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To Chinese young surgeons: Thoughts from a Korean gastric cancer professor surgeon and a German junior surgeon studying in Korea

Berlth FELIX ; Han-KwangYang

Chinese Journal of Practical Surgery.2019;39(01):1-2. doi:10.19538/j.cjps.issn1005-2208.2019.01.01

Gastric cancer is more common in East Asia than other areas, but its epidemic trends and therapeutic mode is distinctive in China. As the standard surgery has been implemented in most medical centers in China, it is the responsivities of Chinese young surgeons to improve the care of gastric cancer and scientific evaluation of different treatment strategies with well-designed clinical trial. Japan and Korea have initiated and accomplished many clinical trials, and these results have been adopted in daily treatment,and broaden their academic influences. Young surgeons from Korea has been nominated as principal investigators for newest clinical trial in Korea and participant enrollment has been finished as scheduled. Young surgeons should broad vision and improve quality, and with the context of clinical trials,collaborate intensively with colleagues from Korea and Japan,and deliver the optimal treatment for patients.

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Basic principles of surgical suture technology and selection of suture materials in general surgery

ZHAOYu-pei ; Tai-ping ZHANG

Chinese Journal of Practical Surgery.2019;39(01):3-5. doi:10.19538/j.cjps.issn1005-2208.2019.01.02

The selection of suturing techniques and suture materials is a common problem in general surgery. In 2008,the Chinse Society of Surgery of Chinese Medical Association draw up the first edition of The Chinese Consensus Statement on General surgical suture technique and suture material. In the last ten years, it has appeared antibacterial sutures, drug elution lines, barbed lines, anti-leakage needles, stabresistant needles, bio-3D staplers in suture materials, which promoted the development of general surgery. At the same time, with the advancement of surgical techniques and the application of laparoscopic and robotic surgery, suture techniques such as triangular anastomosis and nondisconnected Roux-en-Y anastomosis have appeared. This article reviews the progress of new suture materials, introduces the achievements of suturing technique in general surgery, and discusses the significance of the 2018 edition of The Chinese Consensus Statement on General Surgical Suture Technique and Suture Material.

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Perspectives and expectations: gradual improvement and Aptimization of the quality and progress of our current standardized surgical residency

En-hao ZHAO ; BIANZheng-qian ; Hui CAO

Chinese Journal of Practical Surgery.2019;39(01):70-74. doi:10.19538/j.cjps.issn1005-2208.2019.01.12

Standardized surgical residency training is an important part of graduate medical education, a necessary path towards becoming a surgeon with the capability to deal with common clinical surgical problems in an independent, correct and evidence-based manner. It is also the fundamental policy for homogeneous clinician training, medical human resources construction and improvement of health care quality. Since its nationwide implementation at the end of 2013, there have been great achievements while problems and confusions were also exposed. Surgical residency training is now facing new challenges and opportunities. With the rapid development of minimally invasive surgery, young surgeons have been actively promoted to learning laparoscopic technique; however,traditional surgical basic skills as well as the essence of handson apprenticeship shall not be neglected. In the meantime, the Internet, and the series of revolutions and breakthroughs it brings, need to be utilized in residency training and construction of a system for standardized training management,which can be a creative model for future medical education.

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Prospects for gastric cancer treatment based on the revisions of Japanese Gastric Cancer Classification

Guo-li LI

Chinese Journal of Practical Surgery.2019;39(01):75-78. doi:10.19538/j.cjps.issn1005-2208.2019.01.13

Japanese gastric cancer classification marks the lymph nodes associated with gastric cancer metastasis in groups, which allows the surgeons and pathologists to operate as per a uniform specification to obtain the distribution of metastatic lymph nodes in every case. Through a substantial number of cases, the rules and pathways of lymph node metastasis are summarized, thus laying a theoretical foundation for radical gastrectomy. From the simple to the complex, and then to the refined and expansive, the classification categorizes subgroup studies to better rationalize the lymph node dissection; and expands the researches on marker range to investigate the role of enlarged surgery.Researches over decades have explored the law of lymph node metastasis to the extreme, and the surgical efficacy of gastric cancer near limit. Thus, shortly after the mature treatment model was established as the Gastric Cancer Treatment Guidelines by Japanese experts, the revised classification in2010 altered the criterion for staging gastric cancer from the location of metastatic lymph nodes to the number of metastases. This indicates that the exploration of surgical approaches to gastric cancer is basically completed, and the`future efficacy improvement of gastric cancer depends on comprehensive therapy. The formation of radical gastrectomy is the result of multidisciplinary collaborative research.Surgery should still be performed in strict accordance with the specification. Postoperative grouped inspection of lymph nodes has great significance for determining the surgical outcome and prognosis.

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Nutritional therapy in patients with liver dystunction

Chang-Jie CAI

Chinese Journal of Practical Surgery.2019;39(01):79-84. doi:10.19538/j.cjps.issn1005-2208.2019.01.14

The nutritional status of patients with liver dystunction is closely related to the severity of the disease.According to incomplete statistics, the clinical incidence of malnutrition in such patients is about 65%-100%. With the progress and development of modern society, as well as the influence of dietary structure, the characteristics and nutritional status of people suffering from liver dystunction have also undergone great changes. For example, obesity,diabetes and insulin resistance are all controversial and studied fields in the nutritional treatment of liver diseases. In addition, the international nutritional concept of end-stage liver disease complications, such as hepatic encephalopathy,refractory ascites and hepatorenal syndrome, has also changed in recent years. Finally, for the implementation of nutritional therapy for patients with liver dystunction, we advocate "reasonable choice is more important" ! Specific Suggestions and Suggestions are also given for the implementation of individualized nutritional therapy.

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Annual report of Chinese Transanal Total Mesorectal Excision Registry Collaborative in 2018: A nationwide registry study

Hong-wei YAO ; Chien-Chih CHEN ; Hong-yu ZHANG

Chinese Journal of Practical Surgery.2019;39(01):85-91. doi:10.19538/j.cjps.issn1005-2208.2019.01.15

OBJECTIVE: to introduce the study method of Chinese Transanal Total Mesorectal Excision(TaTME) registry Collaborative(CTRC),and report the short-term clinical-oncological outcomes from CTRC. METHODS: Based upon the concept of real world evidence,Data of 601 cases were retrospectively and prospectively analyzed from a nationwide multi-center registry system of CTRC.The safety and effectiveness of these cases were evaluated. RESULTS: The results of the CTRC database showed that:(1) 68.7% of 601 patients were male,the average age of all patients was(59.5±11.4)years,the average BMI was 23.9±3.6. There were 558 cases of rectal cancer among the total enrolled cases. The average distance between the distal edge of rectal cancer and the anal verge was(48.1±14.8)mm,and the ratio of neoadjuvant therapy was 31.7%.(2) 24.6% of the surgical cases were completed under the supervision of TaTME experts. The mean volume of intraoperative blood loss was(115.2 ± 366.5)mL,and the mean operating time was(247.1±87.5)min. Circle stapler was used to make the anastomosis among 74.8% of rectal cancer cases. The protective stoma was performed among 49.6% of the cases of rectal cancer. Maintaining a stable pneumopelvis and excessive smoke obscuring the pelvic view,were the main intraoperative difficulties encountered during transanal procedure. According to the grading of quality and completeness of the mesorectum in the total mesorectal excision specimen,the incidence rates of TaTME specimen graded as "complete", "nearly complete" and "incomplete" were79.6%,16.8% and 0.2% respectively by the evaluation of surgeons.(3)The incidence of postoperative complications was20.2%,and the anastomotic leakage rate was 7.0%.(4) There were 8 cases of specimen perforation. The average number of lymph node harvest was 15.4±7.9. CONCLUSION: TaTME procedure seems be safe and effective regarding to the shortterm clinical-pathological outcomes. The completeness of distal mesorectal dissection,circumferential resection margin and distal resection margin can be promised by the procedure of TaTME. However,the data quality in the database of CTRC needs to be improved,and structured training for TaTME surgery is indispensable. Further national multicenter prospective clinical trials are needed to evaluate the efficacy of TaTME versus TME.

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Application of three-dimensional visualization technique in total mesopancreas excision(TMp E) for pancreatic head carcinoma

Hai-bin LIANG ; Wen-guang WU ; Mao-lan LI

Chinese Journal of Practical Surgery.2019;39(01):92-95. doi:10.19538/j.cjps.issn1005-2208.2019.01.16

OBJECTIVE: To evaluate the application of three-dimensional visualization technique in total mesopancreas excision(TMpE) for pancreatic head carcinoma. METHODS: From January 2013 to June 2017, 105 TMpE for pancreatic head carcinoma were performed in our institution, and clinical data of these cases were analyzed retrospectively. In order to evaluate the feasibility of operation, three-dimensional visualization techniques were applied to observe the site and size of the pancreatic head tumors, and the relationship between the tumors and peripancreatic vessels before the operation. RESULTS: The median operation time was 239 minutes, and the median blood loss was 409 mL. 29 cases with postoperative complications and no perioperative deaths. 74 patients were considered as R0 resection in final threedimensional pathologic examination, and the rate of R0 resection is 70.5%. CONCLUSION: Preoperative application of three-dimensional visualization technique in TMpE can improve preoperative assessment accuracy and increase the rate of R0 resection, in addition to reduce postoperative complications.

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On perihilar surgery

Jia-hong DONG ; Shi-zong YANG ; Xiao-bin FENG

Chinese Journal of Practical Surgery.2019;39(02):110-112. doi:10.19538/j.cjps.issn1005-2208.2019.02.02

The anatomic relationship between bile duct and portal vein/hepatic artery is complicated in perihilar region. As perihilar surgery is technically demanding, both surgical safety and long-term outcome are not satisfactory. Under the guidance of precision surgery, three kinds of technique,including visualization, quantitation and controlization, are focused. Meanwhile, three principles including vessel priority,bleeding control and limit point control are introduced to improve the development of perihilar surgery. In addition,some new types of operation are potentially important and warranted in the near future.

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Application of perihilar surgical techniques in biliary tract surgery

Jian WANG ; Zhi-wei QUAN

Chinese Journal of Practical Surgery.2019;39(02):113-117. doi:10.19538/j.cjps.issn1005-2208.2019.02.03

Perihilar biliary diseases have a wide spectrum of diseases including stones, inflammation, tumors, injuries and congenital malformations. Because of their characteristics such as anatomic variability, pathophysiological complexity, high operative difficulties, more postoperative complications and high operative risk, the perihilar biliary surgery is a high difficulty area in biliary surgery. For common clinical features ,common surgical methods and common technical difficulties of perihilar biliary diseases, the perihilar surgical technique system adequately evaluates hilar anatomy and its variations,liver function and volume of residual liver relying on threedimensional digital medical imaging technology, completely exposes hepatic hilum via combining anterograde and retrograde route from extra and intra-hepatic direction to hepatic hilum, then re-evaluates the relationship between the lesion and the hepatic artery and portal vein, and ultimately sets the surgical procedure . It is developed to improve the R0 resection rate, quality of cholangiojejunostomy, quality of vascular resection and reconstruction and safety of operation,eventually for the purpose of reducing postoperative complication rate and perioperative mortality and improving the prognosis. So surgeons should pay attention to the comprehensive system involving multiple disciplines in order to improve the effectiveness and safety in diagnosis and treatment of perihilar biliary diseases.

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Advance in the perioperative management:Enhanced recovery after surgery,perioperative surgical home and perioperative medicine

Wei-ming ZHU ; Yi-han XU ; Jie-shou LI

Chinese Journal of Practical Surgery.2019;39(02):118-121. doi:10.19538/j.cjps.issn1005-2208.2019.02.04

Surgery plays a pivotal role in the treatment of certain diseases,which in turn promotes the development of enhanced recovery after surgery (ERAS). However,with the renewal of concept and technology,it is gradually realized that the key to a successful treatment is not only surgery itself but also preoperative and postoperative management. Patientbased perioperative management is closely related to the prognosis of the disease. Therefore,“perioperative medicine”and“perioperative surgical home (PSH)”are gaining more and more attention from all over the world. These novel concepts aim to cover the whole disease treatment process and improve the prognosis.

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