzed. Demographic characteristics, esophagogastric junction (EGJ) integrity graded by the AFS system, operative parameters, and postoperative outcomes were compared between patients with and without GERD. Multivariate logistic regression was used to identify predictors of postoperative GERD.Results The overall incidence of GERD after SG was 24.7% (166/672). Multivariate analysis revealed that a preoperative BMI>35 kg/m² (OR=1.68, P=0.033), EGJ integrity AFS grade>2 (OR=2.90, P=0.006), and preoperative reflux symptoms (OR=2.44, P=0.030) were independent risk factors for GERD. A staple line more than 1 cm from the angle of His (OR=0.45, P<0.001) and a bougie size>36 Fr (OR=0.08, P=0.001) were protective factors.Conclusion High BMI, impaired EGJ integrity, and preoperative reflux symptoms significantly increase the risk of GERD after SG, whereas adequate preservation of the His angle and appropriate bougie calibration may reduce it. Comprehensive preoperative EGJ assessment and standardized surgical techniques are essential for minimizing postoperative reflux.

Abstract:Background and Aims Laparoscopic hiatal hernia repair (LHHR) is the gold-standard surgical treatment for hiatal hernia (HH), but postoperative recurrence remains a challenge due to hiatal enlargement and disruption of the phrenoesophageal ligament. This study aimed to assess the feasibility, safety, and short-term efficacy of a novel three-dimensional small intestinal submucosa (3D-SIS) patch designed for circumferential crural reinforcement and ligament-like reconstruction in a porcine LHHR model.Methods Twelve healthy pigs (35-40 kg) were equally randomized into non-mesh group, SIS flat patch group, and 3D-SIS patch group. All animals underwent LHHR and Nissen fundoplication under general anesthesia. In the non-mesh group, the hiatal defect was closed with interrupted sutures. In the SIS flat patch group, a U-shaped SIS patch was placed posterior to the esophagus to reinforce the crura and fixed with medical glue. In the 3D-SIS patch group, an intraoperatively assembled three-dimensional patch was applied, consisting of an upper keyhole-shaped layer for circumferential diaphragmatic reinforcement, a tubular middle part encircling the abdominal esophagus, and a lower small keyhole-shaped patch covering the gastroesophageal junction, all fixed with medical glue. After 3 months, laparotomy was performed to assess recurrence, patch integration, and complications, followed by biomechanical and histological evaluations.Results All procedures were completed successfully with no deaths or major complications. Operative time was slightly longer in the patch groups, while blood loss was similar. No hernia recurrence or patch migration was observed at 3 months. Biomechanical testing revealed higher ultimate load and Young's modulus in both SIS groups than in the non-mesh group. Histological analysis demonstrated neovascularization and collagen deposition in the patch groups, with the 3D-SIS patch showing more complete circumferential integration and ligament-like tissue formation.Conclusion The 3D-SIS patch is feasible and safe in porcine LHHR. It provides circumferential diaphragmatic reinforcement and promotes phrenoesophageal ligament-like regeneration, offering a new concept for reducing postoperative recurrence and reconstructing the anti-reflux barrier.

Abstract:Background and Aims Colorectal cancer (CRC) has a high incidence and mortality rate, and the effectiveness of current therapies for advanced cases remains limited. Kaempferol, a natural flavonoid compound, exhibits antioxidant, anti-inflammatory, and antitumor properties. This study aimed to elucidate the key molecular targets and underlying mechanisms of kaempferol against CRC through an integrated approach combining network pharmacology and experimental validation.Methods Potential targets of kaempferol were identified via SwissTargetPrediction, SEA, PharmMapper, and TargetNet databases, and CRC-related targets were retrieved from GeneCards, OMIM, CTD, and DrugBank. The intersection targets were used to construct a compound-target-disease network. Protein-protein interaction (PPI) analysis using the STRING database and Cytoscape software identified core targets, followed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analyses. In vitro experiments with human CRC HCT-116 cells evaluated cell proliferation (CCK-8 assay), colony formation, migration (scratch assay), invasion (Transwell assay), and expression of apoptosis- and cell cycle-related proteins (Western blot).Results A total of 492 kaempferol targets and 5 078 CRC-related targets were obtained, with 269 overlapping targets identified as potential therapeutic candidates. PPI network analysis revealed 53 core targets, including Akt1, HSP90AA1, ESR1, SRC, CASP3, and NFKB1. GO analysis indicated enrichment in cellular stress response, apoptosis regulation, and oxidative stress processes; KEGG pathways were primarily related to chemical carcinogenesis-receptor activation, prolactin, estrogen, and PI3K/Akt signaling. Experimental validation demonstrated that kaempferol markedly inhibited HCT-116 cell proliferation, colony formation, migration, and invasion in a dose-dependent manner (all P<0.05), accompanied by downregulation of Bcl-2 and cyclin D1 and upregulation of Bax (all P<0.05).Conclusion Kaempferol exerts anti-CRC effects through multi-target and multi-pathway mechanisms, including inhibition of proliferation, migration, and invasion, and induction of apoptosis, potentially via modulation of the PI3K/Akt and estrogen signaling pathways. These findings provide theoretical and experimental evidence supporting kaempferol as a promising candidate for CRC therapy.

Abstract:Background and Aims Elderly patients with inguinal hernia are prone to intraoperative hypothermia due to diminished thermoregulatory capacity, which may increase the risk of postoperative complications such as infection, seroma, and cognitive dysfunction. This study aimed to investigate the relationship between intraoperative body temperature and postoperative complications in elderly patients undergoing inguinal hernia repair and to evaluate its predictive value.Methods Clinical data of 358 elderly patients who underwent tension-free inguinal hernia repair at the Affiliated Hospital of Southwest Medical University from April 2018 to October 2024 were retrospectively analyzed. Patients were divided into a hypothermia group (<36.0 ℃) and a normothermia group (≥36.0 ℃) according to intraoperative temperature levels. Perioperative parameters and postoperative complications were compared between the two groups. Independent risk factors for complications were identified using multivariate logistic regression, and the predictive performance of intraoperative temperature was evaluated by receiver operating characteristic (ROC) curve analysis.Results Compared with the normothermia group, patients with intraoperative hypothermia had significantly longer operative time, higher postoperative white blood cell (WBC) count and neutrophil-to-lymphocyte ratio (NLR), and an increased incidence of complications (25.0% vs. 3.8%, P<0.001). Multivariate analysis identified age, NRS 2002 score, intraoperative blood loss, postoperative WBC, postoperative NLR, and intraoperative hypothermia as independent risk factors for postoperative complications. ROC analysis showed that intraoperative temperature had a good predictive value for complications (AUC=0.717, optimal cutoff=36.42 ℃, sensitivity=70.0%, specificity=89.5%).Conclusion Intraoperative hypothermia significantly increases postoperative complication risk in elderly patients undergoing inguinal hernia repair. Maintaining intraoperative temperature above 36.4 ℃may reduce the incidence of complications and improve perioperative outcomes.

Abstract:Background and Aims Obstructive jaundice (OJ) caused by common bile duct stones (CBDS) is a major risk factor for acute cholangitis (AC). Early identification of high-risk patients is essential for improving prognosis. Soluble CD163 (sCD163) and milk fat globule epidermal growth factor 8 (MFG-E8) are associated with inflammatory diseases, but their predictive value for AC in CBDS-related OJ remains unclear. This study aimed to evaluate the predictive significance of serum sCD163 and MFG-E8 levels for AC in patients with CBDS-OJ.Methods A total of 142 patients with CBDS-OJ admitted from January 2022 to June 2024 were included as the observation group, and 145 healthy individuals undergoing physical examination served as controls. Serum sCD163 and MFG-E8 levels were measured using ELISA. Based on the occurrence of AC within 24 hours after admission, patients with CBDS-OJ were divided into an AC group (n=48) and a non-AC group (n=94). Clinical variables and serological indicators were compared between groups. Multivariate logistic regression was used to identify independent factors associated with AC. Receiver operating characteristic (ROC) curves were generated to assess the predictive performance of sCD163, MFG-E8, and their combination.Results Compared with the control group, patients with CBDS-OJ showed significantly elevated serum sCD163 levels and decreased MFG-E8 levels (both P<0.05). Within the observation group, the AC group had higher AST, ALT and sCD163 levels and lower MFG-E8 levels than the non-AC group (all P<0.05). Logistic regression identified elevated sCD163 as an independent risk factor (OR=3.478, P<0.001) and reduced MFG-E8 as a protective factor (OR=0.526, P=0.020) for AC. ROC analysis showed AUC values of 0.759 for sCD163, 0.787 for MFG-E8, and 0.920 for their combined detection, with the combined model outperforming either marker alone (P<0.001).Conclusion Serum sCD163 elevation and MFG-E8 reduction are closely associated with the development of AC in patients with CBDS-OJ. Combined detection of sCD163 and MFG-E8 provides superior predictive value and may serve as a useful tool for early risk stratification in clinical practice.

Abstract:Deep infiltrating endometriosis (DIE) is defined as endometriotic lesions infiltrating ≥5 mm beneath the peritoneum, commonly affecting the uterosacral ligaments, rectovaginal septum, vaginal vault, and rectal wall. Due to nonspecific clinical manifestations and atypical imaging features, DIE is often misdiagnosed. This study reports a case of rectal DIE diagnosed preoperatively by endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) and summarizes the multidisciplinary treatment experience in conjunction with a literature review. A 35-year-old woman was admitted for defecation difficulty. MRI and EUS-FNA confirmed rectal DIE. After multidisciplinary team (MDT) evaluation involving colorectal, gynecologic, and urologic specialists, laparoscopic resection of the rectal lesion, sigmoid-rectal anastomosis, and protective ileostomy were performed. Pathology confirmed rectal DIE with negative margins. The stoma was successfully reversed 4 months later, and no recurrence was observed during 21 months of follow-up. These findings highlight the pivotal role of EUS-FNA in early diagnosis and demonstrate that an MDT approach led by colorectal surgeons can significantly enhance surgical safety and completeness, providing valuable guidance for the individualized management of complex pelvic endometriosis.

Abstract:Functional constipation is a common functional gastrointestinal disorder with a multifactorial and incompletely understood pathogenesis. Recent studies have revealed that its development involves the interplay of multiple mechanisms, including neurogenic and myogenic dysfunction of the colon, reduction and impairment of interstitial cells of Cajal (ICCs), outlet obstruction, dysregulation of the gut-brain axis, immune activation, and gut microbiota imbalance. Slow-transit constipation is mainly associated with enteric neural abnormalities, disruption of ICC signaling, and inflammation, whereas outlet obstruction constipation often results from pelvic floor dysfunction and rectal hyposensitivity. Dysregulation of the gut-brain axis plays a central role, involving impaired central regulation, hormonal imbalance, and enhanced local immune response. Additionally, gut microbial metabolites such as short-chain fatty acids, bile acids, and methane affect colonic motility and inflammation. This review summarizes the current understanding and research progress on the pathogenesis of functional constipation, providing insights for mechanism-based and individualized therapeutic approaches.

Abstract:As a major global public health concern, the standardized management of gastric cancer has been increasingly systematized in several countries and regions, resulting in the development of distinct clinical guidelines. This review provides a systematic comparison of gastric cancer guidelines from China, Japan, the republic of Korea, Europe, and the United States, revealing that although all guidelines adhere to the principles of evidence-based medicine, notable differences remain in methodology, therapeutic recommendations, update frequency, and review mechanisms. Key variations involve indications for neoadjuvant chemotherapy, criteria for endoscopic resection, and the extent of lymph node dissection, largely attributable to regional epidemiologic profiles, stage distribution at diagnosis, healthcare resource allocation, and health policy orientations. Nevertheless, the fundamental therapeutic principles and overarching goals of these guidelines are convergent: standardizing patient care, delivering high-quality treatment, incorporating the latest clinical trial evidence, and establishing expert consensus to inform policy-making. This review highlights how each guideline is developed, their unique elements, major differences, and the underlying reasons for these divergences.

Abstract:As a major global public health concern, the standardized management of gastric cancer has been increasingly systematized in several countries and regions, resulting in the development of distinct clinical guidelines. This review provides a systematic comparison of gastric cancer guidelines from China, Japan, the republic of Korea, Europe, and the United States, revealing that although all guidelines adhere to the principles of evidence-based medicine, notable differences remain in methodology, therapeutic recommendations, update frequency, and review mechanisms. Key variations involve indications for neoadjuvant chemotherapy, criteria for endoscopic resection, and the extent of lymph node dissection, largely attributable to regional epidemiologic profiles, stage distribution at diagnosis, healthcare resource allocation, and health policy orientations. Nevertheless, the fundamental therapeutic principles and overarching goals of these guidelines are convergent: standardizing patient care, delivering high-quality treatment, incorporating the latest clinical trial evidence, and establishing expert consensus to inform policy-making. This review highlights how each guideline is developed, their unique elements, major differences, and the underlying reasons for these divergences.

Abstract:Colorectal cancer (CRC) ranks among the leading causes of cancer incidence and mortality worldwide. Microsatellite instability (MSI) is a key molecular biomarker with important implications for prognosis and immunotherapy selection. Although conventional detection methods such as immunohistochemistry, PCR, and next-generation sequencing have been standardized, they remain limited by high costs, technical complexity, and inconsistent results. In recent years, artificial intelligence (AI) has shown great potential in MSI detection by integrating multimodal data that includes histopathological images, genomic information, and medical imaging to achieve accurate prediction and enable a data-driven paradigm in oncology. This review summarizes the latest advances in AI-based multimodal modeling for MSI detection in CRC, compares different methodological approaches and their translational challenges, and discusses future directions such as multimodal integration, model generalizability, and interpretability enhancement, providing new insights for precision medicine.

Abstract:Radical resection of mid- and low-rectal cancer requires not only oncologic safety but also preservation of organs and postoperative bowel function. While a 1-2 cm distal resection margin has been largely accepted, the optimal length of the proximal margin remains highly controversial. Clinically, the "10-cm rule" derived from colon cancer is often referenced, yet its applicability to rectal cancer lacks consistent supporting evidence. Previous studies have shown that an excessively long proximal margin may increase anastomotic tension and lead to anastomotic leakage, whereas insufficient resection heightens the risk of positive margins and local recurrence. In addition, the extent of lymph node metastasis, vascular perfusion of the proximal bowel, radiation-induced injury after neoadjuvant chemoradiotherapy, and postoperative bowel function-particularly low anterior resection syndrome-are all important factors influencing the selection of the proximal margin. In recent years, the application of indocyanine green fluorescence imaging has provided new evidence for intraoperative assessment of bowel perfusion; for patients receiving neoadjuvant chemoradiotherapy, radiation injury presents a gradient pattern, and resecting approximately ≥20 cm proximal to the tumor may reduce the incidence of anastomosis-related complications. Based on current literature, this review provides a systematic overview of the historical evolution, influencing factors, and clinical evidence regarding proximal resection margins in rectal cancer surgery, with the aim of informing individualized margin selection and optimizing surgical strategies.

Abstract:Obesity has become a global public health challenge, and metabolic and bariatric surgery (MBS) remains one of the most effective treatments for severe obesity. However, substantial variability in patient characteristics, surgical complexity, and postoperative adherence leads to heterogeneous outcomes. The rapid evolution of artificial intelligence (AI) offers new opportunities to address these limitations. By integrating multidimensional clinical, imaging, and longitudinal follow-up data, machine learning and large language models support key aspects of MBS, including candidate selection, surgical decision-making, perioperative risk prediction, skill assessment, and long-term outcome management. Recent studies have demonstrated notable progress in decision support, complication forecasting, robotic surgery optimization, patient counselling, and postoperative weight-trajectory prediction. Nevertheless, challenges remain regarding model generalizability, ethical and regulatory oversight, data privacy, and transparency in AI-assisted decision-making. This review summarizes current advances, limitations, and future directions of AI applications in MBS, providing a reference for clinicians seeking to understand and apply these emerging technologies.

Abstract:Metabolic bariatric surgery is an effective intervention for obesity and related metabolic disorders. Beyond substantial weight reduction, it modulates orexigenic and anorexigenic neuropeptides and their signaling pathways to improve energy homeostasis and metabolic function. This review summarizes the regulatory effects of various bariatric procedures (such as Roux-en-Y gastric bypass and sleeve gastrectomy) on orexigenic neuropeptides and anorexigenic factors, highlighting the involvement of key signaling pathways including mTOR and AMPK. These mechanisms contribute to weight control, enhanced insulin sensitivity, and remission of metabolic diseases. By integrating central and peripheral regulatory processes, metabolic surgery provides new biological insights into individualized obesity management. Future research should focus on interindividual variability and long-term neuro-metabolic adaptations to optimize surgical outcomes and improve metabolic health.

Abstract:With the continuous evolution of minimally invasive surgical concepts, operative techniques are progressively advancing from "minimal injury" toward "scarless" approaches. Super-minimally laparoscopic surgery (SMLS) is a novel surgical modality developed on the basis of conventional laparoscopic techniques through the innovation and recombination of operative elements, aiming to achieve smaller trauma and improved cosmetic outcomes. Utilizing the umbilical skin fold as a natural scar-concealing site, SMLS establishes no more than two primary operating channels (maximum diameter ≤15 mm), supplemented by auxiliary ports ≤2 mm in diameter on the abdominal wall. Combined with innovative separable surgical instruments and high-definition visualization systems, this approach provides a systematic solution to key issues such as residual access-site scarring. This review summarizes the development, technical innovations, current clinical applications, and potential aesthetic value of SMLS in the evolution of minimally invasive surgery, aiming to offer theoretical insights and research reference for its future promotion and technical refinement.