Chinese expert consensus on thyroid reoperation
Novel technology for lower esophageal sphincter augmentation: indications and limits in current surgical practice
Prevention and management of bleeding in endoscopic thyroid surgery
Feasibility and safety analysis of mixed reality-assisted surgery for substernal goiter: a report of 29 cases
Clinical evaluation of the single-tunnel transmural puncture method in small-incision transoral endoscopic thyroidectomy vestibular approach
Exploration and reflection on robotic complex rectal cancer surgery
Reflections on the technical challenges and strategies in laparoscopic intersphincteric resection
Application of α-cyanoacrylate medical glue for mesenteric fissure closure during laparoscopic radical resection of colorectal cancer
Clinicopathologic features and prognostic analysis of colonic rhabdoid carcinoma: a case report and literature review
Feasibility study of a novel three-dimensional small intestinal submucosa patch in porcine hiatal hernia repair
Digital intelligence empowering pancreatic surgery: technological innovation and clinical practice
Advances in the development of novel pancreatic duct stent materials: from inert implantation to intelligent degradation through medical-engineering integration
Prophylactic dual biliary-pancreatic diversion: a conceptual and translational innovation in preventing postoperative complications after pancreaticoduodenectomy
Robotic surgery for complex bile duct stones: a retrospective single-center comparative study
Current status of assessment and management of variant hepatic arteries in DCD liver transplantation
Clinical value of indocyanine green fluorescence navigation in single-incision laparoscopic cholecystectomy
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Working Group of Thyroid Surgery, Chinese College of Surgeons, Chinese Medical Doctor Association, Thyroid Disease Committee, Chinese Research Hospital Association; Chinese General Surgery Association, China International Exchange, Promotive Association for Medical, Health Care
2025,34(11):2297-2309, DOI: 10.7659/j.issn.1005-6947.250473
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Reoperation for thyroid disease is not uncommon and associated with high risk, constituting a significant challenge in clinical practice. This consensus, developed based on international evidence and Chinese clinical practice, systematically addresses the causes and classification, indications, timing, preoperative assessment, surgical approaches, key techniques, as well as comprehensive postoperative management and follow-up of thyroid reoperations. The expert panel emphasizes the importance of multidisciplinary collaboration, precise evaluation, and individualized treatment, aiming to minimize surgical risks, enhance patient outcomes, and provide evidence-based guidance for informed clinical decision-making.
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2025,34(11):2310-2317, DOI: 10.7659/j.issn.1005-6947.250640
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Gastroesophageal reflux disease (GERD) is primarily driven by dysfunction of the lower esophageal sphincter (LES), allowing gastric contents to reflux into the esophagus and leading to symptoms, mucosal injury, and impaired quality of life. Traditional antireflux procedures such as Nissen, Toupet, and Dor fundoplication aim to reinforce the LES and restore the physiological and mechanical components of the antireflux barrier.Yet concerns regarding postoperative dysphagia, gas-bloat, durability, and long-term recurrence have limited their broader adoption. As advances in minimally invasive surgery have progressed, prosthetic LES augmentation devices-including the magnetic LINXTM system and the RefluxStopTM silicone implant-have emerged as reversible, anatomy-preserving alternatives designed to directly enhance sphincter competence while minimizing common complications. This review summarizes the functional anatomy of the esophagogastric junction, core principles of antireflux surgery, and the mechanisms underlying fundoplication failure. Evidence from short- and long-term studies demonstrates that both Magnetic Sphincter Augmentation (MSA) and the RefluxStop procedure effectively reduce acid exposure, improve GERD-related quality of life, and provide durable reflux control, even in patients with impaired esophageal motility or prior failed surgery. These techniques complement traditional fundoplication and offer expanding therapeutic opportunities for personalized GERD management. Continued refinement of patient selection, procedural technique, and long-term evaluation will help define the optimal role of LES augmentation within contemporary antireflux surgery.
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2025,34(11):2318-2325, DOI: 10.7659/j.issn.1005-6947.250415
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Thyroid cancer is the most common malignancy of the endocrine system, with a continuously rising incidence worldwide. Over the past decade, the implementation of standardized and homogeneous diagnostic and therapeutic strategies in China has led to a remarkable improvement in the 5-year survival rate of thyroid cancer patients, increasing from 67.5% in 2003 to 92.9% in 2021. Nevertheless, thyroid cancer is characterized by significant biological heterogeneity, with substantial variability in clinical presentation, disease progression, therapeutic response, and prognosis among different individuals. Consequently, the traditional treatment paradigm can no longer meet the demands of modern clinical practice. At present, the management of thyroid cancer is gradually shifting toward an individualized and precision medicine-based approach driven by molecular profiling and risk stratification. This review systematically summarizes the current status of precision diagnosis and treatment of thyroid cancer from multiple perspectives, including preoperative accurate diagnosis, risk stratification, selection of treatment modalities, individualized determination of surgical extent, and postoperative comprehensive management (such as thyroid-stimulating hormone suppression therapy, radioactive iodine therapy, and targeted therapy), aiming to provide a reference for clinical precision management of thyroid cancer.
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MA Junjie, XIE Qiuping, XU Hao, WANG Ping
2025,34(11):2326-2334, DOI: 10.7659/j.issn.1005-6947.250582
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Endoscopic thyroidectomy (ET) has rapidly evolved over the past three decades and has become a preferred option for patients with cosmetic concerns. Evidence shows that ET offers safety, efficacy, and oncologic completeness comparable to conventional open surgery; however, its confined operative space imposes higher demands on the surgeon's endoscopic skills, spatial perception, and hemorrhage control techniques. Although the overall incidence of bleeding is similar between ET and open thyroidectomy, achieving hemostasis and restoring visualization during ET are more challenging. Postoperative cervical hematoma, though infrequent, may rapidly lead to airway compromise, requiring prompt recognition and intervention. Systematic prevention and management of hemorrhage is therefore essential for ensuring ET safety. Preoperative optimization-including evaluation of bleeding risks and adjustment of thyroid and coagulation status-is fundamental. Intraoperatively, meticulous dissection, judicious use of energy devices, and careful protection of the superior and inferior thyroid vessels as well as microvasculature around the recurrent laryngeal nerve are key. Postoperatively, close monitoring of drainage and cervical contour is required to detect early signs of hematoma formation, enabling timely decompression and re-exploration when needed. Drawing on extensive institutional experience and current literature, this review summarizes the characteristics, risk factors, preventive measures, and management strategies for bleeding in ET. We aim to provide practical and standardized recommendations that enhance surgical safety, reduce severe complications, and support the standardized and high-quality development of endoscopic thyroid surgery.
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LU Yongjin, SHI Zhiqiang, SUN Lijun, WANG Yongsheng, QIU Pengfei
2025,34(11):2335-2341, DOI: 10.7659/j.issn.1005-6947.250557
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Axillary management for early-stage breast cancer is shifting from maximal tolerated treatment to minimal effective intervention. The introduction of sentinel lymph node biopsy (SLNB) markedly reduced surgical morbidity, and growing evidence now supports omitting axillary surgery in selected patients. The SOUND and INSEMA trials demonstrated that, among strictly defined cN0 patients assessed by high-quality imaging, omission of SLNB is non-inferior to SLNB in terms of invasive disease-free survival while significantly reducing complications such as lymphedema. In ductal carcinoma in situ, low-burden tumors, and elderly patients aged ≥70 years with HR+/HER2- disease, omission of axillary staging has minimal impact on regional control and survival outcomes. Advances in imaging technologies, dedicated lymph node PET, and artificial intelligence have improved the accuracy of identifying true node-negative patients. Furthermore, highly selected HER2+/triple-negative patients who achieve breast pathologic complete response after neoadjuvant therapy may also be candidates for axillary surgery omission. Accurate patient selection remains central to safe de-escalation, although the loss of pathological staging information may influence subsequent systemic and radiation therapy decisions. With accumulating evidence and more refined assessment tools, axillary surgery is expected to evolve toward increasingly individualized and precise management.
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SUN Peng, KE Yifan, ZHANG Peng, WU Jiezhong, HUANG Zenan, HU Kunpeng
2025,34(11):2342-2350, DOI: 10.7659/j.issn.1005-6947.250235
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Background and Aims Mixed reality (MR) enables real-time visualization of three-dimensional (3D) anatomical models within the operative field, potentially enhancing surgical planning and intraoperative navigation. However, its application in substernal goiter (SSG) surgery has not been reported. This study aimed to evaluate the feasibility, safety, and clinical utility of MR-assisted SSG resection.Methods A total of 29 patients who underwent MR-assisted surgery for SSG at Lingnan Hospital of the Third Affiliated Hospital of Sun Yat-sen University between May and December 2024 were retrospectively included. The MR workflow consisted of three sequential stages: 3D reconstruction, holographic visualization, and device deployment. First, contrast-enhanced cervical CT images were imported into 3D Slicer for semi-automatic three-dimensional reconstruction. The reconstructed models were then processed in Unity3D using the Mixed Reality Toolkit to generate holographic visualizations. Finally, the holographic models were deployed to the HoloLens 2 head-mounted display for perioperative review and manipulation by the surgeon. Clinical characteristics, operative parameters, postoperative complications, and MR usage details were systematically collected and descriptively analyzed.Results The median thyroid volume was 71.49 (49.4-113.52) cm3. Thirteen patients underwent unilateral thyroidectomy, 16 underwent bilateral resection, and 8 underwent parathyroid autotransplantation; 3 procedures were endoscopic. The median operative time was 145 (117.5-161) min, with an estimated blood loss of 10 (10-15) mL. Only two patients (6.9%) developed transient hypoparathyroidism, with no permanent complications, recurrent laryngeal nerve injury, postoperative bleeding, or recurrence observed. Reconstruction, holographic processing, and MR application required approximately 60-90 min, 15-20 min, and 10-20 min, respectively. Display distortion or latency occurred in six cases, without device-related adverse effects. Most surgeons reported improved anatomical understanding and surgical planning, despite limitations in display brightness and processing capacity.Conclusion MR-assisted SSG surgery is feasible and safe, offering enhanced spatial perception and operative guidance. It shows promise for improving efficiency and safety in thyroid surgery. Larger prospective studies are warranted to validate its clinical benefits and further optimize the workflow and hardware performance.
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TAO Long, ZHOU Chanyuan, RUAN Jian
2025,34(11):2351-2360, DOI: 10.7659/j.issn.1005-6947.250320
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Background and Aims Transoral endoscopic thyroidectomy vestibular approach (TOETVA) has gained increasing popularity due to its scarless appearance and convenience in central compartment lymph node dissection. However, the conventional approach using a 10-mm endoscope and relatively large vestibular incisions often leads to traction-related injuries of the lips and chin. To minimize maxillofacial trauma, a 5-mm endoscope-based small-incision TOETVA (SITOETVA) has been introduced. Yet the smaller trocar limits the initial working space, making trocar convergence difficult and increasing bleeding risk. This study compares the single-tunnel transmural puncture method with the multi-tunnel transcavity puncture method to determine an optimized cavity-creation strategy for SITOETVA.Methods A retrospective analysis was conducted on 60 patients who underwent SITOETVA between May and September 2024, all operated on by the same surgeon. Among them, 30 patients underwent cavity creation using the single-tunnel transmural puncture method (observation group), and the remaining 30 patients underwent cavity creation using the multi-tunnel transcavity puncture method (control group). The two groups were compared in terms of cavity-creation time, operative time, initial-space bleeding rate, intraoperative blood loss, postoperative drainage volume, number of central compartment lymph nodes dissected, and postoperative length of hospital stay.Results Baseline characteristics were comparable between the two groups (all P>0.05). The observation group demonstrated significantly shorter cavity-creation time [(14.5±2.3) min vs. (24.9±5.7) min], shorter operative time [(81.5±17.6) min vs. (96.8±15.6) min], lower intraoperative blood loss [(2.5±1.4) mL vs. (4.8±3.5) mL], and markedly reduced initial space bleeding rate (3.33% vs. 33.33%) compared with the control group (all P<0.05). No significant differences were observed in postoperative drainage volume, lymph node yield, or hospital stay (all P>0.05). No cases of dyspnea, hoarseness, or limitation of lower-lip movement were observed in either group. During follow-up, no cases of recurrence or distant metastasis were detected in either group, and sensory function of the lips and chin recovered within 2-4 weeks without long-term functional impairment.Conclusion The single-tunnel transmural puncture technique effectively reduces bleeding risk, simplifies trocar convergence, and shortens operative time in SITOETVA. It represents a practical and streamlined modification of the cavity-creation procedure and has strong clinical applicability.
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WANG Xue, CUI Zhexu, WANG Morigen, WANG Mofei
2025,34(11):2361-2367, DOI: 10.7659/j.issn.1005-6947.250337
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Background and Aims Gynecomastia is a common benign breast condition in males that may cause abnormal breast contour and psychological distress. Endoscopic subcutaneous mastectomy has gradually become an important surgical option due to its concealed incision, clear operative field, and superior cosmetic outcomes. This study aimed to summarize the key operative techniques, postoperative complications, and follow-up outcomes of endoscopic mastectomy for gynecomastia.Methods A retrospective analysis was conducted on 17 patients who underwent endoscopic mastectomy for gynecomastia between May 2023 and February 2025. General information, surgical procedures, postoperative complications, and satisfaction results were reviewed. Operative time, intraoperative blood loss, drainage volume during the first three postoperative days, time to drain removal, and length of hospitalization were recorded. Postoperative satisfaction was evaluated using the BODY-Q chest module. Follow-up lasted 3-24 months.Results All procedures were successfully completed without conversion or major complications. The mean unilateral operative time was (69.88±14.23) min, and intraoperative blood loss was (22.38±10.69) mL. The median drainage volumes on postoperative days 1, 2, and 3 were 28.00 (14.00-57.50) mL, 17.50 (15.00-24.75) mL, and 14.00 (7.75-24.75) mL, respectively. The mean time to drain removal was (6.50±1.66) d, and postoperative hospital stay was 5-10 d. All pathological results were benign (15 cases of gynecomastia and 2 cases of fibrofatty hyperplasia). Postoperative complications included skin bruising in 3 patients (17.6%) and subcutaneous hematoma in 1 patient (5.9%); all resolved spontaneously or with simple treatment. No nipple retraction, skin-flap necrosis, sensory disturbance, or breast asymmetry was observed. No glandular residue or recurrence occurred during follow-up. All patients achieved satisfaction scores above 3, indicating excellent cosmetic outcomes.Conclusion Endoscopic mastectomy for gynecomastia is safe, minimally invasive, and associated with a low rate of complications. Its concealed incision and favorable aesthetic results yield high patient satisfaction, making it a technique worthy of wider clinical adoption.
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YANG Liu, DAI Yangyang, WANG Yawen, ZHANG Yuanyuan
2025,34(11):2368-2379, DOI: 10.7659/j.issn.1005-6947.250298
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Background and Aims Breast cancer is the most prevalent malignancy among women worldwide, and chemotherapy resistance and tumor recurrence remain major obstacles to long-term survival. Dysregulation of apoptosis is considered a key mechanism underlying chemoresistance; however, the synergistic roles of apoptosis- and chemotherapy-related genes in prognostic stratification and drug resistance have not been fully elucidated. This study aimed to construct a multigene prognostic risk model based on apoptosis- and chemotherapy-related genes and to further investigate the role of the key gene in breast cancer stemness and chemoresistance.Methods Transcriptomic and clinical data of breast cancer patients were obtained from The Cancer Genome Atlas (TCGA). Differentially expressed apoptosis- and chemotherapy-related genes were identified, and a multigene prognostic risk model was constructed using univariate Cox regression, LASSO regression, and multivariate Cox regression analyses. The predictive performance of the model was evaluated by time-dependent ROC curves, nomograms, and an external GEO dataset. Associations between the risk score and clinical characteristics, immune cell infiltration, and chemotherapeutic drug sensitivity were further analyzed. Functional assays, including wound healing, Transwell invasion, and Western blot analyses, were performed to validate the biological role of the key gene in breast cancer cells.Results A prognostic signature comprising 10 apoptosis- and chemotherapy-related genes was established. The model demonstrated favorable predictive performance in the TCGA cohort, with AUC values of 0.705 and 0.650 for 3- and 5-year overall survival rate, respectively, and was further validated in an external GEO dataset (3-year AUC=0.741). The risk score was identified as an independent prognostic factor and was significantly associated with advanced TNM stage, increased infiltration of immunosuppressive cells, and resistance to chemotherapeutic agents, including NU7441 and fludarabine. PCDHB2 was highly expressed in high-risk patients, and its knockdown markedly inhibited migration and invasion of MDA-MB-231 cells while reducing the expression of the stemness-related protein SOX2.Conclusion This study established a robust multigene prognostic model based on apoptosis- and chemotherapy-related genes for risk stratification and personalized survival prediction in breast cancer. PCDHB2 may contribute to chemoresistance by regulating cancer stemness, highlighting its potential as a novel therapeutic target and providing new insights into breast cancer precision therapy.
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LI Peiting, ZENG Chen, WU Runliu, YANG Meng, LI Jun, ZHOU Jianda, WU Wei
2025,34(11):2380-2388, DOI: 10.7659/j.issn.1005-6947.240612
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Background and Aims Triple-negative breast cancer (TNBC) is highly aggressive and lacks effective targeted therapies. The chemokine receptors CXCR4 and CXCR7 are overexpressed in TNBC and may promote tumour cell migration and invasion by activating the NF-κB signalling pathway. This study aimed to investigate the roles of CXCR4/CXCR7 and the NF-κB pathway in regulating the migration and invasion of TNBC cells.Methods In the TNBC cell line MDA-MB-231, CRISPR/Cas9 technology was used to individually or in combination knock out the CXCR4 and CXCR7 genes. Additionally, a group treated with the NF-κB inhibitor BAY 11-7082 was established. The phosphorylation levels of IκB-α and p65 were assessed by Western blotting to evaluate NF-κB pathway activity. Cell proliferation, migration, and invasion were evaluated using the CCK-8 assay, wound healing assay, and Transwell assay, respectively.Results MDA-MB-231 cell lines with CXCR4, CXCR7, or dual gene knockout were successfully established. Western blot analysis revealed that the phosphorylation levels of IκB-α and p65 were significantly reduced in all knockout groups (all P<0.05), with the dual knockout group exhibiting a more substantial inhibitory effect than the single knockouts. However, BAY 11-7082 (5 μmol/L, 24 h) exerted a more pronounced suppression of IκB-α and p65 phosphorylation compared to the dual knockout group (all P<0.05). Functional assays demonstrated that both gene knockout and NF-κB inhibition significantly impaired the migration and invasion of TNBC cells (all P<0.05). Among all groups, the dual knockout of CXCR4 and CXCR7 showed greater inhibitory effects than either single knockout. At the same time, the BAY 11-7082 treatment exhibited the most potent suppression of both migration and invasion (both P<0.05).Conclusion CXCR4 and CXCR7 promote TNBC cell migration and invasion by activating the NF-κB signalling pathway, suggesting that the NF-κB pathway may serve as a potential therapeutic target for combination immunotherapy in TNBC.
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WANG Yajue, LI Jie, ZHAO Xingjuan, YANG Xuan
2025,34(11):2389-2396, DOI: 10.7659/j.issn.1005-6947.240188
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Background and Aims Human epidermal growth factor receptor 2 (HER2)-positive breast cancer is characterized by high aggressiveness and poor prognosis. MicroRNAs (miRNAs) play critical roles in tumor progression. miR-186-5p has recently been identified as a tumor-related miRNA, but its function in HER2-positive breast cancer remains unclear. This study aimed to investigate the regulatory relationship between miR-186-5p and metadherin (MTDH) and its effect on tumor growth in a HER2-positive breast cancer xenograft model.Methods The potential binding site between miR-186-5p and MTDH was predicted by TargetScan and verified by dual-luciferase reporter assay. BT-474 cells were transfected with miR-186-5p mimic, MTDH overexpression plasmid, or both. The mRNA and protein levels of miR-186-5p and MTDH were detected. Xenograft models were established by subcutaneous inoculation of transfected cells into nude mice. Tumor volume and weight were measured on day 28, and the expression of miR-186-5p and MTDH in tumor tissues was analyzed.Results Dual-luciferase reporter assay demonstrated that miR-186-5p directly targets the 3'-UTR of MTDH mRNA. Compared with the negative control group, overexpression of miR-186-5p significantly downregulated the mRNA and protein expression of MTDH, whereas MTDH overexpression upregulated its expression and partially reversed the inhibitory effect of miR-186-5p on MTDH (all P<0.05). In vivo, tumor growth rate, volume, and weight were significantly reduced in the miR-186-5p overexpression group but significantly increased in the MTDH overexpression group compared with the negative control group (all P<0.05), while no significant differences were observed in the miR-186-5p + MTDH co-transfection group (all P>0.05). Further in vivo analysis revealed that miR-186-5p expression was markedly increased, whereas MTDH mRNA and protein expression were significantly decreased in xenograft tumors of the miR-186-5p overexpression group; MTDH expression was significantly elevated in the MTDH overexpression group; and no significant difference in MTDH expression was observed between the co-transfection group and the negative control group (all P>0.05). Immunohistochemical findings were consistent with the molecular results.Conclusion miR-186-5p suppresses the growth of HER2-positive breast cancer xenografts by targeting and downregulating MTDH, suggesting that the miR-186-5p/MTDH axis may serve as a potential therapeutic target for HER2-positive breast cancer.
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MA Xiaofang, LI Wenjun, MA Wenbiao
2025,34(11):2397-2405, DOI: 10.7659/j.issn.1005-6947.240451
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Background and Aims Spindle pole component 25 (SPC25), a core subunit of the NDC80 complex, is aberrantly overexpressed in various malignancies; however, its role and underlying mechanism in breast cancer remain unclear. This study aimed to investigate whether SPC25 regulates proliferation, migration, invasion, and apoptosis of breast cancer cells through the p53 signaling pathway.Methods A stable SPC25-silenced MCF-7 breast cancer cell line was established using lentivirus-mediated shRNA. The expression levels of SPC25 and p53 pathway-related proteins (p53, p21, and BAX) were examined by qRT-PCR and Western blotting. Cell proliferation, migration, and invasion were assessed using colony formation, wound-healing, and Transwell assays, respectively. Apoptosis was analyzed by flow cytometry. A nude mouse xenograft model was established to evaluate tumor growth in vivo, and the expression of p53 pathway proteins in tumor tissues was detected. A p53 inhibitor (PFT-α) was applied to further verify the mechanism.Results SPC25 silencing significantly inhibited the proliferation, migration, and invasion of MCF-7 cells and promoted apoptosis (all P<0.05). The expression levels of p53, p21, and BAX were markedly upregulated following SPC25 knockdown (all P<0.05). Treatment with the p53 inhibitor PFT-αreversed the inhibitory effects of SPC25 silencing on cell proliferation, migration, invasion, and apoptosis, accompanied by decreased expression of p53, p21, and BAX (all P<0.05). In vivo, SPC25 silencing significantly reduced tumor volume and weight in nude mice and increased the expression of p53 pathway-related proteins in tumor tissues, whereas PFT-α administration attenuated these effects (all P<0.05).Conclusion SPC25 promotes breast cancer cell proliferation, migration, and invasion and inhibits apoptosis by modulating the p53 signaling pathway. These findings suggest that SPC25 may serve as a potential therapeutic target for breast cancer.
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DAI Chun, TAN Ming, ZHU Yu, MO Guangpei, SHI Juncheng, LIU Zengyuan
2025,34(11):2406-2413, DOI: 10.7659/j.issn.1005-6947.250385
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Background and Aim Esophagojejunostomy is a critical and technically challenging step in totally laparoscopic total gastrectomy (TLTG), and the method used for closure of the overlap anastomotic common opening has a direct impact on postoperative complications and quality of life. Conventional closure techniques may be associated with difficulties in preventing esophageal stump retraction and anastomotic stenosis. Based on the self-pulling and latter transection (SPLT) technique, this study aimed to evaluate the safety, feasibility, and effect on postoperative quality of life of a lineal stapler plus hand sewn (L+H) method for closing the overlap anastomotic common opening in TLTG.Methods A retrospective analysis was performed on 61 patients with gastric cancer who underwent TLTG with D2 lymphadenectomy between May 1, 2024, and June 1, 2025. According to the closure method of the overlap anastomotic common opening, patients were divided into the L+H closure group (n=43) and the conventional closure group (n=18). Preoperative clinicopathologic characteristics, intraoperative variables, postoperative recovery, complication rates, anastomotic diameter measured by contrast study, and postoperative 3-month quality of life assessed using the QLQ-STO22 scale were compared between the two groups.Results There were no significant differences between the two groups in baseline clinicopathologic characteristics, including age, sex, comorbidities, American Society of Anesthesiologists classification, Siewert type, and pathological stage (all P>0.05). All procedures were successfully completed with R0 resection and without conversion to open surgery. No significant differences were observed between the L+H closure group and the conventional closure group in total operative time, esophagojejunostomy time, intraoperative blood loss, number of harvested lymph nodes, time to liquid diet, postoperative hospital stay, or incidence of postoperative complications (all P>0.05). Compared with the conventional closure group, the L+H closure group demonstrated a significantly larger anastomotic longitudinal diameter on postoperative contrast imaging [(32.2±7.23) mm vs. (28.4±6.34) mm, P<0.05]. At 3 months after surgery, patients in the L+H closure group showed significantly lower (better) scores for dysphagia, reflux, eating restrictions, and total QLQ-STO22 score (all P<0.05).Conclusion In SPLT-based TLTG, closure of the overlap anastomotic common opening using the L+H technique effectively enlarges the anastomotic diameter and alleviates postoperative functional symptoms without compromising surgical safety or efficiency, thereby improving postoperative quality of life. This technique is safe, feasible, and worthy of wider clinical application.
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LIU Xin, CHEN Peng, SONG Yan, YU Xiaofeng
2025,34(11):2414-2421, DOI: 10.7659/j.issn.1005-6947.250321
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Background and Aims Low rectal cancer is prone to lymph node metastasis due to its special anatomical location, which is a key determinant of postoperative recurrence and distant metastasis. The predictive accuracy of conventional imaging methods remains limited. Increasing evidence suggests that the inflammatory microenvironment and chemokines play important roles in tumor metastasis. This study aimed to investigate the predictive value of preoperative inflammatory burden index (IBI) and macrophage inflammatory protein 3α (MIP-3α) for lymph node metastasis in patients with low rectal cancer.Methods A total of 182 patients with low rectal cancer who underwent radical resection between January 2020 and January 2024 were retrospectively analyzed. Preoperative serum MIP-3α levels, C-reactive protein, neutrophils and lymphocytes were detected, and the IBI was calculated. Patients were divided into the lymph node metastasis-positive and -negative groups according to postoperative pathological findings. Univariate and multivariate Logistic regression analyses were performed to identify independent risk factors for LNM. Receiver operating characteristic (ROC) curves and Hosmer-Lemeshow calibration curves were used to evaluate predictive performance.Results LNM occurred in 70 patients (38.46%). Significant differences were observed between the lymph node metastasis-positive and -negative groups regarding tumor differentiation, tumor stage, vascular invasion, lymphatic invasion, preoperative neutrophil to lymphocyte ratio, IBI, and MIP-3α levels (all P<0.05). Multivariate analysis identified extramural vascular invasion (OR=4.870), lymphatic invasion (OR=5.387), IBI (OR=2.143), and MIP-3α (OR=1.539) as independent predictors of LNM (all P<0.05). The AUC values of IBI and MIP-3α were 0.782 and 0.767, respectively, while the combined model achieved an AUC of 0.821, which was significantly superior to either marker alone (P<0.05). The Hosmer-Lemeshow test demonstrated good calibration (P=0.721).Conclusion Preoperative IBI and MIP-3α are effective predictors of lymph node metastasis in low rectal cancer. Their combined application further improves predictive accuracy and may facilitate preoperative risk stratification and individualized treatment.
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XIN Huilin, DAI Weiwei, ZHANG Ying, ZHANG Qijian, TIAN Hanzhang, CHEN Xuan, SUN Bixia, ZHANG Lei
2025,34(11):2422-2432, DOI: 10.7659/j.issn.1005-6947.250395
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Background and Aims The growing population of patients living with a stoma has led to increasingly complex clinical and long-term management needs. Machine learning (ML), with its strong capability for processing multidimensional data, has been progressively applied to stoma care. This scoping review aims to map current applications of ML in stoma patients, summarize research trends and model performance, and identify existing gaps to support future methodological and clinical development.Methods Guided by the Joanna Briggs Institute scoping review methodology, eight major Chinese and international databases were searched from inception to April 10, 2025. Two reviewers independently screened the literature, extracted data on study characteristics, ML algorithms, application domains, predictors, and model performance. Methodological quality and risk of bias were assessed using the updated PROBAST+AI tool.Results Fifteen studies were included. ML has been applied in multiple domains, including postoperative complication prediction, prognosis assessment, patient education, nursing knowledge-base construction, health economic analyses, and body composition assessment. Ten studies developed a total of 40 prediction models covering six categories of predictors: demographic characteristics, physiological/physical status, surgical factors, disease staging and treatment, stoma-related variables, and psychosocial factors. Most models demonstrated good discriminative ability (AUC>0.80). However, PROBAST+AI revealed generally high risk of bias, mainly due to retrospective designs, incomplete data reporting, and insufficient external validation. Large language model-based educational tools improved information accessibility but showed limited personalization and high reading difficulty. Economic studies suggested that ML-assisted decision-making may offer cost-effective support for protective stoma strategies.Conclusion ML shows promising value across multiple stages of stoma management, especially in risk prediction and decision support. Nevertheless, methodological limitations-particularly high bias risk, limited external validation, and inadequate clinical integration-hamper its broader application. Future research should prioritize multicenter prospective studies, expand to diverse stoma populations including urostomy, enhance model interpretability, and promote clinically deployable intelligent care tools.
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LAN Dongyuan, YANG Mingyu, CHI Hao, WANG Hongbo, BAI Kecheng, QIU Yingjia, SUI Chengqiu, ZHANG Daqi
2025,34(11):2433-2441, DOI: 10.7659/j.issn.1005-6947.250153
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Ki-67, a key marker of cellular proliferation, has gained increasing recognition in the management of medullary thyroid carcinoma (MTC). With the establishment of the International Medullary Thyroid Carcinoma Grading System (IMTCGS), a Ki-67 proliferation index ≥5% has been incorporated as a major criterion for defining high-grade MTC and predicting adverse outcomes. This review provides a comprehensive overview of the role of Ki-67 across the continuum of MTC care. In diagnosis, the Ki-67 index assessed in fine-needle aspiration samples correlates well with surgical specimens and assists in predicting tumor grade and optimizing imaging strategies. In prognosis, elevated Ki-67 levels are significantly associated with aggressive clinicopathological features, shorter survival, and accelerated calcitonin/CEA doubling times, establishing Ki-67 as a robust independent prognostic indicator. In therapeutic decision-making, Ki-67 may help determine surgical extent, guide postoperative surveillance, and serve as a dynamic marker for evaluating response to targeted therapies. Ki-67 also demonstrates potential complementary value when combined with RET mutations and other molecular biomarkers, supporting more refined risk stratification. Although interobserver variability remains a limitation, advances in AI-assisted pathology and preliminary studies on serum Ki-67 offer promising avenues for standardization and non-invasive assessment. Overall, Ki-67 plays an increasingly important role in grading, prognostication, and clinical decision-making in MTC, and may further enhance individualized disease management.
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WEN Bingbing, TANG Yufan, ZHOU Baiquan, SHA Ying, YU Ke, JIA Jiajia, FAN Ruifang
2025,34(11):2442-2453, DOI: 10.7659/j.issn.1005-6947.250273
Abstract:
Differentiated thyroid carcinoma (DTC) generally carries a favorable prognosis; however, its malignant progression and resistance to radioactive iodine therapy are strongly associated with specific driver gene mutations. Alterations in key genes-such as BRAF, RAS, TERT, and RET-not only influence tumor differentiation, aggressiveness, and recurrence risk but also provide critical molecular information for risk stratification, prognostic evaluation, and individualized therapeutic decision-making. With the increasing availability of multi-gene testing, the diagnostic accuracy for cytologically indeterminate thyroid nodules has markedly improved, and gene profiling has become essential in guiding neoadjuvant strategies for locally advanced disease. Targeted therapies, including multi-kinase inhibitors and gene-specific inhibitors (e.g., BRAF and RET inhibitors), have significantly improved survival outcomes in patients with radioactive iodine-refractory DTC. Nevertheless, acquired resistance and treatment-related adverse events remain major limitations. Emerging evidence suggests that dual-target inhibition and combinations of targeted therapy with immunotherapy may yield additional clinical benefits. This review summarizes the clinical implications of major gene mutations in DTC, the application of multi-gene testing, and recent advances in targeted therapies to support precision management.
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2025,34(11):2454-2461, DOI: 10.7659/j.issn.1005-6947.250281
Abstract:
With the widespread adoption of fine-needle aspiration (FNA) in the diagnostic workup of thyroid nodules, the role of intraoperative frozen section (FS) in surgical decision-making has been increasingly re-evaluated in the post-Bethesda era. This review systematically summarizes the clinical value of FS across different Bethesda categories, with particular focus on its role in preventing overtreatment and avoiding insufficient surgery, as well as the notable differences between Western and Asian clinical practices. Current evidence indicates that for Bethesda Ⅵ nodules, the positive predictive value of FNA is extremely high, and routine FS rarely alters surgical management while potentially increasing the risk of under-treatment due to false-negative results. For Bethesda V nodules, the utility of FS largely depends on the population-specific risk of malignancy (ROM): in Western countries with relatively lower ROM, FS may reduce overtreatment caused by FNA false positives, whereas in China and other Asian populations with significantly higher ROM, routine FS provides limited additional benefit. For Bethesda Ⅱ nodules, routine FS is not cost-effective and should be reserved for selected high-risk cases. FS is beneficial in Bethesda I and some Bethesda Ⅲ nodules for clarifying diagnosis and optimizing the extent of initial surgery, but it is not recommended for routine use in Bethesda Ⅳ nodules due to low diagnostic sensitivity. Molecular testing offers new tools for risk stratification in indeterminate nodules, although its application remains limited in China. In conclusion, FS should not be applied uniformly across all patients but rather tailored according to Bethesda category, population-specific ROM, and institutional diagnostic performance of FS.
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CHAO Shijia, LU Guangyuan, GAN Bangjia, OU Keru, TANG Jintao, ZUO Yanan, ZHANG Qinqin
2025,34(11):2462-2468, DOI: 10.7659/j.issn.1005-6947.240601
Abstract:
Chemotherapy is a cornerstone of comprehensive treatment for breast cancer, and the administration of adequate doses on schedule is crucial for improving patient outcomes. However, chemotherapy-related adverse effects, particularly chemotherapy-induced peripheral neuropathy (CIPN), can substantially impair quality of life and compromise treatment adherence, while effective preventive or therapeutic strategies remain limited. Growing evidence indicates that vitamin D deficiency may represent an important risk factor for the development of CIPN in breast cancer patients. Experimental and clinical studies suggest that vitamin D may exert neuroprotective effects by promoting myelination, facilitating axonal regeneration, modulating inflammatory responses, and alleviating oxidative stress, thereby potentially reducing the incidence and severity of CIPN. This review summarizes current advances in the pathophysiological mechanisms of CIPN and the association between vitamin D deficiency and CIPN in breast cancer, and discusses the potential clinical implications of vitamin D supplementation, aiming to provide new insights into the prevention and management of CIPN.
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PU Baohong, CUI Jiaming, ZHANG Xu, MA Shixun, LIU Peng, MA Yueqin, ZHU Junyi, MIAO Changfeng, FANG Wei, TIAN Hongwei, GUO Tiankang
2025,34(11):2469-2479, DOI: 10.7659/j.issn.1005-6947.250350
Abstract:
Advances in 5G networks have enabled remote robotic surgery to transition from technical exploration to clinical implementation, providing a new paradigm for complex general surgical procedures. Supported by low-latency and high-reliability data transmission, telesurgical systems achieve real-time master-slave control across long distances, significantly improving surgical precision and operational flexibility. Applications in gastrointestinal, hepatopancreatobiliary, and thyroid surgery have progressed from single-case demonstrations to multi-center practice, consistently demonstrating low intraoperative blood loss, reduced complication rates, and enhanced postoperative recovery. Domestic robotic platforms have also shown reliable performance in early clinical evaluations. Despite these achievements, telesurgery still faces challenges related to network stability, system redundancy, regulatory and ethical clarity, and the absence of a mature reimbursement framework. Looking ahead, the integration of AI-assisted decision-making, digital twins, and emerging 6G technologies will further drive telesurgery toward intelligent automation, intercontinental collaboration, and innovative emergency-care models. Overall, remote robotic surgery is expected to promote a new era of precision, intelligence, and equitable access in general surgery.
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ZHANG Weiwei, LI Guangyao, LIU Liu, YAO Yuan, WANG Yandong, GE Guochao, HUANG Wei, ZHU Weiwei, ZHU Jiangpeng, ZHANG Zhengjun
2025,34(11):2480-2487, DOI: 10.7659/j.issn.1005-6947.240383
Abstract:
Malignant tumors remain a major global public health challenge owing to their high incidence and mortality. Detection technologies constitute the foundation of precision oncology. Although tissue biopsy is regarded as the gold standard for tumor diagnosis, its invasiveness and limited feasibility for longitudinal monitoring restrict its clinical utility in certain scenarios. In recent years, circulating tumor DNA (ctDNA)–based liquid biopsy has rapidly emerged as a promising analytical approach, offering advantages such as minimal invasiveness, repeatability, and real-time reflection of tumor molecular characteristics. Accumulating evidence indicates that ctDNA plays an important role in early tumor monitoring, auxiliary diagnosis, prognostic evaluation, detection of minimal residual disease and recurrence, prediction of neoadjuvant therapy response, assessment of metastatic disease, therapeutic decision-making, and monitoring of treatment efficacy and drug resistance. This review systematically summarizes the biological characteristics of ctDNA and its current clinical applications throughout the entire continuum of cancer management, and discusses existing challenges and future perspectives, aiming to provide insights for the standardized clinical implementation of ctDNA testing.
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Volume 34,2025 Number 11
GUIDELINE AND CONSENSUS
INVITED ARTICLE
COMMENTARY
SPECIALIST FORUM
MONOGRAPHIC STUDY
BASIC RESEARCH
CLINICAL RESEARCH
REVIEW
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Chinese Society for Metabolic, Bariatric Surgery (CSMBS), Beijing Metabolic & Bariatric Doctor Association (BMBDA), Obesity, Metabolism Specialty Committee of the National Health Commission Capacity Building, Continuing Education Center, ZHU Saihong, ZHANG Peng, BAI Rixing
Abstract:
Hiatal hernia (HH) is highly prevalent in individuals with obesity and is closely associated with gastroesophageal reflux disease (GERD), making it a common and clinically important comorbidity in metabolic bariatric surgery (MBS). Currently, standardized diagnostic and therapeutic strategies for obese patients with different types of HH remain lacking. To improve the standardization and consistency of HH management during MBS in China, the Chinese Society for Metabolic and Bariatric Surgery, together with multiple academic societies, organized 93 national experts to develop a consensus based on the latest evidence and clinical experience. The consensus addresses 12 key issues, including preoperative evaluation, intraoperative diagnosis and differentiation, the necessity of dissecting tissues around the gastroesophageal junction, strategies for concomitant repair, procedure selection according to HH subtype, and reinforcement or fixation of the gastric sleeve. This consensus aims to provide evidence-based guidance for diagnosis, classification, procedure selection, and intraoperative management of HH in obese patients undergoing MBS. It also highlights the current limitations in available evidence and emphasizes the need for further high-quality studies to optimize future clinical guidelines.
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Chinese expert consensus on quality evaluation index system for extracranial carotid artery stenting
Expert Working Group on Carotid Artery Disease of the Expert Committee of the National Peripheral Vascular Intervention Technology Quality Control Cen, Shu Chang, 符伟国
Abstract:
In recent years, the scale of extracranial carotid artery stenting (CAS) procedures in China has continued to expand. Establishing a scientific quality evaluation system, optimizing standardized surgical workflows, and effectively improving the survival quality of patients with carotid stenosis and occlusive diseases have become urgent challenges in the field of vascular surgery. After thorough discussions by the Expert Working Group on Carotid Artery Diseases of Expert Committee of the National Center for Medical Quality Control in Peripheral Vascular Interventional Technology, seven safety indicators were proposed: risk-adjusted 30-day postoperative mortality, risk-adjusted non-rehabilitative discharge rate, risk-adjusted in-hospital stroke/transient ischemic attack incidence, risk-adjusted 30-day unplanned carotid reintervention rate, risk-adjusted postoperative acute coronary syndrome incidence, risk-adjusted acute kidney injury incidence, and risk-adjusted access vessel reintervention rate. In addition, five technical indicators were established: pre- and postoperative antiplatelet medication use rate, preoperative carotid stenosis assessment rate, preoperative intracranial vascular evaluation rate, preoperative coronary artery assessment rate, and intraoperative cerebral protection device utilization rate. The promotion of these key quality indicators is expected to enhance the consistency of CAS surgical quality across medical institutions of different levels and regions.
