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 evaluate the efficacies and risk factors of metabolic and bariatric surgery for obesity hypoventilation syndrome （OHS）. Methods Between January 2018 and June 2022, retrospective review was conducted for 957 OHS patients undergoing metabolic and bariatric surgery.Clinical data of baseline profiles, arterial blood gas analysis, sleep study and anthropometric parameters were collected retrospectively for preoperative assessments and 2-year postoperative follow-ups. Perioperative changes of body mass index （BMI）, arterial blood gas, sleep study and anthropometric parameters were compared. The relationship between OHS resolution and variables was examined. Multivariate analysis was utilized for identifying the risk factors for OHS resolution. Results Among them, 105 were preoperatively diagnosed as OHS [BMI （40.1±7.2） kg/m², partial pressure of carbon dioxide in arterial blood（PaCO₂）（48.5±4.0） mmHg].At 2-year postoperative follow-up 89 cases （84.8%） fulfilled the criteria for OHS resolution. BMI dropped to（28.9±5.4） kg/m²（P<0.001,vs.BMI in preoperation period） and PaCO₂ declined to （44.4±4.8） mmHg （P<0.001, vs. PaCO₂ in preoperation period）. Percentage of total weight loss （%TWL） was lower in non-resolution group than that in OHS resolution group[（25.8±7.9）% vs. （27.7±8.9）%,P=0.017].Multivariate analysis revealed that preoperative arterial blood pH<7.35（OR=3.227,95% CI：1.002-10.392,P=0.049） and preoperative hypertension（OR=5.018,95%CI：1.476-17.064,P=0.010） were independent risk factors affecting OHS resolution after metabolic and bariatric surgery. Conclusion Metabolic and bariatric surgery is efficacious for OHS. And resolution of OHS depends upon achieving a certain level of ∆BMI and %TWL. Preoperative decompensation may be an independent risk factor for postoperative non-resolution of OHS.

Greated the limbs of small bowel has been a key link during Roux-en-Y gastric bypass （RYGB）. However, there is still no consensus on a proper length of small bowel exclusion. In current era of precision medicine, through accurately measuring the length of small bowel, appropriate length of small bowel exclusion may be individualized for optimizing surgical efficacies and lowering the occurrence of postoperative complications. Summarizing the effects of different small bowel exclusion lengths during gastric bypass on surgical outcomes, this review was intended to provide new rationales for future clinical practices and research designs.

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.

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.

Spontaneous rupture of hepatocellular carcinoma（HCC） is a life-threatening acute complication in HCC patients,clinically manifested as spontaneous tumor rupture and intra-abdominal hemorrhage.Although classified in T₄ by the TNM staging system,targeted treatment strategies can significantly improve the survival prognosis of spontaneous rupture of HCC.This review comprehensively analyzed the epidemiological characteristics,risk factors,pathophysiological mechanisms,and the efficacy differences of various treatment modalities for spontaneous rupture of HCC.It focused on the timing of surgery,perioperative management strategies,and the application of postoperative prognostic prediction models,aiming to provide evidence-based guidance for clinical treatment.Additionally,by integrating recent research advancements,we discussed the importance of redefining the staging of spontaneous rupture of HCC to optimize diagnostic and therapeutic strategies,thereby improving the survival and quality of life.The review also incorporated the previous experience of our center to present the clinical experience in managing spontaneous rupture of HCC at Liver Center,Tongji Hospital,Tongji Medical College of Huazhong University of Science and Technology.

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.

此文回顾性分析了1例63岁男性直肠神经内分泌癌病人的临床特点及治疗过程,以提高对此类疾病的认识。该例病人入院完善CT检查及结肠镜检查之后行腹腔镜直肠癌根治+回肠造口术,术后出现吻合口漏、右侧阴囊及右侧腹股沟区出现坏死性筋膜炎,行右侧腹股沟、右侧阴囊坏死性筋膜炎扩创术+封闭式创面负压吸引术,右上腹肋缘下出现坏死性筋膜炎,局部麻醉下行间断切开引流,给予亚胺培南西司他丁抗感染治疗,坏死性筋膜炎区域肉芽组织新鲜后缝合切口出院。病人术后因颈椎转移瘤压迫脊髓引起相关症状,生存2.5个月后死亡。直肠神经内分泌癌是一种罕见的直肠恶性肿瘤,侵袭性强、易发生转移、预后差。

Objective To establish and validate a nomogram prediction model based upon Objective factors for predicting gangrenous/perforated appendicitis （GPA） in children with acute appendicitis （AA）. Methods Between January 2010 and September 2024, the relevant clinical data were retrospectively reviewed for 350 AA children. And patients admitted between January 2010 and December 2019 were allocated into study group （n=225） while those admitted between January 2020 and September 2024 were selected as validation group（n=125）. Appendectomy was performed after a definite diagnosis. They were assigned into two groups of non-gangrenous/perforated appendicitis （N-GPA） and gangrenous/perforated appendicitis （GPA） according to the postoperative results of pathological examination. A comparison was made between two groups. And independent risk factors for GPA were identified through LASSO regression and multivariate Logistic regression analysis. Then these factors were utilized for constructing a nomogram prediction model. Internal validation of nomogram model was conducted with validation group. The area under the receiver operating characteristic curve （AUC） and Hosmer-Lemeshow （H-L） goodness-of-fit test were applied for assessing the model's discrimination and calibration. Results Preoperative computed tomography （CT） findings of fecalith within appendiceal lumen, leukocyte count, duration of symptoms, body temperature and appendiceal diameter as measured by preoperative CT were identified as independent risk factors for GPA in AA children （P< 0.05）. AUC for nomogram prediction model was 0.896 （95%CI： 0.848-0.943） in study group and 0.899 （95%CI： 0.825-0.972） in validation group, indicating an excellent discriminatory power. H-L test results were P=0.459 （χ2=6.72） for study group and P=0.272 （χ2=9.91） for validation group, indicating that nomogram model had a decent predictive accuracy. Conclusion The nomogram prediction model developed here demonstrates high accuracy and it may be readily applied for early identification and risk prediction of GPA in AA children.

Objective To explore the clinical value of Apfel score in predicting postoperative nausea and vomiting（PONV） after laparoscopic sleeve gastrectomy（LSG）. Methods Between January 2022 and March 2023, the relevant clinical data were collected from 80 morbidly obese patients undergoing LSG. They were assessed by the Apfel scoring system, including such factors as gender, smoking history, history of motion sickness or PONV and postoperative opioid use. PONV occurrences within 72 h post-LSG were assessed by visual analogue scale（VAS）, verbal descriptor scale（VDS） and PONV frequency score. Spearman's correlation was utilized for examining the relationship between Apfel and VAS/VDS/PONV frequency scores. Receiver operating characteristic（ROC） curve was plotted for evaluating the predictive value of Apfel score for PONV occurrence/severity and the area under the curve（AUC） calculated. Results Mean Apfel score was （1.76±0.96）. Within 72 h post-LSG, mean VAS/VDS/PONV frequency scores were （4.19±2.96）, （1.09±0.77） and （2.68±1.81）.Spearman's correlation coefficients between Apfel and VAS/VDS/PONV frequency scores were 0.3639, 0.3563 and 0.2985, all denoting a positive correlation （P<0.05）. Apfel score had the highest predictive value for VDS in predicting the occurrence of PONV （AUC=0.741,P<0.05） while it offered the best predictive value for VAS in predicting the severity of PONV （AUC=0.706, P<0.05）. Conclusion Apfel score is correlated with PONV score after LSG. However, its predictive value for VAS/VDS/PONV frequency score varies when assessing the occurrence/severity of PONV. Clinically Apfel score should be utilized with a consideration of specific predictive goals.

Pancreaticojejunostomy is the preferred method of pancreatic digestive tract reconstruction,serving as the most critical step in pancreaticoduodenectomy.It largely determines the occurrence of postoperative pancreatic fistula and other related complications.With the rapid development of pancreatic surgery,the method of pancreaticojejunostomy has undergone different improvements.This article reviewed the characteristics and development trends of common pancreaticojejunostomy in recent years, and proposed a modified pancreaticojejunostomy, namely parallel pancreaticojejunostomy,emphasizing the key points and advantages of the operation, and providing a certain reference for colleagues to perform pancreaticojejunostomy.

Objective This study aims to assess the effectiveness of a modified Chen's pancreaticojejunostomy in laparoscopic pancreaticoduodenectomy （LPD）. Methods A retrospective analysis was conducted on the clinical data of 121 patients who underwent LPD at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology between January 2023 and October 2024. The patients were divided into two groups： traditional surgery group （63 patients） and modified Chen's pancreaticojejunostomy （modified surgery group） （58 patients）. Gender, age, body mass index （BMI）, operation time, pancreatojejunostomy time, intraoperative blood loss, postoperative hospital stay, and the incidence of postoperative complications like pancreatic fistula, abdominal infection, intra-abdominal bleeding, gastrointestinal dysfunction, and mortality were compared between groups. Additionally, moderate-to-high risk patients for pancreatic fistula were identified using the alternative pancreatic fistula risk score system （a-FRS）. The risk of pancreatic fistulas between groups was compared. Quantitative data adhering to a normal distribution were expressed as $\bar{x}±s$ ; otherwise, they were expressed as quartiles [M（Q₁,Q₃）]. Count data were presented as the number of instances. Results Patients in the modified surgery group showed significantly shorter operation time（311.8±55.0 min vs. 357.5±84.5 min,P=0.001）and pancreatojejunostomy time [15.5 （13.8,18.0） min vs. 26.0 （23.0,29.0） min,P<0.001] compared to the traditional surgery group. The incidence of clinically relevant postoperative pancreatic fistula was also significantly lower in the modified surgery group than in the traditional surgery group [3.4% （2/58） vs. 15.9% （10/63）, P=0.022]. There were no significant differences between the two groups in the age, gender, BMI, proportion of patients at moderate-to-high risk for pancreatic fistula, intraoperative blood loss, postoperative hospital stay, rates of abdominal infection, intra-abdominal bleeding, and gastrointestinal dysfunction （P>0.05）. There were no perioperative deaths in both groups. Among the 62 patients at a moderate-to-high risk for pancreatic fistula using the a-FRS model （34 in the traditional surgery group and 28 in the modified surgery group）, those in the modified surgery group still showed significantly shorter operation and pancreatojejunostomy times （P<0.05） and a lower incidence of postoperative pancreatic fistula （P=0.036）. Conclusion The modified Chen's pancreaticojejunostomy simplifies the procedure, decreases the duration of pancreatojejunostomy, and reduces the occurrence of pancreatic fistulas. This technique is effective for patients assessed as having a moderate-to-high risk of developing pancreatic fistulas.

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.

Gastric cancer （GC） is one of the most prevalent malignant neoplasms in the world. Due to mild and often unnoticed early symptoms and a low screening rate, most patients are diagnosed at a locally advanced or a late stage with poor outcomes. In recent years, immunotherapy has made significant headways in the treatment of GC, particularly for those with unresectable tumors and recurrent metastases. It has emerged as a valuable additional option for patients after surgery, chemoradiotherapy and targeted therapy. With a deeper understanding of tumor immunology, theoretical mechanisms of immunotherapy are continuously refined. A series of clinical studies on immune checkpoint inhibitors of programmed death protein-1 and programmed death protein ligand-1 have demonstrated promising efficacy for GC. And immunotherapy is gradually transforming the therapeutic paradigm of GC. This review summarized the latest researches of immunotherapy for GC through elucidating the mechanisms of immunotherapy, examining the utility of programmed death protein ligand-1 protein expression assay in identifying potential beneficiaries of immunotherapy and evaluating the applications of immunotherapy for advanced and progressive GC.

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 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 This study was intended to summarize the clinical characteristics of Crohn's disease （CD） complicated with intestinal perforation and explore the efficacy of surgery.Methods From January 2000 to October 2022, 25 cases of CD complicated with intestinal perforation at Affiliated Union Hospital were retrospectively reviewed. Clinical characteristics, surgical approaches and clinical follow-up data were summarized.Results Among them, males dominated （84%） with a diagnostic age of 17 to 40 years （80%）. The major site of perforation was ileum （72%） and nature of lesions largely transmural （80%）. Surgical approaches included laparoscopic-assisted bowel resection （52%） and multiple ileostomies （76.9%）. The postoperative complication rate was 28% and infections dominated. Both preoperative and postoperative patients were prone to anemia and hypoproteinemia. During follow-ups, there were recurrence （n=12, 48%） and death （n=1）.Conclusion CD complicated with intestinal perforation is more common in males and perforation occurs predominantly in ileum. Emergency surgery is recommended for all patients upon admission. Timely identification of etiology, optimal perioperative management and appropriate selection of surgical procedures may lower the incidence of postoperative complications and recurrence.

双肝外胆管畸形在临床上极为罕见,此文报道了1例由2条独立的肝外胆管相互汇合后进入十二指肠且无异位引流的双肝外胆管畸形病例,探讨双肝外胆管畸形的临床特征和超声声像图特点,并与手术、T管造影进行对照,结合相关文献进行总结分析。双肝外胆管畸形是一种少见的先天性胆道畸形,临床表现不典型,极易漏诊误诊,彩色多普勒超声等影像学检查在双肝外胆管畸形诊断方面具有重要意义。

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。

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.

Occurring primarily between homogenous cells, most commonly tumor cells and epithelial cells, cell-in-cell structures （CICs） refers to the internalization of one or more living cells into other cells. However, it can also happen among heterogeneous cells, such as an internalization of tumor cells in immune cells. In liver diseases, the presence and extent of CICs have attracted growing attention. Serving as a key pathological diagnostic indicator, accurately assessing the type and severity of liver diseases is dependent upon identifying the presence and degree of CICs.The formation of CICs involves multiple mechanisms, including cell cannibalism, phagoptosis, enclysis, entosis and emperipolesis. These processes play some vital roles not only in nutrient acquisition and immune evasion of tumor cells and the regulation of tumor microenvironment but also in the developments of chronic hepatitis B and hepatocellular carcinoma. Through further elucidating the formative mechanisms, the authors anticipate developing more precise therapeutic strategies of potentially revolutionizing liver disease treatment. This review summarized the role and mechanism of CICs in various liver diseases while discussing their potential implications for diagnosis, treatments and drug resistance.

With rapid advances of metabolic and bariatric surgery（MBS）, decision-making process is becoming more and more complex regarding its application in patients with obesity and specific comorbidities. Efficacy and safety of MBS in high-risk cohorts, including those with cirrhosis, renal insufficiency and across an age spectrum from elders to adolescents, has remained controversial subjects. An expert consensus on optimal surgical approaches for these individuals has yet to be established, necessitating further investigations and validations. This paper focused upon the intricacies of conducting MBS in patients with unique metabolic and bariatric profiles.The authors critically assessed the risks and benefits associated with these procedures and offered a comprehensive overview of clinical considerations. There were four major issues of special weight considerations, age-related factors, challenging comorbidities and transitional procedures. The Objective was to contribute valuable insights to the existing body of knowledge and aid clinicians in making informed decisions when contemplating MBS for patients with special needs.

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.

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.

Gastric cancer （GC） is a common malignant tumor with a high incidence and elevated mortality rate. In recent years, PD-1/PD-L1 immune checkpoint inhibitors have rapidly become one of common treatments for GC due to their superior efficacy. Notably, recent studies have highlighted the critical role of tumor microenvironment in cancer progression. Among various cell types present in the tumor microenvironment, tumor-associated macrophages （TAMs） are the most abundant. These macrophages can express PD-1 and interact with PD-L1 on the surface of cancer cells. Therefore TAMs may influence the therapeutic effectiveness of PD-1/PD-L1 immune checkpoint inhibitors for GC. However, there are few current researches on this topic and the underlying mechanisms have remain elsuive. This review summarized the latest researches to provide more treatment options for GC patients.

Objective To explore the effect of preoperative biliary drainage on perioperative period （during hospitalization or 30 days post-operation） in patients with pancreatic head or periampullary carcinoma undergoing open pancreaticoduodenectomy.Methods From October 1, 2019 to October 1, 2022, retrospective analysis was performed for 73 patients of pancreatic head or periampullae carcinoma undergoing pancreaticoduodenectomy including biliary drainage （n=33） and without biliary drainage （n=40）. The changes of total bilirubin（TBIL）, alanine transaminase （ALT）, glutamic oxalacetic transaminase （GOT）, albumin and creatinine before yellowing （at admission） and after yellowing （pre-operation） were compared for evaluating the effect of biliary drainage biliary drainage group. Then statistical differences were examined in postoperative complications between biliary drainage and without biliary drainage groups. Statistical software SPSS21 was used for statistical processings.Results The preoperative levels of TBIL, albumin, ALT and AST declined as compared with admission （P<0.05）. The preoperative level of creatinine had no significant change as compared with admission （P>0.05）. Biliary drainage group was more prone to have a higher incidence of tertiary complications （P<0.05）, a longer time from admission to surgery （P<0.05） and a longer total hospitalization stay （P<0.05）. No significant differences existed in operative duration, intraoperative volume of blood loss, intraoperative unit of blood transfusion, bile leakage, gastroparesis, peritoneal infection, pancreatic leakage, hemorrhage, wound infection, mortality, incidence of complications or postoperative hospitalization stay （P>0.05）.Conclusion Preoperative biliary drainage may lower the level of bilirubin in patients with severe jaundice caused by periampullary carcinoma, improve liver function and have no effect upon the level of creatinine. Preoperative biliary drainage may cause a decline of serum albumin. Preoperative biliary drainage may not reduce operative duration, volume of intraoperative blood loss and unit of intraoperative blood transfusion. It can not reduce the incidence of biliary leakage, gastroparesis, abdominal infection, pancreatic leakage, postoperative bleeding, wound infection, death, other complications or total complications. Length of postoperative hospitalization stay is not shortened. There are higher rates of tertiary and higher complications, longer overall hospitalization stay and extended time from admission to surgery. Patients with severe jaundice （TBIL ≥250 μmol/L） caused by pancreatic head or periampullary carcinoma should not be routinely treated preoperatively with biliary drainage.

2023年10月24日武汉大学中南医院肝胆胰外科收治1例71岁女性罕见胆囊肉瘤样癌合并Ⅰ型神经纤维瘤、胃肠间质瘤病人,该例病人因“上腹痛4 d,加重半天”就诊。腹部增强CT示,胆囊壁不均匀增厚并腔内软组织影并周围渗出、积液并脓肿形成,胆囊癌可能;左侧腹腔见类圆形软组织密度影。病人既往诊断Ⅰ型神经纤维瘤。于2023年10月31日行胆囊切除术+小肠部分切除术。术后病理及免疫组织化学诊断为胆囊肉瘤样癌、胃肠间质瘤。病人术后行放化疗及靶向治疗,2024年6月8日因肝转移瘤-结肠瘘合并腹腔感染死亡。胆囊肉瘤样癌临床罕见,与其他类型胆囊癌鉴别困难,需综合病理和免疫组织化学才能明确诊断,尚未有确切的诊疗指南,预后不佳。Ⅰ型神经纤维瘤老年病人建议常规筛查消化道肿瘤。

Objective To explore the influencing factors of postoperative pancreatic fistula （PF） and construct a prediction model in post-splenectomy patients. Methods The relevant clinical data were retrospectively reviewed for 89 hospitalized patients after splenectomy from June 2019 to June 2022. According to the occurrence of postoperative PF, they were assigned into two groups of PF （n=13） and pancreatic non-fistula （n=76）. Univariate and Logistic multivariate regression were employed for examining the independent influencing factors of postoperative PF and a risk prediction model was established. Receiver operator characteristic （ROC） curve was plotted and area under the curve （AUC） calculated for evaluating the predictive value of the model for the occurrence of PF and analyze the prognosis of PF. Results Univariate analysis revealed that the incidence of PF was higher in patients with BMI ≥27 kg/m², undergoing emergency surgery, splenic rupture, incision closure device, seniority of attending surgeon, splenic length ≥15 cm and poor exposure （P<0.05）. Multivariate regression analysis indicated that BMI ≥27 kg/m² （HR：17.194, 95%CI：2.151, 137.407, P<0.05）, splenic rupture （HR：7.551, 95%CI：1.891, 64.017, P<0.05）, seniority of attending surgeon （HR： 7.250, 95%CI： 1.888, 59.188, P<0.05） and poor exposure （HR： 13.803, 95%CI： 1.515, 125.749, P<0.05） were independent influencing factors of PF. The risk model of PF was Logit（P） =-18.155+2.845×X₁+2.022×X₂+1.981×X₃+2.625×X₄ （X₁ BMI, X₂ splenic rupture, X₃ primary surgeon's qualifications & X₄ poor exposure）. ROC curve analysis showed that area under the curve of PF as predicted by the model was 0.943 with a sensitivity of 0.884 and a specificity of 0.859 （95%CI： 0.875, 1.000, P<0.05）. Among 13 PF patients, there were biochemical fistula （n=8） and grade B （n=5）. All of them improved after conservative measures. Conclusion Obesity, splenic rupture, seniority of attending surgeon and poor intraoperative exposure are independent influencing factors of PF post-splenectomy. The risk prediction model based upon the results of multi-factorial analysis has an excellent value in predicting the incidence of postoperative PF.

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.

The most common symptom of extrahepatic cholangiocarcinoma is jaundice. Due to a lack of early special symptoms, most patients become inoperable at the time of an initial diagnosis. The prognosis of patients with advanced or unresectable extrahepatic cholangiocarcinoma is generally poor owing to ineffective palliative therapy. Stenting for bile duct drainage has been a standard procedure of relieving symptoms and improving quality-of-life. However, no significant improvement of median survival time is noted. Photodynamic therapy is a combination of photosensitizer and laser light. In conjunctions with biliary stenting, surgery and chemoimmunotherapy, targeted accumulation of photosensitizer in tumor tissues and accurate activation by laser light may further boost the curative efficacies. With bright application prospects, it may be employed as an effective local therapy for unresectable extrahepatic cholangiocarcinoma.

The global incidence and mortality of primary liver cancer （PLC） are relatively high. Although 5-year survival rate of patients with early detection and curative treatment surpasses 60%, postoperative stress, complications and tumor recurrence seriously affect the quality-of-life and survival of patients post-operation. Due to their functions of regulating lipid metabolism, lowering oxidative stress and maintaining intestinal health, ω-3 PUFAs were not only extensively applied as a commercial food supplement for preventing the development of liver cancer but also as an active component of parenteral nutrition fat emulsion in postoperative patients. Existing studies have shown that postoperative application of omega-3 PUFAs in PLC patients could blunt inflammatory response, protect liver function, reduce the occurrence of infection and thus shorten the length of hospital stay. In patients at a high risk for recurrence, long-term use of omega-3 PUFAs or in combination with adjuvant therapy offered beneficial effects of mproved adjuvant therapy and prevention of adverse toxic effects. However, another study contradicted the previous findings. Thus the mechanism of action of omega-3 PUFAs is so complex that many regulatory links remain to be further elucidated. Its impact on clinical parameters of postoperative PLC patients should be confirmed with a large amount of data.

An Objective measurement of surgical outcome quality has long been a daunting challenge for researchers. Technical skill of a surgeon is a crucial influencing factor of clinical outcomes. Assessing surgical skills is not only vital for education, training and professional growth of surgeons but also has profound implications for enhancing surgical quality, ensuring patient safety and advancing medicine. Gradually the assessment of surgical skills has evolved from an initial experiential evaluation model by panels of surgical experts to a data-based Objective assessment tool model, including global rating scales, procedure-specific assessment tools and error-based evaluation instruments. In recent years, with a growing integration of medical and engineering fields, some automated assessment tools equipped with automatic recognition capabilities have started to emerge. This article summarized the development, current status, advantages and limitations of different types of laparoscopic skill assessment tools in conjunctions with a literature review.

Objective To explore the effect of neoadjuvant chemotherapy or immunochemotherapy on perioperative safety and efficacy in patients with advanced gastric cancer （GC） and adenocarcinoma of gastroesophageal junction.Methods From January 2021 to January 2024, retrospective review was performed for the relevant clinical data of 88 patients undergoing neoadjuvant therapy and surgery. Individuals on preoperative radiotherapy were excluded. Based upon different preoperative medication regimens, they were assigned into two groups of neoadjuvant chemotherapy alone （n=55） and preoperative immunochemotherapy （n=33）. No statistically significant inter-group differences existed in clinicopathological characteristics. The major outcome measures included operative duration, volume of blood loss, R0 resection rate, dissected lymph node number, time to an initial anal exhaust, length of postoperative hospitalization stay, total hospitalization expense and the incidence of postoperative overall and severe complications. Secondary outcome measure was tumor regression grade （TRG） of primary gastric lesion.Results No statistically significant inter-group differences existed in operative duration, volume of blood loss, R0 resection rate, number of lymph node dissections, time to an initial anal exhaust, total hospitalization expense or length of postoperative stay. The overall incidence of postoperative complications was slightly higher in combination immunotherapy group. There was no statistically significant difference （P>0.05）. Both groups exhibited remarkably low rates of severe complications. There was no statistically significant difference （P>0.05）. As compared with neoadjuvant chemotherapy alone group, preoperative immunochemotherapy group had a significantly higher proportion of complete/partial remission （P<0.05）. And the proportion of TRG grade 0/1 was significantly higher in preoperative immunochemotherapy group （P<0.05）.Conclusion Preoperative immunochemotherapy does not elevate perioperative surgical risks and may achieve better short-term outcomes. Further studies are required for evaluating possible long-term outcomes.

Objective Pancreatic Squamous Cell Carcinoma （PSCC） has a poor prognosis and it lacks individualized prognostic tools. This study aimed to construct prognostic nomograms for PSCC patients based upon machine learning and using large-scale real-world data from the database of SEER, provide precise and individualized prognostic assessments and offer valuable references for clinical decision-making.Methods From 2000 to 2019, the relevant clinical data of 367 pathologically diagnosed PSCC patients were extracted from the database of SEER. They were randomized by a ratio of 7∶3 into training （n=256） and verification （n=111） sets. Multivariate Cox proportional hazard model, LASSO regression and random survival forest model were utilized for identifying independent prognostic factors for patient survival. These factors were utilized for constructing nomograms for predicting cancer specific survival （CSS） and total survival （OS） at Month 3/6. Subsequently, the models were internally and externally validated in training and validation sets by concordance index （C-index）, receiver operating characteristic （ROC） and calibration curves for assessing their accuracy and predictive capacity.Results The median follow-up period in training and verification sets were 3（1,7） and 2（1,8） month. Baseline profiles were comparable between two groups （all P>0.05）. Multivariate Cox proportional hazard model analysis indicated that tumor size, M/N stage, surgery and chemotherapy were independent influencing factors for OS/CSS. LASSO regression analysis revealed that M stage, surgery and chemotherapy were associated with OS/CSS. For OS, top four scoring variables for via random survival forest model were chemotherapy, M stage, surgery and age; For CSS, chemotherapy, M stage, surgery and tumor size. Nomograms for predicting OS/CSS at Month 3/6 were developed based upon these independent prognostic factors. Validation results showed that C-index for OS in training and verification sets were 0.753（95%CI：0.720-0.790） and 0.723（95%CI：0.660-0.780） and for CSS 0.749（95%CI：0.720-0.780） and 0.721（95%CI：0.660-0.780）. ROC curve analysis indicated that AUC values for OS in training and verification sets were 79.8% and 75.9% at Month 3, 78.9% and 76.8% at Month 6 and 78.7% and 77.5% at Month 12; for CSS, 79.3% and 76.3% at Month 3, 78.6% and 76.9% at Month 6 and 77.4% and 78.4% at Month 12 respectively. Calibration curve analysis demonstrated a decent agreement between predicted and actual OS/CSS. Both were closely situated near ideal 45° reference line, demonstrating a high consistency.Conclusion Age, M stage, tumor size, surgery and chemotherapy are independent prognostic factors for PSCC patients. And the above constructed nomogram prediction models exhibit favorable predictive value and facilitate personalized therapeutics for PSCC patients in clinical practices.

Objective To explore the potential categories and influencing factors of grazing behavior among patients undergoing metabolic and bariatric surgery （MBS）. Methods From January to June 2024, MBS outpatients were selected by convenience sampling. Baseline Demographic Information Questionnaire, Chinese version of Repetitive Eating Questionnaire[Rep（eat）-Q], 21-item Three-Factor Eating Questionnaire（TFEQ-R21） and Chinese Version of Depression Anxiety and Stress Scale-21（DASS-21） were administered. One-way ANOVA and Logistic regression analyses were performed for identifying the factors associated with potential categories of grazing behavior. Results Among a total of 236 questionnaires, 230 valid ones were returned with an effective recovery rate of 97.5%. Grazing behavior occured in 178 patients （77.4%）. Grazing behaviors among MBS patients were divided into 3 latent classes of "low risk of grazing behavior-regular"（48.3%）,"medium risk of grazing behavior-compulsive"（37.4%） and "high risk of grazing behavior-repetitive"（14.3%）. As compared with "medium risk of grazing behavior-compulsive", patients with postoperative time <12 month, postoperative time 12-<24 month and lower scores of uncontrolled eating were more likely to be classified as "low risk of grazing behavior-regular"（OR=0.256,P=0.003;OR=0.311,P=0.020; OR=1.195,P<0.001）;As compared with "high risk of grazing behavior-repetitive", patients with no-depression, restricted eating and uncontrolled eating were more likely to be classified as "low risk of grazing behavior-regular"（OR=0.184,P<0.001;OR=0.670,P<0.001;OR=1.261,P=0.001）. Conclusion The incidence of grazing behavior in MBS patients is at a high level with distinct characteristics of classification. Healthcare professionals may design personalized intervention strategies according to the influencing factors of different latent classes of grazing behavior.

Objective To explore an improved laparoscopic mini-invasive surgery to minimize surgical trauma, lower surgical difficulty and expand clinical indications. Methods From July 2021 to August 2023, the relevant clinical data were retrospectively reviewed for 53 patients undergoing laparoendoscopy with transbiliary exploration for lithotomy.According to different surgical approaches, they were assigned into two groups of single-port plus one-port surgery（n=29） and single-port laparoscopy （n=24）. Results No significant differences existed in baseline profiles （P>0.05）.Significant inter-group difference existed in operative duration [130.0（120.0,152.5） vs. 150.0（130.0,195.0） min] and intraoperative volume of blood loss [10.0（10.0, 20.0） vs. 20.0（16.3, 37.5） mL]（P<0.05）. No significant inter-group differences existed in postoperative exhaust time [（17.9±4.0） vs.（19.5±3.6）h], postoperative hospitalization stay [（7.0±1.8） vs. （7.5±2.8） day] or hospitalization expense [（1 9826.2±4 073.8） vs. （21 668.3±5 191.2） yuan] （all P>0.05）. Conclusion It is both feasible and safe to use single hole plus one hole double mirror plus choledochal exploration and lithotomy. It may flatten the learning curve of mini-invasive surgery, shorten operative duration and expand clinical indications.

Marginal ulcer is a common complication after Roux-en-Y gastric bypass and its improper management may cause serious consequences, including perforation, hemorrhage and stenosis.This report described one female case of anastomotic marginal ulcer after Roux-en-Y gastric bypass. She initially underwent laparoscopic Roux-en-Y gastric bypass in April 2011 for metabolic syndrome.In September 2017, there was an onset of recurrent abdominal pain with altered stool consistency. After thorough examinations, marginal ulcer was diagnosed due probably to an enlargement of gastric pouch. Consequently,in October 2019,laparoscopic sleeve gastrectomy was performed along with partial small bowel resection. Despite regular postoperative dosing of antacids, recurrent abdominal pain, nausea and vomiting persisted. Follow-up gastroscopy revealed non-healing of anastomotic marginal ulcer. In June 2022, after completing thorough preoperative preparation, laparoscopic partial gastric-gastrointestinal anastomosis, nutritional branch jejunostomy and gastric bypass revision were performed. Postoperative symptoms improved markedly. Follow-up gastroscopy at Month 8 showed no sign of ulceration. This case illustrated the challenge of managing marginal ulcers since two revision operations over nearly 5 years were required for curing. Focusing upon the relevant literature on marginal ulcers after Roux-en-Y gastric bypass, this review summarized risk factors, treatments and prevention strategies to provide references for bariatric and metabolic surgeons.