Objective To investigate the efficacy of laparoscopic cholecystectomy(LC) followed by endoscopic retrograde cholangiopancreaticography(ERCP) for gallbladder and bile duct stones.Methods A total of 58 patients with both gallbladder and bile duct stones received endoscopic sphincterotomy(EST) in our hospital.After the stones were removed,LC was performed on the patients.Results Of the 58 patients,56 were successfully treated with EST and LC.Two cases were unsuccessful owing to difficulty in intubation during ERCP in one and failure to remove all the stones from the bile duct in the other.These two patients were then cured by LC combined with electronic choledochoscopy.Perioperative complications included bleeding during EST in 1,acute edematous pancreatitis in 2,and mild infection of the puncture site in 1.The overall complication rate was 7.1%(4/56).Retained common bile duct stone was observed in 1 patient,and was successfully removed by subsequent ERCP.Conclusions LC combined with ERCP is a safe and effective minimal invasive method for the treatment of concurrent gallstones and bile duct stones.

Objective To investigate the occurrence and risk factors of surgical site infection(SSI)in patients with colon or rectal cancer.Methods Patients who were diagnosed with colon or rectal cancer and underwent emergency or elective surgery in a hospital between January 1,2008 and December 31,2013 were monitored prospectively.General data,operation condition,and antimicrobial use of patients were analyzed,occurrence of SSI was observed every day and followed up after operation,risk factors of SSI were analyzed by univariate and multivariate analysis.Results A total of 694 patients with colon cancer(n=380)or rectal cancer(n=314)were monitored,SSI occurred in 125 patients,including 15 incisional infection and 110 organ/space infection,incidence of SSI was 18.01%;incidence of SSI in colon cancer patients and rectal cancer patients were 17.11%(65/380)and 19.11%(60/314)respectively.Univariate analysis showed that among colon cancer patients,incidence of SSI was higher in those with co-infection of other sites during perioperative period,underlying diseases,phase Ⅰcancer,and relaxation suture(all P<0.05);among rectal cancer patients,incidence of SSI was higher in those with co-infection of other sites during perioperative period,underlying diseases,obstruction,operation time>2 hours,stoma,drainage,relaxation suture,rinsing during operation,and use of antimicrobial agents>72 hours(all P<0.05);logistic regression analysis showed that the independent risk factors for SSI in colon cancer patients were underlying disease,co-infection of other sites during perioperative period,and relaxation suture(all P<0.05);independent risk factors for SSI in rectal cancer patients were underlying disease,co-infection of other sites during perioperative period,and stoma(all P<0.05).Conclusion Prevention and control measures should be taken according to risk factors of SSI in patients undergoing colon cancer and rectal cancer surgery,especially those who with chronic underlying diseases and other site infection during perioperative period;in addition,patients with colon or rectal cancer should also pay attention to relaxation suture and stoma respectively.

Objective To evaluate the capability of 18 F-FLT uptake and investigate the early radiation response of human colorectal cancer cells HCT116 exposed to 6 MV X-rays.Methods 3.7 kBq 18F-FLT was added to HCT116 cells with different cell numbers (1.0 × 105-1.5 × 106) and cultured with different times (36,60,84 h).The 18F-FLT uptake rate was measured with a γ-counter after exposed to different does of 6 MV X-rays (0,2,4,6,8 Gy) after 24,48,and 72 h of irradiation.Then the cell uptake inhibition rate,cell proliferation,and cell cycle phase were measured.Results The uptake rate of 18F-FLT in HCT116 was (18.97 ± 1.16)％.The 18F-FLT uptake inhibition rates at 24 h after different does of irradiation (2,4,6,8 Gy) were (32.10±0.02)％,(54.46 ±0.04)％,(62.74 ±0.04)％,and (65.81 ±4.81)％,respectively,which was positively correlated with radiation dose.Conclusions The 18F-FLT uptake rate of human colorectal cancer HCT116 cells could be used to evaluate the early radiation response.

Objective To explore the application of biofragmentable anastomosis ring (BAR) in the intestinal reconstruction.Methods Clinical materials and postoperative recovery were compared between patients with radical resection of sigmoid colon cancer by BAR and conventional staplers.Results Totally 61 cases were treated by BAR for intestinal reconstruction,and there were 2 cases of intestinal obstruction,3 cases of anastomotic leakage,and 1 case of incision infection after surgery.Totally 77 cases underwent radical resection of sigmoid colon cancer,including 32 cases in the BAR group and 45 cases in conventional stapler anastomosis group.There were significant differences in postoperative anastomotic bleeding and the anal discomfort (P ＜ 0.05).Conclusion Compared to conventional staplers,BAR can reduce postoperative anastomotic bleeding,anal discomfort and medical costs.

Objective To explore the application of biofragmentable anastomosis ring (BAR) in the intestinal reconstruction.Methods Clinical materials and postoperative recovery were compared between patients with radical resection of sigmoid colon cancer by BAR and conventional staplers.Results Totally 61 cases were treated by BAR for intestinal reconstruction,and there were 2 cases of intestinal obstruction,3 cases of anastomotic leakage,and 1 case of incision infection after surgery.Totally 77 cases underwent radical resection of sigmoid colon cancer,including 32 cases in the BAR group and 45 cases in conventional stapler anastomosis group.There were significant differences in postoperative anastomotic bleeding and the anal discomfort (P ＜ 0.05).Conclusion Compared to conventional staplers,BAR can reduce postoperative anastomotic bleeding,anal discomfort and medical costs.

The current treatment strategy for rectal cancer is a comprehensive treatment centered on surgery. The application of total mesorectal excision (TME) has significantly reduced the local recurrence rate and improved the survival prognosis, but a series of pelvic organ dysfunction caused by pelvic autonomic nerve injury during the operation will reduce the postoperative quality of life of patients. Pelvic autonomic nerve preserving (PANP) radical proctectomy has emerged, but the biggest challenge in the implementation process of this technology is the accurate identification of nerves. A series of studies have shown that pelvic intraoperative autonomic monitoring (pIONM) can effectively assist surgeons to identify nerves, The purpose of this article is to introduce the function of pelvic autonomic nerve, the clinical manifestation of postoperative pelvic dysfunction and its relationship with nerve injury, the key points of implementing PANP, and the current situation and research progress of pIONM technology application.

Objective:This study aimed to share preliminary experiences of single-incision plus two ports laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF).Methods:Following the 6th edition of the Japanese Gastric Cancer Treatment Guidelines, proximal gastrectomy with lymphadenectomy was performed. Using a single-port approach, the esophagus was transected at least 2 cm above the tumor's upper margin with linear staplers. The stomach was then extracted through a periumbilical incision, and the proximal stomach was subsequently transected extracorporeally, while ensuring appropriate resection margins on both the greater and lesser curvatures. A single flap was created before returning the remnant stomach to the abdominal cavity and re-establishing pneumoperitoneum. The No.2 clip was used to grasp and elevate the esophageal stump. An incision was made at the right lower edge of the esophageal stump to guarantee that the esophageal lumen was open. The linear stapler was then inserted into the openings of the stomach and esophagus to perform a side overlap anastomosis with a length of 3 cm. Another barbed suture was used to close the common opening of the esophagus and the stomach, and the same barbed suture were used to suture the gastric wall to the lower edge of the muscle flap. The first barbed suture was then used to sequentially suture the proximal brim of the flap to the esophagus and the right brim of the flap to the right brim of the mucosal window. After completion of anastomosis, a drainage tube was inserted through the right upper port. This procedure was employed from November 2023 to March 2024 on five patients diagnosed with adenocarcinoma of the esophagogastric junction and upper stomach. The cohort consisted of three males and two females, with an age range of 62 to 75 years and a body mass index (BMI) of 13.7 to 24.2 kg/m2. All cases were preoperatively staged as T1-2N0M0, confirmed by endoscopic biopsy and enhanced CT scans of the chest, abdomen, and pelvis.Results:All five patients successfully underwent the surgery. The median surgery time was 180-325 minutes, with the intraoperative blood loss of 30-50 ml. The number of lymph nodes harvested ranged from 18 to 27. The time to first flatus, and restore liquid diet and was 2.0-5.0 and 1.0-3.0 days, respectively. The postoperative length of stay was 9.0-11.0 days. The pain scores on the Numeric Rating Scale (NRS). On the first day, the pain scores were 3.0 in two cases, 2.0 in two cases, and 1.0 in one case. On the second day, the pain scores were 2.0 in two cases and 1.0 in three cases. On the third day, the pain scores were 1.0 in four cases and 2.0 in one case. No short-term postoperative complications were observed, and there were no perioperative deaths.Conclusion:Single-incision plus two ports laparoscopic proximal gastrectomy with ROSF is safe and feasible.

The current treatment strategy for rectal cancer is a comprehensive treatment centered on surgery. The application of total mesorectal excision (TME) has significantly reduced the local recurrence rate and improved the survival prognosis, but a series of pelvic organ dysfunction caused by pelvic autonomic nerve injury during the operation will reduce the postoperative quality of life of patients. Pelvic autonomic nerve preserving (PANP) radical proctectomy has emerged, but the biggest challenge in the implementation process of this technology is the accurate identification of nerves. A series of studies have shown that pelvic intraoperative autonomic monitoring (pIONM) can effectively assist surgeons to identify nerves, The purpose of this article is to introduce the function of pelvic autonomic nerve, the clinical manifestation of postoperative pelvic dysfunction and its relationship with nerve injury, the key points of implementing PANP, and the current situation and research progress of pIONM technology application.

Objective:This study aimed to share preliminary experiences of single-incision plus two ports laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF).Methods:Following the 6th edition of the Japanese Gastric Cancer Treatment Guidelines, proximal gastrectomy with lymphadenectomy was performed. Using a single-port approach, the esophagus was transected at least 2 cm above the tumor's upper margin with linear staplers. The stomach was then extracted through a periumbilical incision, and the proximal stomach was subsequently transected extracorporeally, while ensuring appropriate resection margins on both the greater and lesser curvatures. A single flap was created before returning the remnant stomach to the abdominal cavity and re-establishing pneumoperitoneum. The No.2 clip was used to grasp and elevate the esophageal stump. An incision was made at the right lower edge of the esophageal stump to guarantee that the esophageal lumen was open. The linear stapler was then inserted into the openings of the stomach and esophagus to perform a side overlap anastomosis with a length of 3 cm. Another barbed suture was used to close the common opening of the esophagus and the stomach, and the same barbed suture were used to suture the gastric wall to the lower edge of the muscle flap. The first barbed suture was then used to sequentially suture the proximal brim of the flap to the esophagus and the right brim of the flap to the right brim of the mucosal window. After completion of anastomosis, a drainage tube was inserted through the right upper port. This procedure was employed from November 2023 to March 2024 on five patients diagnosed with adenocarcinoma of the esophagogastric junction and upper stomach. The cohort consisted of three males and two females, with an age range of 62 to 75 years and a body mass index (BMI) of 13.7 to 24.2 kg/m2. All cases were preoperatively staged as T1-2N0M0, confirmed by endoscopic biopsy and enhanced CT scans of the chest, abdomen, and pelvis.Results:All five patients successfully underwent the surgery. The median surgery time was 180-325 minutes, with the intraoperative blood loss of 30-50 ml. The number of lymph nodes harvested ranged from 18 to 27. The time to first flatus, and restore liquid diet and was 2.0-5.0 and 1.0-3.0 days, respectively. The postoperative length of stay was 9.0-11.0 days. The pain scores on the Numeric Rating Scale (NRS). On the first day, the pain scores were 3.0 in two cases, 2.0 in two cases, and 1.0 in one case. On the second day, the pain scores were 2.0 in two cases and 1.0 in three cases. On the third day, the pain scores were 1.0 in four cases and 2.0 in one case. No short-term postoperative complications were observed, and there were no perioperative deaths.Conclusion:Single-incision plus two ports laparoscopic proximal gastrectomy with ROSF is safe and feasible.

Objective:To retrospectively analyze prognostic factors and patterns of recurrence in locally advanced gastric cancer patients receiving chemoradiotherapy (CRT) after radical gastrectomy, aiming to provide reference for postoperative CRT of locally advanced gastric cancer.Methods:Clinical data of 171 patients with curatively resected gastric carcinoma who received postoperative CRT in our hospital between 2008 and 2020 were retrospectively analyzed. The disease-free survival and overall survival (OS) rates were calculated by Kaplan- Meier method. Univariate prognostic analysis was performed by log- rank test. Multivariate prognostic analysis was conducted by Cox model. Results:The median follow-up duration was 63 months. The follow-up rate was 93.6%. 31.0% and 66.7% of the enrolled patients were classified in pathological stage Ⅱ and Ⅲ. The acute grade 3 or 4 gastrointestinal and hematological toxicity rates were 8.8% and 9.9%, respectively. In total, 166 patients completed the entire CRT regimen. No toxicity-related death occurred. Regarding patterns of recurrence, 17 patients had locoregional recurrence, 29 had distant metastasis and 12 had peritoneal metastasis. The 1-, 3-and 5-year overall survival (OS) rates were 83.7%, 66.3%, and 60.0%, while the 1-, 3-and 5-year disease-free survival rates were 75.5%, 62.7%, and 56.5%, respectively. In the multivariate analysis, pathological T stage, perineural invasion and lymph node ratio (LNR) were found to be the independent predictors of OS.Conclusions:Postoperative intensity-modulated radiation therapy and chemotherapy are well tolerated, with acceptable toxicities and encouraging locoregional tumor control and long-term survival. LNR can be used as an independent prognostic indicator for OS. Adjuvant CRT should be considered for all patients with a high risk of locoregional recurrence.