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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)(2289)       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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    The fifth edition of WHO classification of digestive system tumors: update and progress on biliary system tumors
    LUO Fangxiu, MA Qianchen, YUAN Fei
    Journal of Surgery Concepts & Practice    2023, 28 (02): 124-131.   DOI: 10.16139/j.1007-9610.2023.02.08
    Abstract702)   HTML18)    PDF(pc) (3365KB)(1218)       Save

    Overall, there was little change in biliary system tumors of the 5th edition of WHO classification of digestive system tumors after update. The three-tiered classification of biliary intraepithelial neoplasia changed to two-tiered system: high-grade and low-grade, in the section of benign tumors and precancerous lesions. And both intracholecystic and intraductal papillary tumors associated with invasive carcinoma were added. The classification of intrahepatic bile duct tumors introduced parts of bile duct adenoma and bile duct adenofibroma, which were mentioned previously in the differential diagnosis with bile duct carcinoma. Intrahepatic cholangiocarcinoma was divided into small bile duct subtype and large bile duct subtype in the 5th edition of WHO classification, and the names of cholangiocellular carcinoma and cholangiole cell carcinoma were no longer recommended to use. Extrahepatic cholangiocarcinoma was listed as a separate part for the first time, including squamous cell carcinoma, adenosquamous carcinoma and undifferentiated carcinoma in addition to common histological types. Some new contents of molecular pathology in the 5th edition of WHO classification were added, which provided the basis for precise classification and diagnosis of tumors in biliary system.

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    Efficacy of intraoperative indocyanine green fluorescence imaging evaluation for preventing anastomotic leakage after laparoscopic rectal cancer surgery
    LUO Yang, YU Minhao, YE Guangyao, LIN Haiping, GONG Tingyue, LI Hao, ZHONG Ming
    Journal of Surgery Concepts & Practice    2023, 28 (03): 249-253.   DOI: 10.16139/j.1007-9610.2023.03.012
    Abstract641)   HTML3)    PDF(pc) (3438KB)(132)       Save

    Objective To investigate the effect of indocyanine green(ICG) fluorescence imaging to indicate blood supply of sigmoid-rectal anastomosis in laparoscopic anterior resection of rectal cancer. Methods Here a retrospective cohort study including 175 consecutive patients with rectal cancer scheduled for laparoscopic surgery in Department of Gastrointestinal Surgery of Renji Hospital between January 2019 and December 2022 was analysed. These patients were classified into two groups, according to using ICG or not within surgery: the ICG group (n=65) and the control group (n=110). Operation situations and complications were compared between the two groups. Results The operation time of ICG group was longer than that of control group [(151.6±4.8) min vs (139.5±3.7) min, P=0.04], and the preventive ileostomy rate was lower than that of control group (12.3% vs 34.6%, P=0.01), while the other operation data (intraoperative blood loss, number of lymph node dissection), were similar between the two groups (P>0.05). The rate of anastomotic leakage in ICG group were lower than that in control group (4.6% vs 14.6%, P=0.04), and there was no significant differences in wound infection, urinary retention and intestinal obstruction between the two groups (P>0.05). Conclusions The ICG displays that the blood supply in laparoscopic anterior resection of rectal cancer can reduce the incidence of anastomotic leakage, which improves the surgical safety and the quality of postoperative life.

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    Progress and prospect of surgical comprehensive treatment of gastric cancer
    ZHU Zhenggang
    Journal of Surgery Concepts & Practice    2023, 28 (01): 1-6.   DOI: 10.16139/j.1007-9610.2023.01.01
    Abstract588)   HTML19)    PDF(pc) (877KB)(221)       Save

    Gastric cancer is one of the leading malignancies in China and in the world. Surgery is still the most important modality to cure gastric cancer. A series of clinical researches changed the traditional concept of surgery and avoided blindly expanding the scope of surgery. Laparoscopic surgery for both early and locally advanced gastric cancer achieved the same radical effect as open surgery. The key to further improve the efficacy of minimally invasive surgery is controlling indications, establishing a training system for surgical techniques and optimizing the relation between costs and benefits. The relationship between resection of organs and preservation of organ function should be balanced in the extended surgery for gastric cancer. Perioperative treatment of locally advanced gastric cancer would be advocated actively. Conversion therapy preoperatively for far-advanced gastric cancer is advocated. Palliative resection should be strictly controlled for the patients of far-advanced gastric cancer with extensive metastasis, and comprehensive treatment should be carried to prolong the life of patients.

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    Advances in diagnosis and molecular detection of EBV-positive gastric cancer and gastric cancer with lymphoid stroma
    DENG Shijie, YUAN Fei
    Journal of Surgery Concepts & Practice    2023, 28 (01): 53-57.   DOI: 10.16139/j.1007-9610.2023.01.09
    Abstract572)   HTML8)    PDF(pc) (2082KB)(213)       Save

    Epstein-Barr virus-positive gastric cancer, as well as gastric cancer with lymphoid stroma, are the special pathological subtypes of gastric cancer. The histological morphology, immunological and genetic characteristics between two subtypes are overlapped to some extent, however, they are not identical. Therefore, there were not only the confusion in the diagnosis for pathologists but also perplexity in clinical treatment and following research caused by two subtypes of gastric cancer. In this article, the two cancers and other similar diagnostic terms were introduced and compared in detail. The clinicopathological features, genetic variation, molecular detection, and treatment progress were summarized combined with both current controversies and future directions of research.

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    New progression of radiomics in diagnosis of gastric cancer
    ZHANG Huan, CHEN Yong
    Journal of Surgery Concepts & Practice    2023, 28 (01): 42-48.   DOI: 10.16139/j.1007-9610.2023.01.07
    Abstract528)   HTML6)    PDF(pc) (826KB)(218)       Save

    Gastric cancer is a common entity of malignant tumor in China with the third cause of mortality and morbidity among all malignancies. In recent years, radiomics has emerged as a quantitative tool for imaging analysis with the rise of artificial intelligence. Currently, radiomics has been applied in many aspects of gastric cancer. In this review, we will focus on the progression of radiomics in diagnosis of gastric cancer, and describe the role of radiomics in differential diagnosis, staging and detection of histopathological biomarkers in detail, to reveal the value of radiomics in the precision medicine of gastric cancer.

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    Diagnosis and treatment of medullary thyroid carcinoma-an update
    CHEN Chengkun, GUO Bomin, DENG Xianzhao, WU Bo, FAN Youben
    Journal of Surgery Concepts & Practice    2022, 27 (03): 276-280.   DOI: 10.16139/j.1007-9610.2022.03.019
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    Medullary thyroid carcinoma (MTC) arising from the parafollicular cell (C cell) of the thyroid gland, is an aggressive neuroendocrine tumor and a special rare thyroid malignancy. Calcitonin and carcinoembryonic antigen are still commonly used markers now, whose elevation can reliably diagnose MTC. The preoperative value and postoperative doubling time of these markers are of great significance for range of lymph node dissection and evaluation of prognosis. It is recommended that total thyroidectomy and central lymph node dissection would be needed and lateral lymph node dissection would be added when necessary. Routine detection of RET gene is recommended. Targeted therapy is considered for non-operable patients or the patients with distant metastasis. The pathological mechanism of MTC still needs to be paid attention.

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    Controversy over the medial border of lymph node dissection during CME/D3 surgery of right colon cancer
    SUN Yueming, ZHANG Dongsheng
    Journal of Surgery Concepts & Practice    2023, 28 (03): 202-207.   DOI: 10.16139/j.1007-9610.2023.03.005
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    Radical surgery is the most important treatment for colon cancer. The development and application of complete mesentery excision (CME)/D3 lymph node dissection has promoted the standardization of surgical techniques for colon cancer. Right colon cancer surgery is relatively complicated, and is a research hotspot currently. The issues involved the range of lymph node dissection, the range of bowel resection, and the method of bowel reconstruction. The medial border of lymph node dissection for right colon cancer is one of the controversies. The left side of the superior mesenteric vein is generally considered to be the medial border of CME/D3 dissection in right colon cancer surgery. However, with the in-depth development of related research, some scholars believed that the left side of the superior mesenteric artery should be used as the medial border for lymph node dissection. This approach is more consistent with the principle of CME, and can achieve complete lymph node dissection. However, its clinical significance still needs to be evaluated with further research. This article discusses the selection of medial border of lymph node dissection for right colon cancer, hoping to provide reference for clinical practice.

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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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    Classification and surgical treatment of congential biliary dilatation
    WANG Jin, WU Shuodong
    Journal of Surgery Concepts & Practice    2023, 28 (02): 166-170.   DOI: 10.16139/j.1007-9610.2023.02.15
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    Congential biliary dilitation (CBD) is rare biliary tract disease in clinic. Clinical classification and disease characteristics of CBD is the key of accurate treatment. Surgical treatment was regarded as the first choice for adult patients with CBD including traditional surgery. There is still a controversy in the strategy of reconstruction of bile duct during operation. In this article the progress in diagnosis and treatment of CBD was reviewed.

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    Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult laparoscopic cholecystectomy
    MAN Gaoya, DANG Tongke, WU Qingsong, FENG Feiling
    Journal of Surgery Concepts & Practice    2022, 27 (03): 239-243.   DOI: 10.16139/j.1007-9610.2022.03.011
    Abstract468)   HTML8)    PDF(pc) (524KB)(120)       Save

    Objective To explore Rouviere′s sulcus guided retro-gallbladder tunnel dissection cholecystectomy used in difficult laparoscopic cholecystectomy. Methods A retrospective analysis of 1 081 patients with laparoscopic cholecystectomy in Tengzhou Central People′s Hospital from January 2019 to October 2020 was done. A total of 125 cases had scores ≥6 indicating difficult laparoscopic cholecystectomy based on preoperative scoring system to predict difficult laparoscopic cholecystectomy by Gupta. There were 65 cases(study group) with laparoscopic cholecystectomy using Rouviere′s sulcus guided retro-gallbladder tunnel dissection and 60 cases(control group) with routine laparoscopic cholecystectomy. Clinical data with operation and postoperative complication were compared between two groups. Results Operative time of two groups was [(61±23) min vs. (88±24) min], operative blood loss [(46±16) mL vs. (62±23) mL, hospital length of stay [(3.5±1.5) d vs. (5.8±2.2) d] and hospital cost [(12 236±316) yuan vs. (14 199±552) yuan] with statistical significant difference (P<0.05). Visual analog scale at 12 h and 24 h after operation in study group were (2.7±1.1) and (3.0±1.1), less than those in control group (5.9±1.0) and (6.4±1.5) significantly(P<0.05). One case with conversion of laparotomy was present in study group and 6 cases in control group (P<0.05). There was no case with bile leakage in study group and 4 cases in control group (P<0.05). Liver function was more improved significantly 72 hours postoperative in study group than in control group (P<0.05). There was no bile duct injury in study group and 1 bile duct injury in control group (P>0.05). Conclusions Rouviere′s sulcus guided retro-gallbladder tunnel dissection in difficult cholecystectomy could be safe laparoscopic cholecystectomy.

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    Study on myopectineal orifice anatomy using CT three-dimensional imaging
    YAO Junliang, YU Jianping, JIANG Xiaoming, GU Chao, SUN Rongxun
    Journal of Surgery Concepts & Practice    2022, 27 (03): 249-252.   DOI: 10.16139/j.1007-9610.2022.03.013
    Abstract466)   HTML0)    PDF(pc) (553KB)(109)       Save

    Objective To study myopectineal orifice anatomy of the patients with inguinal groin hernia using three-dimensional imaging technology after reconstructing of myopectineal orifice. Methods Preoperative CT images of 90 patients with inguinal hernia including 79 cases with indirect, 9 cases with direct and 2 cases with femoral were collected in our hospital from March 2019 to December 2019. The data of CT imaging were imported into software for three-dimensional reconstruction. The data of myopectineal orifice anatomy after reconstruction were measured and compared after grouping of age, gender and body mass index. Results The mean total width of myopectineal orifice was(7.67±0.75) cm, length (7.34±0.38) cm, length of upper edge(5.79±0.79) cm, length of lower edge(6.57±0.50) cm, and the upper lower angle (120.10±9.36) °. Difference in total width, length, and upper edge length was statistically significant between male group and female group (P<0.05). There was difference in upper edge length between adult group and old group (P<0.05) and in upper lower angle between body mass index low group and high group (P<0.05). Conclusions Three-dimensional CT ima-ging technology could be feasible to measure the morphology of myopectineal orifice. The data of myopectineal orifice collected in this study would be used to direct prosthetic mesh of inguinal hernia according to different age, gender and body mass index.

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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
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    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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    Factors related to intestine have a role in prevention and treatment for gallstone disease
    JIANG Zhaoyan, SHEN Weiyi, HU Hai
    Journal of Surgery Concepts & Practice    2023, 28 (02): 91-93.   DOI: 10.16139/j.1007-9610.2023.02.01
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    Gallstone is a common surgical disease. The factors which related to intestine during the process of gallstone formation have attracted increasing attention. The main factors affecting the formation of cholesterol gallstone including cholesterol absorption, bile acid concentration, gut microbiota changing, are all related to the intestine. A correct understanding of the factors related to intestine during gallstone formation is helpful for the prevention and treatment of gallstone disease. In future, different targets related to intestine may play an important role in both prevention of gallstone disease and post-cholecystectomy management.

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    Vascular reconstruction in radical resection for hilar cholangiocarcinoma
    LI Xiangcheng, CHEN Yananlan, LI Changxian
    Journal of Surgery Concepts & Practice    2023, 28 (02): 104-109.   DOI: 10.16139/j.1007-9610.2023.02.04
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    Radical resection is the only option of curative treatment for hilar cholangiocarcinoma. Microscopically negative resection margin of bile duct (R0 resection) is critical for long-term survival of patients. However, both portal vein and hepatic artery invasions from hilar cholangiocarcinoma were often found, the negative resection margin could not be gotten. Combined vascular resection and reconstruction provide a possible way to solve this problem. At present, the clinical value of resection of portal vein and hepatic artery combining with reconstruction has been fully recognized. The technique of reconstruction for both portal vein and hepatic artery combined with the clinical significance, preoperative evaluation of imaging and postoperative complications for hilar cholangiocarcinoma were included in this article.

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    Stage on development of pathophysiology of gallbladder stone and personalized diagnosis and treatment
    ZHENG Yamin, GU Liguo, XU Chen
    Journal of Surgery Concepts & Practice    2023, 28 (02): 94-99.   DOI: 10.16139/j.1007-9610.2023.02.02
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    Gallbladder stone (GS) is a common disease. There are no obvious symptoms at early stage for the patient with GS. Obstruction will cause acute cholecystitis. Secondary obstructive cholangitis of GS, biliary pancreatitis, gallbladder cancer due to GS would be serious. Many guidelines and consensuses have been published in the world and from many professional organizations, promoting the normative diagnosis and treatment of GS. However, there are still a lot of controversial issues. Currenly, there is a lack of study on the whole course of GS with large samples. Prevention and early diagnosis with treatment of GS are neglected. It results in insufficient personalized diagnosis and treatment. In order to have the prevention, diagnosis, treatment, prognosis and follow-up which are carried out better, the authors divided the course of GS into four stages according to the pathophysiological characteristics of the occurrence, development and outcome of GS. There are: ①stage of stone forming; ②asymptomatic period without obstruction; ③inflammation and infection stage, inclu-ding obstructive inflammation, pyogenic gangrene, perforation abscess; ④stage of secondary lesions, including abnormal gallbladder morphology and function, GS shift, gallbladder carcinoma. According to the pathophysiological staging, it is beneficial to the personalized diagnosis and treatment based on the standard management for the patients who can benefit more.

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    Laparoscopic colorectal surgery 30 years in China: what we learned
    ZHENG Minhua, MA Junjun
    Journal of Surgery Concepts & Practice    2023, 28 (03): 181-185.   DOI: 10.16139/j.1007-9610.2023.03.001
    Abstract425)   HTML9)    PDF(pc) (882KB)(180)       Save

    Since 1993, the first laparoscopic radical surgery for colon cancer was carried out in China, laparoscopic colorectal surgery in China has embarked on a new journey, and has now entered its 30th year. Looking back on the 30 years history of laparoscopic colorectal surgery, it is hoped that through the window of laparoscopic colorectal surgery, from the establishment of a series of key technologies in its initial stage, to the development of training systems, and even the further development of innovative technologies and technology platforms, to review the trajectory in the development of laparoscopic surgery in China, and to think from multiple dimensions, so as to gain experience, guide current practice, and look forward to the future development.

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    Laparoscopic radical resection of hilar cholangiocarcinoma: current status and considerations
    ZHU Siwei, YIN Xinmin
    Journal of Surgery Concepts & Practice    2023, 28 (02): 100-103.   DOI: 10.16139/j.1007-9610.2023.02.03
    Abstract410)   HTML6)    PDF(pc) (768KB)(117)       Save

    Laparoscopic radical resection of hilar cholangiocarcinoma was complex because of the tumor near to hepatic hilum. The resection of hilar cholangiocarcinoma increased in recent years in large medical centers with safety of surgery improved. The current status of laparoscopic radical resection of hilar cholangiocarcinoma was discussed in this article including contraindication of surgery, precision evaluation and obstructive jaundice treated with preoperative biliary duct drainage, coordination among operative team and their experience. The key technology involved both blood vessels and lymphatic nodes dissected and separated which included resection of caudal lobe combined with hepatic lobes and hepatic segments, and then reconstruction of digestive tract. Lastly, there is consideration and prospect of laparoscopic radical resection of hilar cholagiocarcinoma.

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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    2023, 28 (03): 240-248.   DOI: 10.16139/j.1007-9610.2023.03.011
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    Objective: To investigate the incidence, mortality and survival of small intestine cancer in Shanghai from 2002 to 2016. Methods: Data of new small intestine cancer cases and deaths from 2002 to 2016 were obtained from the population-based cancer registry and Vital Statistics System of Shanghai Municipal Center for Disease Control and Prevention. The incidence and mortality of small intestine cancer stratified by year of diagnosis or death, gender and age-group were analyzed. Cases or deaths, proportion, crude rate, age-specific rate, age-standardized rate and others were calculated. Trends of cases or deaths, crude rate, age-specific rate and age-standardized rate of incidence and mortality with follow-up information were estimated. The annual percent change (APC) of age-standardized rates of incidence and mortality was estimated by Joinpoint analysis. The new cases and proportions with selected diagnostic character of small intestine cancer in different diagnosis years were also calculated. Age-standardized rates were calculated using Segi’s 1960 world standard population. The 1- to 5-year observed survival rates were calculated based on the life table. The probabilities of surviving from 0 to 99 years old were estimated according to the Elandt-Johnson model, and then the cumulative expected survival rates were calculated according to the Ederer Ⅱ method. Finally, the 1- to 5-year relative survival rates were calculated. Results: The age-standardized rates of incidence and mortality of small intestine cancer were stable in Shanghai from 2002 to 2016. The new average cases and deaths of small intestine cancer were 280 and 174 per year in Shanghai. The crude rate of incidence was 2.02/105, and the age-standardized rate was 0.96/105. The crude rate of mortality was 1.25/105, and the age-standardized rate was 0.54/105. The age-standardized rates of incidence and mortality in males were higher than those in females. The age-specific cases or deaths and rates of incidence and mortality increased with aging. Duodenum cancer was the dominant anatomical site. Adenocarcinoma was the most histopathological type, and the proportion of gastrointestinal stromal tumors was increasing. The 5-year observed survival rate of small intestine cancer diagnosed from 2002 to 2013 was 36.34% in Shanghai, and the 5-year relative survival rate was 39.98%. All survival rates of male were lower than those of female. The 5-year observed and relative survival rates were stable. And those decreased with the increase of diagnostic years and stages. Relative to other sites, the rates of the duodenum cancer were the lowest. Relative to other histopathological types, those of gastrointestinal stromal tumors were the highest. Conclusions: The diagnostic level of small intestine cancer has been improved in Shanghai, continuously. But the survival rates have not been improved with the times. The proportion of stage Ⅰ was low and without improvement for a long time. This study provides useful information to further research, control and prevention of small intestine cancer. Improvement of the surveillance and research on small intestine cancer will help to promote more efficient control and prevention strategies then decrease cancer burden.

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    Study on hernia repair materials: progress and prospect
    YU Fan, WU Bo, KANG Jie
    Journal of Surgery Concepts & Practice    2022, 27 (04): 375-379.   DOI: 10.16139/j.1007-9610.2022.04.021
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    Hernia is one of common diseases diagnosed and treated in clinic by general surgeons with surgery as major procedure of treatment. Hernia repair materials are used in conventional and laparoscopic tension-free repair. Classification of repair materials based on material quality includes non-absorbable or absorbable man made synthetic mesh, biologic mesh and compound mesh. The mesh would also be classified according to woven way, pore size and density. The hernia repair material in future will be prospected which may have the maximized biologic inertia, minimized overall area, the most excellent surface nature, the most optimized weight of mesh, and biomechanical strength. Further study will be needed on the base of recognition of pathophysiology and material property of mesh.

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