In recent years, significant progress has been made in the field of colorectal cancer surgery in China. With innovations in techniques such as transanal total mesorectal excision and robotic surgery, as well as the exploration of comprehensive neoadjuvant therapy and neoadjuvant immunotherapy, the application of watch-and-wait and local resection strategies, colorectal surgery is gradually evolving a characteristic of minimally invasive operations, more effective tumor treatments, and individualized organ preservation. In light of these hotspots and innovations, many high-quality evidence-based medical studies have emerged in recent years. This article will review and summarize these developments.

The onset of pancreatic cancer is insidious, and most patients have accompanied by distant metastasis at the time of definite diagnosis. Previously, it was believed that regardless of the size, number and location of metastases, the surgical benefits of patients with metastatic pancreatic cancer were extremely limited. However, with the promotion of the concept of oligometastasis in recent years, an increasing number of studies have confirmed that surgical resection after induction therapy can significantly improve the clinical prognosis in some highly selected patients with oligometastatic disease of pancreatic cancer. However, there still remains many controversies about the clear definition, surgical treatment and perioperative management of oligometastatic disease of pancreatic cancer. Therefore, based on the latest research progress, this article proposes to discuss the related hot topics and disputes in the field of oligometastatic disease of pancreatic cancer for purpose of promoting the standardization of the treatment of oligometastatic disease of pancreatic cancer.

Objective:To investigate the clinical characteristics, diagnosis and treatment of duodenal duplication in children.Methods:From Jan 2017 to Jun 2023, clinical data of 8 child patients complaining nonspecific intraabdominal symptoms at Department of General Surgery, Hu'nan Children's Hospital undering surgery were retrospectively analyzed.Results:Five patients had duodenal duplication resected, 3 patients underwent fenestration and mucous membraine removel.Postoperative pathology showed cyst type in 6 cases, tubular type in 2 cases,all with lining of intestinal mucosa, and smooth muscle, including 1 case with ectopic pancreas tissues, 2 cases with ectopic gastric mucosa tissues. Postoperative follow-up were 10-48 months. During the follow-up period, there was no abdominal pain, vomiting, abdominal distension, and other symptoms, and the children recovered well.Conclusions:The clinical manifestations of duodenal duplication are no specific. Definite diagnosis depends on pathology. Duodenal duplication resection or fenestration plus mucosal stripping is the treatment of choice. The prognosis is good.

Objective:To investigate the difference in efficacy of thoracic endovascular aortic repair (TEVAR) for high-risk uncomplicated Stanford B aortic dissection in acute versus subacute phase.Methods:The clinical and follow-up data of of 126 patients with high-risk, uncomplicated Stanford B aortic dissection treated with TEVAR at the Affiliated Hospital of Chengde Medical College from Jan 2014 to Oct 2020 were retrospectively analyzed.Results:One hundred and twenty-six patients were divided according to the time from onset to surgery into an acute phase group ( n=65, 1-14 days) and a subacute phase group ( n=61, 15-90 days). The average hospital stay of patients in the subacute phase group was significantly shorter than that of patients in the acute phase group ( P<0.05). One year post-operatively, abdominal aortic false lumen thrombosis in patients of the acute phase group was better than that in the subacute phase group ( P<0.05). The in hospital overall incidence of adverse events (total complications+death) was lower in the subacute phase group than in the acute phase group ( P<0.05). The difference in the long-term overall incidence of adverse events between the two groups was not statistically significant ( P>0.05). Conclusions:The TEVAR procedure for high-risk, uncomplicated Stanford B aortic dissection performed during the subacute phase had a lower postoperative in hospital incidence of adverse events.

As the rate of sphincter-preserving surgery increases after proctectocy, low anterior resection syndrome (LARS) has gained increasing attention. The prevention and treatment strategies for LARS have continually improved over the past decade. Colorectal surgeons should focus on whole course management of LARS throughout the pre-, intra-and post-operative period. This includes through preoperative assessment of the risks and benefits of sphincter-preserving resections, intraoperative neurofunctional protection, improvements in bowel reconstruction techniques, and precise identification of distal and proximal margins. Postoperatively, LARS patients should receive standardized, stepwise treatment according to the bowel rehabilitation programme.

The success of recent immunotherapy and target immunotherapy further shows the importance of MDT model for colorectal cancer and other related cancers in patients with Lynch syndrome characterized by mismatch repair defect molecular pathology, which urges doctors to first choose targeted drug for suitable patients and develop methods that can accurately judge the curative effect,to study whether we should adopt the "down-scaled version" radical surgery to achieve the goal of radical cure, and to study whether PD-1 inhibitors can prevent the occurrence of Lynch syndrome malignant tumor and achieve organ preservation to a greater extent.

Objective:To explore the safety and effectiveness of ileal bypass with stent to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.Methods:From Dec 2021 to Sep 2024, the clinical data of 55 patients undergoing robot anus-preserving surgery and stent ileal bypass for low rectal cancer in the First Affiliated Hospital of Ningbo University was analyzed retrospectively.Results:All the 55 patients successfully completed the operation. Among them, 47 patients underwent low anterior resection and 8 patients did sphincter resection. The total operation time was (207±37)min, the operation time of ileal bypass was (24±3)min, and the intraoperative blood loss was (32±18)ml. After operation, the time of stent disintegration was (23.93± 2.87) days, and the time of catheter removal was (29.55 ± 3.21) days. By postoperative TNM staging, there were 12 cases in T1 stage, 26 cases in T2 and 17 cases in T3. The number of lymph node dissection was (16.84±4.50), 15 cases being positive for lymph node metastasis, 40 cases being negtive for lymph node metastasis, 36 cases were stage Ⅰ, 4 cases were stage Ⅱ and 15 cases were stage Ⅲ. The median follow-up time was 20 (2-35) months. Delayed anastomotic leakage occurred in 1 patient and anastomotic stenosis occurred in 2 patients.Conclusion:Stent ileal bypass is safe and effective to prevent anastomotic leakage in Da Vinci robot anus-preserving surgery for low rectal cancer.

Objective:To explore the anal function and postoperative complications of 2-stage Turnbull-Cutait pull-through coloanal anastomosis (TCA) for low rectal cancer.Methods:Patients undergoing radical rectal cancer resection from Feb 2023 to Nov 2024 in the First Hospital of Jilin University were divided into the TCA surgery group and the low anterior resection combined with prophylactic stoma (LAR) surgery group.Results:Among the 102 patients, there were 50 cases in the TCA group and 52 cases in the LAR group. In the single-arm analysis of the TCA group, the overall complication rate was 44%. The incidence rates of severe LARS at 1 month, 3 months, and 6 months after surgery were 97%, 77%, and 64% respectively. There was no significant difference in the complication rate within 30 days after surgery between the two groups,(44% vs. 38%, χ2=0.135, P>0.05). There was no significant difference in the incidence rate of severe LARS between the TCA group and the LAR group (77% vs. 69%, χ2=0.202, P>0.05), and there was not significant difference in the incidence rate of severe LARS between the two groups at the 6th month after surgery,(64% vs. 48%, χ2=1.132, P>0.05). Conclusion:In patients who underwent TCA surgery, the LARS symptoms gradually decreased over time. Compared with patients undergoing low anterior resection and stoma reversal, there were no significant differences in complications within 30 days after surgery and LARS symptoms within half a year.

Objective:To evaluate the clinical features and risk factors of anastomotic leakage (AL) in patients with locally advanced rectal cancer (LARC) receiving neoadjuvant chemoradiotherapy (nCRT) followed by laparoscopic radical resection and proctocol ostomy.Method:Clinicla data of LARC patients receiving neoadjuvant chemoradiotherapy followed by laparoscopic radical resection and proctocol ostomy admitted to Peking Union Medical College Hospital between Jan 2019 and Oct 2023 was enrolled. According to the occurrence of AL, patients were divided into AL group and non-AL group.Results:After propersity matching score(PSM), there were 40 patients (33.4%) and 80 patients (66.6%) in the AL and non-AL group, respectively. The first-onset symptoms of AL were abnormal character and color of the drainage (23 cases, 57.5%) and fever (14 cases, 35.0%). About 82.5% of the AL were graded as B,and all 36 patients (90.0%) were managed consveratively by fully drainage anti-infection therapy. Logistic regression analysis indicated that tumor circumferential range more than 1/2 cycle ( OR=5.95, 95% CI:2.12-1.67, P=0.004), male ( OR=4.28, 95% CI:1.22-15.00, P=0.023) and high-ligation of Inferior mesenteric artery ( OR=8.08, 95% CI:1.86-37.78, P=0.006) were independent risk factors of AL. Conclusions:In this series, grade-B AL ranks the top of the incidence, and all were cured by conservative therapy. Special attention should be paid to those patients with the characteristics of male, tumor circumferential range more than 1/2 cycle, and high-ligation of inferior mesenteric artery.

Xenotransplantation using pigs as donors is considered one of the most promising approaches to address the shortage of allogeneic organs and has been seen rapid development in recent years. However, the clinical application of xenotransplantation still faces challenges in immune rejection, physiological compatibility, and biosafety. Among these, humoral rejection is a major barrier affecting the long-term survival of xenografts, and human recipients may have pre-existing antibodies against triple gene knockout (TKO) donor pigs. Nevertheless, early antibody-mediated humoral rejection can still be prevented. Additionally, cellular rejection and inflammatory responses are closely related to the long-term survival of grafts, and the introduction of humanized molecules in donor pigs, combined with the use of anti-inflammatory drugs by recipients, can help improve the survival of xenografts. Moreover, physiological challenges are mainly reflected in the incompatibility of the coagulation cascade and the structural and functional differences between pig proteins and human proteins. In terms of biosafety, breeding donor pigs free of designed pathogens and developing highly sensitive detection methods for pig-derived microorganisms are key to reduce transplant rejection and interspecies infections. At present, further research is needed in gene editing strategies, immunosuppressive regimens, and infection monitoring methods to improve the long-term survival of grafts and recipients.