As a complex surgical procedure, ex-vivo liver resection and autotransplantation （ELRA） is indicated for complex lesions invading inferior vena cava, portal vein, liver vein and their branches. In recent years, ELRA has evolved rapidly after extensive applications and researches. Major indications are advanced liver malignancies and end-stage hepatic alveolar echinococcosis （HAE）. According to a recent study, patients with liver Child-Pugh score B and ratio of residual liver volume （RLV） to standard liver volume （SLV） of 0.35-0.40 might fulfill the liver requirements of ELRA. In addition, in vivo temporary portal vena cava shunting has also become a primary choice for its lower postoperative mortality than extracorporeal venous bypassing. Intraoperative revascularization focuses upon selecting reconstruction mode of retrohepatic inferior vena cava. Based upon defect severity of posterior hepatic inferior vena cava wall after lesion resection, direct suturing, patching and artificial blood vessel may be adopted. This review summarized the latest surgical researches of ELRA to further explore its development potentials.

Objective To explore the occurrences and risk factors of low anterior resection syndrome (LARS) in low rectal cancer patients with neoadjuvant chemotherapy followed by curative restorative anterior resection. Methods For this cross-sectional study, 129 low rectal cancer patients on neoadjuvant chemotherapy were recruited at Sixth Affiliated Hospital between September, 2010 and December, 2020. Those with curative restorative anterior resection were included while those with pelvic radiation, stoma without closure and local tumor recurrence or metastasis excluded. LARS score was utilized for assessing bowel function at least 1 year post-restoration. They were categorized into three groups of no LARS (0-20 points), mild LARS (21-29 points) and severe LARS (30-42 points). Baseline profiles, tumor features, treatment strategies and postoperative complications were included into Logistic regression analysis for assessing the risk factors for overall and severe LARS. Results 30 patients became lost to follow-ups. Only in preoperative body mass index (23.0±3.0 vs. 20.8±2.9) and pathological T stage (pT0-2: 62.8% vs 26.7%)(P＜0.05),differed significantly between the follow-up and lost-follow-up group. There were 84 males and 45 females with an average age of (56.4±12.4) year and an average tumor diameter of (3.8±0.7) cm. Preoperative chemotherapeutic regimen CapeOX/FOLFOX (78.3%) or FOLFOXIRI was offered. 29.5%(38/129) underwent transanal and transabdominal laparoscopy, 71.4%(92/129) had intersphincteric resection, 74.4%(96/129) received prophylactic stomas and 13.2%(17/129) developed postoperative anastomotic leakage. During a median follow-up period of 3.9(1.0-10.4) year, there were an overall LARS incidence of 55.0%(71/129) and a severe LARS incidence of 24.0%(31/129). Constipation (defecation less than once daily) and frequent defecation within 1h were the most common symptoms. Logistic univariate regression analysis indicated that male gender (OR=2.565, P=0.012), anastomotic leakage (OR=4.503, P=0.015) and bowel continuity restoration time ≤4 year (OR=2.285, P=0.021) were risk factors for overall LARS; male gender (OR=2.754, P=0.037), anastomotic leakage (OR=6.190, P=0.001), intersphincteric resection (OR=3.427, P=0.026) and hand-sewn anastomosis (OR=3.538, P=0.008) were risk factors for severe LARS. Multivariate Logistic regression analysis revealed that male gender (OR=2.885, P=0.013), postoperative anastomotic leakage (OR=3.866, P=0.046) and bowel continuity restoration time ≤4 year (OR=2.871, P=0.009) were independent risk factors for overall LARS. However, only anastomotic leakage (OR=5.155, P=0.004) was an independent risk factor for severe LARS. Conclusion Nearly half of low rectal cancer patients on neoadjuvant chemotherapy develop LARS after restorative surgery. Constipation (defecation less than once daily) and frequent defecation within 1h are the most common symptoms. LARS symptoms may self-alleviate overtime. Patients of anastomotic leakage tend to have a worse defecation prognosis.

Objective To retrospectively explore the metastasis characteristics and survival outcomes of lateral and mesenteric lymph nodes after laparoscopic lateral lymph node dissection (LLND) via a facical space priority approach for rectal cancer. Methods From May 2017 to December 2022, the relevant clinical data were collected of 111 patients undergoing laparoscopic lateral lymph node dissection via a facical space priority approach. The status of lateral and mesenteric lymph node metastasis and survival prognosis were examined whether or not lateral lymph node metastasis should be classified as local or distant. Results The survival curves of mesentery (-) lateral (+) (n=20) and mesentery (+) lateral (+) (n=58) groups were analyzed by COX survival curve. The 3-year survival rate of mesentery (-) lateral (+) group (n=20) was 58% and that of mesentery (+) lateral (+) group (n=58) 59.8%. The survival curve of two groups was consistent with survival curve of N₂ stage rectal cancer and 3-year survival rate was similar to that of N2 stage rectal cancer. Conclusion The outcomes of rectal cancer patients with lateral lymph node metastasis without mesorectal lymph node metastasis may be similar to that of those with N₂ stage rectal cancer and much better than that of those with stage Ⅳ rectal cancer. It implies that lateral lymph node metastasis may be classified as regional rather than distant.

Intrahepatic cholangiocarcinoma （ICC） is a highly malignant primary liver cancer with the second highest incidence of primary liver cancer. Surgical resection remains a sole cure for ICC. And due to great invasiveness, its prognosis remains poor. Most patients have lost the chance of surgery when the disease is initially detected. And there is still a high risk of postoperative recurrence. In recent years, transarterial chemoembolization, hepatic arterial infusion and chemoradiotherapy have achieved some successes of ICC treatment. Liver transplantation has gradually been actively explored for early-stage ICC. Currently targeted therapy and immunotherapy are also gradually emerging. Comprehensive and personalized treatments have been formulated with surgery as a mainstay along with a combination of various treatments. With rapid advancements of gene sequencing technology and in-depth researches on tumor microenvironment, molecular classification has also become a recent hotspot. However, some controversial protocols should be validated by large-scale clinical trials. This review summarized the latest advances of molecular classification, local/systemic treatment of ICC and guiding role of molecular classification for targeted therapy and other therapeutics.

Objective To explore the application of uNavigator dual navigation system during perioperative period of laparoscopic liver resection. Methods This 53-year-old female had a history of lumbar disc herniation. Preoperative complete blood count, coagulation function, liver function and renal function were all normal. An 11.2 cm hepatic hemangioma was detected in right lobe of liver close to right posterior and right anterior hepatic pedicles and right hepatic vein. Laparoscopic resection of right posterior lobe and dorsal segment of right anterior lobe was planned. Three-dimensional （3D） hepatic image was reconstructed based upon the DICOM data of abdominal contrast-enhanced computed tomography （CT） for physician-patient communication, preoperative surgical planning and intraoperative navigation. Results Fusion of three-dimensional image and actual liver was utilized for marking left border of hemangioma and course of right anterior and right posterior hepatic pedicles. An ultrasonic scalpel was applied for separating liver parenchyma along border and Endo-GIA for resecting right posterior hepatic pedicle and main right hepatic vein. Operative duration was 180 min and volume of blood loss approximately 300 mL. She recovered well post-operation and was smoothly discharged from hospital at Day 8. Conclusion uNavigator dual navigation system may promote doctor-patient communication and aid clinicians in preoperative planning and intraoperative navigation.

Objective To assess the clinical efficacy of fourth-generation Da Vinci robotic surgical system for mid-low rectal cancer after neoadjuvant chemotherapy. Methods A retrospective analysis was conducted for collecting the relevant clinical data from 101 patients with mid-low rectal cancer on preoperative neoadjuvant chemotherapy between August 2020 and May 2023. Propensity score matching (1∶1, caliper value =0.01) was utilized for pairing propensity scores based upon gender, age, ASA score, body mass index (BMI), tumor location, TNM stage and neoadjuvant therapy. A total of 90 patients were finally enrolled, including 56 males and 34 females. They were assigned into two groups of robot-assisted radical resection of rectal cancer using fourth-generation Da Vinci system (robot, n=45) while laparoscopic-assisted radical resection (laparoscopic, n=45). Observation parameters included perioperative recovery and postoperative pathological conditions. Results As compared to laparoscopic group, robot group exhibited lesser intrpaoerative blood loss, shorter time to first postoperative feeding, quicker removal of urinary catheter, lower postoperative pain intensity and greater number of harvested lymph nodes. However, it had longer operative duration and higher total expense of hospitalization. Conclusion The fourth-generation Da Vinci robotic surgical system is as safe and effective as laparoscopy while potentially offering advantages in terms of surgical trauma reduction, improved postoperative recovery outcomes and oncological radical resection in patients with mid-low rectal cancer after neoadjuvant chemotherapy.

Severe acute pancreatitis （SAP） is frequently associated with a high mortality. With a quick progression, it is accompanied by one or more complications. This review focused upon the application scopes, advantages and disadvantages of various pancreatic scoring systems to assist clinicians in assessing disease severity and predicting outcomes. It was intended to provide references for properly managing SAP.

Objective To explore the preoperative indocyanine green retention rate at 15 min (ICG-R15) plus albumin-bilirubin (ALBI) score and determine clinical significance of ALBI for predicting post-hepatectomy liver failure (PHLF) in patients with primary liver cancer. Methods Clinical data were retrospectively reviewed for patients undergoing hepatectomy for primary liver cancer from January 2020 to August 2022. According to the recovery status of liver function, 38 patients with liver failure after hepatectomy were classified as PHLF group and another 142 patients non-PHLF group. And t or Mann-Whitney U test was utilized for comparing the measurement data between two groups. And χ² test was used for comparing the count data between two groups. Preoperative ALBI score, preoperative ICG-R15, prothrombin time (PT), intraoperative blood loss and hepatic portal occlusion time were compared to determine whether or not significant inter-group differences existed in potential thrombin time. Results Logistic regression model was utilized for examining the independent risk factors of posthepatectomy liver failure. Receiver operating characteristic (ROC) curve was employed for exploring the predictive efficacy of ALBI score and ICG-R15 for PHLF. ALBI score (P=0.001), preoperative ICG-R15 (P＜0.001), intraoperative blood loss (P=0.026), hepatic portal occlusion time (P=0.042), resection extent ≥3 segments (P=0.005) and PT (P=0.023) were independent risk factors for postoperative liver failure. The sensitivity of ALBI score plus ICG-R15 in predicting PHLF was 89.5% and prediction efficiency was significantly higher than that of each alone (P＜0.001). Conclusion ALBI score plus ICG-R15 is more effective in predicting the occurrence of postoperative liver failure.

Objective To evaluate the efficacy and safety of laparoscopic partial splenectomy（LPS） in the surgical treatment of splenic benign lesions. Methods Between January 2018 and July 2023, the relevant clinical data of 85 patients with splenic benign lesions were retrospectively analyzed. Based upon surgical approaches, they were assigned into two groups of LPS （n=25） and LTS group （n=60） according to the surgical methods. The related perioperative parameters were recorded. The incidence of complications （abdominal fluid accumulation, infection, venous thrombosis & thrombocytosis,etc.） were compared between two groups. Results All operation were successfully completed. Postoperative drainage time [（4.6±1.6） vs. （5.9±1.6） day], postoperative ventilation time [（1.4±0.5） vs. （1.9±0.8） day], postoperative activity time [（2.6±0.5） vs. （3.1±0.8） day] and postoperative hospitalization stay [（6.3±1.5） vs. （7.8±3.1） days] were shorter in LPS group than those in LTS group. White blood cell count [（10.2±2.1）×10⁹/L vs. （14.7±4.1）×10⁹/L, （9.5±3.3）×10⁹/L vs. （13.3±3.8）×10⁹/L] and platelet count [（172.8±57.9）×10⁹/L vs. （203.0±61.3）×10⁹/L, （210.1±112.5）×10⁹/L vs. （298.0±125.9）×10⁹/L] were lower in LPS group than those in LTS group at Day 1/3 post-operation. There were statistically significant differences （all P<0.05）. However, no significant inter-group differences existed in operative duration, intraoperative volume of blood loss, postoperative drainage volume, red blood cell count or hemoglobin/albumin level （all P>0.05）. In addition, the incidence of postoperative complications was significantly lower in LPS group than that in LTS group [4.0%（1/25） vs. 30.0%（18/60）] and the difference was statistically significant （χ²=5.457,P<0.05）. Conclusion As an effective, safe and feasible surgery, LPS has an important value in the clinical management of splenic benign lesions. It is recommended for wider popularization at qualified medical centers.

Objective To explore the clinical significance of CTC (circulation tumor cells) in cholangiocarcinoma. Methods From June 2022 to December 2022, patients with cholangiocarcinoma (n=73) and benign biliary disease (n=19) were selected as research subjects. Through an institutional laboratory platform, the pre-treatment levels of CTC were detected and the relevant clinicopathological data collected. Receiver operating characteristic (ROC) curves were plotted for examining the diagnostic value of CTC for cholangiocarcinoma and the predictive value for lymph node metastasis. And relationship between level of CTC and clinical characteristics of cholangiocarcinoma was analyzed. Results As compared with benign diseases, the detection rate and number of peripheral blood CTCs were significantly greater in patients with cholangiocarcinoma. The results of ROC curve analysis implied that CTC had some value in diagnosing biliary tract cancer and predicting lymph node metastasis and distant metastasis of biliary tract cancer. Conclusion Peripheral blood CTCs are potential diagnostic markers for cholangiocarcinoma. Further explorations are required.

Total mesorectal excision (TME) has emerged as a gold standard treatment for patients of mid-low rectal cancer. To enhance the efficacy of TME while preserving functionality, it is crucial to gain a comprehensive understanding of surgical anatomy associated with this procedure. This includes an in-depth knowledge of regional anatomy, fascia anatomy and autonomic nervous system. The present study was intended to summarize a series of research conducted on TME-related anatomy. Notably, our findings revealed the presence of a loosely connected region within left retroperitoneal space, adjacent to vascular pedicle of inferior mesenteric artery. This region served as an optimal starting point for dissecting left retroperitoneal space. For separating left retroperitoneal space during lateral or central approaches, it was necessary to transect left parietal peritoneum, serving as an anatomical basis for "staggered layer phenomenon". In selected advanced cases, intrasheath separation of inferior mesenteric artery with high ligation at its root might be performed for preserving left sheath/trunk of inferior mesenteric artery. Prehypogastric fascia acted as a "fascia barrier" during constant posterior-to-anterior dissection of lateral space. Additionally, pelvic plexus merged with prehypogastric fascia, an outer layer of rectosacral fascia laterally. Therefore, prior to dissecting lateral spaces, it was vital to initially dissect anterior rectal space. After performing a "U"-shaped incision of Denonvilliers′ fascia, dissecting lateral space should proceed from anterior to posterior. Subsequently, lateral attachment of rectosacral fascia was transected to ensure the integrity of mesorectum while avoiding injuries to pelvic plexus. Partial preservation of Denonvilliers′ fascia helped to mitigate the risk of anterior mesorectal disruption and minimize the potential injuries to neurovascular bundles(NVB) at the level of seminal vesicles. Nerve fibers from NVB at the prostate level were small and their functional zones could not be distinguished intraoperatively. Therefore it was crucial to protect fat pad of neurovascular bundles at the prostate level as a whole. Having a distict understanding of morphology of fat pad of NVB at the prostate level provided valuable surgical guidance for dissecting this critical area. In cases of intersphincteric resection or abdominoperineal resection for very low rectal cancer, anterior dissection plane behind Denonvilliers′ fascia disappeared at the level of prostate apex. Prostate and NVB should be employed as landmarks during transanal dissection of non-surgical plane. Rectourethralis muscle should be divided adjacent to rectum side unless there was suspicion of tumor involvement.

Pancreatic cancer （PC） is one of the most malignant tumors in digestive tract. It lacks early screening and diagnostic methods and treatment outcomes are disappointing. Its incidence rate is rising all over the world. This review focused upon the effects of intestinal flora on the occurrence and development of PC and discussed its possible mechanism of action. Other topics included dosing of antibiotics, fecal bacteria transplantation and other measures for regulating the composition of intestinal flora in the comprehensive treatment of PC. It was intended to offer new rationales for an early diagnosis and accurate treatment of PC.

Duodenal perforation is an occasional and yet serious complication of endoscopic retrograde cholangiopancreatography （ERCP） and sphincterotomy. Its early clinical symptoms are often difficult to differentiate with those of postoperative pancreatitis and cholangitis. Delayed diagnosis and retroperitoneal infection may lead to sepsis and multiple organ failure with prolonged hospitalization and higher mortality. Loose intraperitoneal tissue easily spreads along retroperitoneal space and poor blood supply causes early abscess formation. An early diagnosis and timely interventions shall greatly improve patient outcomes. This review summarized the domestic and foreign literature on properly managing retroperitoneal infection in duodenal perforation after ERCP.

N6-methyladenosine (m⁶A) is one of the most significant post-transcriptional modification in eukaryotics. The relationship between m⁶A modification and abdominal tumors has become a hot-button issue. Macrophages are phagocytic cells of innate immune system serving vital functions in the recognition, phagocytosis and degradation of pathogens and tumor cells. Tumor-associated macrophages (TAMs) may switch the functions of suppressing or promoting tumor progression in different tumor microenvironments (TMEs). In recent years, many studies have demonstrated that m⁶A modification could regulate tumor progression through regulating TAMs. This review summarized the characteristics of m⁶A "writers", "erasers" and "readers" and examined the relationship between m⁶A and TAMs to provide new targets and research rationales for TAMs in m⁶A modification.

Traditional laparoscopic hepatectomy has many disadvantages, such as difficulty in tumor localization, inaccurate marking of liver segments, and lack of intraoperative real-time navigation, which cannot meet the requirements of precise hepatectomy and anatomical hepatectomy. The emergence of fluorescence imaging technology represented by indocyanine green has shown powerful advantages in displaying bile ducts, locating tumors, marking liver segments, displaying micro lesions, and examining resection margins, which has made up for the inherent defects of laparoscopy and gradually become the mainstream of laparoscopy. The innovation and development of fluorescence imaging technology such as excitation light source and probe molecule have further promoted the in-depth application of fluorescence imaging technology in laparoscopic hepatectomy.

As one type of primary liver cancer, intrahepatic cholangiocarcinoma （ICC） is characterized by an insidious onset, a rapid progression and a high level of malignancy. Most patients are already in middle and late stages. Radical surgical resection remains a sole cure for ICC. However, postoperative survival time is short and the prognosis rather poor. In recent years, some advances have been made in the diagnosis and treatment of ICC. A surgical based multidisciplinary approach helps to improve the overall prognosis of patients. Based upon current hot issues in the diagnosis and treatment of ICC, this review summarized the latest research advances in the diagnosis and treatment of early and locally advanced ICC under a multidisciplinary integrated management model and explore future prospects.

As the ultimate sphincter-preserving approach for ultra-low rectal cancer, intersphincteric resection has undergone rapid developments. Adequate preoperative imaging evaluation is crucial in ensuring its successful implementation. However, due to unique location and anatomy associated with ultra-low rectal cancer, there are still ongoing controversies of preoperative imaging evaluations. This review summarized the latest advancements in preoperative pelvic imaging for ultra-low rectal cancer based upon the experience of our center.

In recent years, the advancements of systemic and local treatments have catalyzed transformations in the diagnostic and therapeutic paradigms for hepatocellular carcinoma. The traditional "surgery-first" philosophy of prioritizing surgery has gradually evolved into a "strategy-first" approach of treating surgery as a foundation. Various novel therapeutic approaches have been formulated for achieving optimal outcomes. And conversion therapy for liver cancer has played some vital roles in this evolution. This approach has opened up surgical opportunities for patients initially deemed unresectable with poor prognostic expectations. It involves preliminary preoperative interventions for better oncological outcomes. Conversion therapy of liver cancer is a hot research area. However, its clinical applications still have some contentious issues. For instance, how can we scientifically and individually tailor neoadjuvant therapy for patients? Is surgery always necessary for patients with a successful conversion? What is optimal operative timing for ensuring the best therapeutic outcome? How can hepatic artery infusion chemotherapy （HAIC） be judiciously utilized for maximizing the benefits of conversion? And how can we scientifically evaluate and employ treatments of promote the growth of future liver remnant （FLR）, such as terminal branches portal vein embolization （TB-PVE） or associating liver partition and portal vein ligation for staged hepatectomy （ALPPS）? This review provided a preliminary discussion of these common concerns.

Colorectal cancer is the most common cancers in China. And low rectal cancer accounts for a greater proportion. Currently a combination of neoadjuvant chemoradiotherapy and total mesorectal excision (TME) is recommended by domestic and foreign guidelines a standard treatment for locally advanced rectal cancer. Based upon preoperative examination of magnetic resonance imaging (MRI), optimization of neoadjuvant treatments, a greater popularization of "Watch & Wait" treatment strategy and new TME-related surgical procedures, a proper management of low rectal cancer continues to advance in the directions of individualization and precision. The therapeutic goals for patients with colorectal cancer are achieving long-term survival and ensuring decent quality-of-life. This review summarized the latest clinical advances of low rectal cancer.

Objective To explore the high risk factors of senile cholecystolithiasis and construct a nomogram prediction model. Methods From January 2019 to November 2022, 160 elderly patients hospitalized with cholecystolithiasis were selected as case group. Another 160 elders receiving health examination at the same time were selected as control group. The relevant clinical data of two groups were recorded to explore the related factors of elders with cholecystolithiasis. Receiver operating characteristic curve was plotted for examining the statistically significant factors; Logistic regression analysis was utilized for examining the independent risk factors; R language software 4.0 "rms" package was utilized for constructing a nomogram prediction model. The correction curve verified the nomogram prediction model internally and the decision curve was employed for evaluating the clinical prediction efficiency of nomogram model. Results As compared with control group, body mass index(BMI) of study group was higher(P＜0.05), the proportion of diabetes and systolic blood pressure(SBP)≥140 mmHg was higher(P＜0.05), the levels of total cholesterol(TC), triglyceride(TG), low-density lipoprotein-cholesterol (LDL-C) and fasting blood glucose (FBG) were higher and the level of high-density lipoprotein-cholesterol (HDL-C) was lower(P＜0.05). The area under the curve (AUC) of BMI, TC, TG, HDL-C, LDL-C and FBG was 0.846, 0.722, 0.814, 0.825, 0.832 and 0.857 and the optimal cutoff values were 23.24 kg/m², 5.01 mmol/L,1.33 mmol/L, 0.86 mmol/L, 3.8 mmol/L and 5.6 mmol/L respectively. BMI, diabetes mellitus, SBP, TC, HDL-C and FBG were independent risk factors for an onset of cholecystolithiasis in elders. Nomogram model predicted that C-index was 0.725(95%CI: 0.638-0.816) and calibration curve was almost ideal. The threshold value of nomogram model for predicting the incidence of senile cholecystolithiasis was ＞0.19. Nomogram model provided clinical benefits and net benefit was higher than the independent predictors of BMI, diabetes mellitus, SBP, TC, HDL-C and FBG. Conclusion BMI, diabetes mellitus, SBP, TC, HDL-C and FBG are independent risk factors affecting the incidence of senile cholecystolithiasis.Nomogram prediction model is constructed for estimating the incidence of senile cholecystolithiasis. It is conducive to early prevention and timely intervention of senile cholecystolithiasis.

目的 探讨原发性肝脏鳞状细胞癌（primary squamous cell carcinoma of liver,PSCCL）病例的特点及可能的发病机制,总结PSCCL病人目前可供选择的治疗方法及预后。方法 对2022年7月15日收入三峡大学第一临床医学院肝胆胰外科的1例77岁男性罕见PSCCL病人诊治资料进行总结分析,并结合国内外相关文献进行复习。结果 病人因“间断性上腹痛半月余,加重2 d”入院,入院后完善肝脏平扫增强CT、肝脏穿刺活检、正电子发射计算机断层显像（PET-CT）等检查,结合病人肝脏穿刺活检病理、免疫组化、CT及PET-CT检查结果,排除其他部位肿瘤转移所致,考虑为PSCCL。病人家属要求保守治疗,给予对症支持治疗后,病人于2022年8月1日主动要求出院。电话随访,病人于2022年9月因肝癌多发转移致多器官衰竭死亡。结论 PSCCL是一种肝脏异源性恶性肿瘤,发病机制尚不明确,诊断困难,暂无统一的治疗指南,临床上采用根治性肝切除、肝脏移植、放化疗、免疫治疗以及多种方法联合治疗,再辅以个体化支持治疗,可延长病人生存期,改善预后,但此肿瘤总体预后较差。

Objective To explore the safety and efficacy of early laparoscopic cholecystectomy （LC） for severe acute cholecystitis in emergency general surgery （EGS） grade III and above. Methods A total of 1,381 patients with acute cholecystitis underwent LC from January 2017 to June 2022. They were divided into two groups of severe （n=112） and general （n=1 269） according to disease severity. Two groups were compared in terms of preoperative general profiles, operative duration, intraoperative blood loss, intraoperative laparotomy rate, postoperative transfer rate into intensive care unit （ICU）, perioperative mortality, postoperative drainage, postoperative hospital stay and complication rate. Results Compared to general group, there were increases in operative duration [（100.54±22.23） vs. （61.31±10.48） min], intraoperative blood loss [40.00（20.00, 60.00） vs. 5.00（5.00, 10.00） mL], postoperative drainage [100.00（60.00, 152.50） vs 30.00（20.00, 40.00） mL] and postoperative hospital stay [（7.31±2.68） vs. （4.03±1.23） day]. There were statistically significant differences （P<0.05）; rate of conversion into open abdomen in intensive care group was 3.57% （P=0.208）, rate of postoperative transfer to ICU 4.46% （P=0.297）, perioperative mortality rate 0 and the incidence of complications was 7.14% （P=0.133）. There was no statistically significant difference with general group. Conclusion Early LC of severe acute cholecystitis of EGS grade III and above does not increase the incidence of postoperative complications. It is relatively safe and effective for severe acute cholecystitis.

对苏州大学附属第一医院2022年11月5日收治的1例肝脏Castleman病病例资料进行回顾性分析,并复习相关文献。该例病人因“体检发现肝脏占位性病变2月余”就诊,磁共振成像（MRI）平扫及增强检查示肝左叶S4段可见一椭圆形、大小约2.6 cm×2.0 cm异常信号影,考虑淋巴瘤可能,肝细胞癌待排。于2022年11月8日行扩大左半肝切除术+胆囊切除术。术后经病理及免疫组织化学证实为肝脏Castleman病。病人术后恢复良好,第11天痊愈出院。病人术后2周、1个月、半年随访复查均未见明显异常,一般情况良好,截至2023年5月仍持续随访中。肝脏Castleman病临床极其罕见,易误诊,需综合病理、免疫组织化学等方能明确诊断,治疗尚不统一,手术切除目前是首选方案。

Objective To explore the clinicopathological features of colonic neuroendocrine neoplasms （CNENs） and identify prognostic factors. Methods Clinical data were retrospectively reviewed for 28 patients hospitalized with CNENs from January 2012 to December 2022. The differences were examined in clinical characteristics of CNENs between left and right colon. Survival analysis was performed with Kaplan-Meier curve and clinical factors affecting the prognosis of CNENs summarized. Results There were 18 males and 10 females with a median age of 57.0（52.0-64.0） years. Tumor diameter was <2 cm （n=5） and ≥2 cm （n=23）. Tumor was located in right colon （n=28） and left colon （n=9）. Compared with CNENs in left colon, those located in right colon had larger tumor diameters and advanced T stages （P<0.05）. There were endoscopic mucosal resection （n=2）, endoscopic submucosal dissection with additional local resection （n=1）, endoscopic submucosal dissection with additional radical resection （n=1）, radical resection （n=12）, palliative resection （n=7） and non-surgery （n=5）. The clinical stages were T₁ （n=6）, T₃ （n=5） and T₄ （n=17）.Among 20 cases of radical/palliative resection plus lymphadenectomy, 15 were pathologically confirmed as associated lymph node metastasis and 10 had associated distant metastases. During a median period of 34.5（3.0-118.0） month, 11 patients died from disease progression. Seven cases of colonic neuroendocrine tumors （CNETs） without distant metastasis achieved long-term survival after primary tumor resection.Univariate prognostic analysis revealed that tumor diameter, pathological classification, depth of invasion and M stage were associated with cancer-specific survival（CSS）（all P<0.05）. And multivariate analysis indicated that M stage was significantly associated with prognosis [HR=8.958, 95%CI（2.241, 35.811）, P=0.002]. Conclusion CNENs have a high rate of metastasis and an overall poor prognosis.For CNETs without distant metastasis, primary tumor resection is efficacious.

Objective To explore whether or not Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis. Methods A total of 97 patients with hepatitis B cirrhosis and portal hypertension hypersplenism undergoing Hassab operation were selected and divided into two groups of disease （n=40） and control （n=57） according to the diagnostic criteria of splenic artery steal syndrome （SASS）. The inter-group differences in perioperative parameters were compared. Results No significant inter-group differences existed in perioperative parameters （P>0.05） or model for end-stage liver disease （MELD） score at Day 3 post-operation （P>0.05）. At Day 7 post-operation, MELD score of SASS group was significantly better than that of control group [（3.17±2.96） vs.（4.68±2.31）]; At Day 14 post-operation, the values of hepatic artery diameter/velocity were significantly better in SASS group than those in control group [（4.13±0.33） vs.（3.85±0.34） mm; （50.83±3.85） vs.（47.55±3.05） cm/s]（P<0.05）. Conclusion Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis. Introducing the concept of "Cirrhotic SASS" into clinical practices may benefit more patients with cirrhosis, portal hypertension and hypersplenism.

Objective To summarize the experiences of laparoscopic anatomical liver resection through a combination of three-dimensional 3D visualization technology, fluorescent imaging system and Intraoperative ultrasound. Methods From January 2023 to December 2023, the relevant clinical data were retrospectively reviewed for 22 patients of primary liver cancer undergoing laparoscopic anatomical liver resection. Before surgery, a three-dimensional visualization model of liver was established and surgical path planned. During surgery, anatomical liver resection was performed with fluorescent imaging technology and intraoperative ultrasound. Results All operations were successful on the basis of preoperative plan. Indocyanine green（ICG） stain was successful（n=21）. One case of unsuccessful ICG stain was due to severe liver cirrhosis. The pathological diagnoses were hepatocellular carcinoma （n=20）, cholangiocarcinoma（n=1） and mixed liver cancer（n=1）. All margins were negative. All of them recovered well after surgery and were discharged uneventfully. There was no tumor recurrence during a postoperative follow-up period of（2-8） months. Conclusion A combination of 3D visualization, ICG fluorescent imaging and intraoperative ultrasound provides a solid foundation for laparoscopic anatomical liver resection.

Objective To explore the feasibility of associating liver partition and portal vein ligation for staged hepatectomy （ALPPS） for massive liver tumors and summarize the treatment experiences. Method From January 2019 to March 2024, the relevant clinical data were retrospectively reviewed for 3 patients of massive liver tumors undergoing ALPPS. The perioperative data and operative findings were evaluated. Results Three patients had tumor diameters of 11.0 cm× 14.0 cm, 13.0 cm×15.5 cm and 16.5 cm×19.0 cm respectively. All of them underwent ALPPS successfully and there was no surgical mortality. Enhanced computed tomography （CT） re-examinations at Day 7 after ALPPS stage-Ⅰ revealed atrophy （n=2） at tumor-bearing side and hyperplasia at reserved side （64.41% vs. 72.38%）. One case showed no significant enlargement of preserved lateral liver lobe and remedial hepatic artery embolization （HAE） was performed. Future residual liver （FLR： residual liver volume/functional liver volume） was measured by enhanced CT at Day 14. After simulated right half liver/right trillobectomy, FLR was 51.27%, 62.33% and 46.48%. There were biliary leakage after ALPPS stage-Ⅰ （n=1） and chest and abdominal effusion after ALPPS stage-Ⅱ （n=2）. Alanine transaminase, total bilirubin and other indices became transiently elevated and normalized at Day 6. Alpha-fetoprotein （AFP） was <20.0 µg/L. All of them recovered and were smoothly discharged from hospital. Conclusion ALPPS may induce a rapid immediate proliferation of reserved liver lobes, lower the risk of postoperative liver failure in massive liver tumors and expand the limit of radical resection of liver tumors. It is recommended for massive liver tumors.

Objective To summarize the managements of Pneumocystis jiroveci pneumonia（PJP） in an early stage after orthotopic liver transplantation （LT）, explore the risk factors for an onset of disease and optimize its therapeutic outcomes. Methods From December 2020 to December 2023, the relevant clinical data were retrospectively reviewed for 5 PJP patients after LT. The diagnostic and therapeutic experiences were summarized from the aspects of clinical manifestations, early diagnosis, treatment planning, process monitoring and disease outcomes. Results There were 3 males and 2 females. A definite diagnosis of PJP was made by metagenomic next generation sequencing （mNGS）. The positive rates of serum （1, 3）-β-D-glucan assay（G assay） and lactate dehydrogenase （LDH） were both 100%. Two patients received oral endotracheal intubation and ventilator-assisted breathing. One case died while the remainders were discharged smoothly. Three patients received non-invasive ventilation or nasal high-flow oxygen inhalation assistance and eventually recovered. Conclusion Early detection of mNGS in bronchoalveolar lavage fluid may quickly identify the pathogens and compensate for the deficiencies of traditional testing methods. The levels of G assay and LDH are markedly elevated in PJP. With a high sensitivity in diagnosing the pathogen of infection, it is not specific. During treatments, it is necessary to dynamically adjust immunosuppressive regimens and antibiotic doses based upon immune status, organ function status and clinical manifestations. Mortality rate of patients on invasive mechanical ventilation remains high.

Objective To explore the surgical treatments for traumatic pancreatic injury in blunt abdominal trauma. Methods From January 2018 to August 2023, the relevant clinical data were retrospectively reviewed for 12 cases of traumatic pancreatic injury. Underlying causes, diagnostic modes, surgical outcomes and major complications were examined. Results The causes of traumatic pancreatic trauma were traffic accident （n=8） and crush （n=4）. According to the scale of American Association for the Surgery of Trauma （AAST） for pancreatic trauma, the clinical grades were Ⅱ （n=2）,Ⅲ（n=6）,Ⅳ（n=1） and Ⅴ（n=3）. Among 8 cases of preoperative serum amylase examination, 6 cases had an elevated level. Ten cases received preoperative computed tomography （CT） scan. All of them were operated, including removal of peripancreatic hematoma （n=1）, removal of peripancreatic hematoma & pancreatic injury repair （n=1）, distal pancreatectomy （n=2）, distal pancreatectomy plus splenectomy （n=4）, pancreatic necrosectomy plus pancreatic external drainage （n=1）, pancreatoduodenectomy （n=2） and pancreatic necrosectomy and peripancreatic drainage plus superior mesenteric vein repair pancreatic rupture repair （n=1）. The outcomes were mortality （n=1）, pancreatic fistula （n=2） and intra-abdominal infection （n=2）. Conclusion Preoperative CT scan is a vital diagnostic tool of pancreatic trauma in blunt abdominal trauma and an early classification aids in decision-making of surgical approaches. Surgical intervention should be performed as early as possible for high-grade pancreatic trauma under the premise of stable vital signs. Correct surgical approaches and sufficient drainage are essential for preventing postoperative complications.

吞食异物并发消化道穿孔较为常见,但鱼刺致消化道穿孔少见,并且其初期症状轻微,直至出现并发症后才能得到诊断。该文报道了1例鱼刺穿透胃壁致肝脓肿病人的诊治过程,并复习了相关文献。该类病例少见,关键是准确诊断和合理治疗,难点在于术前诊断。

Objective To compare the short-term clinical effects of Cheng's Giraffe reconstruction and dual-channel reconstruction after radical proximal gastrectomy for gastroesophageal junction cancer and evaluate the efficacy of Cheng's "Giraffe" reconstruction. Methods From September 1, 2018 to September 01, 2023, 125 patients undergoing proximal gastrectomy were reviewed retrospectively. Cheng's Giraffe reconstruction （n=91） and double channel reconstruction （n=34） were performed. The relevant observation parameters included operation （operative duration, reconstruction time & intraoperative blood loss）, postoperative status （postoperative hospitalization stay, postoperative drainage time, number of detected lymph nodes, incidence of Clavien-Dindo ≥3 complications, incidence of anastomotic leakage and anastomotic stricture） and follow-ups （incidence of gastroesophageal reflux, hemoglobin and serum albumin at Year 1 post-operation）. Results No significant inter-group differences existed in baseline profiles （all P>0.05）. No significant inter-group differences existed in volume of intraoperative blood loss, postoperative hospitalization stay, postoperative drainage time, the number of lymph nodes detected, the incidence of complications of Clavien-Dindo ≥3, the incidence of anastomotic leakage and anastomotic stenosis. As compared with PG-DT group, reconstruction time （P<0.001） and operative duration （P=0.036） were shorter in PG-Giraffe group. No significant inter-group differences existed in incidence of gastroesophageal reflux, hemoglobin or serum albumin at Year 1 post-operation （P>0.05）. Conclusion After proximal gastrectomy for gastroesophageal junction cancer, clinical efficacy of Cheng's Giraffe reconstruction is similar to that of dual-channel reconstruction and operation is simple. It is an ideal approach of reconstruction.

Peritoneum is a common metastatic site of such abdominopelvic tumors as gastric cancer, colorectal cancer and ovarian cancer. The occurrence of peritoneal metastasis often hints at a poor prognosis. Thus it is imperative to elucidate the underlying mechanism of peritoneal metastasis."Seed and Soil" theory, as a core theoretical basis of peritoneal metastasis, and peritoneal mesothelial cells（PMCs）, as the most important cellular component in "soil", have received growing attention from academic circles. Previously monolayer of PMCs has been treated as an important line of defense against tumor cells. New ideas have suggested that PMCs may promote peritoneal metastasis under certain conditions. This review summarized diverse biological functions of PMCs in various states. Maintaining the barrier function of PMCs is vital for managing peritoneal metastasis.

Objective To explore the risk factors of anastomotic leakage after intersphincteric resection (ISR) in patients with ultra-low rectal cancer. Methods From January 2015 to January 2021, 171 patients with low rectal cancer undergoing ISR were retrospectively reviewed. Based upon the occurrence of postoperative anastomotic leakage, they were divided into two groups of occurrence (n=22) and non-occurrence (n=149). Clinicopathological characteristics of two groups were compared and the independent risk factors for anastomotic leakage after ISR evaluated by logistic regression model. Results The incidence of anastomotic leakage was 12.87%. Proportions of males, body mass index (BMI) ＞25 kg/m², neoadjuvant concurrent chemoradiotherapy, non-preservation of left colonic artery (LCA) and non-prophylactic ileostomy were significantly higher in occurrence group than those in non-occurrence group (P＜0.05). Preoperative level of albumin (ALB) was significantly lower in occurrence group than that in non-occurrence group (P＜0.05). Multivariate Logistic regression model analysis indicated that gender, BMI, neoadjuvant synchronous sparing chemotherapy or not, retaining LCA or not and preventive ileostomy or not were independent risk factors for anastomotic leakage after ISR (P＜0.05). Conclusion The occurrence of anastomotic leakage after ISR in patients with low rectal cancer is correlated closely with gender, BMI, neoadjuvant synchronous sparing chemotherapy or not, retaining LCA or not and prophylactic ileostomy or not.

Objective To explore the influencing factors for perioperative complications of right laparoscopic hemicolectomy and construct a risk model of column graph.Methods From October 2019 to June 2023, the relevant clinical data were retrospectively reviewed for 223 patients undergoing right laparoscopic hemicolectomy. They were divided into two groups of complication （n=42） and non-complication （n=181） according to whether or not complications occurred in perioperative period. Multivariate Logistic regression was utilized for examining the influencing factors for perioperative complications. R4.3.2 software was utilized for constructing a prediction model of perioperative complications. Receiver operating characteristic （ROC） curve was employed for measuring the predictive value of nomogram and Hosmer-Lemeshow goodness of fit calibration curve for evaluating the fitting degree of nomogram. Decision curve analysis （DCA） was employed for examining the clinical utility of predictive model.Results Among them, 42 patients had complications during perioperative period. Multivariate Logistic regression analysis indicated that diabetes mellitus （DM）, operative duration >3 h, low tumor differentiation, external abdominal anastomosis and APACHE-Ⅱ score ≥14 were independent risk factors for perioperative complications （P<0.05）. The prediction probability of perioperative complications could be calculated by constructing the visualization risk prediction diagram of risk factors. DCA curve of nomogram prediction model was plotted. When prediction probability threshold was between 0 and 0.6, net return rate of nomogram model for perioperative complications was higher. The area under ROC curve was 0.941（95%CI： 0.893-0.988） with a sensitivity of 87.46% and a specificity of 81.48%. It suggested that the nomogram prediction model had a decent discriminant capability. Hosmer-Lemeshow goodness of fit test χ²=5.236, P=0.732, actual curve of calibration curve approximated an ideal curve. Predicted probability accorded well with actual probability.Conclusion Concurrent DM, operative duration >3 h, low tumor differentiation, external abdominal anastomosis and APACHE-Ⅱ score ≥14 are independent risk factors for perioperative complications of laparoscopic right hemicolectomy. The prediction model based upon the above nomogram is both accurate and well-differentiated. Clinical practicability is excellent.

Objective To explore the application value of enhanced recovery after surgery （ERAS） in patients with intrahepatic biliary stones plus liver atrophy. Methods From December 2016 to March 2023, a retrospective cohort study was conducted. The relevant clinical data were retrospectively reviewed for 63 patients with intrahepatic biliary stones plus liver atrophy undergoing laparoscopic liver resection. They were assigned into two groups of ERAS（n=32） and control（n=31）. Comparative analysis was performed for examining the effects of ERAS concept on intraoperative status （operative duration & intraoperative blood loss）, hospitalization expense, postoperative liver function, rehabilitation time and complications. Results As compared with control group, ERAS patients had significantly shorter postoperative recovery time [6.0（5.0,7.0） vs. 8.0（5.0,9.0） day, P<0.01], lower hospitalization expense [46 531（38 676, 51 311） vs. 55 553（47 638, 65 529） yuan, P<0.01], lower incidence of complications [31.3%（10/32） vs. 93.5%（29/31）, P<0.01] and lower postoperative T-tube retention rate [28.1%（9/32） vs. 58.1%（18/31）, P<0.01]. However, no significant inter-group differences existed in intraoperative duration, volume of blood loss, plasma alamine/aspartate aminotransferase level, C-reactive protein or prognostic nutritional parameters （all P>0.05）. Conclusion During perioperative management of liver resection, application of ERAS concept is both safe and effective. With a rapid and safe rehabilitation of patients, it is worth popularizing for liver resection of intrahepatic bile duct stones plus liver atrophy.

Choledocholithiasis is a common gastrointestinal disease. Stone incarceration causes secondary cholangitis with biliary obstruction, abdominal pain, chills, high fever, jaundice, hypotension and some nervous system symptoms. It may endanger the life of patients in severe cases. ERCP has gradually become a preferred treatment for choledocholithiasis. As compared with traditional surgery, ERCP offers the advantages of greater mini-invasiveness and significantly shorter hospitalization stay. However, ERCP remains an invasive endoscopic intervention with such common complications as postoperative acute pancreatitis, biliary tract infection, hemorrhage and perforation. Early detection and timely treatment of ERCP-related complications are controversial among endoscopists and vital for patient benefits. This review focused upon common complications, incidence, related risk factors and multidisciplinary preventive and therapeutic measures of choledocholithiasis after ERCP.

Objective To explore the correlation between preoperative prognostic nutritional index （PNI） with postoperative complications and survival of colorectal cancer （CRC） patients with acute bowel perforation （ABP）. Methods From December 2012 to June 2018, the relevant clinical data were retrospectively reviewed for 57 CRC patients with ABP undergoing curative resection and primary anastomosis. The clinicopathological profiles, nutritional status, postoperative complications, 5-year overall survival （OS） and recurrence-free survival （RFS） were recorded. The cut-off value of preoperative PNI was calculated by receiver operating characteristic （ROC） curve. The association of PNI with postoperative complications was examined by Logistic regression. And 5-year OS/RFS was analyzed by Kaplan-Meier method. Results The optimal cut-off value of PNI was 32. PNI-low group had more elders （P=0.0285）, more ASA grade Ⅲ-Ⅳ （P=0.0147） and more T4 stage （P=0.0281） as compared with PNI-high group. Moreover, low PNI was associated with greater anastomotic leakage （P=0.031 4）, higher 30-day mortality （P=0.030 3） and prolonged hospitalization stay （P=0.024 2）. Further multivariate analysis indicated that low PNI was a risk factor of anastomotic leakage （OR=1.63, 95%CI： 1.56-3.82, P=0.030 8）. However, PNI was not associated with 5-year OS/RFS in CRC patients with ABP. Conclusion In CRC patients with ABP, preoperative low PNI （<32） is a clinical predictor of anastomotic leakage, greater 30-day mortality and longer hospitalization stay after primary resection and anastomosis.

Objective To explore the risk factors for textbook outcome （TO） in patients with periampullary cancer after radical pancreaticoduodenectomy. Methods From December 2017 to December 2021, the relevant clinicopathological data were retrospectively reviewed for 134 patients with periampullary cancer undergoing radical pancreaticoduodenectomy. The correlations of 22 clinicopathological factors were examined. Firstly the correlation between clinical factors and TO was screened out by univariate analysis and then independent risk factors related TO were screened out by Logistic regression analysis. Results Among them, 43（32.0%） reached TO and 91（67.9%） non-TO. Univariate analysis revealed that gender, intraoperative hemorrhage >525 mL, open pancreaticoduodenectomy, preoperative biliary drainage, preoperative asymptomatic leukocytosis, preoperative total bilirubin >22 μmol/L, preoperative high CA19-9, degree of differentiation and positive lymph node were the related factors affecting postoperative TO （χ²=2.377, 9.806, 5.905, 10.626, 6.228, 8.536, 6.188, 5.416, 11.317, P<0.05）; Multivariate Logistic regression analysis indicated that intraoperative hemorrhage >525 mL, preoperative biliary drainage, open pancreaticoduodenectomy and positive lymph node were independent risk factors for TO （odds ratio=0.341, 0.311, 0.946, 0.228, 95% confidence intervals of 0.130~0.895, 0.125~0.777, 1.072~8.094, 0.066-0.795, P<0.05）. Conclusion It can effectively predict the prognosis of patients with periampullary cancer according to whether TO is achieved after duopancreaticotomy. Intraoperative hemorrhage >525 mL, preoperative biliary drainage, open pancreaticoduodenectomy and positive lymph node are an independent risk factor for TO.

Neoadjuvant immunotherapy has become an effective modality for enhancing the therapeutic efficacy of locally advanced gastric cancer （LAGC）. In modern era of mini-invasive surgery, favorable tumor response, treatment-related adverse events and potential impact on perioperative tissues from neoadjuvant immunotherapy are correlated closely with perioperative safety and long-term survival. Current evidence suggests that mini-invasive gastrectomy after neoadjuvant immunotherapy is both safe and feasible with comparable short-term outcomes and long-term survival despite intraoperative difficulties. On this basis, clinical cooperation should be actively promoted for addressing such key issues as timing of surgery after neoadjuvant immunotherapy, individualized lymph node dissection and function-preserving mini-invasive gastrectomy to standardize and expand the indications for mini-invasive gastrectomy after neoadjuvant immunotherapy for LAGC.