Gastric cancer is ranked the third cause of cancer deaths in China, and gastric cancer patients from China accounts for 42％ of new gastric cancer cases worldwide.Yet,more than 80％ of diagnosed gastric cancer patients were in the advanced stage partially because of a lack of national screening strategy in China.Laparoscopic gastrectomy of gastric cancer has been becoming popular in the past decades, as with Japan and Korea.Since the safety and efficacy of laparoscopic gastrectomy have not been evaluated by evidence-based medicine, laparoscopic gastrectomy in the treatment of gastric cancer in the advanced stage remains controversial, and scientific and regorous randomized controlled trial is known as the best way providing conclusive evidence.In this context, China has more responsibility for contribution to gastric cancer research.To fill this gap, the Chinese Laparoscopic Gastrointestinal Surgery Study (CLASS) group was established to offer more high-quality Chinese data in the evidense-based medicine with the great help of international academic societies like Korean Gastric Cancer Association, Japanese Gastric Cancer Association, Laparoscopic and Endoscopy Group of Surgery Branch of Chinese Medical Association and Gastric Cancer Association of Chinese Anti-Cancer Association.In this review, the current status of clinical research for laparoscopic surgery of gastric cancer in China was summarized.

Lapareseopic colectomy is commonly performed,but laparoscopic extended right hemicolectomy with D3 lymphadenectomy for cancer located at hepatic flexure of the colon is a complex procedure,even in the hands of experts.Laparoscopic dissection of the lymph nodes around the middle colonic and right gastroepiploic vessels are so complicated that precise vascular anatomy and surgical plane are essential to complete this procedure safely.We herein describe a standard technique for performing laparoscopic extended right hemicolectomy with D3 lymphadenectomy using a medial-to-lateral approach.The main surgical plane of this procedure is the right Toldt's space.The superior mesenteric vein (SMV) is the most important anatomical landmark of vascular dissection.Medial-to-lateral approach makes it easy to locate the right Toldt's space and the SMV.

Different from Japan and Korea,the gastric cancer cases in China are mostly advanced gastric cancer cases.Surgical radical gastrectomy,as the primary method in treating gastric cancer patients has achieved enormous development in recent years,especially laparoscopic radical gastrectomy.Whereas,laparoscopic radical gastrectomy in treatment of advanced gastric cancer remains controversial.The heated debates are mainly focusing on the indications,choosing of surgical approaches and reconstruction methods,completion of laparoscopic D2 lymphadenectomy,short-term postoperative outcomes and long-term oncologiceffectiveness.In this article,current status of laparoscopic radical gastrectomy in treatment of advanced gastric cancer and results of relevant clinical trials were reviewed.

Colorectal cancer is one of the most commonly seen malignant neoplasms in digestive tract.Most patients with colorectal cancer died of metastasis.The details of the metastasis-associated mechanisms are not elucidated completely.Recently,many genes that are involved in this course were detected.In this paper,the latest advances in those metastasis-associated genes and coding genes including C-myc,Ras,Her-2 ,p53,deleted in colorectal cancer gene (DDC),phosphatase and tensin homologue (PTEN),nm23 and other code genes,such as CD44,matrix metalloproteinases (MMPs) and mucins will be reviewed.

Currently adopted surgical approaches of laparoscopic combined organ resection for gastrointestinal cancer include laparoscopic pancreaticoduodenectomy and gastrectomy, laparoscopic gastrectomy combined distal pancreatectomy and splenectomy, laparoscopic gastrectomy and cholecystectomy, laparoscopic rectal anterior resection and total hysterectomy with bilateral salpingo-oophorectomy, and laparescopic colorectal and hepatic metastases resection. Satisfactory clinical outcomes of these procedures for gastrointestinal cancer were obtained in the reported cases. However, the number of cases in current studies on laparoscopic combined organ resection for gastrointestinal cancer was too small and no control groups involved, and multicenter clinical trials were not yet conducted. In conclusion, the future of laparoscopic combined organ resection for gastrointestinal cancer is promising, while its feasibility and safety require further investigation.

Owing to the continuous improvement of surgical techniques and multiple adjunctive therapy,postoperative convalescence of patients has reached great achievements.There are,nevertheless,many problems left for us to discuss.Fast-track surgery employs a variety of methods,such as neodoxy of oral bowel preparation,intraoperative anaesthesia and fluid management,maintenance of body temperature,early ambulation,pain relief etc,to reduce the morbidity of operative stress,complications,and suffering of patients,as well as accelerating the postoperative convalescence so as to shorten the time patient spend in hospital.Fast-track surgery develops a"patient-centered"attitude,and establishes an ultimate goal as giving full benefit to patients when they are in hospital.

The ecological balance of gastrointestinal microbiota plays an important role in digestion,absorption, metabolism,immunity and protection against pathogens. Functional disturbance of gastrointestinal microecology is closely related to gastrointestinal diseases. Recent studies have shown that gastrointestinal microecology was involved in the pathogenesis process of gastric cancer. This article reviewed the progress in study on relationship between gastrointestinal microecology and gastric cancer.

Since the theory of microcosmic syndrome differentiation was put forward in 1986, Chinese medicine academia has been unremittingly exploring this theory. Efforts were made to explain the syndrome in Chi-nese medicine with objective index of modern medicine, so that different syndromes of the same disease can be rec-ognized on the quantitative view and then apply syndrome differentiation with objective index. This paper compre-hensively analyzed and got the primary causes why microcosmic syndrome differentiation was difficult to apply. It in-cluded no-identical criterion, research design such as the choice of syndrome, reference syndrome, objective index and microcosmic level. Additionally, too many virtual syndromes resulting from applying syndrome differentiation on western medicine diseases existed widely. Consequently, it is extremely urgent that solve these problems and regulate the research thought.

Sentinel lymph node (SLN), the hypothetical first regional lymph node or group of lymph nodes to received lymphatic drainage from a primary tumor, can predict the likelihood of further nodal involvement. SLN mapping was initially applied to the treatment of breast cancer and melanoma, and it also shows gratifying effect on thyroid cancer, pancreatic cancer and gastrointestinal tumors. The development of SLN mapping in colorectal cancer has brought us a new approach to design personalized operation and adjuvant therapy plans. However,various SLN mapping techniques in colorectal cancer available present fluctuant navigation performances, which need to be replaced by an economical, convenient and accurate tracing technique. Hopefully the optimized SLN mapping can play a more important role in the management of increasing occurred early colorectal cancer.

Objective To observe the effect of extracorporeal shock wave lithotripsy on non target areas for various renal calculi. Methods Six thousand,one hundred and forty-nine cases of renal calculi patients were divided into 3 groups based on the calculi positions ,including the superior renal calices group ,the middle renal calices group and the inferior renal calices group. We compared the renal CT perfusion parameters in the non target areas of renal stones,successful rates of removing stones and complications. Results Extracorporeal shock wave lithotripsy had renal injures on both target areas and non target areas. When the extracorporeal energy is greater than 11 kV,the kidney damages became severe rapidly. When the E < 9,lithotripsy successful rate was signifi-cantly higher than that of E≥9;when E≥11 ,the energy wave lithotripsy complication rates were less than that of E<11 energy wave lithotripsy. Conclusions When the shock wave energy is in the range of 9~11 kV,there is not only low injuries on non target areas ,but also low successful rates of removing stones and complication rates. So the shock wave energy in a range of 9~11 kV is the best choice of energy regimen in treatment of patients with renal stones.