Gallstones are the primary benign disease diagnosed and treated in biliary surgery.With the development of medical technology and the increasing awareness of health among the population,the detection rate of gallstones has been increasing annually,with the majority being asymptomatic or mild cases.Currently,the clinical treatment of gallstones mainly includes observation,conservative,or surgical treatment(laparoscopic cholecystectomy).However,there remains some controversy regarding the clinical management of these patients.For asymptomatic or mild gallstones,the main point of contention in both academic and clinical settings is how to determine the indications for cholecystectomy.This article reviews relevant literature from both domestic and international sources,addressing the controversies surrounding the clinical management of gallstones and the determination of indications for cholecystectomy,and elaborates on these issues from multiple perspectives.

Chronic constipation is a common functional bowel disorder that significantly impacts patients'quality of life and mental health.The Surgical Diagnosis and Treatment Guidelines for Constipation were first published in 2008 and revised in 2017,respectively,and have contributed to the growth of constipation surgery in China.With a deeper understanding of the underlying mechanisms and advancements in minimally invasive surgical techniques,the branch has again assembled multidisciplinary experts to enhance the diagnosis and treatment system.Based on the latest local and global evidence and utilizing the GRADE system to assess the quality of evidence and strength of recommendations,they have developed the Guidelines for Surgical treatment of constipation(2025 Edition).The new edition systematically updates information on causes,diagnostic methods,and non-surgical and surgical treatment options for constipation.It clearly defines surgical indications and principles for procedure selection,emphasizing personalized treatment and evidence-based decision-making.This guideline aims to standardize diagnosis and treatment,improve clinical decision-making,and promote consistency and effectiveness in surgical approaches for treating constipation.

Obesity is a major global public health challenge and a leading cause of multiple metabolic disorders,including hypertension and diabetes.In China,more than half of the adult population is overweight or obese.While anti-obesity pharmacotherapies(such as GLP-1 receptor agonists)and bariatric surgery have both advanced rapidly,strategies for integrating these two modalities remain unclear.In particular,controversies persist regarding surgical eligibility after drug discontinuation,and standardized clinical guidelines are lacking.In July 2025,the International Federation for the Surgery of Obesity and Metabolic Disorders released the world's first statement focusing on"metabolic bariatric surgery after pharmacotherapy-induced weight loss",which emphasizes the chronic disease model of obesity management and clarifies the synergistic relationship between pharmacotherapy and surgery.This article interprets the statement from the perspectives of treatment strategies,surgical eligibility,and drug-surgery coordination,aiming to provide evidence-based reference for clinicians and to promote standardized,integrated obesity management.

Complex rectal cancer often requires extended multivisceral resection beyond the total mesorectal excision plane or lateral lymph node dissection(LLND)beyond the conventional range.Owing to the deep pelvic location,limited operating space,and complex local anatomy,conventional open or laparoscopic surgery is associated with restricted visualization,technical difficulty,and increased surgical risk.With the advancement of robot-assisted surgical technology,its high-definition three-dimensional vision,articulated robotic arms with multiple degrees of freedom,and ergonomic improvements effectively overcome the limitations of traditional laparoscopy,allowing precise manipulation in narrow pelvic spaces.These advantages have made robotic surgery increasingly valuable in complex rectal cancer procedures such as LLND and multivisceral resection.This review summarizes recent literature and the authors'clinical experience to discuss the feasibility,advantages,and limitations of robotic-assisted rectal cancer surgery.

Laparoscopic intersphincteric resection(ISR)represents a key technique for achieving maximal sphincter preservation in ultra-low rectal cancer.Based on 400 cases of surgical experience,this study proposes a series of systematic strategies addressing some major technical challenges of ISR.To facilitate precise dissection of the intersphincteric space,a"knife-edge position transanal-priority"approach was adopted,improving exposure and reducing the risk of circumferential margin positivity.To prevent and reduce anastomotic leakage,ISR combined with the modified Bacon(Turnbull-Cutait)delayed anastomosis was introduced as a"stoma-free but safe"alternative.For large anastomotic disruptions,a stoma-therapist-involved management protocol with transanal"U-shaped"repair was implemented to promote healing.Furthermore,a transabdominal levatorplasty was explored to enhance pelvic floor support and improve postoperative continence.Our initial experience suggests that,these strategies contribute to optimizing the balance between oncological radicality and functional preservation,offering a practical and individualized pathway for sphincter-saving surgery in ultra-low rectal cancer.

Background and Aims:Colorectal cancer(CRC)has a high incidence and mortality rate,and the effectiveness of current therapies for advanced cases remains limited.Kaempferol,a natural flavonoid compound,exhibits antioxidant,anti-inflammatory,and antitumor properties.This study aimed to elucidate the key molecular targets and underlying mechanisms of kaempferol against CRC through an integrated approach combining network pharmacology and experimental validation.Methods:Potential targets of kaempferol were identified via SwissTargetPrediction,SEA,PharmMapper,and TargetNet databases,and CRC-related targets were retrieved from GeneCards,OMIM,CTD,and DrugBank.The intersection targets were used to construct a compound-target-disease network.Protein-protein interaction(PPI)analysis using the STRING database and Cytoscape software identified core targets,followed by Gene Ontology(GO)and Kyoto Encyclopedia of Genes and Genomes(KEGG)enrichment analyses.In vitro experiments with human CRC HCT-116 cells evaluated cell proliferation(CCK-8 assay),colony formation,migration(scratch assay),invasion(Transwell assay),and expression of apoptosis-and cell cycle-related proteins(Western blot).Results:A total of 492 kaempferol targets and 5 078 CRC-related targets were obtained,with 269 overlapping targets identified as potential therapeutic candidates.PPI network analysis revealed 53 core targets,including Akt1,HSP90AA1,ESR1,SRC,CASP3,and NFKB1.GO analysis indicated enrichment in cellular stress response,apoptosis regulation,and oxidative stress processes;KEGG pathways were primarily related to chemical carcinogenesis-receptor activation,prolactin,estrogen,and PI3K/Akt signaling.Experimental validation demonstrated that kaempferol markedly inhibited HCT-116 cell proliferation,colony formation,migration,and invasion in a dose-dependent manner(all P<0.05),accompanied by downregulation of Bcl-2 and cyclin D1 and upregulation of Bax(all P<0.05).Conclusion:Kaempferol exerts anti-CRC effects through multi-target and multi-pathway mechanisms,including inhibition of proliferation,migration,and invasion,and induction of apoptosis,potentially via modulation of the PI3K/Akt and estrogen signaling pathways.These findings provide theoretical and experimental evidence supporting kaempferol as a promising candidate for CRC therapy.

Background and Aims:Tumor deposits(TDs)may influence prognosis beyond the current 8th edition AJCC pTNM nodal classification in gastric cancer(GC).This study investigates the prognostic value of TD number and proposes an improved pN staging(mpN)that classifies patients with TD number>1 as pN3b.We validated the mpN staging against the 8th AJCC pN staging.Methods:A dual-center retrospective cohort study was performed,including 1 327 patients who underwent radical gastrectomy at Sun Yat-sen University Cancer Center(2011-2015;test cohort)and 340 patients from Guangdong Provincial People's Hospital(2015-2022;validation cohort).Patients were dichotomized into low-TD(≤1)and high-TD(>1)groups.Outcomes were overall survival(OS)and disease-free survival(DFS).Survival analyses used Kaplan-Meier curves,IPTW,and Cox regression.Predictive performance of staging systems was assessed by time-dependent ROC(tROC)/tAUC,concordance index(C-index)and Akaike information criterion(AIC).Results:TDs were present in 435/1 327(32.7%)in the test cohort.Presence of TD was associated with worse OS(IPTW-adjusted HR=2.69,95%CI=2.18-3.31,P<0.01)and DFS(HR=2.82,95%CI=2.32-3.42,P<0.01).In multivariable models,TD remained an independent adverse factor for OS(HR=1.65,95%CI=1.34-2.05;P<0.01)and DFS(HR=1.74,95%CI=1.43-2.11,P<0.01).Increasing TD number correlated with progressively poorer survival;X-tile identified>1 as an optimal cutoff,with high-TD patients showing markedly worse outcomes(OS:adjusted HR=3.65,95%CI=2.74-4.88;DFS:adjusted HR=3.74,95%CI=2.85-4.91;both P<0.01).Incorporation of TD number into the mpN staging(assigning TD>1 to pN3b)improved prognostic discrimination:in the test cohort 5-year OS tAUC was 0.746 for mpN vs.0.703 for AJCC pN(C-index 0.738 vs.0.721,AIC 5 805.27 vs.5 849.30);similar improvements were observed in the validation cohort.Conclusion:TD presence and number exert significant negative prognostic impact in GC.Classifying patients with TD number>1 as pN3b enhances prognostic accuracy.Routine reporting of TD counts and further prospective multicenter validation of mpN staging are warranted.

Background and Aims:Microsatellite-stable(MSS)colorectal cancer(CRC)generally exhibits poor responsiveness to immune checkpoint inhibitors(ICIs),and effective immunotherapy strategies remain lacking.Anti-angiogenic agents such as bevacizumab(BEV)can improve the tumor immune microenvironment and act synergistically with ICIs.This multicenter real-world study compared the efficacy of different immunotherapy-based combination regimens in patients with MSS/MSI-L/pMMR advanced CRC,aiming to identify the optimal treatment strategy.Methods:A total of 100 patients with MSS/MSI-L/pMMR advanced CRC who received systemic treatment between November 2019 and February 2025 at four tertiary hospitals in Hunan,China,were retrospectively enrolled.Patients were classified into six treatment groups:chemotherapy alone,chemotherapy+targeted therapy,immunotherapy alone,immunotherapy+chemotherapy,immunotherapy+targeted therapy,and immunotherapy+chemotherapy+targeted therapy.The primary endpoints were overall survival(OS)and progression-free survival(PFS),while secondary endpoints were objective response rate(ORR)and disease control rate(DCR).Additionally,among patients receiving immunotherapy,subgroup analysis was performed according to BEV administration.Results:Among all 100 patients,the immunotherapy+chemotherapy+targeted therapy group achieved the highest ORR(32.0%)and DCR(76.0%)and was the only regimen yielding a complete response(CR).Compared with chemotherapy or immunotherapy alone,the triplet regimen significantly improved OS(P<0.05);although PFS improvement did not reach statistical significance,a clear late-stage separation of survival curves was observed.In the immunotherapy subgroup,BEV-containing regimens achieved markedly better outcomes than non-BEV regimens,with DCR of 75.0%vs.48.8%,median OS of 18.9 vs.11.5 months,and median PFS of 13.8 vs.7.2 months(all P<0.001).Cox regression analysis showed that compared with chemotherapy alone,the triplet regimen significantly reduced the risk of death(HR=0.11)and disease progression(HR=0.25)(both P=0.002).Vascular invasion was identified as an adverse prognostic factor for PFS(HR=3.0,P=0.007).Conclusion:This multicenter real-world study demonstrated that combining immunotherapy with chemotherapy and targeted therapy significantly improves DCR and survival outcomes in patients with MSS/MSI-L/pMMR advanced CRC,with BEV-containing triplet regimens providing the most pronounced benefit.BEV may enhance immune responsiveness by modulating the tumor microenvironment and promoting effector T-cell infiltration,offering a promising therapeutic direction for"immune-cold"CRC.Prospective randomized studies are warranted to further validate its clinical value and define appropriate patient populations.

Background and Aims:Elderly patients with inguinal hernia are prone to intraoperative hypothermia due to diminished thermoregulatory capacity,which may increase the risk of postoperative complications such as infection,seroma,and cognitive dysfunction.This study aimed to investigate the relationship between intraoperative body temperature and postoperative complications in elderly patients undergoing inguinal hernia repair and to evaluate its predictive value.Methods:Clinical data of 358 elderly patients who underwent tension-free inguinal hernia repair at the Affiliated Hospital of Southwest Medical University from April 2018 to October 2024 were retrospectively analyzed.Patients were divided into a hypothermia group(<36.0℃)and a normothermia group(≥36.0℃)according to intraoperative temperature levels.Perioperative parameters and postoperative complications were compared between the two groups.Independent risk factors for complications were identified using multivariate logistic regression,and the predictive performance of intraoperative temperature was evaluated by receiver operating characteristic(ROC)curve analysis.Results:Compared with the normothermia group,patients with intraoperative hypothermia had significantly longer operative time,higher postoperative white blood cell(WBC)count and neutrophil-to-lymphocyte ratio(NLR),and an increased incidence of complications(25.0%vs.3.8%,P<0.001).Multivariate analysis identified age,NRS 2002 score,intraoperative blood loss,postoperative WBC,postoperative NLR,and intraoperative hypothermia as independent risk factors for postoperative complications.ROC analysis showed that intraoperative temperature had a good predictive value for complications(AUC=0.717,optimal cutoff=36.42℃,sensitivity=70.0%,specificity=89.5%).Conclusion:Intraoperative hypothermia significantly increases postoperative complication risk in elderly patients undergoing inguinal hernia repair.Maintaining intraoperative temperature above 36.4℃may reduce the incidence of complications and improve perioperative outcomes.

Background and Aims:Mucinous adenocarcinoma of the colorectum(MAC)is a distinct histologic subtype of colorectal cancer characterized by high malignancy and low diagnostic accuracy of preoperative biopsy,posing challenges for clinical decision-making.Given the critical role of the inflammatory microenvironment in tumor progression,this study aimed to develop and validate a nomogram model integrating preoperative systemic inflammatory indicators and clinical features to improve the preoperative diagnosis of MAC.Methods:Clinical data of 293 patients with colorectal cancer who underwent radical resection between June 2017 and June 2022 at the First Affiliated Hospital of the University of South China were retrospectively analyzed.Based on postoperative pathology,patients were classified into the mucinous adenocarcinoma(MAC)group and the non-specific adenocarcinoma(AC)group.Propensity score matching(PSM,1∶1)was used to balance age,T stage,and N stage.Differences in preoperative inflammatory indices were compared between groups.Univariate and multivariate logistic regression analyses were performed to identify independent predictors of MAC,which were incorporated into a diagnostic nomogram.The model's discrimination,calibration,and clinical utility were evaluated using the area under the receiver operating characteristic curve(AUC),calibration plots,and decision curve analysis(DCA).Results:Among the 293 patients,46 had MAC and 247 had AC,with a preoperative colonoscopic diagnostic rate of 54%for MAC.After PSM(43 pairs),platelet count,platelet lymphocyte ratio(PLR),systemic immune inflammation index(SII),inflammation related prognostic index(IPI),and systemic inflammation score(SIS)were significantly higher in the MAC group,while lymphocyte monocyte ratio(LMR)was lower(all P<0.05).Multivariate analysis identified tumor location,maximum tumor diameter,and preoperative IPI as independent predictors.The AUCs of the nomogram in the training(n=206)and validation(n=87)cohorts were 0.759(95%CI=0.662-0.856)and 0.776(95%CI=0.649-0.903),respectively.Calibration plots showed good agreement between predicted and observed probabilities,and DCA demonstrated satisfactory clinical applicability.Conclusion:A nomogram model integrating tumor location,tumor size,and preoperative IPI was successfully developed and validated for preoperative diagnosis of colorectal MAC.This model provides a practical,quantitative tool with good predictive performance to assist clinicians in individualized treatment planning,particularly for patients ineligible for surgical biopsy.