Abstract:The Guidelines for the diagnosis and treatment of primary liver cancer (2026 edition) were officially finalized and released in April 2026, representing the most up-to-date national guidance for liver cancer management in China. The new edition systematically integrates recent high-quality evidence from both domestic and international studies, with particular emphasis on original research led by Chinese investigators and published in leading international journals, reflecting the growing global impact of China's liver cancer research. A major update of the 2026 guidelines is the establishment of "prevention, screening, and surveillance" as an independent chapter for the first time, providing a comprehensive framework for primary prevention and risk management in high- and moderate-risk populations. This structural innovation signifies a paradigm shift from a treatment-centered approach toward a full-spectrum continuum of care encompassing prevention, early detection, diagnosis, and treatment. In therapeutic strategies, the Guidelines further emphasize comprehensive treatment aimed at surgical resection, formally recognizing the roles of conversion therapy and neoadjuvant therapy in improving resectability and curative outcomes. In the field of interventional oncology, hepatic arterial infusion chemotherapy (HAIC) and selective internal radiation therapy (SIRT) are, for the first time, recommended as independent treatment options, together with transarterial chemoembolization (TACE), forming a more diversified and precise treatment landscape. In addition, the Guidelines underscore the integration of antiviral therapy, hepatoprotective measures, and supportive care into the overall management strategy, highlighting the importance of balancing tumor control with preservation of liver function and overall patient health. As a national consensus-based framework, the 2026 guidelines are expected to play a pivotal role in advancing standardized, precise, and individualized liver cancer care in China. Their implementation will contribute to earlier diagnosis, improved long-term survival, and better quality of life for patients, while also offering China's evidence-based experience and insights to the global liver cancer community.

Abstract:Intersphincteric resection (ISR) has become an important ultimate sphincter-preserving procedure for low rectal cancer. With advances in anatomical understanding and minimally invasive techniques, several expert consensuses have been published worldwide to standardize ISR. In 2023, the International Standardization and Optimization Group for Intersphincteric Resection (ISOG-ISR) released a modified Delphi consensus that systematically addressed the anatomical basis, definition, indications, surgical techniques, and functional assessment of ISR. In the same year, the Colorectal Surgery Group of the Surgery Branch of the Chinese Medical Association published the Chinese expert consensus on intersphincteric resection for low rectal cancer (2023 edition), integrating current evidence with Chinese clinical practice to summarize key anatomical concepts, perioperative management, and long-term outcomes. From an anatomical perspective, this article provides a comparative interpretation of the domestic and international consensuses, focusing on the definition of ISR, intersphincteric anatomy, indications and contraindications, surgical approaches and technical details, margin assessment, and postoperative functional outcomes. In addition, recent advances involving novel concepts such as the intersphincteric complex are discussed to further analyze the anatomical basis underlying the differences between the consensuses and their potential surgical implications. This review aims to provide references for the standardized and precision-oriented development of ISR.

Abstract:Fecal microbiota transplantation (FMT), as an important biological strategy for reconstructing intestinal microecology, has evolved from an empirical therapy for recurrent Clostridioides difficile infection to a promising intervention for a wide range of intestinal and extraintestinal diseases, including inflammatory bowel disease, functional gastrointestinal disorders, chronic liver diseases, and neuropsychiatric disorders. FMT is currently transitioning toward an era of precision, standardization, and mechanism-oriented microecological therapy. Based on major advances in FMT research over the past decade and the extensive clinical experience of our team, this review systematically summarizes the developmental trajectory of FMT from "empirical treatment-standardized practice-precision intervention". Key issues and challenges are discussed, including donor screening and quality control, gut microbiome detection, donor-recipient matching, optimization of treatment timing and therapeutic courses, selection of transplantation routes, establishment of efficacy evaluation systems, and long-term follow-up management. In addition, recent progress in emerging fields such as the gut-organ axis, live biotherapeutic products, and bacteriophage therapy is highlighted. Future development of FMT will increasingly rely on multi-omics technologies, artificial intelligence-assisted matching strategies, and functional microbiota analysis, thereby promoting the transformation of FMT from an empirical intervention into a precise, controllable, and reproducible microecological therapeutic modality.

Abstract:Biologic meshes have been increasingly explored in hernia and abdominal wall surgery because of their potential advantages in promoting tissue regeneration and reducing permanent foreign-body implantation. However, their clinical efficacy has long lacked support from high-level evidence, and their role in inguinal and ventral hernia repair remains controversial. Recent randomized controlled trials and meta-analyses have shown that biologic meshes do not demonstrate clear superiority over synthetic meshes in terms of recurrence, postoperative complications, or cost-effectiveness. The BIOLAP randomized clinical trial published in 2025, which adopted a unique self-controlled design in patients with bilateral inguinal hernias, directly compared biologic and synthetic meshes in laparoscopic inguinal hernia repair. The study demonstrated that biologic meshes not only failed to reduce chronic postoperative pain, but were also associated with significantly higher rates of hernia recurrence and seroma formation, thereby challenging their routine clinical use. Based on the findings of the BIOLAP study, this article systematically reviews the material characteristics, clinical applications, and major controversies surrounding biologic meshes, with particular emphasis on current evidence in inguinal hernia repair, ventral hernia repair, and prophylactic abdominal wall reinforcement. In addition, the possible mechanisms underlying the limitations of biologic meshes and future directions for material innovation are discussed. Current evidence suggests that biologic meshes are unlikely to serve as a universal substitute for synthetic meshes, and their future value may lie in precision application in selected high-risk scenarios and in the development of novel intelligent, composite, and functional biomaterials.

Abstract:Terminal ileostomy is an essential strategy in sphincter-preserving surgery for low rectal cancer to reduce the severity of anastomotic leakage and reoperation rates. However, it is associated with various complications, including peristomal skin injury, high-output stoma, stoma retraction or necrosis, prolapse, parastomal hernia, and stoma reversal-related complications, which impair quality of life and increase healthcare burden. With the rising incidence of rectal cancer and increasing use of sphincter-preserving procedures, optimizing ileostomy-related management has become increasingly important. In recent years, based on fundamental principles of stoma construction, the one-stitch technique and its modifications have been proposed and gradually adopted in China to simplify procedures, shorten operative time, and reduce mucocutaneous separation, leakage and the incidence of stoma retraction by achieving loop exteriorization and fixation with a single suture. This review summarizes ileostomy- and reversal-related complications, risk factors, and management strategies, with a particular focus on the technical details and clinical evidence of the one-stitch technique, aiming to provide references for optimizing surgical strategies.

Abstract:Background and Aims The incidence of adenocarcinoma of the esophagogastric junction (AEG) has increased steadily in recent years, and laparoscopic total gastrectomy has become an important treatment option. Circular-stapled esophagojejunostomy may provide better proximal margin control for high tumors, but remains technically challenging under a totally laparoscopic approach. Comparative evidence between totally laparoscopic total gastrectomy (TLTG) and laparoscopy-assisted total gastrectomy (LATG) using circular-stapled esophagojejunostomy is still limited. This study aimed to compare the perioperative safety and short-term outcomes of these two procedures using propensity score matching (PSM).Methods Clinical data of patients with AEG who underwent laparoscopic total gastrectomy with Roux-en-Y circular-stapled esophagojejunostomy at Yancheng First People's Hospital and Hanzhong Central Hospital between January 2023 and June 2025 were retrospectively analyzed. Patients were divided into the TLTG group and LATG group according to surgical approach. Baseline characteristics, operative outcomes, postoperative recovery, and complications were compared. A 1∶2 PSM analysis was performed to minimize baseline bias.Results A total of 436 patients were enrolled, including 98 in the TLTG group and 338 in the LATG group. After PSM, 80 patients in the TLTG group and 160 patients in the LATG group were successfully matched with balanced baseline characteristics. Operative time and anastomosis time were significantly longer in the TLTG group (both P<0.001). However, intraoperative blood loss, number of retrieved lymph nodes, and hospitalization cost were comparable between the two groups (all P>0.05). Compared with the LATG group, the TLTG group showed lower postoperative 24-h pain scores, earlier first flatus, and shorter postoperative hospital stay (all P<0.001). No significant differences were observed in overall postoperative complications or Clavien-Dindo grade Ⅰ-Ⅲ complications between groups (all P>0.05). No grade Ⅳ complications or perioperative deaths occurred.Conclusion Circular-stapled esophagojejunostomy after TLTG is as safe as that after LATG in the perioperative setting and offers significant advantages in postoperative pain relief, gastrointestinal recovery, and hospital stay reduction. With the assistance of laparoscopic purse-string devices and multifunctional sealing caps, intracorporeal circular anastomosis can be performed safely and reliably, particularly in patients with Siewert type Ⅱ tumors requiring adequate proximal esophageal margins.

Abstract:Background and Aims Esophagojejunal anastomotic leakage is one of the most severe complications after total gastrectomy and may lead to intra-abdominal or mediastinal infection with high mortality. Endoluminal vacuum-assisted closure (EVAC) has recently emerged as a minimally invasive treatment for gastrointestinal leaks; however, evidence regarding its application in esophagojejunal anastomotic leakage remains limited. This study aimed to evaluate the efficacy and safety of EVAC in the treatment of esophagojejunal anastomotic leakage.Methods Clinical data of 21 patients with esophagojejunal anastomotic leakage treated with EVAC at Jiangyin People's Hospital between January 2022 and July 2025 were retrospectively analyzed. All patients were diagnosed by endoscopy or imaging examinations and underwent placement of a self-made EVAC device under endoscopic guidance. Technical success rate, fistula closure rate, duration of EVAC therapy, healing time, length of hospital stay, changes in inflammatory markers, treatment-related complications, and long-term outcomes were evaluated.Results All 21 patients successfully underwent EVAC placement and negative-pressure therapy, with a technical success rate of 100%. Fistula closure was achieved in 18 patients, yielding a closure rate of 85.7%. The mean duration of EVAC therapy was (15.8±8.2) d, and the mean healing time was (19.1±9.4) d. The median postoperative hospital stay was 27 (25-49) d. White blood cell count and C-reactive protein levels were significantly reduced after treatment compared with pre-treatment values (both P<0.05). No severe treatment-related complications, including major gastrointestinal bleeding, stenosis, or foreign body retention, were observed. During a mean follow-up of (22.4±12.6) months, no recurrence of anastomotic leakage, gastrointestinal stenosis, or newly developed abscess was detected.Conclusion EVAC is an effective and safe minimally invasive treatment for esophagojejunal anastomotic leakage, with high technical success and fistula closure rates. It can effectively control infection and promote fistula healing, making it an important therapeutic option for this complication.

Abstract:Background and Aims Right-sided overlap and single-flap valvuloplasty (ROSF) is an important reconstruction method after laparoscopic proximal gastrectomy that balances anti-reflux efficacy and functional preservation. However, conventional ROSF still presents technical challenges in esophageal incision, closure of the common opening, and prevention of esophageal stump retraction. This study aimed to evaluate the safety and feasibility of a modified ROSF technique optimized by esophagus two-step-cut combined with purse-string suspension of the esophageal stump.Methods Clinical data of 33 patients who underwent laparoscopic proximal gastrectomy with modified ROSF reconstruction at the Affiliated Cancer Hospital of Zhengzhou University between August 2024 and December 2025 were retrospectively analyzed. The modified technique included esophagus two-step-cut, purse-string suspension fixation of the esophageal stump, and layered esophageal incision. Perioperative outcomes, postoperative complications, and short-term follow-up results were analyzed.Results All 33 patients successfully completed the operation without conversion to open surgery or perioperative death. The esophagus two-step-cut technique enabled a neat esophageal incision and satisfactory alignment between the mucosal and muscular layers. Purse-string suspension effectively prevented esophageal stump retraction and improved anastomotic stability. The mean ROSF reconstruction time was (37.9±9.7) min. Intraoperative blood loss was (137.2±45.8) mL. The time to first flatus, first liquid intake, and postoperative hospital stay were (2.1±0.5) d, (5.9±0.3) d, and (10.0±3.2) d, respectively. Perioperative complications occurred in 4 patients (12.1%), all classified as Clavien-Dindo grade Ⅰ-Ⅱ, including pneumonia in 2 patients, acute coronary syndrome in 1 patient, and fat liquefaction of the incision in 1 patient. All recovered after conservative treatment. No anastomotic leakage, anastomotic bleeding, or anastomotic stenosis occurred. During a median follow-up of 5.0 (1.0-12.0) months, no tumor recurrence or distant metastasis was observed. Only 1 patient developed mild reflux symptoms, which were relieved with medication.Conclusion Esophagus two-step-cut combined with purse-string suspension can optimize the ROSF procedure by improving anastomotic stability and reducing operative difficulty. This modified technique is safe and feasible for laparoscopic proximal gastrectomy and demonstrates satisfactory short-term outcomes.

Abstract:Background and Aims Although proximal gastrectomy preserves partial gastric function, postoperative reflux esophagitis and anastomotic stricture remain major challenges. The double-flap technique provides satisfactory anti-reflux efficacy but is limited by impaired blood supply to the seromuscular flap, a relatively high incidence of anastomotic stricture, and technical complexity. Based on the previously developed tunnel anastomosis, we further designed a trapezoid-shaped tunnel anastomosis (tTunnel method). This study aimed to evaluate the safety, feasibility, and short-term efficacy of this modified reconstruction technique after proximal gastrectomy.Methods Clinical data of 30 patients with proximal gastric cancer who underwent radical proximal gastrectomy combined with the tTunnel method at Jiangsu Cancer Hospital between August 2024 and April 2025 were retrospectively analyzed. Operative outcomes, postoperative recovery, perioperative complications, reflux esophagitis, anastomotic stricture, Reflux Disease Questionnaire (RDQ) scores, and endoscopic findings were evaluated.Results All 30 patients successfully underwent proximal gastrectomy with tTunnel reconstruction, including 9 robotic, 17 laparoscopic, and 4 open procedures. The mean operative time was (297.1±82.25) min, tunnel creation time was (8.0±2.05) min, hand-sewn anastomosis time was (52.4±9.59) min, and intraoperative blood loss was (41.3±19.01) mL. R₀ resection was achieved in all patients. The overall perioperative complication rate was 20.0% (6/30), with one patient (3.3%) experiencing a Clavien-Dindo grade ≥Ⅲ complication. Follow-up endoscopy revealed anastomotic stricture in 2 patients (6.7%), both classified as outlet-type strictures, while no inlet-type stricture was observed. Reflux esophagitis occurred in 3 patients (10.0%), all of whom had mild disease (Grade A in 1 patient and Grade B in 2 patients). RDQ scores gradually decreased during follow-up, and no patient experienced clinically significant reflux symptoms.Conclusion The tTunnel method is safe and feasible for digestive tract reconstruction after proximal gastrectomy. It provides satisfactory anti-reflux efficacy with a relatively low incidence of anastomotic stricture, particularly reducing the risk of inlet-type stricture. Owing to its simplified procedure, this technique may have promising clinical applicability. However, its long-term outcomes require further validation in large-scale prospective studies.

Abstract:Background and Aims Postoperative complications remain a major factor affecting both short-term recovery and long-term survival in patients undergoing radical gastrectomy for gastric cancer. However, large-scale real-world evidence regarding perioperative complications and prognosis after radical gastrectomy is still limited. This study aimed to investigate the incidence of postoperative complications, long-term survival outcomes, and their associated risk factors using a real-world single-center cohort.Methods A retrospective cohort study was conducted including patients who underwent radical gastrectomy for gastric cancer at Hunan Cancer Hospital between January 2011 and December 2023. Postoperative complications were evaluated according to the Clavien-Dindo classification, and grade Ⅱ or higher complications were defined as clinically significant events. Logistic regression analysis was used to identify independent risk factors for postoperative complications. Overall survival (OS) was estimated using the Kaplan-Meier method, and independent prognostic factors were analyzed using Cox proportional hazards regression models.Results A total of 5 111 patients were included, among whom 538 (10.53%) developed 693 events of postoperative complications of Clavien-Dindo grade Ⅱ or higher. The most common complications were pulmonary infection (3.1%), intra-abdominal infection (2.3%), pleural effusion (1.8%), intra-abdominal effusion (1.0%), and anastomotic leakage (0.9%). Perioperative mortality occurred in 30 patients (0.59%). Multivariate logistic regression analysis identified age ≥65 years, comorbidities, preoperative albumin <35 g/L, operative time ≥240 min, intraoperative blood loss ≥300 mL, open surgery, and total gastrectomy as independent risk factors for postoperative complications (all P<0.05). The estimated 5-year OS rate for the entire cohort was 62.5%. Multivariate Cox regression analysis demonstrated that age ≥65 years, low body mass index (BMI), total gastrectomy, perioperative blood transfusion, postoperative complications, and advanced pTNM stage were independent predictors of poor OS (all P<0.05).Conclusion The incidence of clinically significant postoperative complications after radical gastrectomy was 10.53%, and these complications were closely associated with patient condition, nutritional status, and surgical factors. Postoperative complications adversely affected not only perioperative safety but also long-term survival. Tumor pTNM stage remained the most important prognostic factor.

Abstract:Background and Aims Gastric cancer remains an important contributor to the cancer burden in China. However, under the combined influences of population aging, changes in risk-factor exposure, and improvements in diagnosis and treatment, its disease burden characteristics have undergone substantial changes. This study aimed to systematically analyze the trends in incidence, mortality, and disability-adjusted life years (DALYs) of gastric cancer in China from 1990 to 2023, explore sex- and age-specific differences, and predict future disease burden trends bese on Global Burden of Disease Study 2023 (GBD 2023) to provide evidence for precision prevention and control strategies.Methods Data on incidence, mortality, and DALYs of gastric cancer in China from 1990 to 2023 were extracted from the (GBD 2023). Age-standardized incidence rate (ASIR), age-standardized mortality rate (ASMR), and age-standardized DALY rate (ASDR) were calculated, and temporal trends were evaluated using estimated annual percentage change (EAPC). Das Gupta decomposition analysis was performed to assess the contributions of population growth, population aging, and epidemiological changes to variations in disease burden. Bayesian age-period-cohort (BAPC) models were constructed to predict future trends in gastric cancer burden in China from 2024 to 2040.Results From 1990 to 2023, the number of incident gastric cancer cases in China increased from 473 430 to 575 712, whereas the ASIR decreased from 54.23/100 000 to 25.04/100 000, with an EAPC of -2.76%. During the same period, the number of deaths decreased from 428 073 to 381 500, and the ASMR declined from 50.93/100 000 to 16.62/100 000, with an EAPC of -3.84%. DALYs decreased from 12.14 million to 8.91 million, while the ASDR declined from 1 314.69/100 000 to 390.14/100 000, with an EAPC of -4.17%. Males consistently exhibited higher ASIR, ASMR, and ASDR than females, and the disease burden was mainly concentrated in individuals aged 55-79 years. Decomposition analysis showed that population aging was the major driver of the increasing incidence burden, whereas epidemiological changes mainly contributed to the reductions in mortality burden and DALYs. BAPC projections indicated that the ASIR of gastric cancer in China may slightly rebound by 2040, with males continuing to bear a substantially higher burden than females, while ASMR and ASDR among females may show an upward trend.Conclusion Although the age-standardized burden of gastric cancer in China has generally declined over the past three decades, population aging has led to a continuous increase in the absolute number of cases, accompanied by marked sex- and age-related heterogeneity. Gastric cancer prevention and control in China still face considerable challenges. Future strategies should further strengthen precision screening and comprehensive interventions based on sex, age, and high-risk populations to continuously reduce the burden of gastric cancer.

Abstract:Background and Aims Gastric cancer lacks highly effective and widely applicable biomarkers for early detection. Circulating proteins are measurable molecular intermediates with potential biological and clinical relevance. This study aimed to systematically evaluate the genetic associations between circulating plasma proteins and gastric cancer risk and to prioritize proteins with convergent genetic evidence.Methods A two-sample Mendelian randomization (MR) analysis was conducted using pQTL summary statistics for 4 907 plasma proteins as exposures and FinnGen Release 12 gastric cancer GWAS data as the outcome. Candidate signals were further evaluated using summary-data-based Mendelian randomization (SMR)/heterogeneity in dependent instruments (HEIDI) analysis and Bayesian colocalization analysis to assess the probability of shared causal variants between protein and gastric cancer signals. Independent European gastric cancer GWAS data were subsequently used for external validation and meta-analysis. TCGA-STAD, GTEx, and GEPIA2 datasets were further used to investigate tissue expression, prognostic relevance, and associated biological processes of the prioritized candidate gene.Results The MR screen identified 84 candidate proteins associated with gastric cancer risk, including 36 risk-increasing and 48 protective signals. SMR analysis further prioritized 11 positive proteins. Bayesian colocalization analysis showed that HGF had the strongest evidence for a shared causal variant (PP.H4=0.792). External GWAS validation and meta-analysis further supported the association between genetically predicted higher circulating HGF levels and increased gastric cancer risk (OR=1.224, 95% CI=1.070-1.401, P=0.003). Transcriptomic analyses demonstrated that HGF was upregulated in gastric cancer tissues, and high HGF expression was associated with poorer overall survival and disease-free survival. GSEA indicated that HGF-related genes were mainly enriched in extracellular matrix remodeling, angiogenesis, and immune regulatory processes.Conclusion This study constructed a genetic prioritization landscape of circulating proteins associated with gastric cancer risk and provided convergent genetic evidence supporting HGF as a prioritized gastric cancer-related candidate protein. These findings offer molecular clues for future risk stratification, mechanistic investigation, and clinical validation in gastric cancer.

Abstract:Background and Aims Prognostic heterogeneity remains substantial among patients undergoing radical gastrectomy for gastric cancer, while conventional TNM staging is insufficient to fully reflect tumor biological behavior. This study aimed to investigate the prognostic value of preoperative serum c-Myc and GINS complex subunit 4 (GINS4) levels and their combined detection in patients undergoing radical gastrectomy for gastric cancer.Methods A total of 180 patients who underwent radical gastrectomy for gastric cancer between January 2019 and January 2022 at Jinan No.4 People's Hospital were retrospectively collected, and 50 healthy individuals undergoing health maintenance examination were included as controls. Serum c-Myc and GINS4 levels were measured using double-antibody sandwich ELISA. Patients were classified into double high-expression, single high-expression, and double low-expression groups according to cutoff values of c-Myc and GINS4 levels. Kaplan-Meier analysis was performed to compare survival outcomes among groups. Cox proportional hazards regression analysis was used to identify independent prognostic factors. Receiver operating characteristic (ROC) curves were constructed to evaluate predictive efficacy.Results Serum c-Myc and GINS4 levels were significantly elevated in gastric cancer patients compared with controls (both P<0.001). The overall 3-year survival rate was 58.3%. Patients in the double high-expression group had a median survival time of 24 months and a 3-year survival rate of 25.58%, which were significantly worse than those in the single high-expression and double low-expression groups (both P<0.001). Univariate analysis showed that TNM stage, lymph node metastasis, serum c-Myc level, and serum GINS4 level were associated with prognosis (all P<0.05). Multivariate Cox regression analysis identified TNM stage, c-Myc, and GINS4 as independent prognostic factors (all P<0.05). ROC analysis demonstrated that the combination of TNM stage, c-Myc, and GINS4 achieved an AUC of 0.875, which was superior to each individual indicator alone.Conclusion Elevated preoperative serum c-Myc and GINS4 levels are closely associated with poor prognosis in patients undergoing radical gastrectomy for gastric cancer. Combined detection of these two biomarkers shows favorable prognostic predictive performance and may serve as a potential serological marker for postoperative risk stratification and prognostic assessment.

Abstract:Background and Aims Single-port laparoscopic surgery may further reduce abdominal wall trauma and improve cosmetic outcomes; however, its application in low rectal cancer remains technically challenging. For patients requiring enterostomy, establishing a single-port access through the predetermined stoma site may avoid additional abdominal incisions. This study aimed to evaluate the safety, feasibility, and short-term outcomes of single-port laparoscopic surgery via the enterostomy site in patients with low rectal cancer.Methods A retrospective analysis was conducted on 184 patients with low rectal cancer treated at the Affiliated Hospital of North Sichuan Medical College between September 2020 and September 2023. According to the surgical approach, patients were divided into a single-port laparoscopy group (single-port group) and a conventional multi-port laparoscopy group (multi-port group). Among them, 116 patients underwent surgery via prophylactic ileostomy access (58 in each group), and 68 underwent surgery via permanent sigmoid colostomy access (34 in each group). Baseline characteristics, intraoperative outcomes, and short-term postoperative outcomes were compared between the groups.Results No significant differences were observed in baseline clinicopathologic characteristics between the two groups (all P>0.05). In both ileostomy and permanent sigmoid colostomy subgroups, operative time was significantly longer in the single-port group than in the multi-port group (all P<0.001), whereas intraoperative blood loss was comparable between the groups (all P>0.05). No significant differences were found in the number of harvested lymph nodes, time to bowel function recovery, postoperative hospital stay, postoperative complications, postoperative bleeding, in-hospital mortality, or 30 d readmission rates (all P>0.05). The single-port group demonstrated lower postoperative visual analogue scale pain scores on postoperative days 1-3 and higher patient satisfaction scores than the multi-port group (all P<0.05). The median follow-up duration was 23 months, and no severe procedure-related long-term complications were observed.Conclusion Single-port laparoscopic surgery via the predetermined enterostomy site for low rectal cancer is safe and feasible. This technique can reduce abdominal wall trauma, alleviate postoperative pain, and improve patient satisfaction while maintaining satisfactory short-term outcomes, showing promising clinical application potential.

Abstract:Background and Aims Mixed hemorrhoids are among the most common benign anorectal diseases, and Milligan-Morgan hemorrhoidectomy remains a classical surgical treatment. However, postoperative constipation is still a common complication that adversely affects postoperative recovery and quality of life. Currently, studies focusing on risk prediction of postoperative constipation in patients with damp-heat type mixed hemorrhoids are limited. This study aimed to identify risk factors for postoperative constipation and construct predictive models based on Logistic regression and large language model (LLM) to evaluate their predictive performance and provide references for early postoperative intervention.Methods Clinical data of 734 patients with damp-heat type mixed hemorrhoids who underwent Milligan-Morgan hemorrhoidectomy at the Department of Traditional Chinese Medicine, Affiliated Hospital of Yangzhou University, from September 2022 to December 2024 were retrospectively collected. Patients were randomly divided into a training set (n=513) and a testing set (n=221) at a ratio of 7:3. Demographic characteristics, comorbidities, laboratory indicators, and perioperative medication data were collected. Postoperative constipation was defined as the study endpoint. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors and establish a nomogram prediction model. Receiver operating characteristic (ROC) curves were used to evaluate model performance. In addition, an LLM-based prediction model using Llama-3.1-8B-Instruct was constructed, and its accuracy, recall, and F1 score were assessed.Results No statistically significant differences were observed in baseline characteristics between the training and testing sets (all P>0.05). Among the training cohort, 163 patients (31.77%) developed postoperative constipation. Univariate Logistic regression analysis showed that hemoglobin level and anemia were significantly associated with postoperative constipation (both P<0.05). Multivariate Logistic regression analysis further demonstrated that decreased hemoglobin level and anemia were independent risk factors for postoperative constipation in patients with damp-heat type mixed hemorrhoids after surgery (both P<0.05). The Logistic regression prediction model achieved AUC values of 0.78 and 0.76 in the training and testing sets, respectively, indicating good predictive performance. The LLM model achieved optimal performance at 65 training epochs with a learning rate of 5.00E-05, yielding an accuracy of 85.99%, recall of 89.40%, and F1 score of 87.66%.Conclusion Decreased hemoglobin level and anemia are important risk factors for postoperative constipation in patients with damp-heat type mixed hemorrhoids undergoing Milligan-Morgan hemorrhoidectomy. Both the Logistic regression and LLM-based models demonstrated favorable predictive performance, while the LLM model showed higher predictive accuracy. These findings may provide a reference for early identification and individualized intervention in high-risk patients with postoperative constipation.

Abstract:Background and Aims CLSTN3 has recently been identified as a potential biomarker for colorectal cancer (CRC); however, its expression pattern, clinical significance, and underlying mechanisms in CRC remain unclear. This study aimed to investigate the biological role and prognostic value of CLSTN3 and its interaction with amyloid precursor protein (APP) in CRC.Methods A total of 313 paraffin-embedded CRC specimens and 17 fresh CRC tissue samples were collected. Immunohistochemistry and Western blot analyses were performed to evaluate the expression of CLSTN3 and APP and their associations with clinicopathological characteristics and prognosis. HCT8 cells with CLSTN3 overexpression and HCT116 cells with CLSTN3 knockdown were established. Cell proliferation was assessed using CCK-8 assays and nude mouse xenograft experiments. Potential interacting molecules of CLSTN3 were predicted using the GeneMANIA database, and the interaction between CLSTN3 and APP was validated by co-immunoprecipitation assays.Results CLSTN3 expression was significantly increased in CRC tissues and cell lines compared with normal controls (all P<0.05). Immunohistochemistry demonstrated that the positive expression rate of CLSTN3 was markedly higher in CRC tissues than in adjacent tissues (68.7% vs. 27.2%). High CLSTN3 expression was significantly associated with TNM stage, tumor necrosis, and neurovascular invasion (all P<0.05). Kaplan-Meier analysis showed that patients with high CLSTN3 expression had significantly worse overall survival (OS) and disease-free survival (DFS) (both P<0.001). Multivariate Cox regression analysis identified CLSTN3 overexpression as an independent prognostic factor for both OS and DFS in CRC patients. Functional experiments demonstrated that CLSTN3 overexpression significantly promoted CRC cell proliferation and tumor growth in vivo, whereas CLSTN3 knockdown inhibited tumor growth. Bioinformatics analysis suggested APP as a key interacting molecule of CLSTN3. Co-immunoprecipitation assays confirmed a direct interaction between CLSTN3 and APP in CRC cells. Western blot analysis further showed a positive correlation between CLSTN3 and APP expression in CRC tissues (r=0.604, P=0.012), and both proteins were more highly expressed in tumors with necrosis.Conclusion CLSTN3 is aberrantly upregulated in CRC and promotes tumor progression by enhancing cancer cell growth. High CLSTN3 expression predicts poor prognosis and may exert oncogenic effects through interaction with APP. CLSTN3 may serve as a novel prognostic biomarker and potential therapeutic target for CRC.

Abstract:Background and Aims Curcumin is a safe and inexpensive natural compound, but its clinical application in gastric cancer therapy is severely limited by poor water solubility and low bioavailability. This study aims to construct an implantable curcumin/gelatin nanofibrous membrane for local sustained drug release and to investigate its molecular mechanisms in inhibiting GC cell proliferation.Methods Curcumin/gelatin nanofibrous membranes were prepared by electrospinning. Morphology was observed by scanning electron microscopy, and the in vitro drug release profile was determined by high-performance liquid chromatography-tandem mass spectrometry. Biocompatibility was evaluated using human gastric mucosal cells GES-1. Human gastric cancer cell lines MKN-45, SGC-7901, and AGS were treated with conditioned media from the nanofibrous membranes. Colony formation assay, reactive oxygen species (ROS) detection, and Western blot were performed to assess cell proliferation, ROS levels, and the expression of endoplasmic reticulum stress pathway proteins (BiP/p-PERK/p-eIF2α) and phosphorylated STAT3. A subcutaneous xenograft model in nude mice was established, and the membrane was placed locally on the tumor surface to evaluate in vivo anti-tumor efficacy. Immunohistochemistry was used to detect the expression of BrdU, BiP, and p-STAT3 in tumor tissues.Results The prepared nanofibrous membrane had a smooth surface with amorphous and uniform dispersion of curcumin. In vitro release lasted for over 120 h. The material showed no obvious toxicity to normal GES-1 cells (P>0.05). It significantly inhibited colony formation of MKN-45, SGC-7901, and AGS cells (inhibition rate 60%). Mechanistically, treatment with curcumin/gelatin nanofibrous membrane significantly increased intracellular ROS levels, upregulated the expression of BiP, p-PERK, p-eIF2α, and cleaved caspase-3, and downregulated p-STAT3. At the same time, these changes were reversed by the ROS scavenger NAC (all P<0.05). In vivo, local application of the membrane significantly suppressed xenograft tumor growth, reduced tumor volume, decreased BrdU-positive cells (all P<0.05), increased BiP expression, and lowered p-STAT3 levels.Conclusion The curcumin/gelatin nanofibrous membrane significantly enhances the bioavailability of curcumin through localized sustained release. It effectively inhibits the proliferation of gastric cancer cells and promotes their apoptosis by inducing ROS generation, activating endoplasmic reticulum stress, and suppressing STAT3 phosphorylation. With favorable biocompatibility, simple preparation, and low cost, this material shows promise as a novel and safe formulation for postoperative local adjuvant therapy of gastric cancer.