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    Chinese interpretation of Japanese Gastric Cancer Treatment Guidelines 2021 (6th edition) and Ruijin clinical practice
    YAN Chao, LU Sheng, YAN Min, ZHU Zhenggang
    Journal of Surgery Concepts & Practice    2023, 28 (04): 326-354.   DOI: 10.16139/j.1007-9610.2023.04.010
    Abstract930)   HTML23)    PDF(pc) (4954KB)(2291)       Save

    “Japanese Gastric Cancer Treatment Guidelines” have been important guidelines for the treatment of gastric cancer in Japan and worldwide. The English version “Japanese Gastric Cancer Treatment Guidelines 2021 (6th Edition)” published in January 2023 consists of two parts. The first part includes diagnostic and treatment methods, such as surgery, endoscopic resection, chemotherapy, follow-up. The second part addresses clinical issues, including recommendations and explanations for clinical hot topics. This article will provide a Chinese interpretation of the guidelines and briefly introduce our hospital's clinical practice in the diagnosis and treatment of gastric cancer.

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    Development and prospects of ERCP in China
    LI Wen
    Journal of Surgery Concepts & Practice    2023, 28 (04): 279-282.   DOI: 10.16139/j.1007-9610.2023.04.001
    Abstract483)   HTML10)    PDF(pc) (838KB)(616)       Save

    Endoscopic retrograde cholangio-pancreatography (ERCP) is an interventional endoscopic technique aimed at the diagnoses and treatment of biliary and pancreatic diseases under the guidance of endoscopy and X-ray ima-ging. ERCP was introduced into China from the 1970s. In the 1990s, ERCP was gradually popularized and applied in China with the development of medical technique and improvement of equipment, more medical institutions started to carry out ERCP. After 2000, ERCP technology and equipment were further upgraded and improved in China. Many secondary and tertiary hospitals began to establish the ERCP centers. Meanwhile, workshops and training also facilitated the teaching and practice of ERCP and cultivated more professionals of ERCP. In recent years, the technical level of ERCP in China has been continuously improved, and technologies and equipments are constantly updated and iterated. Currently, ERCP has become one of important techniques in the endoscopic field, playing an important role in the diagnosis and treatment of biliary and pancreatic diseases. The vigorous development of ERCP in China is attributed to the advancement of medical science, the improvement of technology and the efforts of generations of ERCP specialists.

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    Efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy for locally advanced gastric cancer
    SUN Qi, HUANG Wenbo, HE Bingliang, LIU Chang, XU Yuhang, ZHAO Wei
    Journal of Surgery Concepts & Practice    2023, 28 (04): 366-370.   DOI: 10.16139/j.1007-9610.2023.04.013
    Abstract464)   HTML0)    PDF(pc) (889KB)(71)       Save

    Objective To explore the efficacy with prognostic value of postoperative prophylactic hyperthermic intraperitoneal chemotherapy (HIPEC) for locally advanced gastric cancer with clinical stage cT3-4NxM0. Methods A retrospective collection and analysis of clinical data was conducted from 60 patients with locally advanced gastric cancer (cT3-4NxM0) who underwent D2 radical surgery between January 2016 and December 2021 at our department. Patients who underwent prophylactic HIPEC were classified into the HIPEC group (n=30), while patients who did not undergo prophylactic HIPEC were clssified into the control group (n=30). Both groups of patients routinely were treated with postoperative adjuvant systemic chemotherapy. The median survival time, and overall survival rate of the two groups were compared through follow-up, and the risk factors affecting the overall survival rate were analyzed. Results The median survival time of the HIPEC group was 51.0 months (95% CI: 40.7-61.3), which was higher than that of the control group with 30.0 months (95% CI: 16.3-43.7). The 3-year and 5-year overall survival rates of the HIPEC group (66.7%, 53.3%)were higher than those of the control group(56.7%, 43.3%) (P=0.019). Prophylactic HIPEC was the protective factor affecting the overall survival rate of postoperative patients with locally advanced gastric cancer (P=0.021). Conclusions For patients with locally advanced cT3-4NxM0 gastric cancer, prophylactic HIPEC plays an important role in prolonging the median survival time, hence impro-ving the overall survival rate of patients.

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    Interpretation of the 2022 edition of “guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China”
    XU Bojin, PENG Wenfang, HUANG Shan
    Journal of Surgery Concepts & Practice    2023, 28 (06): 512-519.   DOI: 10.16139/j.1007-9610.2023.06.05
    Abstract198)   HTML1)    PDF(pc) (889KB)(782)       Save

    “Guidelines for diagnosis and management of hyperthyroidism and other causes of thyrotoxicosis in China” (2022) (referred to as the “guidelines”) was officially published in August 2022 in the Chinese Journal of Endocrine Metabolism. These guidelines have been extensively updated from the 2007 version, with 15 sections covering the etiology, clinical manifestations, diagnosis, evaluation, and treatment of hyperthyroidism, as well as the management of specific types of thyrotoxicosis. The new version guidelines proposed 107 recommended opinions supported by stronger evidence, offering comprehensive and reliable guidance for clinical doctors and medical professionals dealing with thyrotoxicosis. This article aimed to extract the key points and recommended strategies from the guidelines to help clinical doctors better understand and apply the latest guiding principles.

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    The role of ERCP in the diagnosis and treatment of chronic pancreatitis
    ZHANG Ling, ZOU Duowu
    Journal of Surgery Concepts & Practice    2023, 28 (04): 283-287.   DOI: 10.16139/j.1007-9610.2023.04.002
    Abstract176)   HTML3)    PDF(pc) (876KB)(91)       Save

    Chronic pancreatitis (CP) is a chronic progressive disease that causes varying degrees of functional damage on pancreatic endocrine and exocrine, seriously affecting the quality of life of the patients. Endoscopic retrograde cholangio-pancreatography (ERCP) with minimal trauma, high safety, and good efficacy has become a first-line treatment method for CP. ERCP is a first-line treatment method for pancreatic duct stones and pancreatic duct stricture, and complications of CP.

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    Risk factors and prevention methods for post-ERCP pancreatitis
    NIE Haihang, WANG Fan, WANG Hongling, ZHAO Qiu
    Journal of Surgery Concepts & Practice    2023, 28 (04): 310-315.   DOI: 10.16139/j.1007-9610.2023.04.007
    Abstract156)   HTML2)    PDF(pc) (872KB)(129)       Save

    Endoscopic retrograde cholangio-pancreatography (ERCP) is one of the primary procedural techniques used for diagnosing biliary and pancreatic diseases. Post-ERCP pancreatitis (PEP) is the most common complication of ERCP, which resulted in prolonged hospitalization and potential risk of patients' lives, especially in severe cases. Understanding the risk factors associated with PEP is of paramount importance for its prevention. Currently, recognized risk factors for PEP encompass both patient-related factors and ERCP procedure-related factors. By considering these risk factors, implementing appropriate preoperative, intraoperative, and postoperative interventions could effectively reduce the incidence of PEP. In this article, we concisely summarized the common risk factors and preventive methods for PEP, offering valuable insights for healthcare professionals in clinical practice.

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    Diagnostic application of SpyGlass in indeterminate stricture of hilar bile duct
    HU Xianrong, YANG Dangdang, WU Jun, ZHAO Yi, CHEN Cui, ZHANG Ting, HU Bing
    Journal of Surgery Concepts & Practice    2023, 28 (04): 361-365.   DOI: 10.16139/j.1007-9610.2023.04.012
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    Objective: To investigate the diagnostic value of SpyGlass choledochoscopy system in indeterminate stricture of hilar bile duct. Methods: A retrospective analysis was conducted on 146 patients with indeterminate stricture of the hilar bile duct who underwent endoscopic retrograde cholangio-pancreatography (ERCP) and SpyGlass examinations at our hospital between January 2018 and December 2022. The study recorded the visual impressions of the lesions, direct visualization-guided biopsy pathology, and conventional brush cytology results obtained using SpyGlass system. The sensiti-vity, specificity, and accuracy of different diagnostic methods were compared, taking pathological diagnosis as the gold standard and considering long-term follow-up results as well. Results: Out of the 146 patients, the procedure was successful in 145 cases (99.3%). The average procedure time was (51.5±16.9) min. The sensitivity, specificity, and accuracy of SpyGlass visual impression diagnosis for indeterminate biliary stricture were 83%, 84%, and 83%, respectively, outperforming brush cytology results (47%, 100%, and 52%). The combination of visual diagnosis and SpyBite biopsy yielded sensiti-vity of 91%, specificity of 63%, and accuracy of 85%. Adverse events occurred in 24.7% of cases, all of which were clinically mild. Conclusions: SpyGlass choledochoscopy has a high accuracy and safety in differential diagnosis of indeterminate stricture of the hilar bile duct. Its widespread application is warranted.

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    Current status and prospect of endoscopic photodynamic therapy for unresectable extrahepatic cholangiocarcinoma and ampullary carcinoma
    ZHANG Hongzhan, ZHANG Kai
    Journal of Surgery Concepts & Practice    2023, 28 (04): 316-320.   DOI: 10.16139/j.1007-9610.2023.04.008
    Abstract121)   HTML1)    PDF(pc) (907KB)(120)       Save

    Unresectable extrahepatic cholangiocarcinoma and ampullary carcinoma have high malignant degree and poor prognosis. At present, internal or external biliary drainage is the main palliative treatment, which can improve patients' quality of life,but has no therapeutic effect on the tumor itself. Endoscopic photodynamic therapy (PDT) is a new technology for minimally invasive treatment of biliary tumors in recent years. It can kill tumor cells locally and cause systemic immune response, prolong the survival time of patients, and has a broad clinical application prospect. With the deepening of the research on the molecular mechanism of PDT and the combination with chemotherapy, radiotherapy,immunotherapy and so on, endoscopic PDT has achieved significant efficacy in killing primary tumor, reducing the tumor stage and treating the recurrent tumors. In this paper, we analyze the current status of endoscopic PDT in unresectable extrahepatic cholangiocarcinoma and ampullary carcinoma, and look forward to the future direction.

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    Application of endoscopic ultrasound interventional therapy in biliary and pancreatic diseases
    HOU Senlin, YU Tingting, LIU Pengxiang, ZHANG Lichao
    Journal of Surgery Concepts & Practice    2023, 28 (04): 300-306.   DOI: 10.16139/j.1007-9610.2023.04.005
    Abstract121)   HTML8)    PDF(pc) (968KB)(145)       Save

    Endoscopic ultrasound (EUS) has been greatly developed in the diagnosis of digestive diseases. In recent years, with the continuous innovation of endoscopic technology and accessories, important breakthroughs have been made in endoscopic ultrasound-guided interventional therapy, especially in the treatment of refractory biliary and pancreatic diseases. Based on the latest literatures and work experience, in this paper, we reviewed the latest progress of EUS interventional treatment for biliary and pancreatic diseases, including EUS- guided bile duct drainage, EUS-guided gallbladder drainage, EUS-guided pancreatic duct drainage, EUS guided-pancreatic pseudocyst drainage, and EUS guided pancreatic tumor treatment.

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    Current status and prospect of CAR-T cell immunotherapy for colorectal cancer
    ZHANG Tianshuai, ZHOU Leqi, YU Guanyu, ZHANG Wei
    Journal of Surgery Concepts & Practice    2023, 28 (05): 483-487.   DOI: 10.16139/j.1007-9610.2023.05.15
    Abstract121)   HTML2)    PDF(pc) (872KB)(32)       Save

    Chimeric antigen receptor T (CAR-T) cell therapy is a new method of immunotherapy for cancer that has achieved remarkable results in treating blood tumors. However, colorectal cancer(CRC), as a solid tumor, has different characteristics from hematological tumors, which impose certain constraints on the selection of its therapeutic targets and the effectiveness of treatment of CAR-T therapy. Therefore, it is necessary to select therapeutic targets with high specificity and effectiveness according to the characteristics of CRC, as well as to break through the constraints such as adverse effects caused by the treatment and the solid tumor microenvironment, to make CAR-T therapy applicable in the treatment of CRC. This article aimed to summarize the strategy of selecting therapeutic targets for CAR-T cell immunotherapy for CRC, analyze the restrictive factors of this therapy in the treatment of CRC, and forecast the prospect of CAR-T cell immunotherapy for CRC.

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    Application experience of enteroscopy ERCP in benign biliary stricture after cholecystojejunostomy
    WENG Mingzhe, WANG Xuefeng
    Journal of Surgery Concepts & Practice    2023, 28 (04): 296-299.   DOI: 10.16139/j.1007-9610.2023.04.004
    Abstract119)   HTML3)    PDF(pc) (3765KB)(79)       Save

    Benign biliary stricture is a common complication of cholecystojejunostomy and is hard to handle. Ente-roscopy ERCP possesses the advantages such as repeatability, minimally invasive, and compliance with normal physiological structures in treatment. We shared our experiences of enteroscopy ERCP in benign biliary stricture after cholecystojejunostomy, hoping to improve the success rate of this treatment.

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    Tracheal diverticula discovered during surgery: a report of 2 cases and literature review
    HE Wen, GU Jianhua, XING Xujian, WENG Ziyi, FEI Jian
    Journal of Surgery Concepts & Practice    2023, 28 (04): 383-387.   DOI: 10.16139/j.1007-9610.2023.04.016
    Abstract118)   HTML2)    PDF(pc) (2334KB)(84)       Save

    To analyze the reasons why tracheal diverticula is easy to be missed or misdiagnosed in the diagnosis and treatment of thyroid tumors, and to strengthen the understanding of the clinical characteristics of the disease. The reasons of the misdiagnosis and missed diagnosis in similar cases were analyzed, and the anatomy, differential diagnosis, and examination methods by reviewing the relevant literature in the past 20 years were further analyzed. At the same time, a retrospective analysis was carried out on two recent clinical cases of tracheal diverticula discovered during surgery. Tracheal diverticula is easily confused with thyroid tumor and may be misdiagnosed for the following reasons: tracheal diverticula is asymptomatic in most patients; symptomatic tracheal diverticula has similar clinical symptoms to thyroid nodules; lack of character in imaging findings. General surgeons should improve their awareness and vigilance of tracheal diverticula. Neck CT should be listed as a routine examination before thyroid-related surgery.

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    Prognostic analysis of breast-conserving surgery or mastectomy in patients with stage Ⅰ-Ⅲ triple-negative breast cancer
    ZHU Qiaoli, MIAO Yiming, CHEN Xiaosong
    Journal of Surgery Concepts & Practice    2023, 28 (04): 371-377.   DOI: 10.16139/j.1007-9610.2023.04.014
    Abstract116)   HTML1)    PDF(pc) (1370KB)(152)       Save

    Objective: To investigate the effect of breast-conserving surgery (BCS) or mastectomy (M) in patients with stage Ⅰ-Ⅲ triple-negative breast cancer (TNBC) on disease free survival (DFS) and overall survival (OS). Methods: A total of 844 patients with stage Ⅰ-Ⅲ TNBC who were admitted to Comprehensive Breast Health Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine from January 2009 to December 2018 were collected and divided into BCS and M groups according to the surgical method. COX regression analysis was used to evaluate the influence of clinical characteristics and surgical methods on DFS and OS of the patients. The propensity score was further used to balance the differences in baseline characteristics between the two groups of patients, and to evaluate the differences in the prognosis of two groups of patients. Results: There were 533 patients (63.15%) underwent M and 311 patients (36.85%) underwent BCS. Patients with younger age, smaller tumor size, negative lymph node, and loss of HER2 expression (HER2-0) were more tend to BCS group compared to M group. Median follow-up time was 72 months. Multivariate COX analysis showed that the OS of M group was lower than that of BCS group (HR=2.02, 95% CI: 1.04-3.91, P=0.038), but there was no significant difference in DFS between the two groups (HR=1.42, 95% CI: 0.94-2.15, P=0.100). After propensity score matching for factors such as T stage, N stage and age, the results showed that there was no significant difference in OS (P=0.114) and DFS (P=0.124) between BCS and M groups. Conclusions: Among patients with stage Ⅰ-Ⅲ TNBC, patients with younger age, smaller tumor, negative lymph node, and HER2-0 were more likely to choose BCS. After propensity score matching for relevant clinicopathological parameters, the results indicated that there was no significant difference in OS and DFS of the TNBC patients undergoing BCS or M surgery.

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    Endoscopic treatment of gallbladder diseases
    ZHANG Jianguo
    Journal of Surgery Concepts & Practice    2023, 28 (04): 321-325.   DOI: 10.16139/j.1007-9610.2023.04.009
    Abstract114)   HTML3)    PDF(pc) (910KB)(148)       Save

    In recent years, with the rapid development of digestive endoscopy technology, new endoscopic diagnosis and treatment techniques and methods for gallbladder diseases have emerged, showing unique advantages, vitality and good application prospects. It can be predicted that the diagnosis and treatment of gallbladder diseases in the future will be more diversified and more minimally invasive, and the diagnosis and treatment strategy will be more individual rather than "one-size-fits-all". Endoscopic gallbladder technology is expected to become another important method after the era of laparoscopic gallbladder surgery, or even a milestone method. Although the current gallbladder endoscopy technology is still in the development stage, it still faces many problems and challenges. However, opportunities often coexist with challenges, and this trend seems unstoppable in any case.

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    Research progress of anti reflux digestive tract reconstruction for proximal gastrectomy
    SUN Qiang, YAO Jun, ZHANG Xin, DU Shanshan, WANG Weijun
    Journal of Surgery Concepts & Practice    2023, 28 (04): 388-393.   DOI: 10.16139/j.1007-9610.2023.04.017
    Abstract111)   HTML1)    PDF(pc) (6296KB)(53)       Save

    The incidence rate of proximal gastric cancer in China and some Asian countries is increasing year by year. Surgery is the most effective and commonly used treatment for proximal gastric cancer. Traditional total gastrectomy has a good curative effect, but its complications, such as dystrophic metabolism and decreased quality of life, limited its use. In recent years, the proximal gastrectomy carried out clinically can remove tumor tissue and preserve part of gastric tissue, which is conducive to improving the postoperative nutritional status of patients. However, during proximal gastrectomy, the esophageal sphincter and His angle were damaged, resulting in residual gastric acid reflux and gastroesophageal reflux, resulting in reflux esophagitis, which also affected the quality of life of the patients. In order to solve these problems, surgeons have explored different digestive tract reconstruction methods. So far, many digestive tract reconstruction methods have been reported. This paper introduced the commonly used digestive tract reconstruction methods, and summarized the literature on postoperative quality of life and survival outcomes, so as to provide reference and choice for surgeons.

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    Application of ERCP in diagnosis and treatment of biliary complications during perioperative period of primary liver cancer
    YE Feng, GONG Xiaoyong, REN Jiajun, CAI Qiang, CHEN Sheng
    Journal of Surgery Concepts & Practice    2023, 28 (04): 355-360.   DOI: 10.16139/j.1007-9610.2023.04.011
    Abstract105)   HTML2)    PDF(pc) (940KB)(61)       Save

    Objective: To review the experience of using endoscopic retrograde cholangio-pancreatography (ERCP) in the clinical diagnosis and treatment of biliary complications during perioperative period of primary liver cancer at our hospital. Methods: A retrospective analysis was conducted on the clinical data of patients undergoing ERCP treatment for biliary complications during perioperative period of primary liver cancer at our hospital from October 2016 to June 2023. According to the indications of ERCP for biliary complications, the cases were divided into bile duct tumor thrombus group, bile duct stricture group, and bile leakage group. The baseline data, laboratory test results before and after ERCP treatment, treatment outcomes, and other datas of the patients with different types of biliary complication were statistically analyzed. Results: A total of 25 patients underwent 25 cases of ERCP, among which 23 patients were successfully cannulated, with a success rate of 92.0%. There were 14 cases of bile duct stenosis, mainly treated with biliary balloon dilation, probe dilation, stent implantation, and nasobiliary drainage; 6 cases of bile leakage, mainly treated with stent implantation and nasobiliary drainage; 5 cases of bile duct tumor thrombus, mainly treated with net basket and balloon thrombectomy, stent implantation, and nasobiliary drainage. After ERCP treatment, the patient's serum total bilirubin, serum direct bilirubin, and γ-glutamyl transferase significantly decreased compared to those before the treatment (P<0.05). The postoperative average amylase was (85.0±69.4)(21-306) U/L. No bleeding, gastrointestinal perforation, pancreatitis, or other ERCP-related complications occurred in all cases. Conclusions: Bile duct stricture is the most common biliary complication during the perioperative period of primary liver cancer. For these patients with biliary complications during perioperative period of primary liver cancer ERCP treatment is safe and effective.

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    Endoscopic intervention strategy for pancreaticoduodenectomy-related cholangiopancreatic diseases
    DONG Yuanhang, CHEN Jie
    Journal of Surgery Concepts & Practice    2023, 28 (04): 307-309.   DOI: 10.16139/j.1007-9610.2023.04.006
    Abstract102)   HTML0)    PDF(pc) (893KB)(78)       Save

    The pancreaticoduodenectomy-related cholangiopancreatic complications include anastomotic stricture, cholangiopancreatic duct stones, cholangitis, pancreatitis, obstructive jaundice due to tumor recurrence, etc. Because of the complexity of the operation, the multiple organs involved and digestive tract reconstruction, endoscopic retrograde cholangio-pancreatography is difficult to carry out. In this article, we introduced two kinds of endoscopic interventional strategies, retrograde gastrostomy via biliary/pancreaticojejunostomy and endoscopic ultrasonography (EUS)-guided biliary drainage/ EUS-guided pancreatic drainage through digestive wall to provide some reference for clinicians.

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    Role of the spleen in patients with liver cancer and cirrhosis
    CHANG Jessica, CHEN Xuxiao, CHEN Yongjun
    Journal of Surgery Concepts & Practice    2023, 28 (04): 394-398.   DOI: 10.16139/j.1007-9610.2023.04.018
    Abstract101)   HTML6)    PDF(pc) (906KB)(104)       Save

    The spleen is the largest lymphoid organ that can affect the immunological microenvironment in the liver via the portal system. Patients with liver cancer, often develop hypersplenism and splenomegaly from underlying cirrhosis and portal hypertension. The malfunction of the spleen not only induces hepatic fibrogenesis, but also changes the immune responses in the liver, so that liver cirrhosis accelerates while liver regeneration subdues. As a result, the hepatic microenvironment and the rest of the immune system reach a “tumor progressing” or “tumor tolerant” state. Splenectomy has been shown to improve immune responses, liver function and general condition in patients with liver cancer. Hence, splenectomy may possibly improve the tolerance in live cancer patients for other anticancer treatments. However, the long-term benefits and effects on the overall survival of concomitant hepatectomy and splenectomy for liver cancer patients with portal hypertension and hypersplenism still remain controversial.

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    Application of high dose intravenous vitamin C in critical cared diseases
    ZHAO Bing, YU Xianxian, MAO Enqiang
    Journal of Surgery Concepts & Practice    2023, 28 (05): 437-440.   DOI: 10.16139/j.1007-9610.2023.05.08
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    Vitamin C is an essential micronutrient for human and its deficiency will lead to scurvy. In recent years, as a new therapeutic strategy, high dose intravenous vitamin C(HDIVC) has been widely studied in critical cared diseases. In this review, we summarized the progress of HDIVC in sepsis, including its research history, rationality of usage, controversy and prospect, problems and outlook. The application of HDIVC in critical cared diseases underwent three periods: early, preheating and outbreaking period. Given the reduction of vitamin C in critical diseases, it requires rapid intravenous supplementation. We confirmed the therapeutic efficacy of HDIVC in COVID-19 and severe acute pancreatitis respectively. It is well known that HDIVC has effect of suppressing inflammatory responses, stabilizing the circulation and improving the immunity. But the application of HDIVC in critical cared diseases is still controversial, for the opposing findings in multiple large-scale randomized controlled trials. Future studies should be better to pay further attention on the dose and time of vitamin C and vitamin C plasma concentration monitoring.

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    Incidence, mortality and survival analysis of small intestine cancer in Shanghai population⁃based study from 2002 to 2016
    WU Chunxiao, GU Kai, PANG Yi, WANG Chunfang, SHI Liang, XIANG Yongmei, GONG Yangming, DOU Jianming, SHI Yan, FU Chen
    Journal of Surgery Concepts & Practice    DOI: 10.16139/j.1007-9610.2023.03.00
    Accepted: 02 August 2023