Top Read Articles

Published in last 1 year |

In last 2 years |

In last 3 years |

All

Please wait a minute...


For Selected: Download Citations EndNote Ris BibTeX Toggle Thumbnails

Select

Current status and reflections on immunotherapy and targeted therapy for unresectable biliary tract cancer YU Liqin, YAN Xiaoyu, WANG Puxiongzhi, WANG Wei, WANG Jian Journal of Surgery Concepts & Practice    2025, 30 (06): 544-550.   DOI: 10.16139/j.1007-9610.2025.06.14 Abstract （277）   HTML （48）    PDF（pc） （939KB）（754）       Knowledge map    Save Biliary tract cancer (BTC) represents a group of highly malignant solid tumors with a five-year survival rate of only 10%. For patients with unresectable BTC, gemcitabine combined with cisplatin has been the conventional first-line treatment regimen. With the remarkable efficacy of immunotherapy and targeted therapy observed in other solid tumors, numerous studies have investigated their potential in unresectable BTC. This article provides an overview of the current status of targeted and immunotherapeutic approaches for unresectable BTC, with a focus on research advancements in immune checkpoint inhibitor (ICI) and targeted agents against fibroblast growth factor receptor(FGFR), isocitrate dehydrogenase(IDH), and human epidermal growth factor receptor 2(HER2), as well as future trends in immunotherapy and targeted therapy, aiming to contribute to the development of more effective treatment strategies. Reference | Related Articles | Metrics | Comments（0）

Select

Characteristics of cyst fluid can predict the benign or malignant nature of intraductal papillary mucinous neoplasms WANG Jingyuan, FAN Jiayu, ZHANG Pingping, MA Hongyun, CHEN Ying, LI Gang, JIN Zhendong, JIN Gang, WANG Kaixuan Journal of Surgery Concepts & Practice    2025, 30 (06): 509-516.   DOI: 10.16139/j.1007-9610.2025.06.09 Abstract （269）   HTML （49）    PDF（pc） （1972KB）（764）       Knowledge map    Save Objective To investigate the predictive ability of cyst fluid characteristics for malignant intraductal papillary mucinous neoplasms (IPMNs). Methods We prospectively collected fresh cyst fluid from patients undergoing pancreatic resection at the Department of Hepatobiliary Pancreatic Spleen Surgery, Changhai Hospital, Shanghai, from September 2023 to December 2024, who were ultimately pathologically confirmed with IPMN. We assessed the characteristics of cyst fluid, including viscosity, clarity, and color, and explored its predictive performance for benign or malignant. Results A total of 40 patients with IPMN were included. The sensitivity of the string sign （+） for diagnosing high-grade dysplasia/ invasive carcinoma （HGD/IC） was 90.9%, specificity was 92.9%, and accuracy was 76.0%. The cyst fluid of intestinal-type IPMN often exhibited a gelatinous consistency, and there was no significant difference in the distribution of gelatinous consistency between the HGD/IC group and the low-grade dysplasia （LGD） group. There were no significant differences in CEA, glucose, and amylase levels in the cyst fluid between the HGD/IC group and the LGD group. Conclusions The characteristics of pancreatic cyst fluid, especially viscosity, can effectively predict the benign or malignant nature of IPMN. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Current status and prospects of minimally invasive surgery for breast cancer in China DUAN Shiyu, JIN Yiting Journal of Surgery Concepts & Practice    2025, 30 (06): 537-543.   DOI: 10.16139/j.1007-9610.2025.06.13 Abstract （264）   HTML （47）    PDF（pc） （928KB）（615）       Knowledge map    Save This article provided a systematic review of the current application and development prospect of minimally invasive surgery for breast cancer in China. Although application of endoscopic and robotic surgical procedures remain limited in breast surgery, they have shown advantages in cosmetic outcomes and postoperative recovery across various procedures, including axillary lymph node dissection, breast-conserving surgery, mastectomy, and breast reconstruction. Nonetheless, further high-quality clinical evidence is needed to confirm their long-term oncological safety. Despite current challenges of prolonged operation time and high medical cost, minimally invasive techniques are poised to become an integral component of breast cancer surgical care with continuous refinements of technology and accumulating clinical evidence. Reference | Related Articles | Metrics | Comments（0）

Select

Research progress on the mechanism of regulated cell death in thyroid carcinoma NIU Lingshan, ZHAO Yue, SHI Xu, YANG Zheyu, PAN Ruijun, CAI Wei Journal of Surgery Concepts & Practice    2025, 30 (06): 529-536.   DOI: 10.16139/j.1007-9610.2025.06.12 Abstract （238）   HTML （25）    PDF（pc） （1254KB）（656）       Knowledge map    Save Thyroid carcinoma is one of the malignant tumors with rapidly increasing incidence rates. Some refractory patients face challenges from drug toxicity and resistance, urgently requiring the discovery of new therapeutic pathways to improve prognosis. Regulatory cell death（RCD）is a highly regulated orderly death mode, including apoptosis, necroptosis, pyroptosis, ferroptosis, and cuproptosis. Recent studies have found that RCD is closely associated with tumor progression, invasion, and resistance. This article systematically reviewed various death modes in thyroid cancer, including the core signaling nodes of each death pathway, and explored their specific functions in tumor progression. It also summarized potential therapeutic strategies targeting these death pathways. However, the complexity of RCD mechanisms and the sensitivity of treatments remain controversial. Future efforts should focus on screening broad-spectrum targets and developing synergistic therapies to ultimately achieve precise treatment based on cell death, thereby improving the prognosis of refractory thyroid cancer. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Advances of prevention and management for post-pancreatectomy acute pancreatitis CHEN Haoda, SHEN Baiyong Journal of Surgery Concepts & Practice    2025, 30 (06): 524-528.   DOI: 10.16139/j.1007-9610.2025.06.11 Abstract （200）   HTML （10）    PDF（pc） （1190KB）（551）       Knowledge map    Save Post-pancreatectomy acute pancreatitis (PPAP) is a common complication following pancreatic surgery, characterized primarily by early postoperative local and systemic inflammatory responses. These responses can trigger a series of subsequent complications, significantly impacting patient’s clinical outcomes. In recent years, PPAP has been recognized as a distinct postoperative complication, and the International Study Group of Pancreatic Surgery (ISGPS) has proposed standardized definitions and grading criteria for it, which required a combination of postoperative enzyme elevation, imaging features, and changes in clinical management. This has garnered widespread attention within the field of pancreatic surgery. The occurrence of PPAP is closely related to microcirculatory disturbances. Clinically, it can manifest as self-limiting inflammation and is closely associated with pancreatic fistula development. In some cases, it may progress to necrotizing pancreatitis, potentially requiring surgical intervention. Current prevention and management strategies focus on intraoperative preservation of pancreatic blood supply, perioperative use of anti-inflammatory medications, and symptomatic supportive care. However, the diagnostic criteria, pathogenesis, and comprehensive management framework for PPAP still require further research and refinement. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Gasless subclavicular lateral approach: an anatomically tailored surgical technique for parathyroid surgery FENG Wenqing, GAO Haoji Journal of Surgery Concepts & Practice    2025, 30 (06): 503-508.   DOI: 10.16139/j.1007-9610.2025.06.08 Abstract （181）   HTML （9）    PDF（pc） （4209KB）（551）       Knowledge map    Save Objective To explore the safety and effectiveness of gasless subclavicular lateral approach in parathyroid surgery. Methods A retrospective comparative study was conducted to collect a total of 53 patients with primary hyperparathyroidism who underwent surgical treatment at Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from November 2024 to April 2025. Among them, 20 patients underwent subclavicular lateral approach surgery (experimental group). The control group was matched 1∶1 based on criteria including gender, age, tumor size, and preoperative （parathyroid hormone, PTH） levels. Twenty patients who underwent conventional anterior cervical approach during the same period were selected for a case-control study. The surgical efficacy, postoperative incision pain, incidence of complications, and cosmetic effects between two groups were compared. Results There was no statistically significant difference (P>0.05) in operative time, intraoperative bleeding, hospitalization time, and surgical efficiency between the two groups. There was no statistically significant difference in the incidence of postoperative complications such as hoarseness, water choking, incision infection, incision hematoma, fever, and postoperative pain scores between the two groups during hospitalization (P>0.05). In the scar assessment one month after surgery, the score of the experimental group was lower than that of the control group (P<0.05). The satisfaction score of the beauty effect in the experimental group was significantly better than that in the control group (P<0.01). Conclusions Gasless subclavicular lateral approach for parathyroidectomy, as an emerging and anatomically optimized surgical technique, has good effectiveness and safety, without significantly increasing surgical risks. It can safely remove lesions without leaving surgical scars in the anterior neck, and has the advantage of good cosmetic effects. As a safe and feasible surgical method, it provides a new and ideal choice for patients undergoing parathyroid surgery. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Application progress of artificial intelligence in preoperative diagnosis of pancreatic cancer MAO Liang, QIU Yudong Journal of Surgery Concepts & Practice    2025, 30 (06): 479-482.   DOI: 10.16139/j.1007-9610.2025.06.04 Abstract （169）   HTML （8）    PDF（pc） （865KB）（583）       Knowledge map    Save Pancreatic cancer is the most challenging issue in the field of pancreatic surgery. Accurate preoperative diagnosis is the key to improving prognosis. Currently, there have been research reports on the application of artificial intelligence(AI) in the early diagnosis, differential diagnosis, and stratified diagnosis of pancreatic cancer. This article summarized the representative studies and focused on introducing their innovative thinking, modeling methods, research results, and clinical significance, demonstrating the application potential of AI in preoperative diagnosis of pancreatic cancer, with the aim of providing inspiration for subsequent research in this field. Reference | Related Articles | Metrics | Comments（0）

Select

Obesity significantly increases the risk of erectile dysfunction: a meta-analysis based on observational studies JI Lang, HAO Shaolong, SUN Haitao, SUN Wuqing, Ma Jihong, BAI Rixing, HAN Wei Journal of Surgery Concepts & Practice    2025, 30 (06): 494-502.   DOI: 10.16139/j.1007-9610.2025.06.07 Abstract （157）   HTML （9）    PDF（pc） （1865KB）（611）       Knowledge map    Save Objective To quantify the association between obesity and erectile dysfunction (ED) risk through a meta-analysis. Methods Following PRISMA guidelines, systematic searches of Chinese and English databases (up to March 2025) were conducted to include observational studies (cohort, cross-sectional, case-control). Adjusted effect sizes (OR and 95% CI) were extracted. Study quality was assessed using the Agency for Healthcare Research and Quality(AHRQ) scale, and a random-effects model was applied to pool effect sizes. Subgroup analyses (geographic region, obesity definitions) and sensitivity analyses were performed to validate robustness. Results Ten studies (n=230 744), including nine cross-sectional studies, were included. The meta-analysis revealed that obesity significantly increased ED risk (random-effects OR=1.80, 95% CI: 1.29-2.51), with high heterogeneity (I2=99.9%). Subgroup analyses indicated stronger associations in USA populations (OR=2.10, 95% CI: 1.23-3.60) than in Chinese populations (OR=1.16, 95% CI: 1.05-1.28). The highest effect size was observed when using BMI≥25 kg/m3 as the obesity threshold (OR=3.05, 95% CI: 2.06-4.51). Sensitivity analyses confirmed robust results (OR: 1.60-1.94 after excluding any single study). Conclusions Obesity is a critical risk factor for ED, with effect strength influenced by geographic region and obesity definitions. Interventions targeting BMI≥30 kg/m2 in Western populations and metabolic risks at BMI≥25 kg/m3 in Asian populations are recommended. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Anatomical classification and intraoperative management strategies of dorsal pancreatic artery in 576 standard pancreatic surgeries OU Huiyi, JIN Kaizhou, YE Longyun, WU Weiding Journal of Surgery Concepts & Practice    2025, 30 (06): 483-487.   DOI: 10.16139/j.1007-9610.2025.06.05 Abstract （154）   HTML （4）    PDF（pc） （4943KB）（571）       Knowledge map    Save Dorsal pancreatic artery (DPA) is one of the most commonly studied arteries in the pancreas. The management of DPA during pancreatic standard resection/radical surgery (pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy) is closely related to complications such as late bleeding caused by pancreatic fistula erosion after surgery. This article collected data from patients who underwent open/minimally invasive standard pancreatic resection/radical surgery from August 2024 to July 2025, displayed different origins of DPA, and discussed the management of DPA during standard pancreatic resection/radical surgery. This article updated and improved the latest classification of DPA, and highlighted the importance of programmatic management of DPA in pancreatic surgery to reduce the risk of late postoperative bleeding. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Clinical experience with arterial resection during radical resection for pancreatic cancer YIN Jie, JIANG Kuirong Journal of Surgery Concepts & Practice    2025, 30 (06): 469-473.   DOI: 10.16139/j.1007-9610.2025.06.02 Abstract （142）   HTML （2）    PDF（pc） （922KB）（473）       Knowledge map    Save With advancements in surgical techniques and the application of neoadjuvant and conversion therapies, arterial resection and reconstruction offers a potential curative option for patients with locally advanced pancreatic cancer. Preoperative meticulous assessment of arterial involvement using imaging, combined with biological markers and the patient's physical status, allows for strict patient selection. Intraoperative strategies such as the “artery-first approach” and “sub-adventitial divestment” can be employed to determine the feasibility of radical resection. For arteries that cannot be preserved, procedures such as celiac axis resection, hepatic artery resection, or superior mesenteric artery resection and reconstruction may be performed depending on the site of involvement. Given the technical complexity of arterial resection and the associated high morbidity and mortality rates, this procedure should be carried out in high-volume pancreatic centers with extensive experience, and further large-scale studies are needed to validate its long-term efficacy. Reference | Related Articles | Metrics | Comments（0）

Select

Clinical evaluation and management of checkpoint inhibitor pneumonitis with advanced biliary tract cancer: a report of 3 cases SUN Xueying, WU Bin, JIANG Yifei, LIAO Zhuojun, ZHAO Jinyan, ZHOU Ying, ZHANG Shulong, WANG Yan, LIU Houbao Journal of Surgery Concepts & Practice    2025, 30 (06): 517-523.   DOI: 10.16139/j.1007-9610.2025.06.10 Abstract （138）   HTML （7）    PDF（pc） （2436KB）（675）       Knowledge map    Save Objective To report cases of checkpoint inhibitor pneumonitis （CIP） in patients with advanced biliary tract cancer, aiming to provide additional approaches for the assessment, treatment, and monitoring of this condition. Methods Three patients developed oxygen desaturation and interstitial lung lesions during chemotherapy combined with immunotherapy, and were diagnosed with CIP in collaboration with the respiratory department. Antitumor therapy was discontinued in the acute phase, and glucocorticoids were administered, with regular monitoring of disease progression. During follow-up, case 1 developed lung metastasis; case 2 showed improvement; case 3 had concurrent infection and tumor progression. Results Glucocorticoids improved lung lesions and hypoxic symptoms in patients with CIP, but attention should be paid to the potential for concurrent infections and tumor progression. Conclusions Comprehensive assessment and early identification of CIP are crucial for patients with advanced biliary tract cancer. For those with recurrent symptoms after glucocorticoid therapy, timely and accurate adjustment of the treatment regimen is essential. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Interpretation of the Asian Consensus on systemic therapy for pancreatic ductal adenocarcinoma WEN Chenlei, ZOU Siyi, LI Fanlu, ZHAN Qian, SHEN Baiyong Journal of Surgery Concepts & Practice    2025, 30 (06): 461-468.   DOI: 10.16139/j.1007-9610.2025.06.01 Abstract （126）   HTML （5）    PDF（pc） （1020KB）（692）       Knowledge map    Save Pancreatic ductal adenocarcinoma (PDAC) is difficult to diagnose in its early stages. Most patients are diagnosed at a locally advanced or metastatic stage. Systemic therapy has become the key to improve survival. To bridge the differences in guidelines across Asian countries and address regional clinical practice needs, 14 leading experts in the Asia-Pacific region developed the “Asian Consensus on systemic therapy for pancreatic ductal adenocarcinoma” on the Delphi method. The consensus centers on 14 core recommendations (R1-R14) and proposes stratified management strategies based on disease stage. For resectable PDAC, adjuvant modified FOLFIRINOX (mFOLFIRINOX) is the preferred option, while for the patients with poor performance status gemcitabine plus capecitabine, S-1 monotherapy, and other regimens can be selected. For borderline resectable PDAC, neoadjuvant therapy is recommended, with GnP or FOLFIRINOX as the preferred regimens. For locally advanced PDAC, combination or monochemotherapy is selected based on their performance status. For metastatic PDAC, first-line options include GnP, NALIRIFOX, or mFOLFIRINOX, with second-line therapy the cross-use of gemcitabine-based and 5-FU-based regimens are emphasized. This consensus provides for the first time a comprehensive and standardized management framework for systemic therapy of PDAC in Asia, aiming to enhance regional homogeneity in clinical practice and improve patient outcomes. This article interpreted the consensus content with the goal of guiding clinical practice. Reference | Related Articles | Metrics | Comments（0）

Select

Technical innovation in precise enucleation of pancreatic head tumors and postoperative pancreatic fistula prevention strategies YANG Feng, XU Yecheng, FU Deliang Journal of Surgery Concepts & Practice    2025, 30 (06): 488-493.   DOI: 10.16139/j.1007-9610.2025.06.06 Abstract （125）   HTML （13）    PDF（pc） （2326KB）（567）       Knowledge map    Save Benign and low-grade malignant tumors of the pancreatic head have distinct clinicopathological features and a relatively indolent biological behavior, leading to favorable prognoses and high surgical cure rates. When indicated, enucleation enables maximal preservation of pancreatic function with minimal trauma, demonstrating considerable clinical promise. This article focused on recent technical advances in enucleation for pancreatic head tumors and postoperative pancreatic fistula (POPF) prevention strategies, offering a systematic review of current concepts and clinical practices in the field. In the context of advancing precision surgery and minimally invasive techniques, enucleation—as a pancreatic function-preserving procedure—continues to present challenges in indication selection, intraoperative technique, and perioperative management. Covered topics included preoperative multimodal imaging and three-dimensional reconstruction for tumor localization, the application of intraoperative ultrasound and fluorescence navigation, comparison and selection of surgical approaches (such as anterior, posterior, and retroperitoneal laparoscopic routes), and the advantages and limitations of minimally invasive techniques including robotic and laparoscopic surgery. Proactive strategies for POPF prevention and management were also discussed. Finally, the importance of multidisciplinary collaboration and individualized decision-making was emphasized, with the goal of improving surgical safety, reducing complications, and enhancing patient prognosis. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Reflections on key issues in neoadjuvant therapy for pancreatic cancer: a paradigm shift from evidence-based medicine to precision medicine KANG Xiaochao, LI Yikai, GUO Shiwei, JIN Gang Journal of Surgery Concepts & Practice    2025, 30 (06): 474-478.   DOI: 10.16139/j.1007-9610.2025.06.03 Abstract （111）   HTML （3）    PDF（pc） （925KB）（607）       Knowledge map    Save Neoadjuvant therapy for pancreatic cancer is undergoing a paradigm shift from conventional chemotherapy to precision medicine. This expert forum discussed cutting-edge issues in pancreatic cancer neoadjuvant therapy from an evidence-based perspective, incorporating the latest clinical research advances. We focused on innovative directions including immunotherapy combination strategies, liquid biopsy applications, artificial intelligence (AI)-assisted decision making, and individualized precision medicine. We proposed forward-looking concepts such as molecular subtyping-guided individualized treatment strategies, multi-omics integrated efficacy prediction models, and standardized multidisciplinary collaborative care systems. These innovative concepts will drive pancreatic cancer neoadjuvant therapy toward more precise and effective directions. Reference | Related Articles | Metrics | Comments（0）

Select

From case volume to learning systems: pathways and prospects for thyroid oncology discipline development WANG Yu Journal of Surgery Concepts & Practice    2026, 31 (04): 279-286.   DOI: 10.16139/j.1007-9610.2026.04.01 Abstract （0）   HTML （4）    PDF（pc） （1025KB）（24）       Knowledge map    Save In recent years, the incidence of thyroid cancer in China has risen steadily, rendering it one of the most rapidly increasing solid malignancies nationwide. Relative to Western populations, China confronts a “dual disease burden”: a substantial cohort of patients with low-risk papillary thyroid carcinoma coexists alongside pressing clinical needs for effective management of advanced and high-risk disease. Consequently, implementing risk-stratified management for low-risk patients—while delivering intensified, multimodal therapeutic strategies for high-risk cases—has emerged as a pivotal challenge in advancing thyroid oncology in China. This article presented a systematic review of the evolution of thyroid tumor disciplines in China, synthesizing cutting-edge domestic and international research evidence alongside recent institutional innovations at Fudan University Shanghai Cancer Center. It underscored four critical enablers of discipline advancement: (1) high-quality, standardized clinical databases and biobanks as foundational infrastructure; (2) artificial intelligence (AI)-driven enhancements in data curation, dynamic risk stratification, and longitudinal care coordination; (3) neoadjuvant therapy as an integral pillar of precision medicine for locally advanced or high-risk thyroid cancer; and (4) robust multidisciplinary collaboration and scalable national research networks as essential organizational frameworks for investigating rare and aggressive subtypes. Looking ahead, China is well positioned to adapt proven translational research paradigms from lung and breast cancer—particularly those grounded in learning health systems—to establish a data-informed, multidisciplinary collaboration, and iteratively refined learning health system of precision medicine, thereby contributing a distinctive, evidence-based Chinese model for optimized diagnosis and treatment for thyroid cancer. Reference | Related Articles | Metrics | Comments（0）

Select

Application and innovation of nerve monitoring technology in robotic thyroid surgery WANG Ning, BAI Kecheng, ZHANG Daqi Journal of Surgery Concepts & Practice    2026, 31 (04): 287-292.   DOI: 10.16139/j.1007-9610.2026.04.02 Abstract （0）   HTML （2）    PDF（pc） （1006KB）（19）       Knowledge map    Save The clinical application of robotic thyroid surgery has become increasingly widespread; however, factors, including the constrained operative space and the lack of tactile feedback in robotic systems, present multiple challenges to the effective use of intraoperative nerve monitoring (IONM). In recent years, investigators have continuously advanced the application and development of IONM in robotic thyroid surgery through diverse strategies, including optimization of probe approaches, modification of dedicated instruments, refinement of monitoring modalities, and targeted nerve preservation. This article systematically examined the current research landscape and recent progress, analyzed the efficacy and limitations of existing strategies, and explored innovative approaches to safer and more efficient IONM in robotic thyroid surgery, with the aim of informing further optimization and broader clinical adoption. Reference | Related Articles | Metrics | Comments（0）

Select

Diagnosis and treatment of chylous leakage following cervical lymph node dissection for thyroid cancer LI He, AI Zhilong Journal of Surgery Concepts & Practice    2026, 31 (04): 293-299.   DOI: 10.16139/j.1007-9610.2026.04.03 Abstract （0）   HTML （2）    PDF（pc） （1019KB）（24）       Knowledge map    Save Chylous leakage is an uncommon but potentially severe complication following cervical lymph node dissection for thyroid cancer. Persistent or high-output leakage may result in hypoproteinemia, malnutrition, fluid and electrolyte disturbances, immunosuppression, wound infection, skin-flap necrosis, and chylothorax, and in severe cases, it may cause respiratory or circulatory compromise. Based on the Chinese expert consensus, recent case series, retrospective studies, and personal experiences, this paper summarized the epidemiology, risk factors, clinical classification, diagnostic pathways, stepwise treatment strategies, and prognosis of chylous leakage, providing a reference for standardized and individualized clinical management. Reference | Related Articles | Metrics | Comments（0）

Select

Application and prospects of AI-assisted multi-omics for diagnosis and treatment of thyroid cancer CAI Xue, WANG Yingrui, GUO Tiannan Journal of Surgery Concepts & Practice    2026, 31 (04): 300-305.   DOI: 10.16139/j.1007-9610.2026.04.04 Abstract （0）   HTML （1）    PDF（pc） （1010KB）（20）       Knowledge map    Save Thyroid cancer, the most common malignancy of the endocrine system, is undergoing a profound transformation in precision diagnosis and treatment driven jointly by artificial intelligence (AI) and multi-omics technologies. Confronted with longstanding challenges, including the strong subjectivity of ultrasound interpretation, diagnostic uncertainty in cytology, difficulty in preoperative differentiation of follicular neoplasms, and the lack of precise indicators for recurrence risk assessment, this field is gradually shifting from a traditional paradigm reliant on a single information dimension and empirical judgment toward a data-driven, multidimensional integrative approach to precision diagnosis and treatment. First, leveraging the advantages of deep learning and computer vision, AI technologies have significantly improved the accuracy and efficiency of intelligent ultrasound image interpretation, shifting nodule malignancy differentiation from experience-dominated practice toward AI-assisted decision-making. Second, multi-omics technologies such as genomics and proteomics have systematically revealed key driver genes and molecular biomarkers associated with thyroid nodules, providing important supplementary information for the precise classification of indeterminate nodules. Meanwhile, AI models integrating multilevel information from genomics, proteomics, and other omics layers have demonstrated distinct advantages in diagnostic performance and recurrence risk prediction, offering new insights for individualized treatment decision-making and continuous patient monitoring. Overall, research on AI-driven multi-omics approaches in thyroid nodules has progressed from isolated technical exploration toward multidimensional integration aimed at clinical translation. Reference | Related Articles | Metrics | Comments（0）

Select

Tumor size as a predictor for preoperative assessment of cervical lymph node metastasis in medullary thyroid carcinoma: a retrospective study based on the SEER database TIAN Yuan, LIU Xun Journal of Surgery Concepts & Practice    2026, 31 (04): 306-318.   DOI: 10.16139/j.1007-9610.2026.04.05 Abstract （0）   HTML （4）    PDF（pc） （1622KB）（20）       Knowledge map    Save Objective To systematically evaluate influencing factors of cervical lymph node metastasis in medullary thyroid carcinoma (MTC) patients using the SEER database, with a focus on the dose-response relationship between tumor size and lymph node metastasis, and to determine the optimal clinical cut-off value. Methods A total of 2,875 MTC patients diagnosed between 2000 and 2023 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Univariate and multivariate logistic regression were used to identify independent predictors, with Poisson regression estimating risk ratios (RR). Restricted cubic spline (RCS) assessed the dose-response relationship, and maximally selected rank statistics (MAXSTAT) determined the optimal cut-off value. Model performance was assessed through internal validation, calibration curves, and decision curve analysis (DCA), and sensitivity analyses were conducted stratified by the extent of lymph node dissection. Results Multivariate logistic regression and sensitivity analyses showed that female sex (OR=0.40, P<0.001) and age ≥75 years (OR=0.40, P<0.001) were protective factors, while tumor size was a significant independent risk factor (P<0.001). RCS revealed an approximate log-linear relationship between tumor size and lymph node metastasis risk (overall P<0.001). The optimal cut-off was diameter 12 mm; using this threshold, >12 mm group had a significantly higher metastasis rate than the ≤12 mm group (52.6% vs. 20.2%, OR=4.38, P<0.001). Internal validation yielded an area under the receiver operating characteristic curve (AUC) of 0.657 (95% CI: 0.629-0.686), with calibration curves and DCA indicating clinical net benefit. Sensitivity analyses confirmed the robustness of the tumor size effect across different dissection extent subgroups. Conclusions Tumor size is an important independent predictor of lymph node metastasis in MTC. The 12 mm threshold may serve as a candidate ancillary tool for preoperative risk stratification, prompting enhanced imaging evaluation. This threshold should be interpreted in conjunction with calcitonin levels, RET mutation status, and clinical N stage to inform treatment planning. Given the absence of these molecular and biochemical data in the SEER database, this threshold alone cannot be used as an independent criterion for determining the extent of lymph node dissection. Table and Figures | Reference | Related Articles | Metrics | Comments（0）

Select

Significance of peritoneal lavage cytology at different sampling time points of radical gastrectomy LI Hualin, XIANG Rongchao, ZOU Hongbo, CHEN Guofeng Journal of Surgery Concepts & Practice    2026, 31 (04): 319-325.   DOI: 10.16139/j.1007-9610.2026.04.06 Abstract （0）   HTML （2）    PDF（pc） （2135KB）（19）       Knowledge map    Save Objective To explore the influence of peritoneal lavage cytology at different sampling time points on the detection rate of intraperitoneal free cancer cells (IFCCs) in the abdominal cavity during radical gastrectomy. Methods Retrospective analysis of clinicopathological data of peritoneal lavage cytology in 125 patients with advanced gastric cancer undergoing radical gastrectomy. Peritoneal lavage fluid samples was collected before and after operation, and cytopathology examination was conducted respectively. The relationship between positive cytology (CY1) detection rate of peritoneal lavage and sampling time points of peritoneal lavage cytology, and the related clinicopathological characteristics affecting the detection rate was analyzed. Results There were 27 cases (21.6%) of CY1 patients before operation and 43 cases (34.4%) after operation. Univariate analysis revealed statistically significant differences in tumor differentiation, T stage, N stage between the preoperative CY1 and CY0 groups (P<0.05), as well as in tumor differentiation, T stage, N stage, and operation time between the postoperative CY1 and CY0 groups (P<0.05). Multivariate mixed-effects logistic regression analysis showed that the postoperative CY1 detection status (positive/negative) was only associated with tumor T stage, N stage and lavage cytology examination time points. Conclusions Peritoneal lavage cytology examination time points is a factor affecting the detection rate of CY1 in advanced gastric cancer. Postoperative sampling yielded a higher detection rate, suggesting that sampling time point impacts detection. The elevated positivity associated with intraoperative procedures awaits validation by prospective studies. It is suggested that peritoneal lavage cytology should be performed after operation and before closing abdomen to improve the detection rate of CY1. Table and Figures | Reference | Related Articles | Metrics | Comments（0）