The safety and efficacy of laparoscopic surgery for colorectal cancer has been confirmed by several large-scale clinical studies. Laparoscopy has become the main modality of surgical treatment for colorectal cancer in China. Based on evidence-based medicine and the experience accumulated in clinical practice, laparoscopic colorectal surgical techniques are still being continuously optimised and improved. The key techniques mainly revolve around the following three aspects:①complete surgical excision extension;②appropriate lymph node dissection area;③safe digestive tract reconstruction. Prioritizing the standardization of laparoscopic colorectal cancer surgery, promoting the consistent implementation of these procedures, establishing a scientific evaluation system, thoroughly assessing surgical outcomes, and conducting high-quality clinical research are essential for enhancing the standardization of laparoscopic colorectal cancer surgery in China.

The advancements in colorectal minimally invasive surgical techniques represent not merely technological innovation but also a significant leap in surgical philosophy. Over the past half-century, we have witnessed the historic transition from traditional open surgery to minimally invasive procedures, a change propelled by continuous innovations in surgical platforms and techniques. The innovations of platforms encompass developments in imaging platforms, energy platforms, instrumentation platforms. Furthermore, innovations in surgical techniques primarily focus on exploring variables within five key elements of surgical techniques: the approach, extent of bowel resection, lymph node dissection, reconstruction of the digestive tract, and specimen extraction. The progress in colorectal minimally invasive surgery has significantly reduced surgical trauma, and enhanced patients' postoperative quality of life and the overall safety of surgeries. This progress is underpinned by stringent quality control throughout the surgical process, ensuring standardized and homogeneous execution of procedures. Moving forward, the ongoing drive to innovate surgical techniques and philosophies will continue to improve the efficacy and safety of colorectal minimally invasive surgeries. This journey not only necessitates the relentless advancement of medical technologies, but also requires surgeons to continuously deepen and actively pursue surgical philosophies.

Early rectal cancer is defined as any size of rectal epithelial tumor with infiltration depth limited to the mucosa and submucosa, regardless of with or without lymph node metastasis. Local resection is one of the main treatment methods for early rectal cancer without local lymph node metastasis. The development of endoscopic mucosal resection (EMR), endoscopic submucosal dissection (ESD), transanal endoscopic microsurgery (TEM), and transanal minimally invasive surgery (TAMIS) has brought more options for the treatment of early rectal cancer. About 8%-12% of early rectal cancer patients have local lymph node metastasis and therefore still require total mesorectal excision (TME). The current guidelines recommend that early rectal cancer with high-risk pathological features requires additional salvage radical surgery. Various minimally invasive and anal sphincter-preserving surgical techniques, such as natural orifice specimen extraction surgery (NOSES), transanal total mesorectal excision (TaTME), intersphincteric resection (ISR), and conformal sphincter-preserving operation (CSPO), have better achieved the goal of anal sphincter preservation and anal function preservation. The overall prognosis of early rectal cancer is good, but full-process surveillance is equally important. With the innovation of early diagnosis, early treatment and full-process surveillance, the development of endoscopic and surgical techniques will further improve the standardization of diagnosis and treatment for early rectal cancer.

Locally advanced rectal cancer (LARC) is associated with a high risk of local recurrence and distant metastasis, making it difficult to be cured by surgery alone. Neoadjuvant chemoradiotherapy followed by surgery is the standard treatment for LARC, with reduced local recurrence rates. However, neoadjuvant chemoradiotherapy is associated with patients' urogenital and sexual dysfunction, which severely affecting their quality of life. Therefore, determining the optimal timing of surgery to balance oncologic and functional outcomes is crucial and challenging. We proposed that choosing the optimal timing of surgery based on preoperative risk assessment of LARC is an effective strategy. The patients with low to moderate risk of recurrence can be considered to perform surgery directly or have preoperative chemotherapy followed by radical surgery. Patients with high risk of recurrence should extend neoadjuvant therapy before surgery to improve oncologic outcomes. In this study we explored the optimal timing of radical surgery for LARC, providing a new idea for individualized and precise treatment of LARC.

This review explored recent advancements in organ preservation strategies for early rectal cancer. Although total mesorectal excision (TME) remains the standard treatment, there is a growing interest in organ preservation approaches due to the potential decline in quality of life associated with TME. We discussed precise staging methods for early rectal cancer and proposed specific organ preservation protocols for cT1N0M0 and cT2N0M0 patients. Additionally, immunotherapy has shown significant potential for patients with deficient mismatch repair/microsatellite instability-high (dMMR/MSI-H) status. This review summarized current research findings and provided guidance for clinicians on organ preservation options when treating early rectal cancer.

In this paper we interpretated the background about Standardized surgical procedure of conformal sphincter-preservation operation (CSPO) for low rectal cancer (2023 edition), and several key issues need to be attention, for example, the definition of conformal resection, the clarity of relevant anatomical concepts, the functional advantages of CSPO, the main differences between CSPO and intersphincteric resection(ISR), the clinical value and indications, the principles and details of surgery, and the key issues of perioperative nursing.

For locally advanced rectal cancer (LARC), the standard treatment of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) leaded to limited tumor regression grade and organ preservation rate, and didn’t decrease the rate of distant metastasis. Radiotherapy can promote the immune response and has good synergistic effect with immunotherapy, which is likely to overcome the treatment difficulty of the microsatellite stable(MSS) colorectal cancer. Recently, multiple clinical trials are ongoing in terms of the combination of nCRT and immunotherapy in LARC. Most of them have achieved promising complete response rates, providing new treatment options for preservation of organ functions in mid-low MSS LARC. Large-scale randomized controlled trials are needed in the future to validate these findings and explore the benefit of organ preservation and long-term survival. In addition, studies are still needed on the optimal combination patterns of radiotherapy and immunotherapy and the precise efficacy evaluation, etc.

Objective To analyze the serum PD-L1 levels of gastric cancer patients and its relationship with tumor stage and prognosis. Methods Serum of sixty patients with pathological diagnosis of gastric cancer in our hospital from August 2018 to December 2019 were collected, and the serum of 15 healthy adults as a control. The serum PD-L1 levels was measured by enzyme linked immunosorbent assay(ELISA). The serum PD-L1 levels between gastric cancer patients and healthy adults were compared.The relationship between the serum PD-L1 levels and prognosis of gastric cancer patients with different stages was analyzed. Finally, the PD-L1 expression in tumor tissues was detected by immunohistochemical staining, and its correlation with serum PD-L1 levels was analyzed. Results The serum PD-L1 levels of gastric cancer group was significantly higher than that of the control group. The serum PD-L1 levels in patients with stage Ⅲ and Ⅳ gastric cancer was significantly higher than that in stage Ⅰ and Ⅱ. The serum PD-L1 levels in gastric cancer patients with peritoneal metastasis was significantly elevated, indicating poor prognosis. Kaplan-Meier survival analysis showed that the survival time of gastric cancer patients with higher level of serum PD-L1 was shorter than those with lower ones. We further evaluated the PD-L1 expression in tumor tissues. There was no significant correlation between the serum PD-L1 levels and that in tumor tissues. Conclusions The serum PD-L1 levels of gastric cancer patients was higher than that of healthy adults, and which gradually increased with the progression of the disease. Gastric cancer patients with peritoneal metastasis had a much higher serum PD-L1 levels, and there was no significant correlation between serum PD-L1 levels and PD-L1 expression in tumor tissues.

Objective To analyze the influencing factors of delayed postoperative bleeding (DPPB) after endoscopic submucosal dissection (ESD) for early gastric cancer and construct a Nomogram model. Methods The clinical information of 234 patients who underwent ESD treatment at our hospital and pathologically diagnosed with early gastric cancer from April 2021 to April 2023 were collected. The patients were grouped based on the presence or absence of DPPB. Logistic regression analysis was applied to screen for risk factors affecting DPPB after ESD in early gastric cancer patients. R software was applied to construct a Nomogram model for predicting the risk of DPPB in early gastric cancer patients after ESD. Receiver operator characteristic (ROC) curve, calibration curve, and Hosmer-Lemeshow goodness of fit test were plotted to evaluate the Nomogram model. Results A total of 23 (9.8%) of 234 early gastric cancer patients who underwent ESD treatment developed DPPB. Multivariate Logistic regression analysis showed that the number of biopsies ≥ 3 (95%CI: 2.482-20.424, P=0.000), the maximum diameter of lesions ≥ 3 cm (95%CI: 1.620-13.244, P=0.004), the depth of invasion to submucosa (95%CI: 1.421-10.536, P=0.008), and intraoperative bleeding (95%CI: 1.160-11.300, P=0.027) were independent risk factors for DPPB after ESD in early gastric cancer patients. The area under ROC curve (AUC) was 0.838 (95%CI: 0.743-0.932). The slope of the calibration curve was close to 1. Hosmer-Lemeshow goodness of fit test showed χ²=3.328, P=0.505. Conclusions The number of biopsies ≥ 3, the maximum diameter of lesion ≥ 3 cm, the depth of invasion to submucosa, and intraoperative bleeding are independent risk factors for DPPB after ESD in early gastric cancer patients. The Nomogram model based on these four independent risk factors can effectively predict the risk of DPPB after ESD in early gastric cancer patients.

Objective To investigate the risk factors and preventive strategies of pancreaticoduodenectomy postoperative hemorrhage. Methods A total of 208 patients who underwent pancreaticoduodenectomy in the Department of Hepatobiliary Surgery of the 904th Hospital of Joint Logistics Support Force, PLA from January 2017 to December 2021 were enrolled. Twenty-one patients with postoperative hemorrhage were retrospectively analyzed. Results Univariate analysis indicated that postoperative hemorrhage was mainly associated with pancreatic leakage, biliary leakage, abdominal infection, hypoproteinemia, diabetes, improper use of ultrasound knife, skeletonization, intraoperative blood loss, preoperative jaundice, etc.(P<0.05), but not gender and age (P>0.05). Among the 21 patients with postoperative hemorrhage, 4 cases recovered after conservative treatment such as hemostasis and blood transfusion, 6 cases underwent interventional treatment, 11 cases underwent abdominal exploration, and 2 cases died of postoperative multiple organ failure. Pancreatic leakage (OR=3.963,95%CI: 1.120-14.025), biliary leakage (OR=4.013,95% CI: 1.173-13.734) and abdominal infection (OR=7.545,95%CI: 1.833-31.051) were independent risk factors for postoperative hemorrhage. Conclusions The improvement of anastomotic manipulation, reduction of anastomotic leakage, and control and prevention of abdominal infection are important to prevent postoperative hemorrhage of pancreaticoduodenectomy. Surgical treatment should be performed as soon as possible for the patients with poor conservative treatment effect.

Objective To explore the feasibility and rationality of advanced integrated two-stage laparoscopic simulation training course in standardized training of surgical residents. Methods From December 2019 to December 2021, the advanced integrated two-stage laparoscopic simulation training course was carried out among 2019—2020 surgical residents who received standardized training in our hospital. The course was divided into two stages. In the first stage, BEST (best essential surgical technology training) course, adopted Darwin^® endoscopic training system, Tianyan^® endoscopic training system, Microport^® 3D laparoscopic training system and simple simulative models were used. The second stage, BEST PLUS course, same platform as that in BEST course and in vitro animal models were used. The questionnaire survey method (before and after class questionnaire) was adopted to evaluate the curriculum setting, such as curriculum form, simulators, teaching method, time arrangement, curriculum difficulty, training effect, curriculum satisfaction and so on. Results A total of 37 surgical residents completed the two-stage course training and the questionnaire survey. The overall satisfaction rate with the curriculum setting was 100%. There were 32 residents (86.5%) thought that first stage training course could significantly improve their clinical skills, 35 residents (94.6%) thought that second stage training course could significantly improve their clinical skills, and 36 resident (97.3%) thought that the first stage curriculum could significantly help them improve performance in the second stage curriculum. Conclusions The trainees had a high degree of recognition and satisfaction for the advanced integrated two-stage laparoscopic simulation training course. The overall design of course was reasonable and feasible, and was attractive to trainees.

Objective To investigate the application of synchronized immersion course (SIC) in teaching of clinical practice of surgery for eight-year program students. Methods A total of 94 eight-year program students in French class and 4+4 class who received SIC in the study of surgery in Ruijin Clinical School, Shanghai Jiao Tong University from September 2017 to June 2019 were selected as the pilot group. A total of 91 students in English class who were taught in the traditional way in the same period were selected as a horizontal control group. A total of 84 students in French class and 4+4 class who were studying from September 2015 to June 2017 were selected as the longitudinal control group. Teaching satisfaction evaluation, examination results and specialization choice were compared among students in each group to assess teaching effectiveness. Results The total score (3.8±0.3) and satisfaction rate (98.9%) of the questionnaire in the pilot group were better than those in the horizontal control group (3.6±0.4, 90.1%)（P=0.001，P=0.008）. For the case analysis station in objective structured clinical examination (OSCE), the mean score (86.2±6.9) and pass rate (97.9%) in the pilot group were better than those in the horizontal control group (79.7±11.4, 89.0%)（P=0.001，P=0.014）, as well as better than those in the longitudinal control group (79.5±13.5, 88.1%)（P=0.001，P=0.009）. For the history inquiry station, the mean score (86.3±10.7) and pass rate (96.8%) in the pilot group were better than those in the horizontal control group (81.4±11.6, 86.8%)（P=0.003，P=0.013）. The proportion of students choosing the surgical specialty was higher in the pilot group (55.3%) than in the horizontal control group (46.2%) and the longitudinal control group (44.0%) without statistically significant difference. Conclusions SIC can help eight-year program students strengthen their clinical thinking and practice skills. Meanwhile, SIC can increase students’ satisfaction with teaching and their interest in surgery.

In order to reduce intraoperative recurrent laryngeal nerve injury, intraoperative neural monitoring(IONM) is widely used in thyroid-related surgery, especially in reoperations. However, some incidental injuries have also been observed during IONM. This article reported a case suffered skin thermal injury at the site of hypodermic needle electrode placement during IONM in Shanghai International Medical Center. Combining relevant adverse event information and analyzing the causes was essential to understand and prevent potential risks, and prioritize patient safety.

Colorectal cancer(CRC) ranks in third place in terms of incidence but second in terms of mortality. Cancer vaccine, as a novel immunotherapy, presents tumor antigens to human immune system and further elicits anti-tumor immune response, leading to long-term immune memory. This review summarized representative research progress in both clinical and basic scenario of past five years, and prospected the future of CRC vaccine.

Breast cancer is the most common malignant tumor in women. With the development of genomics technology and medical frontier technology, the systemic treatment of breast cancer has gradually entered the era of personalized medicine. However, the decision-making of adjuvant radiotherapy for breast cancer still mainly relies on traditional clinicopathological factors, and there is a lack of scientific and reliable tools to guide precise radiotherapy in different populations. Hormone receptor (HR) positive/human epidermal growth factor receptor 2 (HER2) negative breast cancer is the most common molecular subtype of breast cancer. The 21-Gene recurrence score (RS) test (Oncotype Dx™, Genomic Health, Redwood City, CA) is a commercially available genomic test for breast cancer. In this article, we reviewed the current research evidence on the use of 21-Gene RS test for radiotherapy decision-making in HR-positive HER2-negative early breast cancer. Current clinical studies support the predictive value of 21-Gene RS test for adjuvant radiotherapy, and several large-scale prospective clinical studies in this area are underway.