0.05]. During the (6.5?2.4) month (range 1 to 10 months) follow-up, the angina incidence rate of the Firebird group was lower than the BMS group (21.0%, 35 5%, P

Indocyanine green (ICG) fluorescence imaging has been widely used in surgery. In colorectal surgery specifically, more and more studies have shown that intraoperative fluorescence imaging is a safe and feasible method to assess anastomotic perfusion, and its use may decrease the incidence of anastomotic leakage. Meanwhile, indocyanine green can also be used to mark the location of lesion, identify sentinel lymph nodes, protect the ureter, and so on. It can also provide detection and guidance in the operation of peritoneal metastasis and liver metastasis of colorectal cancer. The application of indocyanine green fluorescence imaging can offer great value for surgery through improving the accuracy and outcomes of oncological resections. According to existing studies, we are still at an early application stage of indocyanine green fluorescence imaging technology in colorectal surgery. Lacking prospective randomized controlled studies, neither standards nor guidelines for injection dosage, site and observation period are satisfactory. Therefore, deep researches and establishment of standardized operational procedure are required to enhance the safety and accuracy of tumor resection and improve outcomes.

Objective:To explore the clinical characteristics, diagnosis and treatment of Petersen hernia after gastrectomy.Methods:The clinical data of 6 patients with Petersen hernia developed after gastrectomy in Shizuoka Cancer Center from Jan 2014 to Dec 2019 were retrospectively analyzed.Results:All 6 patients were males, with a median age of 76 years. The operative procedures for preceding gastrectomies were robotic-assisted total gastrectomy in 2 patients, laparoscopic distal gastrectomy in 2 patients, and laparoscopic proximal gastrectomy in 2 patients. Petersen′s defect was closed in all patients at previous gastrectomy. The time of onset was 1 month to 55 months after surgery. The main manifestations are acute pain in upper abdomen with nausea and vomiting. In all the cases, abdominal CT showed obstruction caused dilatation of the small intestine. The whirl sign was present in 3 patients. All the patients underwent reoperation with reduction and repair of the hernia. All the patients did not show obvious bowel necrosis. Their postoperative courses were uneventful, and all the patients were discharged. During the follow-up period, none of the patients developed complications related to the Petersen hernia.Conclusions:Petersen hernia is a rare complication of gastrectomy. It is important to conduct abdominal CT scanning as early as possible from the clinical history and physical findings, and to determine the surgical indication.

Objective Energy based surgical devices such as high frequency electrotome,Harmonic scalpel and LigaSure are widely used in thyroid operations.This study is to demonstrate the difference of tissue thermal damage among different surgical instruments.Methods 12 beagle dogs were randomly divided into 3 groups,electrotome 15 W groups (group A),three-speed Harmonic scalpel (group B) and LigaSure middle gear group (group C).Patients of each group received energy instruments operating on their thyroid tissue which mimics traditional thyroidectomy.The temperatures of gland tissue during procedures were monitored by infrared thermal imager,and the operated thyroid tissues were histologically analyzed.Results The highest temperature was (83.9±8.2)℃ in the electrotome group,(70.7±7.5)℃ in three-speed Harmonic scalpel group,and (56.6±5.7)℃ in LigaSure group.The highest temperature among the three groups was statistically significant.The electrotome (15 W) caused more serious thermal damage to thyroid tissues than that caused by either the Harmonic scalpel or LigaSure (thermal damaged depth:(0.96±0.07) mm vs (0.74±0.07) mm,P＜0.01;(0.96±0.07) mm vs (0.72± 0.11) mm,P＜0.01).Nevertheless,the thermal damage had no significant differences between the Harmonic scalpel and LigaSure group (P=0.845).The thermal damage caused by the 15 W electrotome was significantly larger than that in the other two groups,and the difference had statistical significance (P＜0.01).Conclusion Compared to the high frequency electrotome,Harmonic scalpel and LigaSure lead less tissue thermal damage during thyroid surgeries,owing to less heat production.In that way,Harmonic scalpel and LigaSure are superior to electrotome in terms of safety.

Papillary thyroid microcarcinoma(PTMC),which lacks lymph node metastasis,distant metastasis,extra-thyroid invasion,high-risk subtypes,and invasion of the trachea or recurrent laryngeal nerve,may be classified as low-risk PTMC based on clinical assessment.Surgical intervention such as lobectomy or total thyroidectomy is the primary treatment modality for PTMC.This study comprised 124 patients who underwent conformal thyroidectomy and revealed that this innovative surgical approach yielded long-term oncological outcomes comparable to those who received lobectomy or total thyroidectomy.The surgical intervention may play a significant role in the comprehensive management of PTMC,while the implementation of PTMC precision medicine necessitates the utilization of genetic testing,molecular typing,and other advanced technologies to detect early-stage high-risk factors like lymph node microinvasion and integrate biology-based surgery concept for optimal outcomes.

OBJECTIVETo compare the safety and efficacy between extralevator abdominoperineal excision(ELAPE) and traditional abdominoperineal excision(APE) in patients with low rectal cancer.

METHODSFrom January 2011 to December 2013, 61 patients undergoing abdominoperineal excision for low rectal cancer at the Department of Gastrointestinal Surgery, Peking University People's Hospital were enrolled. The safety and efficacy of two procedure groups, ELAPE group (33 patients) and traditional APE group (28 patients) were reviewed retrospectively.

RESULTSLess intraoperative blood loss [(201 ± 147) ml vs. (343 ± 308) ml, P=0.022], shorter exhaust time [(3.8 ± 1.5) d vs. (4.6 ± 1.6) d, P=0.039] and lower perineal wound complication rate (9.1% vs. 25.0%, P=0.042) were observed in the ELAPE group as compared to the traditional APE group. However, longer operation time [(292 ± 46) min vs. (256 ± 28) min, P=0.008] and perineal drainage removal time [(11.1 ± 4.8) d vs. (7.1 ± 2.7) d, P<0.01] were noted in the ELAPE group than those in the traditional APE group. Number of lymph node retrieved and positive lymph node retrieved was not significantly different between two groups. The ELAPE group had lower rate of IOP (intraoperative perforation) (6.1% vs. 17.9%, P=0.055), but no significant difference was found. There were no significant differences in bowel movement, diet restoring time, average perineal drainage, postoperative hospitalization time and removing perineal stitches time between the two groups (all P>0.05).

CONCLUSIONELAPE possesses less intraoperative blood loss and lower perineal wound complication rate than traditional APE. ELAPE is associated with better safety and efficacy than traditional APE.

Objective To summarize and analyze the clinical characteristics,pathological features and follow-up data of patients with pulmonary lymphaugitic carcinomatosis(PLC) caused by gastric cancer.Methods A retrospective analysis was performed on 7 cases of gastric cancer with pulmonary carcinomatosis in Peking University People's Hospital between Jan 2000 and Dec 2017.Results 7 patients were identified from our database.All patients were female,with an average age of (54 ± 18) years.4 patients were treated with respiratory symptoms and 3 patients presented with gastrointestinal symptoms.One patient received gastrectomy,one did chemotherapy,5 patients had other site metastasis,one was still alive at the end of follow up.Patients average survival time was (4.8 ± 4.0) months.Conclusions Pulmonary lymphatic carcinomatosis caused by gastric cancer is rare clinical entity and the prognosis is poor.Patients often present with respiratory symptoms.Chest CT showed diffusely nodular thickening of interlobular septa and peribronchovascular interstitium.Biopsy of the gastric tumor often establish the diagnosis.

With certain advantages of superior surgical fields and better chances for anus reservation, transanal total mesorectal excision (TaTME) is a novel surgical approach for low rectal cancer. Guidelines recommend multidisciplinary team (MDT) work as a clinical routine for standardized treatment of rectal cancer. Indication of TaTME depends on multidisciplinary discussion including preoperative staging, prediction of recurrence risks. Standardized preoperative evaluation by MDT and decisions after MDT discussion are the guarantee for the stan-dardized implementation and reasonable promotion of TaTME. Meanwhile, as a procedure for improving local efficacy of rectal cancer, TaTME could save a part of patients with low rectal cancer the trouble of neoadjuvant chemoradiotherapy based on accurate staging by radiologists. That might upgrade status of colorectal surgeons in the MDT and contribute to optimize both curative effects and health economics.

Objective:To investigate the role of indocyanine green(ICG) fluorescence imaging in laparoscopic anterior resection for rectal cancer.Methods:A retrospective analysis was performed on 7 patients who had undergone laparoscopic anterior resection with the use of ICG fluorescence imaging at Peking University People′s Hospital between Oct 2018 and Mar 2019. The clinicopathological variables, surgical factors, short-term outcome and complications were analyzed.Results:The median operation time was 185 min. The median estimated blood loss was 50 ml. The median time from ICG injection to anastomotic perfusion was 45 s. One patient received extended proximal resection of bowel due to poor perfusion as suggested by ICG imaging. The median time to soft diet was 4 days, and the median hospital stay was 8 days. The median number of lymph nodes harvested was 16. There were no major complications in all these patients. No adverse events related to ICG were recorded.Conclusions:ICG fluorescence imaging was safe and effective in detecting insufficient blood supply around newly established bowel anastomsis, hence potentially reducing the anastomotic leakage rate.

Objective To investigate the influence of mismatch repair status on clinicopathological characteristics and prognosis in patients with colon cancer.Methods Patients who underwent radical excision for colon cancer between Nov 2012 and Mar 2016 at Peking University People's Hospital were enrolled.Clinicopathological data and prognosis were collected.Multivariate analysis were used to identify independent characteristics of MMR-deficient colon cancer.The influence of MMR-deficient on prognosis of colon cancer were analyzed through Kaplan-Meier curve.Results The overall rate of MMR-deficient in colon cancer was 17.1％ (51/299).Multivariate logistic regression analysis showed that low differentiation (OR =3.555,95％ CI:1.685-7.640,P ＜ 0.001),right-sided colon cancer (OR =5.645,95％ CI:2.483-14.715,P ＜ 0.001) and UICC Stage Ⅰ-Ⅱ (OR =4.099,95％ CI:1.863-9.840,P ＜0.001) were associated with MMR-deficient colon cancer.Conclusion Low differentiation,right-sided colon cancer and UICC Stage Ⅰ-Ⅱ were more common in MMR-deficient colon cancer.