Objective To analyze the prognostic factors and recurrence patterns of locally advanced gastric cancer （LAGC） patients who underwent D2 radical gastrectomy after receiving neoadjuvant chemotherapy combined with immunotherapy. Methods A total of 76 LAGC patients who received neoadjuvant chemotherapy combined with immunotherapy followed by D2 radical gastrectomy at the Department of Gastrointestinal Surgery, Union Hospital, Huazhong University of Science and Technology, from January 2020 to October 2023, were enrolled. According to postoperative recurrence, patients were divided into the recurrence group （22 cases） and non-recurrence group （54 cases）. Clinical and follow-up data were collected. Results There were 14 patients with a single recurrence mode （63.6%）, and the proportion of patients with local recurrence, regional recurrence, abdominal metastasis and distant metastasis was 4.5%, 4.5%, 4.5%, and 50.1%, respectively. Statistically significant differences were found between the recurrence and non-recurrence groups in terms of nerve invasion, vascular invasion, posttreatment pathological tumor （ypT） staging and posttreatment pathological lymph node （ypN） status（all P<0.05）. Univariate analysis revealed that signet-ring cell carcinoma, nerve invasion, vascular invasion, ypT stage, and ypN status were significantly related with disease-free survival （DFS） after D2 radical gastrectomy in LAGC patients receiving neoadjuvant chemotherapy and immunotherapy （all P<0.05）. Multivariate analysis showed that signet-ring cell carcinoma （P=0.048） and ypN status （P=0.035） were independent factors affecting DFS after D2 radical gastrectomy. Additionally, there was a significant difference in the incidence of double recurrence between the ypN0 group and the ypN₊ group patients. Conclusion Signet-ring cell carcinoma and ypN status are independent prognostic factors for LAGC after neoadjuvant chemotherapy combined with immunotherapy and surgery. Preventing distant recurrence after neoadjuvant chemotherapy combined with immunotherapy and surgery is an important approach to further improve the long-term prognosis of LAGC.

In recent years, the surgical management of gastrointestinal tumors has undergone progressive standardization and refinement, with increasing consensus on operative strategies and resection margins. The advent of advanced laparoscopic techniques and the Da Vinci robotic-assisted surgical system has revolutionized the surgical treatment paradigm, bringing new breakthroughs in the treatment of gastrointestinal tumors. Beyond technical advancements, the integration of perioperative chemotherapy, radiotherapy, targeted therapy, and multidisciplinary team strategies has contributed to the prognosis improvement of gastrointestinal tumors. Moreover, advancements in molecular biology have further driven the evolution of gastrointestinal oncologic surgery toward precision medicine.

As the ideal window for surgical intervention in necrotizing enterocolitis （NEC） lies between the onset of intestinal gangrene and perforation, an accurate assessment of bowel injury severity and timely surgical intervention are critical for improving outcomes. Portal venous gas（PVG） is a significant marker of advanced NEC, particularly in extremely low birth weight（ELBW） infants, where its presence correlates with a markedly increased risk of extensive intestinal necrosis（> 75%-80% bowel involvement）. Pneumatosis intestinalis（PI） is commonly associated with NEC. Besides, linear PI may indicate a benign course, whereas cystic PI with fixed bowel loops raises suspicion for necrosis. Notably, the extent of PI does not directly correlate with bowel injury severity. Fixed bowel loops（FBL）,identified on serial radiographs, are associated with higher surgical and mortality rates, necessitating close clinical and imaging monitoring. Ascites, particularly complex ascites with debris on ultrasound, may be the sole sign of perforation. Most of scoring systems for assessing surgical indications for NEC have not been widely adopted. It is essential for further developing precise, dynamic risk assessment models, thus achieving the goal of transforming the experience-driven decision mode to data-driven mode.

Objective To investigate the short-term effect of preoperative neoadjuvant chemoradiotherapy combined with programmed cell death 1 （PD-1） inhibitors on the treatment of ulcerative colitis related colorectal cancer （UCRCC）. Methods Clinical data of UCRCC patients who received PD-1 inhibitors combined with neoadjuvant therapy and surgically operated in the Second Hospital of Nanjing from March 2021 to December 2023 were retrospectively collected. Patients were divided into the control group （n=46） and combination group （n=34） based on preoperative treatment regimens. Patients in the control group received two cycles of capecitabine + oxaliplatin chemotherapy preoperatively, followed by two cycles of radiotherapy after a 2-week rest. Those in the combination group received PD-1 inhibitors every 3 weeks for two cycles, plus clinical management as the same as in the control group. All patients underwent surgery （total colorectal resection with ileostomy or radical intestinal tumor resection） 4-6 weeks after neoadjuvant chemoradiotherapy. The effect of neoadjuvant therapy, tumor markers, drug toxicity, side effects, perioperative indicators and postoperative pathology were compared between the two groups. Results Disease control rate in the combination group was significantly higher than that of the control group （P<0.05）. The levels of carbohydrate antigen 242, carbohydrate antigen 72-4, carcinoembryonic antigen and carbohydrate antigen 199 in the combination group were significantly lower than those of the control group （P<0.05）, and the percentage of tumor regression grades 0 and 1 was significantly higher compared to the control group. There were no significant differences in the incidence of toxic and side effects and perioperative indexes between the two groups （P>0.05）. Conclusion Preoperative neoadjuvant chemoradiotherapy combined with PD-1 inhibitors demonstrates favorable efficacy in controlling UCRCC, reducing tumor marker levels, improving postoperative pathological outcomes, and exhibiting an acceptable safety profile.

Pancreatic cancer is a highly aggressive malignancy of the digestive system. Over 80% of patients are diagnosed at an advanced stage. The majority of pancreatic cancer patients progresses to cancer cachexia, characterized by uncontrolled weight loss, muscle wasting, and a systemic inflammatory response. To date, effective therapeutic strategies for managing cancer cachexia are scant.This article aims to provide an in-depth review of the latest research advancements both domestically and internationally, systematically elucidate the pathophysiological mechanisms and etiology of pancreatic cancer-associated cachexia.

Abdominal hernia is a common surgical condition that is divided into primary and secondary abdominal wall hernias. The former includes umbilical hernia, white line hernia, semimeniscus hernia, and lumbar hernia, and the latter refers to incisional hernia. It is generally believed that immediate surgery should be performed even in the absence of any clinical manifestations, and surgery is the only effective treatment for abdominal wall hernias. Commonly used surgical modalities include open sublay, laparoscopic intraperitoneal onlay mesh （IPOM）, mini/less open sublay MILOS/endoscopic mini/less open sublay technique （eMILOS）, transabdominal preperitoneal （TAPP）, laparoscopic totally extra-peritoneal hernia repair （TEP）, enhanced-view totally extraperitoneal （eTEP）, and transabdominal partial extraperitoneal tape. In recent years, endoscopic sublay repair （ESR） has become widely used. It is divided into transabdominal sublay （TAS） and totally extraperitoneal sublay （TES）, which are evolved from TAPP and TEP, respectively. Its practicality and effectiveness require a large number of clinical data to verify. This article reviewed the relevant literatures on ESR in the treatment of abdominal wall hernia, discussed the application and research progress of ESR in the treatment of abdominal wall hernia, and analyzed the feasibility and superiority of ESR.

Objective To investigate the clinical characteristics， diagnostic methods， and treatment strategies for liver abscess complicating laparoscopic appendectomy in children. Methods A rare case of a boy at 6 years and 11 months with liver abscess following laparoscopic appendectomy for acute appendicitis was reported. The child was admitted to the Affiliated Children's Hospital of Xi'an Jiaotong University on August 6， 2024， presenting with fever for 4 days， and 26 days after laparoscopic appendectomy for acute appendicitis. Initial blood tests revealed a leukocyte count of 15.07×10⁹/L.Color Doppler ultrasound and CT confirmed a right hepatic lobe abscess. A literature review was conducted by searching key words of "acute appendicitis" "appendectomy" "liver/hepatic abscess" and "children" in both Chinese and English languages in the PubMed， Medline， Springer Link， The Cochrane Library， Wanfang， and CNKI databases. Articles published up to December 2024 were included for analysis， and the related cases were analyzed and summarized. Results The patient underwent ultrasound-guided percutaneous catheter drainage， anti-infective therapy， and oral traditional Chinese medicine.The liver abscess significantly resolved， and the child was discharged after 16 days of hospitalization， without a recurrence during a 3-month follow-up. Including this case， 8 pediatric cases were reviewed. In details，comprising 4 males and 4 females aged 5 to 14 years.Seven patients underwent laparoscopic appendectomy while one had open appendectomy；three cases involved gangrenous appendicitis and five involved perforated suppurative appendicitis. Diagnosis occurred between 1 week and 4 months post-appendectomy， with the primary clinical manifestations being fever and abdominal pain emerging 1 to 4 weeks after surgery， confirmed by color Doppler ultrasound or abdominal CT. In terms of treatment，4 received ultrasound-guided percutaneous drainage combined with antibiotics，2 received antibiotics alone，1 underwent anti-infective therapy + abscess drainage + exploratory laparotomy， and 1 underwent laparoscopic stone removal + drainage + antibiotics. Length of hospital stay ranged from 8-49 days， with all cases achieving a full recovery. Conclusion Postoperative liver abscess is a rare complication of acute appendicitis in children. Early ultrasound-guided percutaneous drainage combined with antibiotic therapy yields favorable outcomes.

Objective To explore the impacts of laparoscopic sleeve gastrectomy （LSG） combined with jejunal-jejunal bypass （JJB） on metabolic indicators in obese patients. Methods The medical records of 36 obese patients in Xiaolan People's Hospital of Zhongshan from July 2020 to July 2023 were retrospectively analyzed. According to the different surgical methods, patients were divided into the observation group （n=18, LSG+JJB） and control group （n=18, LSG）. The weight loss-related indicators, lipid metabolism, glucose metabolism, quality of life and complications were compared between groups before surgery and 12 months after surgery. Results At 1 year postoperatively, the body mass index （BMI）, waist circumference, abdominal circumference, and hip circumference in both groups were significantly reduced compared to preoperative levels, which were significantly lower in the observation group than the control group （all P<0.05）. Postoperative lipid metabolism indicators, glucose metabolism indicators, and quality of life in both groups were significantly improved compared to preoperative levels, which were more pronounced in the observation group than the control group （all P<0.05）. Severe postoperative complications were not reported in both groups, and there was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion For patients with obesity, LSG+JJB treatment can enhance the effect of weight loss, improve the function of glucolipid metabolism, and increase the quality of life, without increasing the risk of postoperative complications. It has a high safety profile and can be used as a good choice for weight loss surgery.

The clinical application of immune checkpoint inhibitors （ICIs） has significantly improved cancer treatment outcomes, yet ICI-induced hyperprogressive disease （HPD） has become a critical issue affecting the prognosis. This review systematically summarized research advances in HPD, focusing on controversies in its definition, underlying mechanisms, and clinical management strategies. Currently, the absence of unified diagnostic criteria for HPD leads to substantial heterogeneity in evaluation systems based on tumor growth kinetics and imaging characteristics, resulting in incidence variations ranging from 4.8% to 37.3% across studies. Mechanistic investigations revealed that HPD development is closely associated with multifactorial interactions involving oncogenic pathway abnormalities, immune microenvironment remodeling, and cytokine dysregulation. We proposed establishing multidimensional predictive models that integrate clinical features, genomic biomarkers, and radiomics, and exploring targeted intervention strategies to optimize immunotherapy decision-making.

Objective To explore the risk factors and the predictive value of combined indexes for gallstone recurrence after gallbladder-preserving cholecystolithotomy with laparoscopy and choledochoscopy（LC-GPC）. Methods Clinical data of 44 patients undergoing LC-GPC in the First Affiliated Hospital of Gannan Medical University from September 2019 to May 2024 were retrospectively collected. Based on the 6-month gallstone recurrence after LC-GPC, patients were divided into the gallstone recurrence（GR） group （n=6） and the non-GR group （n=38）. The t-test or Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Logistic regression analysis was used for univariate and multivariate analyses, and the receiver operating characteristic （ROC） curve was used to evaluate the predictive power of the combined indicators. Results GR occurred in 6 out of 44 patients（13.6%）. Multivariate logistic analysis showed that the Gallbladder Status Score（GSS）（OR=0.361,95%CI：0.131-0.994,P=0.049）,and total cholesterol（OR=0.215,95%CI：0.056-0.822,P=0.025） were independent risk factors for the recurrence of gallstone after LC-GPC.The area under ROC the curve（AUC） of GSS,total cholesterol and GSS+total cholesterol for predicting gallstone recurrence after LC-GPC was 0.759, 0.811 and 0.930, respectively. Conclusion GSS+total cholesterol has a good predictive value and clinical significance for gallstone recurrence after LC-GPC.

Hepatoblastomas（HB） are usually found in a large size. Due to the immature, vulnerable tissues in children, a precise anatomy is particularly important that increases the surgical challenges. In recent years, artificial intelligence （AI） has played an important role in preoperative planning and intraoperative navigation of HB surgery. This article reviewed the development status of intelligent planning and surgical navigation of HB surgery, mainly including the following aspects： （1）AI-guidedsurgical planning： three-dimensional reconstruction and virtual simulation of medical images, and optimization of AI-driven resection path; （2）Surgery planning： Augmented reality （AR） navigation, intraoperative multimodal real-time navigation fusion and intelligent navigation of robotic surgery; （3）AI-guidedsurgical planning and navigation of HB in special sites： HB in the second hepatic portal and in the caudate lobe of the liver were mainly discussed.

Objective To observe the efficiency of ultrasound-guided percutaneous transhepatic gallbladder drainage（PTGBD） and laparoscopic cholecystectomy（LC） in patients with moderate-level acute moderate cholecystitis. Methods Clinical data of patients with moderate-level acute cholecystitis in the Qingdao Municipal Hospital from March 2021 to December 2023 were retrospectively analyzed. According to the different treatment methods, they were divided into the LC group（LC treatment） and PTGBD+LC group （LC treatment after PTGBD）.The propensity score matching （PSM） at 1∶ 1 matching was performed with a caliper of 0.01,and 65 cases were included in each group. The surgical indicators, incidence rates of complications, liver function indicators （alkaline phosphatase [ALP], indirect bilirubin [IBIL], direct bilirubin [DBIL]）, serum inflammatory factors（tumor necrosis factor-α[TNF-α],C-reactive protein [CRP], interleukin-6[IL-6]） and 30-day mortality before and after treatment were compared between groups. Results In comparison to LC group,the intraoperative blood loss （31.13± 7.95 mL vs.44.86± 9.63 mL）,surgical time（62.47± 11.13 min vs.81.32± 10.52 min）,rate of intraoperative drainage （80.00% [52/65] vs.98.46%[64/65]）,and rate of LC conversion to laparotomy（0 vs.9.23% [6/65]） were significantly lower in the PTGBD+LC group （all P< 0.05）.The incidence of surgical complications in the PTGBD+LC group was significantly lower than that of the LC group （4.62%[3/65] vs.15.38%[10/65],P< 0.05）.Compared with preoperative values,ALP,IBIL,DBIL,CRP,and IL-6 at 72 h postoperatively were significantly reduced in both groups （all P< 0.05）. The above liver function indexes and serum inflammatory factors in the PTGBD+LC group at 72 h postoperatively were significantly lower than those of the LC group （all P< 0.05）. There was no significant difference in the 30-day mortality rate between the two groups（P> 0.05）.No cholecystitis recurred during the follow-up period. No significant difference in the 36-Item Short Form Health Survey （SF-36） score was found between groups （P> 0.05）. Conclusion PTGBD combined with LC can reduce intraoperative bleeding and shorten operation time, promote the postoperative recovery of AC patients, quickly relieve the inflammatory state, and improve the liver function. It has few surgical related complications, good therapeutic effect and important clinical application value.

Gastric cancer is one of the most common malignancies worldwide, and standardized surgical treatment plays a crucial role in improving its survival and prognosis. Clinical research provides scientific evidence for establishing standardized surgical treatment systems, while clinical practice continuously validates and refines research outcomes during their practical application. This article explored the core value of clinical research in driving the evolution of surgical approaches in gastric surgery, and highlighting the core value of clinical research in clinical practice. Moreover, we discussed implementation strategies for high-quality clinical research in surgery, and identified challenges and future directions in clinical research. Furthermore, this article elucidated the significant role clinical research plays in developing standardized treatment systems, aiming to provide theoretical support and practical references for designing and conducting future high-quality clinical research.

Objective Peritoneal metastasis is the most common site of distant metastasis in gastric cancer and associated with poor prognosis. Occult peritoneal metastasis （OPM）, characterized by the absence of imaging signs, is challenging to diagnose preoperatively, posing difficulties for clinical decision-making. This study aims to develop a prediction tool for OPM in gastric cancer based on clinical features using a decision tree model. Methods This was a retrospective study involving gastric cancer patients who underwent contrast-enhanced CT and laparoscopic exploration at the Gastrointestinal Oncology Center of Peking University Cancer Hospital from 2015 to 2019. Univariate and multivariate analyses were conducted to identify clinicopathological features associated with OPM. A decision tree model was constructed and its diagnostic performance was evaluated in both the training and validation sets. Results A total of 414 patients were included, of whom 63 （15.22%） had peritoneal metastasis. Multivariate logistic regression analysis identified that tumor long diameter （OR=1.023,95%CI：1.003-1.044;P=0.026）, cN3 staging （OR=6.587,95%CI： 1.362-31.846;P=0.019）, Borrmann type Ⅳ （OR=47.012,95%CI：4.903-1521.541;P=0.005）, and CA125 level （OR=1.014,95%CI：1.002-1.027;P=0.021） were independent risk factors for OPM in gastric cancer. The decision tree model incorporated six classification variables, including the tumor long diameter, cN stage, Borrmann classification, CA125 level, CA19-9 level, and Lauren classification. In the validation set, the model achieved a diagnostic accuracy of 87.2%, sensitivity of 68.3%, specificity of 90.6%, an area under the curve （AUC） of 0.807 （95% CI：0.766-0.847;P<0.001）, and a negative predictive value of 0.941. Conclusion This study developed a decision tree model based on clinical features, demonstrating good diagnostic performance for OPM in gastric cancer with negative CT findings.

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization（TACE） combined with hepatic arterial infusion chemotherapy（HAIC）, camrelizumab and apatinib in the treatment of unresectable hepatocellular carcinoma（uHCC） in the real world. Methods This was a multicenter, prospective,real-world study involving 135 uHCC patients treated with camrelizumab and apatinib from July 2022 to March 2025 in 19 medical centers.Patients were divided into the TACE group（58 cases） and the TACE+HAIC group（77 cases） based on the interventional treatment plan.The primary endpoints were overall survival（OS）, progression-free survival（PFS）, and treatment-related adverse events（TRAEs）.Propensity score and inverse probability treatment weighting（IPTW） were used to adjust for baseline differences between the groups. Results The median follow-up time for the overall cohort was 17.7 months. After IPTW, the Objective response rate（ORR） in the TACE+HAIC group was significantly higher than that in the TACE group（45.2% vs.31.3%,P=0.027）. Compared with the TACE group, the TACE+HAIC group showed a trend of improved PFS and OS,but the differences were not statistically significant （OS： P=0.490;PFS： P=0.425）.Subgroup analysis revealed that in patients achieving Objective response, the PFS in the TACE+HAIC group was significantly better than that in the TACE group（P=0.048）. In terms of safety, the overall rate of TRAEs in the TACE+HAIC group was significantly lower than that in the TACE group（67.5% vs. 86.2%,P=0.012）,but there was no significant difference in the rate of grade≥; 3 TRAEs（27.6% vs.28.6%,P=0.900）.No treatment-related deaths occurred in either group. Conclusion TACE combined with HAIC,camrelizumab and apatinib can significantly improve tumor response depth in uHCC patients, showing an overall high safety. However, the long-term survival benefit still needs to be verified through further follow-up.

The tumor microenvironment （TME） refers to the local environment surrounding tumor cells. Apart from tumor cells themselves, the TME encompasses a variety of non-tumor cells, extracellular matrix, blood vessels, lymphatic vessels, and an array of molecular signals. The TME plays a crucial role in the pathophysiology of tumors, thereby affecting the onset and progression of tumors. Research on the various components of the TME has been annually grown, among which immune cells have been the most extensively studied with a significant influence. Colorectal cancer （CRC） is a type of malignancy with a steadily increasing incidence rate, and TME in CRC is a hot research spotlight. Progression and metastasis of CRC often indicate a poor prognosis. This article aims to review immune cells within the TME involved in the e progression and metastasis of CRC.

Laparoscopic sleeve gastrectomy （LSG） is currently the most common bariatric surgery procedure. However, gastroesophageal reflux disease （GERD） caused by post-operative intrathoracic sleeve migration（ITSM） is the most concerned long-term complication. This article discussed the morbidity and possible mechanisms, clinical manifestation and diagnosis, prevention and treatment of ITSM. It is crucial to take feasible measures during the initial LSG to prevent ITSM. The possible approaches include avoiding damage to the phrenoesophageal ligament and fixing the left crus to the upper part of stomach. For patients with preoperative GERD symptoms, grade B or C esophagitis on endoscopy, or Hill grade Ⅲ or Ⅳ, simultaneous hiatal exploration, repair, and proper fixation should be considered. Regardless of the surgical approach, the fundamental measure for treating ITSM is to return the distal esophagus from the mediastinum to the abdominal cavity. Comprehensive hiatal repair and proper fixation around the gastro-esophageal junction are essential measures to ensure efficacy and prevent recurrences. Adding a gastroileal anastomosis can decrease the pressure in the sleeve which is favoring to GERD symptom, and simultaneously improve constipation and weight regain caused by ITSM.

Hepatocellular carcinoma（HCC） is a prevalent tumor of digestive system. Surgical removal has been a primary treatment. However, HCC patients have a high postoperative risk of recurrence, particularly within 2 years. Therefore elucidating the signaling pathways for early recurrence after HCC surgery aids in formulating early and effective intervention measures.Counter-measures help to prevent or delay early recurrences of HCC,thereby enhancing patient survival.This review focused upon primary signaling pathways for early recurrence after HCC surgery, aiming to enhance understanding and refine precise prevention and intervention strategies for early recurrence of HCC.

Objective To analyze the clinical features of congenital intestinal malrotation （CIM） combined with Hirschsprung's disease （HD）, thus improving its clinical diagnosis and treatment. Methods Clinical data of neonates with CIM plus HD were collected, including birth weight, gestational age, initial symptoms, age at onset, meconium passage status, physical examination findings, imaging data, pathological diagnoses, and surgical approaches. A retrospective analysis was conducted to evaluate clinical characteristics and diagnostic/therapeutic outcomes. Results Eight neonates with combined CIM and HD were included,including 5 males and 3 females. The gestational age ranged from 34 to 40 weeks, and the birth weight was between 2 400 and 3 500 g. The age at disease onset was （13.9± 4.3） days （range：2-26 days）. Four cases were preoperatively diagnosed and underwent elective Ladd's procedure combined with stage-one radical surgery for HD （all short-segment type）. In the remaining four cases, three were diagnosed intraoperatively with transitional zones in the colon during exploratory surgery for CIM .Then, enterostomy and colonic biopsies confirmed HD, and they were treated with stage-two radical HD surgery（short-segment type）. One case showed no colonic dilation intraoperatively but developed recurrent postoperative abdominal distension, leading to a subsequent diagnosis of long-segment HD requiring subtotal colectomy.Among the seven cases with short-segment HD,abdominal upright X-rays revealed fixed dilated mid-abdominal bowel loops, while this sign was absent in the long-segment HD case. Conclusions In cases of CIM combined with HD, a miss diagnosis of HD is common. The presence of fixed dilated mid-abdominal bowel loops on preoperative abdominal upright X-rays differs from isolated CIM, which should raise suspicion for concurrent HD. Stage-one surgery for CIM combined with HD is safe and effective.

Intersphincteric resection （ISR） has emerged as a pivotal sphincter-preserving procedure for low-level rectal cancer, demonstrating significant improvements in anal preservation rates while maintaining optimal oncological outcomes. This technique necessitates concomitant rectal resection with partial or complete internal anal sphincter excision, followed by ultra-low anastomotic reconstruction. This substantially elevates the risk of postoperative low anterior resection syndrome （LARS）. Characterized by increased stool frequency, urgency, and bowel dysfunction, LARS has garnered escalating clinical attention in recent years. However, perioperative interventions for preventing and managing LARS remain inadequately standardized. This article systematically reviewed current evidence to elucidate critical technical elements for perioperative anal function preservation following ISR.

Objective To summarize the experience of laparoscopic management for choledochoenterostomy anastomotic stricture after choledochal cyst excision in children. Methods Clinical data of 8 pediatric patients who were re-examined by surgery for choledochoenterostomy anastomotic stricture after laparoscopic treatment for choledochal cysts at the Pediatric Surgery Department of Fujian Medical University Union Hospital from July 2016 to June 2024 were retrospectively analyzed. underwent laparoscopic biliary-enteric anastomotic reconstruction for postoperative biliary-enteric anastomotic stenosis. The operation time, intraoperative blood loss, time to first flatus, postoperative hospital stay, and complications were collected. Results All 8 children successfully underwent complete laparoscopic biliary-enteric anastomotic reconstruction. The operation time ranged from 120 minutes to 270 minutes,with an average of 188.5± 47.5 minutes. Blood loss ranged from 15 mL to 185 mL, with an average of 99.1± 62.1 mL. The postoperative hospital stay ranged from 7 days to 14 days, with an average of 9.2± 1.8 days. There were no cases of postoperative intra-abdominal bleeding, intra-abdominal infection, need for reoperation, or mortality. The follow-up period ranged from 6 months to 60 months, with an average of 30.2± 16.1 months. None of the followed-up children experienced recurrent biliary-enteric anastomotic stenosis. One child developed postoperative cholangitis, which was successfully treated with conservative management including anti-inflammatory and gallbladder-soothing medications, as well as traditional Chinese medicine. Conclusion Laparoscopic reconstruction of the choledochoenterostomy anastomotic stricture following choledochal cyst excision is safe and effective.

Objective To investigate the clinical efficacy of totally laparoscopic surgery in the treatment of neonates with type I high jejunal atresia. Methods A total of 46 neonates with type I high jejunal atresia （within 10 cm of the ligament of Treitz） admitted to the Third Affiliated Hospital of Zhengzhou University from January 2017 to September 2024 were retrospectively analyzed. According to whether laparoscopic surgery was used or not, they were divided into laparoscopic procedure（LP） group （n=16） and open procedure （OP） group （n=30）.The general data, perioperative inflammation,operation time, intraoperative bleeding, the first defecation time,the first postoperative oral feeding time, postoperative full oral feeding time, postoperative abdominal drain removal time, postoperative complications, unexpected second operations,the length of hospital stay, and mortality were compared between the two groups. Continuous variables that followed or approximately followed a normal distribution were expressed as x±s, and compared by the t-test.Continuous variables that did not conform to a normal distribution were expressed as the median（Q1,Q3）.Count data were compared by the chi-square test. Results The operation was successfully completed in both groups. There were no significant differences in the gender,gestational age,weight,preterm birth rate,and abnormal prenatal diagnosis between groups（all P> 0.05）. Compared to the OP group, the LP group had significantly less intraoperative bleeding （2.00 [1.00,2.38] mL vs. 2.00 [2.00,5.25] mL）, shorter time to first defecation （2.25± 1.24 d vs. 3.20± 1.37 d）, shorter time to first postoperative oral feeding （7.19± 2.07 d vs. 9.00± 3.18 d）, shorter time to postoperative full oral feeding （15.56± 6.77 d vs. 23.43± 14.94 d）, shorter time to abdominal drain removal（10.43± 3.67 d vs.13.47± 4.98 d）, and shorter length of hospital stay （21.50± 7.30 d vs. 29.50± 14.21 d） （all P< 0.05）.There were no significant differences between the two groups in C-reactive protein（CRP）,operation time, postoperative complications, unexpected second operations, and mortality（all P> 0.05）. Conclusion Totally laparoscopy is safe and feasible in the treatment of neonatal type Ⅰ high jejunal atresia, and offering significant advantages in reducing bleeding, restoring gastrointestinal function as soon as possible, and shortening hospital stay.

目前加速术后康复（enhanced recovery after surgery,ERAS）已应用于肝切除术,但在右肝巨大肿瘤切除术中应用较少。此文对1例右肝巨大肿瘤（大小为27.0 cm×20.0 cm×15.0 cm）切除术病人（17岁,女性）,采用一系列围手术期优化处理措施,减少了病人术后并发症,加速了病人康复进程,病人于术后第7天出院。通过此例病人围手术期中的ERAS实践,显示出ERAS管理路径在右肝巨大肿瘤切除术围手术期中安全可行,值得进一步探索和优化。

Objective To investigate the risk of gastroparesis and prognosis of late-phase gastroparesis in severe acute pancreatitis （SAP）, and to constructa nomogram to early predict its risk, thus reducing the incidence of gastroparesis. Methods A retrospective analysis was conducted on the clinical data of 240 SAP patients who were admitted to the Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, from October 2019 to December 2023. Based on the occurrence of gastroparesis at 2 weeks of SAP, they were divided into the gastroparesis group and non-gastroparesis group, and clinical data were compared between groups. A total of 240 SAP patients were randomly divided into the training set （192 cases） and validation set （48 cases） at a ratio of 8∶2. Correlation analysis was conducted on the variables in the training set, and Lasso regression and multivariate logistic regression was used to identify risk predictors for gastroparesis. A nomogram was constructed, validated, and analyzed. Results The incidence of gastroparesis in the late phase of SAP was 29.6% （71/240）. Compared with the non-gastroparesis group, patients with gastroparesis demonstrated significantly increased hospitalization costs, prolonged hospital stays, higher rates of extended ICU admission, elevated 60-day all-cause mortality, and greater frequencies of both overall surgical interventions and laparotomy procedures. Through analysis of the training cohort, seven independent predictive factors were identified： Nutritional Risk Screening 2002 （NRS2002） score, time interval from SAP onset to enteral nutrition initiation, mean 72-hour blood glucose （Glu） levels, C-reactive protein concentration, leukocyte count, as well as the extent and anatomical distribution of pancreatic/peripancreatic necrosis or inflammatory exudation. These parameters were incorporated into a nomogram, which exhibited excellent discriminative ability, calibration, and clinical utility in both training and validation datasets. Conclusion The validated nomogram provides clinicians with a practical tool for early identification of high-risk patients and targeted intervention to improve the prognosis of SAP.

回顾性分析 2018年8月至2022年12月青海红十字医院肝胆胰疝外科收治的42例胆囊结石合并胆总管细小结石单纯行腹腔镜下胆囊切除术病人的临床资料,其中男性20例,女性22例,年龄（48.9±13.6）岁,体重指数（23.57±2.93） kg/m²。42例病人胆总管直径（0.87±0.25） cm,胆总管结石直径（0.35±0.14）cm;胆总管泥沙样结石6例,单发结石36例;术前肝功能异常3例,其余均为无症状胆总管结石。术后3个月复查磁共振胰胆管成像,结石排出率78.57%（33/42）,均为无症状排石,其中2例为术前有症状的病例。9名胆总管结石未排出的病人,给予牛黄熊去氧胆酸胶囊口服,服药半年后复查磁共振胰胆管成像,所有病例胆总管结石均已排出;其中1例有排石症状,出现上腹痛,持续数小时后自行缓解、无黄疸,伴有肝酶升高,口服保肝药物后好转。该研究中所有病人的胆总管结石均在胆囊切除术后自动排出,无严重并发症发生,提示胆总管细小结石行观察处理的排出率高,且绝大多数病人均为无症状排石,同时可保留Oddi括约肌及胆总管的完整性。

Severe acute pancreatitis develops rapidly and extremely dangerous, with a high incidence of complications, and poor prognosis. Infected pancreatic necrosis （IPN） is one of the complications of severe pancreatitis. Approximately 20% of severe acute pancreatitis patients develop pancreatic or peripancreatic necrosis, with a mortality rate ranging from 8% to 39%. Early diagnosis of IPN remains challenging due to limited diagnostic methods, and controversies persist regarding optimal treatment strategies and timing. So far, a "step-up" strategy is the main strategy for treating IPN. This paper reported the diagnosis and treatment of an adult male IPN patient with repeated courses and long hospital stay. Based on our clinical experience and literature review at home and abroad, we introduced and summarized the etiology, pathogenesis, early diagnosis, and treatment of IPN, in order to enhance clinicians' understanding and provide practical guidance for clinical practice.

Objective To evaluate the safety and efficacy of pre-procedural magnesium sulfate in preventing post-endoscopic retrograde cholangiopancreatography （post-ERCP） pancreatitis （PEP） using propensity score matching （PSM）. Methods We retrospectively analyzed patients with common bile duct stones who underwent ERCP in the Department of General Surgery at the Second People's Hospital of Hefei from January 2022 to October 2024. Patients receiving magnesium sulfate before ERCP were compared with those receiving normal saline. Data were processed with SPSS 22. PSM （1∶1） was used to balance measured confounders. The effects of pre-procedural magnesium sulfate on postoperative inflammatory markers, liver function indexes, amylase, and pancreatitis in ERCP patients were analyzed. Results Before matching, the groups differed by sex and number of cannulation attempts （P<0.05）. After PSM, 128 patients were matched （64 per group） with balanced baseline characteristics （all P>0.05）. At 24 hours, liver function tests （total and direct bilirubin, aspartate transaminase, alanine aminotransferase） did not differ between groups （all P>0.05）. In contrast, white blood cell count, C-reactive protein, and interleukin-6 were significantly lower in the magnesium sulfate group than in controls （all P<0.05）. The incidences of hyperamylasemia and PEP at 12 and 24 hours were also significantly lower in the magnesium sulfate group （P<0.05）. Conclusion Pre-procedural magnesium sulfate was associated with a reduced early inflammatory response and a lower incidence of hyperamylasemia and post-ERCP pancreatitis.

Severe acute pancreatitis （SAP） remains a major clinical challenge with high mortality. Surgical management has shifted from early aggressive operations to a modern, evidence-based "delayed, minimally invasive, step-up" strategy. This article explicates the pathophysiological rationale for that shift—centered on the "two-hit" theory—and highlights the need to avoid iatrogenic second hits during the peak systemic inflammatory response. Regarding timing, we review evidence supporting delay of intervention until at least 4 weeks after onset （to allow acute necrotic collections to evolve into walled-off necrosis） as the gold standard, with abdominal compartment syndrome identified as the only one exception requiring earlier intervention. Regarding modality, we trace the development and validation of the step-up approach： Initial percutaneous catheter drainage or endoscopic transluminal drainage, followed by endoscopic or minimally invasive surgical necrosectomy. The roles of direct "single-step" necrosectomy and the redefined, limited place of open surgery in contemporary practice are also discussed. Strict adherence to this evidence-based framework can significantly improve outcomes for patients with SAP.

For most patients with obesity, metabolic and bariatric surgery （MBS） is the most effective option after failure of non-surgical treatment.These procedures achieve weight loss through restrictive and/or malabsorptive mechanisms that reduce gastric volume and intestinal absorptive area. However, rapid weight loss, preoperative nutritional status, procedure-specific anatomical changes, and decreased intake and absorption of key micronutrients can predispose patients to adverse outcomes, notably anemia. This review summarizes the current landscape of anemia following different MBS procedures, examines patient- and procedure-related factors associated with its development, and outlines practical screening, prevention, and treatment strategies. Proactive identification and management of anemia in the postoperative period are essential to mitigate surgical morbidity and improve patients'quality of life.

Severe acute pancreatitis （SAP） is an urgent abdominal condition characterized by a critical clinical course, multiple complications, and high mortality. Treatment strategies have evolved from early aggressive surgery to conservative care and now to a multidisciplinary, comprehensive model integrating minimally invasive and open procedures. Surgical decision-making for SAP is primarily guided by multi-disciplinary team （MDT） discussion. Recent studies have demonstrated that minimally invasive, stepwise strategies significantly improve patient outcomes. In addition, optimizing individualized timing of intervention and applying machine learning-based prediction models offer promising directions for more precise, tailored treatment.

Objective To establish an improved mouse model of gastroesophageal reflux disease （GERD） by combining partial pyloric and forestomach ligation with postoperative dietary intervention. Methods A total of 48 C57BL/6J mice were randomly assigned to four groups： 2-week sham, 2-week model, 7-week sham, and 7-week model. Model groups underwent partial ligation at the pylorus （pyloric semi-ligation） and forestomach, followed by a high-fat diet and postoperative nutritional gel. Sham groups received laparotomy only and standard chow. Body weight and survival were monitored. At 2 and 7 weeks, esophagi were harvested for hematoxylin-eosin （HE） histology to assess reflux esophagitis, and model induction success was calculated. Inflammatory profiles were evaluated by quantitative real-time PCR （qRT-PCR） and enzyme-linked immunosorbent assay （ELISA）. Statistical analyses were performed in GraphPad Prism. Results Successful model induction rates were 83.3% at 2 weeks and 66.7% at 7 weeks （P<0.05）. Compared with shams, model mice exhibited esophageal wall thickening, basal cell hyperplasia, and inflammatory cell infiltration on HE staining. qRT-PCR and ELISA demonstrated significantly increased expression of M1 macrophage-associated mediators and markers （e.g., interleukin-6], monocyte chemoattractant protein 1, cluster of differentiation 80 [CD80], CD86） and decreased expression of M2-associated mediators and markers （e.g., interleukin-10, CD163, CD206） in model mice （all P<0.05）. Conclusion This combined surgical-dietary approach induces robust reflux esophagitis while maintaining acceptable survival. The model recapitulates key pathological features of human acid-reflux-related GERD, including M1-predominant inflammation, and provides a practical platform for mechanistic studies and preclinical therapeutic evaluation.

Objective To investigate the effect of skeletal muscle density （SMD） on blood glucose levels during supplemental parenteral nutrition （SPN） after laparoscopic total gastrectomy. Methods We retrospectively analyzed 258 patients who received SPN following laparoscopic total gastrectomy at Baoding No.1 Central Hospital from February 2018 to February 2021. Demographic and clinical data, nutritional and inflammatory markers, SMD, and postoperative blood glucose were collected. Patients were categorized by SMD into SMD-H （high SMD; males ≥38.5 HU, females ≥28.6 HU; n=208） and SMD-L （low SMD; males <38.5 HU, females <28.6 HU; n=50）. Risk factors for hyperglycemia during SPN were assessed by multivariable logistic regression, and postoperative glucose metrics and complication rates were compared between groups. Results Compared with the SMD-H group, the SMD-L group had a significantly higher incidence of hyperglycemia （χ²=8.066, P=0.005） and postoperative complications （χ²=18.391, P<0.001）. Mean （t=3.944, P<0.001）and maximum （t=5.134, P<0.001） venous plasma glucose values during SPN were higher in the SMD-L group, and glucose variability during SPN was greater（t=5.134, P<0.001）. Multivariable analysis identified age >60 years （OR=2.21, P=0.011）, anemia （OR=3.676, P<0.001）, and low SMD （OR=0.343, P=0.004） as independent predictors of hyperglycemia during SPN. Conclusion Low skeletal muscle density is associated with increased risk of hyperglycemia during SPN after laparoscopic total gastrectomy, suggesting that lower SMD may be related to greater insulin resistance.

Objective To evaluate the clinical effectiveness of an APR triangle-guided Glissonean pedicle approach in laparoscopic anatomical right hemihepatectomy for primary hepatocellular carcinoma （HCC）. Methods This retrospective study included 46 patients with primary HCC who underwent laparoscopic anatomical right hemihepatectomy at Taihe Hospital of Shiyan City from January 2020 to October 2022. Patients were stratified into two groups： APR group （n=23）： Glissonean pedicle transection via the APR triangle. Conventional group （n=23）： Standard extrahepatic （hilar） approach. Outcomes included operative time, hepatic inflow occlusion duration （Pringle maneuver）, intraoperative blood loss, postoperative liver function recovery, intraoperative and postoperative complications, and length of hospital stay. Results Compared with the conventional approach, the APR triangle-guided technique was associated with shorter operative time （P<0.05）, reduced hepatic inflow occlusion duration （P<0.05）, and less intraoperative blood loss （P<0.05）. Postoperatively, the APR group showed faster hepatic recovery, with significantly lower alanine aminotransferase （ALT） and aspartate transaminase （AST） at 1, 3 and 5 days postoperatively, and lower total bilirubin （TBIL） at 1 and 3 days postoperatively （all P<0.05）. The overall rate of complications （including bile leak, pleural effusion, and ascites） was significantly lower in the APR group [13.04%（3/23） vs 43.48%（10/23）, P<0.05], and hospital stay was significantly shorter （P<0.05）. Conclusion Compared with conventional technique, the APR triangle-guided Glissonean pedicle approach in laparoscopic anatomical right hemihepatectomy appears safe and effective, with shorter operative time, reduced surgical risk, faster postoperative hepatic recovery, fewer complications, and a shorter length of stay.

Aggressive fibromatosis （AF） is a rare, benign yet locally invasive fibroblastic neoplasm. Intra-abdominal aggressive fibromatosis （IAF） is the least common subtype and generally carries a poorer prognosis due to its proximity to mesenteric vessels and bowel. IAF occurs sporadically—most often driven by activating CTNNB1 mutations—or as part of hereditary syndromes associated with familial adenomatous polyposis （FAP） due to germline APC mutations. Imaging with ultrasound, CT, and MRI aids lesion characterization and delineation of extent, while definitive diagnosis is supported by histopathology demonstrating nuclear β-catenin expression. Management has shifted from routine upfront surgery to a risk-adapted strategy prioritizing active surveillance for asymptomatic or stable disease, given high local recurrence rates after resection. Among pharmacologic options, cytotoxic chemotherapy, tyrosine kinase inhibitors, and γ-secretase inhibitors have shown clinical activity, though optimal sequencing and long-term safety require further study. Despite ongoing challenges, multidisciplinary management enhances diagnostic accuracy, treatment selection, and outcomes. Future work should focus on validating prognostic biomarkers, elucidating biological mechanisms of response and resistance, and defining evidence-based algorithms that balance efficacy with safety.

Cholangitis is highly prevalent after Kasai surgery for biliary atresia. The occurrence of cholangitis accelerates the failure of liver function and seriously affects the survival rate of the autologous liver. The diagnosis of cholangitis is lack of specificity, and early diagnosis can be made from multiple perspectives according to the diagnostic criteria at home and abroad. Reasonable, sufficient and sufficient antibiotic application is very critical to the treatment of cholangitis. Before identifying the pathogenic bacteria, the third-generation cephalosporins or carbapenems can be empirically selected for treatment. The treatment courses and antibiotic types of different types of cholangitis vary a lot. It is generally accepted that prophylactic antibiotics within 6 months are used to prevent cholangitis, although the efficacy is not clear.

With advances in hepatobiliary surgery, procedures such as hemihepatectomy, caudate lobectomy, and partial portal vein resection with anastomosis are being performed with increasing frequency. Consequently, intraoperative dissection of the portal vein bifurcation and the left or right portal vein trunks at the hepatic hilum has become increasingly common. The principal technical challenge in this dissection is the safe management of the small, short portal venous branches （short hepatic portal veins） that arise from the portal vein bifurcation or from the left or right trunks. The team led by Prof. Jiang Xiaoqing conducted an anatomical study of these short portal veins and proposed the concept of the "fourth hepatic hilum", which provides a structured framework for this region and has important implications for operations involving it.

Objective To identify early risk factors for failure of conservative （nonoperative） management in acute appendicitis during pregnancy （AAP） and to determine optimal diagnostic thresholds to inform individualized treatment strategies. Methods We retrospectively analyzed 80 pregnant patients with AAP treated at Baoding No.1 Central Hospital from January 2013 to June 2023. Cases were categorized as successful conservative management （n=48） or failed conservative management （n=32）. Univariate analyses and multivariable logistic regression were used to identify independent predictors of failure. Receiver operating characteristic （ROC） analysis with the Youden index was applied to determine optimal cutoffs for continuous predictors. Results Univariate analysis showed that compared with the success group, the failure group had significantly longer hospital stays （t=-3.450, P<0.05）, higher proportion with fever （body temperature >37.3 °C; χ² =8.437, P<0.05）, higher neutrophil percentage （NEUT%; t=-3.370, P<0.05）, and longer symptom duration prior to conservative treatment （t=-3.161, P<0.05）. In multivariable logistic regression analysis, longer symptom duration, fever, and higher NEUT% were independent predictors of conservative management failure. The areas under the ROC curve for symptom duration and NEUT% were 0.810 and 0.775, respectively （both P<0.05 versus 0.5）. The optimal cutoffs were 27 hours for symptom duration and 88.96% for NEUT%, yielding Youden indices of 0.562 and 0.502, sensitivities of 87.5% and 75.0%, and specificities of 31.3% and 18.8%, respectively. Conclusions ymptom duration >27 hours, fever, and NEUT% >88.96% are early predictors of failure of conservative management in AAP. Early surgical intervention should be considered for patients meeting these criteria to improve outcomes.

Objective To evaluate the effects of laparoscopic total extraperitoneal hernia repair （TEP） in elderly patients with inguinal hernia, focusing on clinical outcomes, perioperative serum gastrin and motilin levels, and postoperative pain management. Methods From April 2023 to April 2024, 112 elderly patients with inguinal hernia were enrolled and randomized using a random number table into two equal groups （n=56 each）. The control group underwent laparoscopic transabdominal preperitoneal repair （TAPP）, while the TEP group received laparoscopic total extraperitoneal repair （TEP）. Postoperative recovery parameters, intraoperative variables, respiratory indicators after pneumoperitoneum, hormonal and gastrointestinal peptide levels, pain, and complications were compared between groups. Results There were no statistically significant differences between groups in intraoperative blood loss, operative time, length of hospital stay, or overall postoperative complication rate （P>0.05）. The TEP group had earlier recovery of gastrointestinal function, as shown by shorter times to first oral intake, first flatus, and return of bowel sounds （P<0.05）. Airway pressure and end-tidal CO₂ （P_ETCO₂） measured at 10 and 30 minutes after pneumoperitoneum were higher in the TEP group than in the TAPP group （P<0.05）. At postoperative day 3, the TEP group showed lower levels of gastrin, plasma motilin, cortisol, adrenocorticotropic hormone （ACTH）, epinephrine, and norepinephrine compared with the TAPP group （P<0.05）. Conclusions In elderly patients with inguinal hernia, TEP repair more effectively minimizes impairment of gastrointestinal function, produces less postoperative pain, and promotes faster recovery, although it may adversely affect intraoperative respiratory parameters.

Objective To evaluate whether preoperative diffuse reduction of spleen density on computed tomography （CT） predicts overall survival （OS） in patients with intrahepatic cholangiocarcinoma （ICC） undergoing surgical resection. Methods We retrospectively analyzed 106 consecutive ICC patients who underwent curative resection at the Department of Hepatobiliary Surgery, Affiliated Hospital of Qinghai University, from April 2017 to June 2020. Spleen density was measured on CT cross-sectional images for each patient. Receiver operating characteristic （ROC） analysis identified the optimal CT threshold for spleen density; patients were then classified as having diffuse reduction of spleen density （DRSD） or non-DRSD based on that cutoff. Median OS was estimated by the Kaplan-Meier method and compared with the log-rank test. Univariate and multivariate Cox proportional hazards models were used to identify independent predictors of OS. Results The optimal CT cutoff for spleen density predicting survival yielded an area under the curve （AUC） of 0.667 （95% CI： 0.560-0.774）. Using the identified threshold （44.9 HU）, 39 patients （36.8%） were classified as DRSD （CT<44.9 HU）. Baseline characteristics did not differ significantly between DRSD and non-DRSD groups （P> 0.05）. Median OS was 13.5 months （95%CI： 6.5-20.5） in the DRSD group versus 37.0 months （95%CI： 31.5-42.5） in the non-DRSD group （χ²=12.444, P<0.001）. Subgroup analysis by stage showed that DRSD was strongly associated with worse OS in stage Ⅰ-Ⅱ patients： median OS 13.5 months （95%CI： 1.5-26.5） versus 46.6 months （95%CI： 31.5-42.5） in non-DRSD （χ² =19.941, P<0.001）. For stage Ⅲ-Ⅳ patients, median OS was 12.0 months （95%CI： 2.4-21.6） in the DRSD group and 28.0 months （95%CI： 12.3-43.2） in the non-DRSD group, but this difference was not statistically significant （χ²=0.242, P=0.623）. In multivariate Cox analysis, DRSD （HR=2.898, 95%CI： 1.722-4.876, P<0.001）, lymph node metastasis （HR=2.193, 95%CI：1.280-3.756, P=0.004）, and microvascular invasion （HR=4.577, 95%CI： 2.419-8.658, P<0.001） were independent predictors of poorer OS. Conclusions Preoperative diffuse reduction of spleen density on CT is an independent predictor of worse overall survival in patients with stage Ⅰ-Ⅱ intrahepatic cholangiocarcinoma undergoing surgical resection. CT-based measurement of spleen density may provide a simple, noninvasive imaging biomarker to aid prognostic stratification in ICC.

Objective To evaluate the expression of recombination signal binding protein for immunoglobulin kappa J region （RBPJ） and tripartite motif protein 25 （TRIM25） in colorectal cancer （CRC） and to assess their diagnostic value. Methods We prospectively selected 112 CRC patients who underwent surgical resection at the No.2 Hospital of Baoding between June 2021 and June 2023. Tumor and matched adjacent non-tumor tissues were collected intraoperatively. Fifty healthy adults who underwent routine physical examinations during the same period served as the healthy control group for serum analyses. Tissue expression of RBPJ and TRIM25 was assessed by immunohistochemistry. Associations between marker expression and clinicopathological features were examined, and correlations between the two markers were evaluated using Spearman's rank correlation. Receiver operating characteristic （ROC） curve analysis was performed to assess the diagnostic performance of serum RBPJ and TRIM25 levels individually and in combination. Results The positive expression rates of RBPJ and TRIM25 in CRC tissues （70.54% and 68.75%, respectively） were significantly higher than those in adjacent tissues （27.68% and 33.04%; P<0.05）. Spearman's rank correlation analysis showed that the RBPJ and TRIM25 expression levels in tumor tissues were positively correlated （r=0.663, P<0.05）. Higher expression of both markers was significantly associated with advanced TNM stage, lymph node metastasis, and greater depth of invasion （all P<0.05）. Serum levels of RBPJ and TRIM25 were significantly higher in CRC patients than in healthy controls （both P<0.05）. For the diagnosis of CRC, the areas under the ROC curve （AUCs） for serum RBPJ and TRIM25 were 0.878 and 0.708, with sensitivities of 75.89% and 91.96% and specificities of 92.00% and 54.00%, respectively. The combined use of both markers yielded an AUC of 0.930, with 77.68% sensitivity and 96.00% specificity. Conclusion RBPJ and TRIM25 are overexpressed in CRC tissues and correlate with adverse clinicopathological features. Elevated serum levels of these markers—especially when combined—show promise for the diagnostic evaluation of CRC.