Gastrointestinal neoplasms is the most common digestive tract neoplasms, and its incidence rate is increasing year by year. Compared with other solid tumors, the application of immune checkpoint inhibitors in gastrointestinal neoplasms is still in the stage of continuous exploration. This paper intends to review the relevant research and latest progress of immune checkpoint inhibitors in advanced gastric cancer, mismatch repair function defect/microsatellite high instability and mismatch repair function integrity/microsatellite stability or microsatellite low instability, and further evaluate the effectiveness and safety of immunotherapy combined with relevant studies.

Objective:To explore the value and advantages of perioperative nutritional support in enhanced recovery after surgery (ERAS).Methods:The clinical data of patients admitted to Jinjiang City Hospital for acute abdomen and undergoing surgery from April 2018 to January 2021 were collected. They were divided into two groups: the enhanced recovery after surgery group (ERAS group, 78 cases) and the traditional perioperative management group (CPM group, 75 cases). The nutritional risk assessment of NRS2002 was performed on admission to the two groups. The postoperative inflammatory indexes, nutrition and rehabilitation related indexes were compared between the two groups.Results:There was no significant difference in preoperative NRS 2002 score, operation method, operation time and blood loss between ERAS group and CPM group ( P>0.05). There was no significant difference in C-reactive protein (CRP), albumin (Alb) and prealbumin (PA) between ERAS group and CPM group before operation ( P>0.05). The ALb and PA of the two groups on the first day after operation were significantly lower than those before operation, and the CRP levels on the first, third, fifth and seventh day after operation were higher than those before operation( P<0.05), with significant difference. The CRP level of ERAS group was lower than that of CPM group on the third day after operation, with significant difference ( P<0.05). On the 7th day after operation, the levels of Alb and PA in ERAS group were higher than those in CPM group ( P<0.05). The recovery time of gastrointestinal function and hospitalization days in ERAS group were significantly reduced, and the total cost of hospitalization was significantly less than that in CPM group ( P<0.05). Conclusions:Perioperative effective nutritional support is helpful to accelerate the recovery of patients with acute abdomen. The application of enhanced recovery after surgery can effectively improve the nutritional status of patients with acute abdomen, reduce the incidence of complications and improve the clinical outcome of patients.

Objective:To explore the relationship between the level of C-reactive protein/serum albumin ratio (CAR) and early postoperative anastomotic leakage in patients with colorectal cancer.Methods:From September 2016 to September 2019, all colorectal cancer patients who were treated in gastrointestinal surgery of Jinjiang hospital in Fujian Province were collected for retrospective analysis. The baseline data of the patients were collected. The blood C-reactive protein (CRP), procalcitonin (PCT) and serum albumin (ALB) were monitored on the first, third, fifth and seventh days after operation, and the results were statistically analyzed.Results:There was no significant difference in baseline data such as age, body mass index (BMI), operation time and intraoperative hemorrhage between the anastomotic leakage group and the non anastomotic leakage group ( P>0.05), but the hospitalization time of the anastomotic leakage group was longer than that of the non anastomotic leakage group ( P<0.05). The CRP level on the 3rd and PCT level on the 5th day after operation in the anastomotic leakage group were higher than those in the non anastomotic leakage group, with significant difference ( P<0.05). The CAR value on the 3rd and 5th day after operation in the anastomotic leakage group was higher than those in the non anastomotic leakage group with significant difference ( P<0.05). Conclusions:CAR can predict early anastomotic leakage in patients with colorectal cancer.

Objective:To compare the clinical efficacy and quality of life of patients between Billroth Ⅱ+ Braun anastomosis and simple Billroth Ⅱ anastomosis in digestive tract reconstruction after laparoscopic distal gastric cancer radical resection.Methods:A retrospective analysis was performed on clinical data of 68 patients who underwent laparoscopic distal gastric cancer radical resection in Jinjiang Municipal Hospital from January 2019 to January 2022. Forty patients who underwent Billroth Ⅱ+ Braun anastomosis were included in the observation group, and 28 patients who underwent simple Billroth Ⅱ anastomosis were included in the control group. Perioperative indicators and postoperative indicators one year after surgery were collected to observe the safety and efficacy of patients after surgery.Results:There were no significant differences in operation time, intraoperative bleeding volume, postoperative exhaust time, time to remove gastric tube and drainage tube, and postoperative hospital stay between the two groups (all P>0.05). There were also no significant differences in postoperative complications between the two groups ( P>0.05). One year after surgery, the incidence of food retention and residual gastritis in the observation group were lower than those in the control group (all P<0.05), while there were no significant differences in the incidence of bile reflux and reflux esophagitis between the two groups (all P>0.05). One year after surgery, nutritional evaluation showed that the total protein decline and prognostic nutritional index (PNI) in the observation group were lower than those in the control group, with significant differences (all P<0.05). The incidence of bloating and reflux symptoms in the observation group one year after surgery was lower than that in the control group, with significant differences (all P<0.05). Conclusions:Billroth Ⅱ+ Braun anastomosis is a safe method for digestive tract reconstruction after laparoscopic distal gastric cancer resection, which can improve patients′ quality of life after surgery.

Objective:To explore the application effect of preoperative autologous blood localization method in laparoscopic resection of gastric stromal tumors in unfavorable areas of the stomach.Methods:A retrospective analysis was conducted on the case data of 40 patients with gastric stromal tumors in unfavorable locations admitted to Jinjiang Hospital from January 2019 to December 2022. The patients were divided into a control group (intraoperative endoscopic localization method) and an autologous blood localization group according to different intraoperative lesion localization methods, with 20 cases in each group. The surgical time, intraoperative blood loss, hospitalization time, postoperative exhaust time, and adverse reactions were compared between the two groups.Results:The surgery time of the autologous blood localization group was shorter than that of the control group [(92.30±8.80)min vs (108.20±14.87)min, P<0.05]. There was no statistically significant difference in intraoperative bleeding, hospitalization time, and postoperative exhaust time between the two groups (all P>0.05). Two groups of patients did not show an increase in inflammatory indicators such as white blood cells and C-reactive protein on the day after surgery. Both groups of patients did not experience adverse reactions such as fever, abdominal pain, or postoperative complications. Conclusions:The autologous blood injection localization method provides a safe, simple, and effective method for preoperative localization of gastric stromal tumors in unfavorable areas of the stomach under laparoscopy, and is worthy of clinical promotion and use.

Objective    To investigate the predictive value of volatile organic compounds (VOCs) on pulmonary nodules in people aged less than 50 years. Methods    The 147 patients with pulmonary nodules and aged less than 50 years who were treated in the Department of Thoracic Surgery of Sichuan Cancer Hospital from August 1, 2019 to January 15, 2020 were divided into a lung cancer group and a lung benign disease group. The lung cancer group included 36 males and 68 females, with the age of 27-49 (43.54±5.73) years. The benign lung disease group included 23 males and 20 females, with the age of 22-49 (42.49±6.83) years. Clinical data and exhaled breath samples were collected prospectively from the two groups. Exhaled breath VOCs were analyzed by gas chromatography mass spectrometry. Binary logistic regression analysis was used to select variables and establish a prediction model. The sensitivity, specificity, and area under the receiver operating characteristic (ROC) curve of the prediction model were calculated. Results    There were statistically significant differences in sex (P=0.034), smoking history (P=0.047), cyclopentane (P=0.002), 3-methyl pentane (P=0.043) and ethylbenzene (P=0.009) between the two groups. The sensitivity, specificity and area under the ROC curve of the prediction model with gender, cyclopentane, 3-methyl pentane, ethylbenzene and N,N-dimethylformamide as variables were 80.8%, 60.5% and 0.781, respectively. Conclusion    The combination of VOCs and clinical characteristics has a certain predictive value for the benign and malignant pulmonary nodules in people aged less than 50 years.