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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
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    “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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    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
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    “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
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    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 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
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    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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    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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    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
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    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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    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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    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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    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
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    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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    Practice of single-port and reduced-port laparoscopic gastric cancer surgery in China
    YAN Su, ZHENG Minhua
    Journal of Surgery Concepts & Practice    2023, 28 (03): 233-239.   DOI: 10.16139/j.1007-9610.2023.03.010
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    The application and development of laparoscopic surgery for gastric cancer has experienced a history of more than two decades, from exploratory development to clinical validation, and then to large-scale clinical studies. Gra-dually, laparoscopic gastric cancer surgery has been supported by high-level evidence. Laparoscopic surgery is progressively recommended as one of the alternative treatment for gastric cancer and is widely performed in gastric cancer surgery worldwide, especially in East Asia, such as Japan, Korea and China. Single-port and reduced-port laparoscopic surgery was first performed for cholecystectomy and appendectomy, is becoming more popular among gastrointestinal surgeons due to its minimally invasive outcomes and better cosmetic effects. However, the clinical application of single-port and reduced-port laparoscopic surgery for gastric cancer is still in the exploratory stage. The results of initially observational studies have shown that single-port and reduced-port laparoscopic surgery have potential advantages in terms of cosmetic results and enhanced recovery after surgery compared with the conventional five-port laparoscopic surgery for gastric cancer. But its surgical safety and feasibility are still not confirmed by high-level evidence of evidence-based medicine.

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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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    Progress of minimally invasive thyroid surgery
    LI Jiamin, KANG Jie, WU Bo, FAN Youben
    Journal of Surgery Concepts & Practice    2023, 28 (03): 273-277.   DOI: 10.16139/j.1007-9610.2023.03.016
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    The incidence of thyroid cancer has increased in recent years. The desire for aesthetics and quality of life, combined with the development of energy devices and robotics make surgeons introduction of minimally invasive procedures both more refined and difficult techniques, resulting less painful and better aesthetic results. Thyroidectomy has been expanded to include minimally invasive video-assisted thyroidectomy, multi-approach to endoscopic thyroidectomy, thermal ablation, chemical ablation and robot-assisted thyroidectomy.

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    Interpretation of NCCN clinical practice guidelines for hepatocellular carcinoma, version 2.2023
    SHI Chunchao, WANG Kui
    Journal of Surgery Concepts & Practice    2024, 29 (02): 99-105.   DOI: 10.16139/j.1007-9610.2024.02.02
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    The National Comprehensive Cancer Network (NCCN), as the world's leading non-profit consortium in the field of oncology, continues to update clinical practice guidelines for multiple malignancies annually and has become a benchmark for clinical practice guidelines in oncology worldwide. Currently, the NCCN clinical practice guidelines for hepatocellular carcinoma have been updated to version 2.2023, as compared with version 1.2023 of its main updates for the content of the discussion section. The NCCN guidelines for hepatobiliary cancers have been reorganized to separate guidelines for biliary tract cancers and hepatocellular carcinoma since version 1.2023. The main updates focus on tumor screening, diagnosis, surgery, adjuvant therapy, locoregional therapy, systemic therapy, and so on. The molecular testing was added for the first time. Therefore, the updates of version 1.2023 were highlighted again in the new version 2.2023. This article interpreted the new guidelines and focused on the aspects of updates.

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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
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    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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    Review and prospect of neoadjuvant chemoradiotherapy combined with immunotherapy in locally advanced rectal cancer
    WANG Yaqi, XIA Fan, ZHANG Zhen
    Journal of Surgery Concepts & Practice    2024, 29 (03): 220-229.   DOI: 10.16139/j.1007-9610.2024.03.07
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    For locally advanced rectal cancer (LARC), the standard treatment of neoadjuvant chemoradiotherapy (nCRT) followed by total mesorectal excision (TME) leaded to limited tumor regression grade and organ preservation rate, and didn’t decrease the rate of distant metastasis. Radiotherapy can promote the immune response and has good synergistic effect with immunotherapy, which is likely to overcome the treatment difficulty of the microsatellite stable(MSS) colorectal cancer. Recently, multiple clinical trials are ongoing in terms of the combination of nCRT and immunotherapy in LARC. Most of them have achieved promising complete response rates, providing new treatment options for preservation of organ functions in mid-low MSS LARC. Large-scale randomized controlled trials are needed in the future to validate these findings and explore the benefit of organ preservation and long-term survival. In addition, studies are still needed on the optimal combination patterns of radiotherapy and immunotherapy and the precise efficacy evaluation, etc.

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    Interpretation of 2023 2nd NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma
    CHEN Jiahao, JIANG Chongyi
    Journal of Surgery Concepts & Practice    2024, 29 (01): 10-13.   DOI: 10.16139/j.1007-9610.2024.01.03
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    Pancreatic adenocarcinoma, a severe digestive malignancy, is characterized by its poor prognosis. The National Comprehensive Cancer Network (NCCN) persistently refines its guidelines, integrating cutting-edge evidence-based medical insights to standardize the diagnostic and therapeutic strategies of pancreatic adenocarcinoma. The NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma were updated twice on May 4 and June 19, 2023, respectively. Compared to the 2022 predecessor, these two updates placed a particular emphasis on immunotherapy/targeted therapy, the introduction of NALIRIFOX regimen, and supplementary treatment protocols for patients with intermediate performance status. This article provided an interpretation of the latest updates to the NCCN clinical practice guidelines in oncology-pancreatic adenocarcinoma, integrating relevant evidence-based medical findings.

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    Meticulous surgical techniques for endoscopic thyroid surgery
    WANG Bin, QIU Ming
    Journal of Surgery Concepts & Practice    2023, 28 (03): 197-201.   DOI: 10.16139/j.1007-9610.2023.03.004
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    The refinement of thyroid surgery has become a standardized requirement and a symbol of improved technical level in thyroid surgery. Endoscopic equipment magnifies the surgical field of view in high definition, making it more conducive to perform the surgery meticulously. Here we explored the key points of refined surgery based on the technical points of endoscopic thyroid surgery. We also focused on the establishment of endoscopic operation space, exposure of thyroid tumors, and protection of key organs and tissues. With regard to the establishment of endoscopic operation space, the separation of subcutaneous layer should show the view of “red sky and yellow ground”, which means the gap between the platysma muscle and the deep layer of the superficial fascia. The subcutaneous dissection area should be present as “long tunnel, small cavity”, and the shape from the bilateral sternoclavicular joints to the bilateral areola, which seems like the fan-shape with “thin neck and wide bottom”. With regard to the exposure of thyroid tumors, the key technical points include the dissociating and traction of anterior cervical muscles. Three spaces [the median space (the white line space of the neck), the inner space (the space between the thyroid surgical capsule and the anterior cervical muscles) and the outer space (the space between the anterior cervical muscles and the sternocleidomastoid muscle)] need to be fully dissociated. Furthermore, the assistant with special sutures or hooks to fully dissociate the anterior cervical space and the use of a reasonable grasping method as well as a suitable energy platform to prevent thyroid bleeding. With regard to the protection of key organs and tissues, nerve monitoring technology helps to find and locate the recurrent laryngeal nerve. In addition, careful manipulation at the entrance to the larynx is the key to avoid the damage of recurrent laryngeal nerve. Lymph negative imaging techno-logy helps to identify the parathyroid gland. Accurate identification of the anatomical type of the parathyroid gland and meticulous dissection of the intermembrane space of the parathyroid gland is benefit to protect the blood supply of the parathyroid gland in situ. To achieve the refinement and minimally invasive surgery, it is necessary to improve the surgical instruments and materials. What is more important, surgeons should update their surgical concepts, be well acquainted with anatomical relationships and constantly improve surgical techniques.

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    Prevention and treatment of anastomotic leakage after laparoscopic anterior resection of low rectal cancer
    LUO Yang, ZHONG Ming
    Journal of Surgery Concepts & Practice    2023, 28 (03): 220-225.   DOI: 10.16139/j.1007-9610.2023.03.008
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    Anastomotic leakage (AL) is one of the inevitable and severe complications after laparoscopic-assisted anterior resection of low rectal cancer. With the improvement of surgical technology and cognitive concept, the position of sigmoid-rectal anastomosis is becoming lower and lower, and the problem of AL is more challenging. Preventive stoma is currently a common method to deal with AL, but over-reliance on stoma and the stoma-related complications have also troubled surgeons. Based on years of practical experience, we summarized how to avoid unnecessary stoma through the risk assessment scale, and how to detect and deal with AL in the early stage of laparoscopic-assisted anterior resection of low rectal cancer.

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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
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    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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    Interpretation of the updated international guidelines for groin hernia management (2023)
    XU Jing, ZHUANG Qiulin, DONG Ruizhao, YANG Ziang
    Journal of Surgery Concepts & Practice    2024, 29 (04): 316-322.   DOI: 10.16139/j.1007-9610.2024.04.08
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    Since the International guidelines for groin hernia management were published in 2018, many new evidences have been published. In October 2023, the HerniaSurge Group published Update of the international HerniaSurge guidelines for groin hernia management. It updated eight chapters of the last guidelines, proposed 20 key questions, and 39 new statements and 32 recommendations, of which 16 were strong recommendations. This article combined clinical concerns to sort out and interpret the updated version.

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