Colorectal cancer (CRC) ranks among the most prevalent malignant tumors globally and poses a severe threat to human health. Surgical resection remains the cornerstone of CRC treatment. With the rapid advancement of minimally invasive techniques, the Da Vinci surgical robot has been increasingly adopted in CRC management. This article will systematically review the current application of the Da Vinci robotic system in minimally invasive CRC treatment, analyzes its advantages and limitations, and discusses future prospects, aiming to provide references for clinical practice and further research.

Objective To analyze the epidemic status of breast cancer globally and in China based on gender(female),age,and human development index(HDI)according to the Global cancer statistics 2022 published by the International Agency for Research on Cancer.Methods The epidemiological data of breast cancer from 185 countries and territories were sourced from the GLOBOCAN 2022 database.The HDI data were compiled based on the Human development report 2022 published by the United Nations Development Programme.The epidemiological data were stratified by age,gender,and HDI to describe the prevalence of breast cancer globally and in China.Pearson correlation analysis was used to evaluate the correlation of standardized incidence rate(SIR),standardized mortality rate(SMR)and mortality-to-incidence ratio(M/I)with HDI.Results The data of 175 countries and territories were included.The number of breast cancer incident cases worldwide was 2 297 000 in 2022,ranking the 2nd only to lung cancer,with an SIR of 46.8 per 100 000(ranking the 1st in the world).The number of breast cancer deaths globally was 666 000,ranking the 4th among all cancer deaths,with an SMR of 12.7 per 100 000(ranking the 2nd worldwide).In China,the number of breast cancer incident cases was 357 000,ranking the 6th among all cancers,accounting for 15.5％of the global breast cancers,with an SIR of 33.0 per 100 000(ranking the 2nd among all cancers in China).The number of breast cancer deaths in China was 75 000,ranking the 7th among all cancer deaths,accounting for 11.3％of the global breast cancer deaths,with an SMR of 6.1 per 100 000(ranking the 6th among all cancer deaths in China).For females around the world,the number of breast cancer incidents and deaths,SIR,and SMR ranked the 1st among all cancers.For Chinese females,both the incident number of breast cancer and SIR ranked the 2nd,while the deaths and SMR ranked the 5th and the 4th,respectively.SIR was positively correlated with HDI(r=0.76,P＜0.01),M/I was negatively correlated with HDI(r=-0.89,P＜0.01),while SMR was not correlated with HDI(r=-0.09,P=0.23).The incidence of breast cancer worldwide and in China increased with age from 25 to 29 years old.The number of breast cancer deaths in the world increased with age from 30 years old,peaked at 50-59 years old,and declined after 70 years old.The breast cancer deaths in China showed 2 small peaks at the age of 50-54 and 65-69 years old,and gradually decreased after 70 years old.The age-dependent trend of SIR varied in different countries and territories with different HDI levels,as well as globally and in China,whereas SMR continued to increase with age.Conclusion The disease burden of breast cancer is serious globally and in China.Especially in females,both SIR and SMR rank the 1st in the world;although they rank the 2nd and the 4th,respectively,in China,the number of incidents and deaths cannot be ignored.HDI is positively correlated with SIR and negatively correlated with M/I,however,with no correlation with SMR.The SIR in countries and territories with different HDI levels changes differently with age,while SMR increases with age in all.

Background and purpose:Approximately 30%of patients with metastatic colorectal cancer(CRC)develops pulmonary metastasis,yet less than 10%are eligible for surgical resection.Radiofrequency ablation(RFA)serves as an alternative therapy for non-surgical candidates,but the relationship between its efficacy and tumor diameter remains controversial.This study aimed to investigate the impact of tumor size on survival outcomes and local progression risk in CRC patients with pulmonary metastasis after RFA,and to validate the clinical utility of a 3 cm threshold for prognosis.Methods:This retrospective study included CRC patients with pulmonary metastasis who underwent RFA at Fudan University Shanghai Cancer Center between January 2016 and December 2024.Patients were stratified into two groups based on maximum lesion diameter:≤3 cm(Small group)and 3-5 cm(Large group).Patient inclusion criteria:⑴ pathologically confirmed lung metastases originating from CRC,with metastases limited to the lungs or extra-pulmonary metastatic lesions having been radically treated;⑵ maximum lesion diameter<5 cm;⑶complete clinical data available;⑷ complete imaging data available,including computed tomography(CT)images during ablation and contrast-enhanced CT images during postoperative follow-up;⑸ follow-up time of at least＞6 months after RFA;⑹ technical complete ablation;⑺ fewer than 3 pulmonary metastatic lesions.Exclusion criteria:⑴ target lesions previously treated with local therapies such as RFA or radiotherapy;⑵ patients unable to tolerate RFA;⑶ patients with follow-up time＜6 months after RFA.Three senior interventional physicians performed percutaneous RFA under guidance of a 64-slice spiral CT scanner.Chest contrast-enhanced CT scans obtained 1 month after RFA were used as the baseline,followed by contrast-enhanced CT scans every 3 months for 1 year,then every 6 months for subsequent follow-up.This study was approved by the medical ethics committee of Fudan University Shanghai Cancer Center(ethical approval number:2108241-11).Primary endpoints included overall survival(OS),progression-free survival(PFS),and local tumor progression(LTP).Kaplan-Meier analysis and multivariate COX regression were employed to evaluate the independent prognostic value of tumor size.Results:A total of 134 patients who met the inclusion criteria were ultimately enrolled,including 77 in the Small group and 57 in the Large group.With a median follow-up of 35 months,the≤3 cm group demonstrated superior 1-,3-,and 5-year OS rates(100.0%,95.1%,74.2%)compared to the 3-5 cm group(94.7%,36.8%,27.0%,P＜0.0001),and the≤3 cm group demonstrated superior 1-,3-,and 5-year PFS rates(90.9%,34.4%,23.3%)compared to the 3-5 cm group(13.8%,0.0%,0.0%,P＜0.000 1).The≤3 cm group also exhibited significantly lower 1-,3-,and 5-year LTP rates(0.0%,19.7%,33.6%)compared to the 3-5 cm group(46.0%,75.5%,75.5%,P＜0.000 1).Multivariable analysis identified tumor diameter＞3 cm as an independent predictor of worse OS[hazard ratio(HR)=6.49,95%CI:3.18-13.24,P＜0.001],while elevated preoperative carcinoembryonic antigen(CEA)(≥5 ng/mL)correlated with shorter OS(HR=1.82,P=0.033).Conclusion:CRC patients with pulmonary metastasis and tumor diameters of 3-5 cm exhibited significantly inferior survival outcomes after RFA compared to the≤3 cm group.A tumor diameter of 3 cm can serve as a critical threshold for selecting RFA indications,and combining preoperative CEA levels can optimize patient stratification.

Hepatocellular carcinoma(HCC)is a severely detrimental global public health issue,and its incidence and mortality rates remain at a high level.According to the data from the World Health Organization,there were 866 000 new cases of HCC and 759 000 deaths worldwide in 2022,and it is predicted that by 2040,there will be significant increases in the numbers of new cases and deaths due to HCC.In the face of these great challenges,significant advances have been made in the diagnosis and treatment of HCC in recent years,and from the improvements in traditional surgeries and local treatment to groundbreaking innovations in targeted therapy and immunotherapy and the application of the concept of precision medicine,various treatment methods have provided more treatment options and survival opportunities for patients with different stages.This article reviews the advances in the treatment of HCC and analyzes current therapeutic difficulties and future development directions,in order to provide a reference for clinical practice and academic research.

Objective To investigate the longitudinal clinical manifestations of acute radiation dermatitis(ARD)induced by particle therapy in nasopharyngeal carcinoma patients and to analyze associated risk factors.Methods A longitudinal study design was employed,encompassing nasopharyngeal carcinoma patients who underwent particle therapy at the Shanghai Proton and Heavy Ion Center from Mar to Sept 2023.Participants were assessed weekly(1-12 weeks)following the commencement of radiotherapy and at baseline,prior to the start of treatment.Data collection included the patient demographic questionnaire,the Radiation Therapy Oncology Group(RTOG)grading criteria for acute radiation injury,and the radiation-induced skin reaction assessment scale(RISRAS).Photographic documentation was utilized to capture changes in the irradiated skin area.The enrolled patients with nasopharyngeal carcinoma were grouped according to different particle therapy regimens.Survival data were analyzed by Log-rank and Cox regression methods,while a linear mixed-effects model was applied to repeated measures data.Results A total of 119 patients with nasopharyngeal carcinoma were enrolled.The overall incidence of ARD was 89.1%,which included 39.5%of grade 1,45.4%of grade 2 and 4.2%of grade 3.With the extension of time,the severity of ARD peaked at week 7(RISRAS=13.26±4.512),then began to decrease,ultimately reaching a lower level.Multiple Cox proportional hazards models were constructed,revealing that proton/heavy ion radiotherapy was associated with a lower risk of ARD compared to photon/proton plus heavy ion radiotherapy(HR=0.19,95%CI:0.04-0.92,P=0.039).Additionally,concurrent cisplatin/nedaplatin chemotherapy was identified as a risk factor for the development of ARD.Least squares(LS)mean differences were calculated at different time points,and the results demonstrated that the RISRAS scores of the photon/proton plus heavy ion group were consistently and significantly higher from week 5 to week 7 compared with the proton plus heavy ion group,and despite a decrease by week 8,statistical differences remained(week 5:LS mean difference 3.35,95%CI:0.94-5.76,P=0.007;week 6:LS mean difference 5.23,95%CI:2.20-8.26,P=0.001;week 7:LS mean difference 7.13,95%CI:3.67-10.59,P<0.001;week 8:LS mean difference 4.04,95%CI:0.74-7.34,P=0.017).Patients undergoing concurrent cisplatin chemotherapy had higher RISRAS scores from week 7 to week 8 of radiotherapy compared with those not receiving chemotherapy[week 7:adjusted mean difference(Adj.MD)4.20,95%CI:1.96-6.57,P=0.006;week 8:Adj.MD 2.79,95%CI 0.55-5.03,P=0.015].Similarly,patients on concurrent nedaplatin chemotherapy had higher RISRAS scores from weeks 6 to 7 compared with those not on chemotherapy(week 6:Adj.MD 3.75,95%CI:1.54-5.96,P=0.001;week 7:Adj.MD 4.41,95%CI:2.12-6.70,P<0.001).Skin care measures during treatment and accompanying symptoms such as weight loss were not statistically associated with the development of ARD.Conclusion Proton/heavy ion radiotherapy has a lower risk of ARD,while concurrent cisplatin/nedaplatin chemotherapy is a risk factor for ARD.

Immune checkpoint inhibitors(ICIs)represent the most widely used immunotherapeutic approach for antitumor treatment,yet the understanding of their associated hepatotoxicity remains incomplete.This article delves into and analyzes the similarities and differences among the management guidelines on ICI-related hepatotoxicity issued by the Chinese Society of Clinical Oncology(CSCO),the National Comprehensive Cancer Network(NCCN)of the United States,and the American Society of Clinical Oncology(ASCO),aiming to provide a more comprehensive management strategy for clinical practice.By reviewing and analyzing the latest guidelines,this study compares the differences and similarities in the diagnosis,assessment,grading criteria,and treatment strategies for ICI-related liver toxicity among these guidelines.The definitions and diagnostic criteria for ICI-related liver toxicity are generally consistent across different guidelines,primarily relying on the elevated levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),bilirubin,and alkaline phosphatase(ALP)for grading.Notably,the ASCO guidelines place a stronger emphasis on the assessment of symptoms of hepatic dysfunction.In terms of treatment strategies,all guidelines recommend using corticosteroids or immunosuppressants based on the toxicity grade.However,there are discrepancies in management strategies among the guidelines.Clinicians should tailor management strategies by considering the specific conditions of patients and integrating the recommendations from various guidelines.Additionally,given the current inadequate understanding of ICI-induced hepatotoxicity primarily manifested as cirrhosis in the existing guidelines,it is imperative to continuously update and refine these management guidelines as research progresses and clinical experience accumulates.

Associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)is a groundbreaking and innovative technique in the field of liver surgery,and it has significantly increased the resection rate of large or multifocal liver cancer that cannot be resected in stage Ⅰ surgery.Continuous improvements in the ALPPS surgical procedure have further enhanced surgical safety.Compared with systemic therapy and local treatment for oncological conversion,ALPPS has notable advantages in the success rate of surgical resection and the time interval required for the procedure.Future research will focus on the long-term oncological outcomes and quality of life of patients after ALPPS.

Background and purpose:Thyroid cancer is the most common malignant endocrine tumor,particularly prevalent among the Asian population.The overall survival for thyroid cancer patients is relatively high,but there are significant survival differences among patients.Based on long-term hospital-based cancer registry database,this study analyzed the 10-year observed overall survival(OS)rate of thyroid cancer cases and the distribution of causes of death,providing real-world evidences to further survival management of thyroid cancer in China.Methods:A total of 55343 thyroid cancer patients who underwent treatment at Fudan University Shanghai Cancer center from 2005 to 2021 were included in this study.Clinical information and the follow-up endpoint data were collected through medical records review,telephone visits and death registry data linkage.The last follow-up date was October 31,2024.Kaplan-Meier method was applied in evaluating the OS rate,and survival data were described by different subgroups as age group,gender,treatment period,tumor staging and pathological characteristics.The standardized mortality ratio(SMR)and absolute excess risk(AER)were calculated using general Shanghai population as the reference,and the mortality risk was described by gender,age at diagnosis and histological subtype.Results:With a median follow-up time of 63.01 months,the overall 1-,3-,5-and 10-year OS rates of thyroid cancer patients were 99.67%(95%CI:99.62%-99.72%),99.11%(95%CI:99.03%-99.19%),98.48%(95%CI:98.36%-98.60%)and 95.81%(95%CI:95.50%-96.11%),respectively.The 10-year OS rates of stage Ⅰ,Ⅱ,Ⅲ and Ⅳ were 97.99%(95%CI:97.70%-98.28%),89.80%(95%CI:87.24%-92.37%),77.84%(95%CI:70.76%-84.92%)and 62.95%(95%CI:55.37%-70.54%),respectively.The differences in OS among patients with different age,gender and histological classification were significant.1256(2.27%)deaths occurred,of which 18.63%,50.88%and 7.32%were attributable to thyroid cancer,other cancers and cardiovascular disease(CVD),respectively.Compared with the general population,patients with different subtypes of thyroid cancer had higher all-cause mortality rates,progressively increasing with papillary,follicular,medullary and anaplastic thyroid carcinoma/poorly differentiated carcinoma.Compared with general population,the death risk was 2.24 times higher in papillary thyroid cancer patients(95%CI:2.06-2.44),9.94 times higher in follicular thyroid cancer patients(95%CI:6.79-14.09),12.16 times higher in medullary thyroid cancer patients(95%CI:8.05-17.69),and the highest risk was observed in patients with anaplastic thyroid carcinoma/poorly differentiated carcinoma[SMR=79.67(95%CI:58.38-106.31),AER=766.01/1 000 person-years].Conclusion:The 10-year long survival data and cause of death for thyroid cancer patients with different histological types were reported in China based on a large single institution hospital-based cancer registry database.Staging and histological characteristics were the most important factors directly affected the survival.Early diagnosis and individualized treatment are crucial for improving prognosis.

Minimally invasive enucleation of pancreatic tumors has become a focal topic in the field of pancreatic surgery. This technique, which allows for complete tumor removal while preserving maximal pancreatic function, has seen widespread application in clinical practice in recent years. Preoperative evaluation is essential, requiring a thorough assessment of the necessity, feasibility, and appropriateness of surgery, and a careful choice between follow-up observation, parenchyma-sparing resection, or radical resection. If the lesion carries a potential risk of malignancy, radical resection, such as pancreaticoduodenectomy, should be performed. During minimally invasive local resection, selecting an appropriate surgical approach, accurately localizing the tumor, protecting the main pancreatic duct (MPD), and effectively repairing and reconstructing the MPD in case of injury are key to ensuring both surgical safety and efficacy. In addition, pancreatic wound management and the long-term prognosis of patients who undergo MPD repair and reconstruction are also areas of significant concern.

Surgical resection is the mainstay of curative treatment for long-term survival of patients with liver cancer. However, many patients are excluded for surgical resection due to insufficient future liver remnant(FLR). The two-stage hepatectomy (induction of FLR hypertrophy followed by tumor resection) is one of the main treatment strategies for insufficient FLR. The new associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) is an important innovative procedure for inducing FLR hypertrophy, which has the advantages of rapid and significant induction of FLR hypertrophy as well as high tumor resection rate, but it was controversial in the early years due to high postoperative morbidity and mortality. After more than 10 years of development, ALPPS has made tremendous advance. Surgical safety of ALPPS has been significantly improved, and oncological benefits and other issues have been largely clarified. This article aims to introduce the current status and progress of ALPPS.