Diagnosis and treatment of Hem-o-lok clip migration into the common bile duct after laparoscopic cholecystectomy: a case report and literature review
Comparison of single-incision plus one-port versus conventional muti-port laparoscopic common bile duct exploration
Technical key points of endoscopic electro-scissors-assisted subcutaneous glandular excision of the breast via a single-port axillary approach
Auxiliary liver transplantation using discarded liver: innovative clinical applications and future perspectives
Applied anatomy of segmental Glissonian pedicles at the hepatic hilum guided by the Laennec's membrane concept and its value in laparoscopic surgery
Application of augmented reality navigation combined with indocyanine green fluorescence imaging in laparoscopic resection of central hepatic tumors
Expression characteristics of FGL1 in peritumoral tissues of hepatocellular carcinoma and its association with prognosis
Expert consensus on fibrin sealant aneurysm sac filling during endovascular abdominal aortic aneurysmal repair
Vascular trauma management from the perspectives of international guidelines and Chinese consensus: an integrated interpretation of the 2025 ESVS guidelines and the Chinese expert consensus
Comparison of venous access strategies for endovascular management of central venous stenosis or occlusion in hemodialysis patients
Impact of prophylactic inferior mesenteric artery embolization on outcomes after endovascular abdominal aortic aneurysm repair: a single-center retrospective analysis
Chinese expert consensus on thyroid reoperation
Feasibility and safety analysis of mixed reality-assisted surgery for substernal goiter: a report of 29 cases
Novel technology for lower esophageal sphincter augmentation: indications and limits in current surgical practice
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LEI Jianjun, LI Qi, LIU Hengchao, GUAN Yichen, ZHANG Dong, CHEN Chen, GENG zhimin
2026,35(2):201-222, DOI: 10.7659/j.issn.1005-6947.250652
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The recommendations on perihilar cholangiocarcinoma. the Milan jury-based consensus, published in June 2025, was developed by 71 international experts organized into eight working groups. Based on the review of 570 studies, the consensus was formulated using the Zurich-Danish model in combination with the GRADE methodology and the Oxford Centre for Evidence-Based Medicine 2011 Levels of Evidence. A total of 71 recommendations were established to standardize the diagnosis and management of perihilar cholangiocarcinoma (pCCA) and to identify priorities for future research. The consensus comprehensively addresses key aspects of pCCA management, including definition and diagnostic strategies, preoperative assessment and optimization, surgical resection, liver transplantation, and standardized outcome reporting. Particular emphasis is placed on controversial issues in surgical management and decision-making algorithms. In this article, we systematically interpret the core recommendations of the consensus and compare them with existing domestic and international guidelines, integrating relevant clinical experience, in order to facilitate their understanding and implementation in clinical practice.
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2026,35(2):223-229, DOI: 10.7659/j.issn.1005-6947.260042
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The recent release of the World Health Organization guideline on the use and indications of glucagon-like peptide-1 therapies for the treatment of obesity in adults further establishes the role of GLP-1 receptor agonists in obesity management. From a surgical perspective, this article systematically interprets the key recommendations of the guideline, with a focus on the impact of GLP-1-based therapies on the current treatment paradigm and their implications for bariatric and metabolic surgery. In addition, the potential clinical pathways for integrating pharmacological and surgical approaches in China are discussed, aiming to provide insights for optimizing comprehensive obesity management.
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2026,35(2):230-241, DOI: 10.7659/j.issn.1005-6947.260052
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Radical resection remains the cornerstone of long-term survival in biliary tract cancers (BTC). However, obstructive jaundice, cholangitis, impaired hepatic reserve, and treatment-related liver injury concentrate perioperative risks along a "cholestasis-infection-functional failure" cascade, and minimally invasive access alone cannot offset these functional costs. Based on current guidelines and emerging evidence, we propose a multistage care pathway centered on the concept of functional resectability, encompassing conversion/neoadjuvant therapy, preoperative functional reassessment, function-oriented surgery, and postoperative rehabilitation with long-term follow-up. Preoperative decision-making is anchored to combined "volume-plus-function" evaluation of the future liver remnant. When necessary, regional liver function is quantified using 99mTc-mebrofenin SPECT/CT and indocyanine green clearance testing, while selective biliary drainage, infection control, nutritional and coagulation optimization, and portal vein embolization are applied to establish a functional safety window. Intraoperatively, indocyanine green fluorescence imaging, intraoperative ultrasound, and three-dimensional planning are integrated to facilitate R0 resection and optimize reconstruction. Postoperatively, ERAS-based management is adopted, and key endpoints-including post-hepatectomy liver failure, clinically relevant postoperative pancreatic fistula, and patient-reported outcomes-are used to evaluate treatment benefit. This pathway emphasizes a "function-first, minimally invasive second" strategy, forming a closed loop of dynamic assessment, proactive intervention, and outcome measurement to maximize functional preservation and quality of life while maintaining oncological radicality.
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2026,35(2):242-251, DOI: 10.7659/j.issn.1005-6947.250686
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Biliary tract carcinoma (BTC), including intrahepatic cholangiocarcinoma (iCCA), perihilar cholangiocarcinoma (pCCA), and distal cholangiocarcinoma (dCCA), is associated with poor prognosis. In recent years, advances in neoadjuvant therapy (NAT), molecular stratification, and transplant selection criteria have substantially expanded the role of liver transplantation in BTC. For pCCA, the combination of NAT and liver transplantation, particularly under the Mayo protocol, has significantly improved long-term survival in selected unresectable patients, although recurrence and vascular complications remain major challenges. For iCCA, liver transplantation has evolved from a contraindication to a potential therapeutic option in highly selected patients, especially those with very early-stage disease or those successfully downstaged by NAT, achieving survival outcomes comparable to hepatocellular carcinoma. Meanwhile, the emergence of targeted therapy and immunotherapy provides new opportunities for optimizing NAT strategies. This review summarizes the evolution of indications, prognostic factors, candidate selection, and recent advances in liver transplantation for BTC, and discusses future perspectives to inform clinical decision-making.
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2026,35(2):252-259, DOI: 10.7659/j.issn.1005-6947.260060
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With the acceleration of population aging in China, the incidence of gallstones among elderly and advanced-age individuals has continued to rise, seriously affecting patients' life expectancy and quality of life. Elderly patients often present with reduced physiological reserve, multimorbidity, and a mismatch between clinical manifestations and the severity of pathological injury, which markedly increases the difficulty of diagnosis and treatment. In recent years, the concept of precision individualized medicine has emphasized multidisciplinary comprehensive assessment and the implementation of a full-process management model of "screening-diagnosis-evaluation" for elderly patients, enabling early identification of high-risk populations and timely intervention. For patients with confirmed gallstones, it is essential to balance active intervention with surgical risk, formulate individualized treatment strategies, and determine the optimal timing for surgery. Laparoscopic cholecystectomy remains the treatment of choice, but the principles of damage control should be strictly followed. For high-risk patients, percutaneous transhepatic gallbladder drainage can be adopted as a bridging strategy in a "two-step" approach to reduce perioperative risk. Intraoperatively, indocyanine green fluorescence imaging or intraoperative ultrasound may assist in identifying anatomical structures; if necessary, subtotal cholecystectomy or timely conversion to open surgery should be performed to ensure safety. Refined perioperative management is a key component in promoting rapid recovery in elderly patients. In the future, big data and artificial intelligence may help establish risk prediction models tailored to the elderly population in China, facilitate the development of regional biliary disease centers, and ultimately achieve a closed-loop management model ranging from community screening to whole-process care.
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YOU Jinshan, LI Zimu, JIAN Rui, WANG Zhixin, LIU Zhipeng, DAI Haisu, BAI Jie, JIANG Yan, CHEN Zhiyu
2026,35(2):260-268, DOI: 10.7659/j.issn.1005-6947.250513
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Background and Aims Lymph node metastasis (LNM) markedly impairs survival in patients with perihilar cholangiocarcinoma (pCCA). However, reliable preoperative predictors of pathological LNM remain limited. This study aimed to identify independent preoperative predictors of LNM and to develop a clinically applicable prediction model.Methods A total of 327 consecutive patients with pCCA who underwent curative-intent resection between October 2020 and October 2024 at the First Affiliated Hospital of Army Medical University (Southwest Hospital) and the Affiliated Hospital of Qinghai University were retrospectively enrolled. Patients were stratified into LNM-positive (n=131) and LNM-negative (n=196) groups according to postoperative pathological findings. Baseline characteristics were compared between the two groups. Univariate and multivariable logistic regression analyses were performed to identify independent predictors of pathological LNM. A nomogram was subsequently constructed based on the multivariable model.Results Patients with LNM had significantly shorter median overall survival (16.0 months vs. 42.0 months) and recurrence-free survival (12.0 months vs. 32.0 months) compared with those without LNM (both P<0.001). Multivariable logistic regression analysis demonstrated that age ≥65 years was a protective factor (OR=0.556, P=0.021), whereas CA19-9≥200 U/mL (OR=2.266, P=0.001) and radiologic suspicion of nodal involvement (OR=2.917, P=0.001) were independently associated with an increased risk of pathological LNM. The resulting nomogram demonstrated the ability to provide an individualized quantitative estimate of preoperative LNM risk.Conclusion Age, CA19-9 level, and radiologic nodal status independently predict pathological LNM in pCCA. The proposed nomogram provides a simple and clinically practical tool for preoperative risk stratification and surgical planning.
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MENG Linglei, LI Shaoteng, WANG Xiaojuan, LI Demao, GAO Fengxiao
2026,35(2):269-278, DOI: 10.7659/j.issn.1005-6947.250284
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Background and Aims Biliary tract infection is a common complication after interventional treatment for malignant biliary obstruction (MBO), yet reliable early predictive markers are lacking. This study aimed to investigate the expression of Toll-like receptor 2 (TLR2) mRNA, histidine decarboxylase (HDC), and neutrophil CD64 and evaluate their predictive value for postoperative biliary infection after DSA-guided biliary stent combined with radioactive seed chain implantation.Methods A retrospective cohort of 285 patients with MBO who underwent DSA-guided biliary stent combined with radioactive seed chain implantation between January 2021 and February 2024 was analyzed. Patients were divided into an infection group (n=46) and a non-infection group (n=239) according to the occurrence of postoperative biliary infection. Baseline characteristics, inflammatory markers (CRP, PCT, and white blood cells), and the expression levels of TLR2 mRNA, HDC, and CD64 before surgery and on postoperative day 1 were compared. Pearson correlation analysis was performed to evaluate correlations with CRP levels. Multivariate logistic regression was used to identify independent factors associated with postoperative infection. Receiver operating characteristic (ROC) curves were used to assess predictive performance. An additional prospective cohort of 50 patients (March-October 2024) was used for validation.Results The proportions of diabetes, gallstones, and high-level obstruction were significantly higher in the infection group (all P<0.05). On postoperative day 1, levels of CRP, TLR2 mRNA, HDC, and CD64 were significantly higher in the infection group than in the non-infection group (all P<0.05). TLR2 mRNA, HDC, and CD64 levels were positively correlated with CRP (r=0.729, 0.682, and 0.755, respectively; all P<0.05) and infection severity. After adjusting for diabetes, gallstones, and obstruction level, TLR2 mRNA, HDC, and CD64 remained independent factors associated with postoperative biliary infection (all P<0.05). ROC analysis showed that the combined detection of TLR2 mRNA, HDC, and CD64 achieved an AUC of 0.923, with a sensitivity of 89.13% and specificity of 84.10%. Prospective validation demonstrated good agreement between predicted and actual outcomes (κ=0.864).Conclusion Elevated levels of TLR2 mRNA, HDC, and CD64 are associated with postoperative biliary infection in patients with malignant biliary obstruction. Combined detection of these biomarkers may serve as a promising strategy for early prediction of postoperative biliary infection.
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WEI Tonghui, ZHANG Bo, YANG Zhenyu
2026,35(2):279-288, DOI: 10.7659/j.issn.1005-6947.250625
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Background and Aims Hem-o-lok clips are widely used for cystic duct and vascular closure during laparoscopic cholecystectomy (LC). Although rare, postoperative clip migration may occur, with the clip entering the common bile duct (CBD) and acting as a foreign body. Its imaging features often mimic choledocholithiasis, posing diagnostic and therapeutic challenges. Clinical awareness of this late complication remains insufficient. This study aims to summarize the clinical characteristics and management strategies through a case analysis and literature review.Methods The clinical data of a 29-year-old woman admitted in October 2025, four years after LC, were retrospectively reviewed. She was diagnosed with suspected CBD stones during routine examination one year prior to admission. Preoperative imaging revealed multiple filling defects in the CBD. The patient declined endoscopic retrograde cholangiopancreatography and underwent laparoscopic common bile duct exploration (LCBDE). Intraoperative findings, imaging characteristics, diagnostic process, and management were analyzed in conjunction with relevant literature.Results Preoperative imaging suggested multiple CBD stones. During LCBDE, three migrated Hem-o-lok clips were identified and removed from the middle and lower CBD under choledochoscopic guidance. No pigment stones were observed around the clips. The final diagnosis was foreign bodies in the CBD (Hem-o-lok clips). A T-tube was placed for drainage. The patient recovered uneventfully and was discharged. Two months later, T-tube cholangiography confirmed a patent CBD without residual stones or foreign bodies, and the tube was removed successfully.Conclusion Hem-o-lok clip migration is a rare long-term complication after LC and is easily misdiagnosed as choledocholithiasis. In patients with a history of LC, clip migration should be considered in the differential diagnosis. LCBDE is an effective diagnostic and therapeutic approach. Standardized surgical techniques, appropriate selection of closure devices, and long-term follow-up are essential to minimize this complication.
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REN Long, WANG Xing, SHEN Zhenwei, LI Kai, SHI Kaihang, ZHANG Kai, YANG Ya
2026,35(2):289-297, DOI: 10.7659/j.issn.1005-6947.250464
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Background and Aims Laparoscopic common bile duct exploration (LCBDE) is a standard minimally invasive approach for choledocholithiasis. Although single-incision plus one-port laparoscopy (SILS+1) has demonstrated advantages in cholecystectomy, its safety and efficacy in common bile duct exploration remain unclear. This study aimed to compare perioperative outcomes between SILS+1 and conventional multi-port LCBDE under standardized adjunctive conditions including indocyanine green (ICG) fluorescence cholangiography and spontaneous biliary stent placement.Methods A retrospective analysis was conducted on 132 patients who underwent LCBDE between March 2024 and March 2025. Patients were divided into a SILS+1 group (n=32) and a conventional multi-port group (n=100). After propensity score matching, 32 patients in the SILS+1 group and 64 in the control group were included. Perioperative outcomes, postoperative recovery, complications, and cosmetic satisfaction were compared.Results There were no significant differences in operative time or bile duct suturing time between the two groups (both P>0.05). The SILS+1 group showed significantly shorter specimen extraction time, reduced total incision length, lower 24 h postoperative pain scores, and higher cosmetic satisfaction (all P<0.001). No significant differences were observed in intraoperative blood loss, hospital stay, total cost, or complication rates. All bile leakage cases were successfully managed conservatively without reoperation. No retained stones or stent-related complications were observed.Conclusion Under standardized adjunctive conditions, SILS+1 LCBDE is a safe and feasible technique that reduces surgical trauma, alleviates postoperative pain, and improves cosmetic outcomes without increasing complication rates. Further multicenter studies with long-term follow-up are needed to validate its clinical benefits.
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WANG Song, LI Quan, LIU Jian, ZHU Zhengquan, LIU Fu
2026,35(2):298-305, DOI: 10.7659/j.issn.1005-6947.250612
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Background and Aims Bile leakage is a common and clinically significant complication after laparoscopic cholecystectomy (LC), which may delay recovery and increase the need for reintervention. This study aimed to identify risk factors for bile leakage after LC and to develop a predictive regression model.Methods A retrospective analysis was conducted on 1 630 patients who underwent LC between September 2020 and May 2025. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors, and a predictive model was established. The performance of the model was evaluated using receiver operating characteristic (ROC) analysis.Results Bile leakage occurred in 81 patients (4.97%). Multivariate analysis identified common bile duct diameter ≤3 mm, gallbladder neck stones, anatomical variation, Calot's triangle adhesion, adhesion to surrounding organs, gallbladder wall thickness ≥5 mm, and electrocautery in Calot's triangle as independent risk factors (all P<0.05). The regression equation was: Logit (P)=-9.126+1.362×gallbladder neck stones +0.784×CBD diameter+1.695×adhesion to surrounding organs +1.108×electrocautery+0.895×Calot adhesion +0.679×anatomical variation +0.559×wall thickness. The model showed good discrimination with an AUC of 0.903, sensitivity of 82.72%, and specificity of 84.44%.Conclusion Multiple anatomical and intraoperative factors are associated with bile leakage after LC. The proposed regression model demonstrates good predictive performance and may assist in perioperative risk assessment.
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MI Xingyu, LU Shiqi, MAN Yifan, PAN Yilin, CHEN Kui, YUAN Ye, CAO Huiwei, XIE Yanhui, ZHOU Ledu
2026,35(2):306-322, DOI: 10.7659/j.issn.1005-6947.260074
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Background and Aims Hepatocellular carcinoma (HCC) is characterized by a high recurrence rate and unsatisfactory long-term outcomes after curative treatment. With the development of the bio-psycho-social model, the role of psychological factors in cancer prognosis has gained increasing attention. However, prospective evidence regarding the impact of preoperative anxiety and depression on survival in HCC remains limited. This study aimed to evaluate their association with long-term outcomes after curative treatment.Methods This single-center prospective cohort study consecutively enrolled 213 HCC patients who underwent curative resection or ablation in 2019. Preoperative psychological status was assessed using the Zung Self-Rating Anxiety Scale (SAS) and Self-Rating Depression Scale (SDS). Overall survival (OS) was the primary endpoint, while disease-free survival (DFS) was the secondary endpoint. Survival analyses were performed using the Kaplan-Meier method and Cox regression models.Results The prevalence of preoperative anxiety and depression was 37.6% and 31.0%, respectively, with 45.1% of patients exhibiting at least one condition. Patients with anxiety or depression had significantly worse DFS and OS (both P<0.05). In multivariable analysis, neither anxiety nor depression alone was independently associated with outcomes. However, the combined variable ("anxiety or depression") independently predicted poorer DFS (HR=1.589, P=0.003) and OS (HR=1.844, P<0.001). CNLC stage, surgical approach, and microvascular invasion were also identified as independent prognostic factors.Conclusion Preoperative psychological distress is common in HCC patients and is associated with unfavorable long-term outcomes. A composite assessment of anxiety and depression provides greater prognostic value than individual symptoms, supporting the integration of psychological screening into perioperative management.
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HAI Xiuling, BAI Xiaolin, PENG Huihui, LUO Xia, YUAN Yingchun, ZHANG Xiaomin, WANG Yanjuan
2026,35(2):323-333, DOI: 10.7659/j.issn.1005-6947.250439
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Background and Aims Recurrence remains common in patients with intermediate to advanced liver cancer after sequential transarterial chemoembolization (TACE) and radiofrequency ablation (RFA). Reliable preoperative risk stratification tools are lacking. This study aimed to develop and validate a multimodal ultrasound-based machine learning model integrating superb microvascular imaging (SMI) and shear wave elastography (SWE) to predict postoperative recurrence after sequential TACE-RFA therapy in patients with intermediate to advanced liver cancer, with model interpretability assessed using SHAP analysis.Methods A total of 215 patients with BCLC stage B/C liver cancer were retrospectively enrolled and randomly divided into a training set (n=150) and a testing set (n=65) at a 7∶3 ratio. Clinical characteristics, laboratory parameters, and SMI/SWE-derived features were collected. Feature importance was ranked using random forest, support vector machine, and extreme gradient boosting (XGB), followed by intersection selection and bidirectional stepwise logistic regression to identify independent predictors. Seven machine learning algorithms were trained with 10-fold cross-validation. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, Brier score, and decision curve analysis (DCA). Tree SHAP was applied to interpret feature contributions.Results Preoperative tumor diameter, AFP level, maximum elastic modulus (Emax), elastic ratio (Eratio), and vascular morphology were identified as independent predictors of recurrence. The XGB model achieved the best performance, with AUCs of 0.989 in the training set and 0.959 in the testing set. Brier scores were 0.034 and 0.056, respectively. DCA demonstrated superior net benefit across a wide range of threshold probabilities. SHAP analysis indicated that higher Eratio, elevated AFP, irregular vascular morphology, and larger tumor diameter were associated with increased recurrence risk, whereas lower Emax was associated with reduced risk.Conclusion The proposed SMI-SWE-based XGB model provides accurate and clinically useful prediction of recurrence after sequential TACE-RFA therapy in intermediate to advanced liver cancer. SHAP-based interpretation enhances model transparency and supports individualized preoperative risk assessment.
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YUAN Baihui, SONG Zhiyuan, WANG Hao, ZHANG Weijie, QI Tian, XU Xinhe, YU Yanlong
2026,35(2):334-342, DOI: 10.7659/j.issn.1005-6947.250694
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Background and Aims Post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) is the most common complication and is associated with prolonged hospitalization and increased healthcare burden. Although several risk factors have been identified, a simple and clinically applicable prediction tool based on routine variables remains lacking. This study aimed to identify risk factors for PEP and to develop a practical prediction model.Methods A retrospective analysis was conducted on 537 patients who underwent ERCP between January 2020 and June 2025. Patients were divided into PEP and non-PEP groups. Univariate and multivariate logistic regression analyses were performed to identify independent risk factors. A nomogram was constructed and evaluated using receiver operating characteristic (ROC) and calibration curves.Results PEP occurred in 93 patients (17.3%). Multivariate analysis identified a history of hypertension (OR=2.014), pancreatic duct opacification (OR=4.663), endoscopic papillary balloon dilation (OR=2.459), and cannulation time >57 min (OR=3.530) as independent risk factors (all P<0.05). The nomogram demonstrated good discrimination (AUC=0.750) and calibration (Hosmer-Lemeshow test, P=0.793). Among patients undergoing endoscopic papillary balloon dilation, there was no significant difference in the incidence of PEP between those with and without pancreatic duct stent placement (P>0.05).Conclusion A history of hypertension, pancreatic duct opacification, endoscopic papillary balloon dilation, and prolonged cannulation time are closely associated with the occurrence of PEP. The proposed nomogram provides a simple and effective tool for individualized risk prediction and may assist in optimizing preventive strategies for ERCP patients.
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HE Yijia, LIU Yongrong, ZHANG Xin, WU Keke
2026,35(2):343-349, DOI: 10.7659/j.issn.1005-6947.250598
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Background and Aims Early detection of pancreatic cancer (PC) remains challenging, and conventional biomarkers such as CA19-9 are inadequate for population screening. Routine blood and urine biochemical markers are widely accessible and reflect systemic physiological status; however, their causal relationships with PC risk remain unclear. Therefore, this study aimed to systematically evaluate the potential causal associations between 35 routine biochemical biomarkers and pancreatic cancer risk using a two-sample Mendelian randomization (MR) framework.Methods A two-sample MR study was conducted using genome-wide association study (GWAS) summary data from the UK Biobank for 35 biochemical traits. Outcome data for PC were obtained from the FinnGen consortium (release R12). The inverse-variance weighted (IVW) method was used as the primary analysis, complemented by MR-Egger, weighted median, and weighted mode approaches. Sensitivity analyses were performed to assess robustness.Results Two kidney function-related traits showed consistent causal associations with PC risk. Genetically predicted higher serum creatinine levels were associated with an 18% increased risk of PC per 1-standard deviation increment (OR=1.18, 95% CI=1.03-1.36, P=0.019), whereas higher estimated glomerular filtration rate (eGFR) was associated with a 17% reduced risk (OR=0.83, 95% CI=0.72-0.97, P=0.016). Sensitivity analyses supported the robustness of these findings, with no evidence of substantial heterogeneity or horizontal pleiotropy.Conclusions This MR study provides genetic evidence supporting a potential causal role of kidney function-related pathways in pancreatic cancer. Serum creatinine and eGFR may serve as promising host-related biomarkers for risk stratification and early detection, warranting further mechanistic and prospective validation.
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ZHOU Wenbin, WANG Dandan, PAN Hong, SHI Liang, XIA Tiansong, LIANG Yan, MA Dandan, WANG Shui, QI Xiaowei, DING Qiang
2026,35(2):350-356, DOI: 10.7659/j.issn.1005-6947.250280
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Conventional open mastectomy is associated with significant surgical trauma and visible scarring, which may adversely affect patients' physical and psychological well-being as well as quality of life. With the advancement of minimally invasive techniques, single-port endoscopic subcutaneous mastectomy via the axillary approach has gained increasing attention due to its concealed incision and favorable cosmetic outcomes. Based on this approach, our team has developed an endoscopic electro-scissors-assisted technique and continuously refined the surgical procedure in clinical practice. Using electro-scissors as the primary dissection instrument, combined with tumescent infiltration and standardized anatomical planes, this technique helps reduce thermal injury to skin flaps, improve surgical exposure, and enhance procedural precision and safety. In addition, it features a relatively short learning curve and is easy to master. Based on experience from over 200 cases, this article systematically summarizes the preoperative preparation, instrumentation, surgical steps, and key technical points, aiming to provide a practical reference for the standardized implementation of minimally invasive breast surgery.
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WU Jiaxin, SHA Fanchao, QIU Guogao, SU Jiayong, ZHONG Jianhong, MA Liang, CAO Chan
2026,35(2):357-366, DOI: 10.7659/j.issn.1005-6947.260022
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The European Society for Medical Oncology (ESMO) Congress 2025, held in Berlin from October 17 to 21, presented a series of pivotal advances in hepatobiliary malignancies, covering immunotherapy, targeted therapy, perioperative strategies, conversion therapy, and biomarker development. In hepatocellular carcinoma (HCC), immune-based combination therapies remain the standard first-line treatment, while dual immunotherapy and triplet regimens are under active investigation; however, some intensified combinations failed to demonstrate additional survival benefits. Conversion therapy and perioperative strategies have shown promising potential in improving patient outcomes. In biliary tract cancers (BTC), breakthroughs have been achieved in neoadjuvant and conversion therapies, and precision-targeted treatments are emerging, particularly in refractory settings and rare molecular subtypes. Meanwhile, biomarkers are increasingly important for risk stratification and treatment response prediction. This review summarizes the key studies presented at the congress, highlights their clinical implications and limitations, and discusses future research directions to inform clinical decision-making.
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YANG Lifei, WU Xiaoning, QIAN Yerong, LIU Peng, REN Yaoxing, WANG Fumin, ZHANG Xufeng, LU Yi, XIANG Junxi
2026,35(2):367-375, DOI: 10.7659/j.issn.1005-6947.260046
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Hepatocellular carcinoma (HCC) is one of the most prevalent primary liver malignancies worldwide and is associated with high mortality. The complex tumor immune microenvironment limits the overall efficacy of current immunotherapies. Recent studies have identified tertiary lymphoid structures (TLS), ectopic lymphoid aggregates formed in chronic inflammatory or tumor tissues, as key regulators of anti-tumor immunity in HCC. Accumulating evidence indicates that the presence, density, maturation status, and spatial distribution of TLS are closely associated with improved survival outcomes, reduced recurrence risk, and enhanced responsiveness to immune checkpoint inhibitors. Moreover, several anti-tumor treatments, including radiotherapy and hepatic arterial infusion chemotherapy, can induce TLS formation or promote their maturation, thereby reshaping the tumor immune microenvironment and strengthening anti-tumor immune responses. This review summarizes the structural characteristics and formation mechanisms of TLS and discusses their prognostic and predictive value in HCC. In addition, potential therapeutic strategies aimed at inducing or targeting TLS and their prospects for clinical translation are highlighted, providing new insights for precision immunotherapy in HCC.
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SUN Han, CAI Zhongliang, JI Wu
2026,35(2):376-383, DOI: 10.7659/j.issn.1005-6947.250671
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With advances in communication technologies and surgical robotics, telerobotic surgery has gradually evolved from early feasibility demonstrations to exploratory clinical application. The implementation of fifth-generation mobile communication, dedicated networks, and low-Earth-orbit satellite communication has significantly improved the real-time performance and stability of remote manipulation, providing an essential technical foundation for cross-regional surgical practice. In recent years, China has accumulated growing experience in this field, with exploratory applications based on domestically developed robotic platforms across multiple surgical specialties, preliminarily demonstrating the feasibility and safety of telerobotic surgery. However, compared with local robotic surgery, telerobotic surgery presents distinct challenges, including communication uncertainty, dual-team coordination, emergency management of intraoperative complications, and limitations in current training systems. In addition, most available evidence is derived from case reports or small series, and the quality of evidence as well as the boundaries of clinical indications remain unclear. This article reviews the current technological and clinical progress in telerobotic surgery, analyzes its operational characteristics and risk structure, summarizes a safety-oriented implementation framework covering preoperative assessment, intraoperative safety control, complication management, and postoperative quality management, and discusses the major challenges for its standardized implementation.
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YAN Shenhui, SUN Xiaobing, YANG Yonglin
2026,35(2):384-390, DOI: 10.7659/j.issn.1005-6947.250408
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Hypoxia at high altitude is an important environmental factor influencing human metabolism and disease patterns. Recent epidemiological studies have shown that the prevalence of gallbladder stones is significantly higher in high-altitude regions than in low-altitude areas, yet the underlying mechanisms remain incompletely understood. Emerging evidence suggests that high-altitude hypoxia may promote gallstone formation through multiple pathways, including alterations in hepatic lipid and cholesterol metabolism, changes in bile composition, impairment of gallbladder contractility, disruption of gut microbiota homeostasis, and activation of inflammatory responses. In addition, hypoxia-induced oxidative stress, DNA damage, and epigenetic regulation may further contribute to lithogenesis. Genetic adaptation to hypoxia, such as polymorphisms in EPAS1 and related genes, may also influence individual susceptibility to gallstone disease among high-altitude populations. This review summarizes current research progress on the relationship between high-altitude hypoxia and gallbladder stones, focusing on potential mechanisms involving metabolic regulation, gallbladder motility, gut microbiota alterations, and inflammatory-epigenetic pathways, with the aim of providing insights for prevention and future research on gallstone disease in high-altitude regions.
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Volume 35,2026 Number 2
INTERPRETATION OF GUIDELINES
SPECIALIST FORUM
MONOGRAPHIC STUDY
CLINICAL RESEARCH
TECHNIQUE IMPROVEMENT
INTERNATIONAL UPDATES
REVIEW
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Department of Medical Administration, National Health Commission of the People''s Republic of China
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In April 2024, the "Guidelines for the diagnosis and treatment of primary liver cancer (2024 edition)"were officially released. The guidelines were developed by experts and scholars from various disciplinesin the field of liver cancer across the country under the leadership of the Department of MedicalAdministration of the National Health Commission of the People""s Republic of China and with guidancefrom the Expert Committee on the Compilation of Guidelines for the Diagnosis and Treatment ofPrimary Liver Cancer, the National Cancer Center, and the Liver Cancer QualityControl ExpertCommittee of the National Cancer Quality Control Center. The main updates in the "Guidelines for thediagnosis and treatment of primary liver cancer (2024 edition)" include: updates tosurgical treatmentmethods and concepts; objective evaluation of the value of local ablation; revitalization of vascular ntervention therapy; further exploration and optimization of radiotherapy; and significant breakthroughsin systemic treatment. As a normative guidance document for primary liver cancer, the guidelines keeppace with the times, timely reflecting new developments and concepts in the field of liver cancerdiagnosis and treatment, which will effectively drive the elevation of standardized diagnosis and treatment levels for liver cancer in China, enhanced the influence of our country in this field within the academic community, and hold high guiding significance for the future
