Recent research from the International Agency for Research on Cancer (IARC) of the World Health Organization (WHO) indicates that breast cancer is the most prevalent malignant tumor among women, posing a significant threat to women's health. Surgery remains the primary therapeutic modality for breast cancer. Recently, endoscopic and robotic breast surgical techniques have gained acceptance among both surgeons and patients. However, considerable variation exists in surgical approaches and outcomes. To standardize these techniques, facilitate their broader clinical adoption, and ultimately improve patient care, the Endoscopic-robotic Breast Surgery Clinical Trials Consortium (ErBSCTC) of China has developed this guideline. This document encompasses the technologies and instrumentation utilized in endoscopic and robotic breast surgery, surgical techniques, perioperative management, complication handling, long-term follow-up, and oncologic outcomes, aiming to provide evidence-based guidance for healthcare professionals involved in the prevention, diagnosis, and treatment of breast diseases.

Breast cancer is the most common malignant tumor among women in China, with surgery being one of the primary treatment modalities. Endoscopic/robotic breast surgery (ErBS) is gaining widespread acceptance among patients and surgeons alike due to its advantages of minimal invasiveness, superior cosmetic outcomes, and accelerated recovery. However, substantial heterogeneity currently exists across China regarding patient selection, standardized operative techniques, perioperative management, and complication handling, underscoring the urgent need for evidence-based consensus guidelines. To promote standardization and ensure consistent quality of ErBS, the Chinese Endoscopic-Robotic Breast Surgery Clinical Trials Consortium (CErBSCTC) has systematically reviewed the latest high-quality evidence and formulated the "Protocol for China Endoscopic and Robotic Breast Surgery Guidelines (2026 edition)", which outlines a comprehensive methodology for guideline development.

This guideline, presented in three parts, details the core aspects of endoscopic/robotic breast surgery, including its techniques, equipment, surgical procedures, perioperative management, complication treatment, long-term follow-up, and outcomes. Part one offered a comprehensive overview of indications for endoscopic and robotic breast surgery, intraoperative techniques, surgical instrument choices, and common endoscopic and robotic breast reconstruction procedures. This part will cover other endoscopic breast procedures beyond immediate breast reconstruction and include perioperative management strategies, to provide healthcare professionals involved in endoscopic and robotic breast surgery with systematic operational guidelines and clinical decision-making references.

BACKGROUND: While emotional distress, encompassing anxiety and depression, has been associated with negative clinical outcomes, its impact across various clinical departments and general hospitals has been less explored. Previous studies with limited sample sizes have examined the effectiveness of specific treatments (e.g., antidepressants) rather than a systemic management strategy for outcome improvement in non-psychiatric inpatients. To enhance the understanding of the importance of addressing mental health care needs among non-psychiatric patients in general hospitals, this study retrospectively investigated the impacts of emotional distress and the effects of early detection and management of depression and anxiety on hospital length of stay (LOS) and rate of long LOS (LLOS, i.e., LOS >30 days) in a large sample of non-psychiatric inpatients. METHODS: This retrospective cohort study included 487,871 inpatients from 20 non-psychiatric departments of a general hospital. They were divided, according to whether they underwent a novel strategy to manage emotional distress which deployed the Huaxi Emotional Distress Index (HEI) for brief screening with grading psychological services (BS-GPS), into BS-GPS ( n = 178,883) and non-BS-GPS ( n = 308,988) cohorts. The LOS and rate of LLOS between the BS-GPS and non-BS-GPS cohorts and between subcohorts with and without clinically significant anxiety and/or depression (CSAD, i.e., HEI score ≥11 on admission to the hospital) in the BS-GPS cohort were compared using univariable analyses, multilevel analyses, and/or propensity score-matched analyses, respectively. RESULTS: The detection rate of CSAD in the BS-GPS cohort varied from 2.64% (95% confidence interval [CI]: 2.49%-2.81%) to 20.50% (95% CI: 19.43%-21.62%) across the 20 departments, with a average rate of 5.36%. Significant differences were observed in both the LOS and LLOS rates between the subcohorts with CSAD (12.7 days, 535/9590) and without CSAD (9.5 days, 3800/169,293) and between the BS-GPS (9.6 days, 4335/178,883) and non-BS-GPS (10.8 days, 11,483/308,988) cohorts. These differences remained significant after controlling for confounders using propensity score-matched comparisons. A multilevel analysis indicated that BS-GPS was negatively associated with both LOS and LLOS after controlling for sociodemographics and the departments of patient discharge and remained negatively associated with LLOS after controlling additionally for the year of patient discharge. CONCLUSION Emotional distress significantly prolonged the LOS and increased the LLOS of non-psychiatric inpatients across most departments and general hospitals. These impacts were moderated by the implementation of BS-GPS. Thus, BS-GPS has the potential as an effective, resource-saving strategy for enhancing mental health care and optimizing medical resources in general hospitals.
Humans ; Retrospective Studies ; Male ; Length of Stay/statistics & numerical data* ; Female ; Middle Aged ; Adult ; Psychological Distress ; Inpatients/psychology* ; Aged ; Anxiety/diagnosis* ; Depression/diagnosis*

The free inferior epigastric artery perforator flap is currently a highly regarded autologous breast reconstruction technique. However, in clinical practice, the anatomical characteristics of the lower abdominal vasculature and surrounding tissue structures do not always permit ideal perforator flap harvesting. In many cases, it becomes necessary to preserve a larger rectus abdominis muscle cuff to ensure reliable blood supply to the flap through the perforating vessels. Compared with various forms of rectus abdominis myocutaneous flaps that all require incision of the anterior sheath and intramuscular vascular pedicle dissection, the superficial inferior epigastric artery (SIEA) perforator flap significantly reduces donor-site morbidity. Nevertheless, the anatomical variability of the superficial inferior epigastric vessels increases surgical uncertainty. Based on clinical observations, this study establishes a comprehensive clinical strategy algorithm. Primarily focusing on different configurations of free rectus abdominis flaps, it incorporates additional preparation of free SIEA perforator flaps when anatomical conditions permit. The objectives are to ensure reliable perfusion of the lower abdominal flap while minimizing donor-site damage and reducing surgical complexity.

Objective:To evaluate the efficacy and safety of remedial pedicled rectus abdominis myocutaneous flap transplantation for breast reconstruction.Methods:This retrospective study included 23 female breast cancer patients who underwent autologous breast reconstruction with a remedial pedicled rectus abdominis myocutaneous flap at Hunan Cancer Hospital from June 2022 to June 2023. The patients' ages ranged from 24 to 56 years, with a mean age of (43.2±1.3) years. All patients had previously undergone mastectomy and tumor resection before receiving the remedial pedicled rectus abdominis myocutaneous flap reconstruction. Follow-up was conducted through outpatient visits and telephone interviews, with a median follow-up period of 10 (6-15) months. Observation indicators included survival rate of flaps, patient satisfaction rate and aesthetic outcomes. Adverse reactions including but not limited to flap contracture and deformation, during and following the surgical procedure were also recorded.Results:The remedial pedicled rectus abdominis myocutaneous flap technique was utilized for autologous breast reconstruction in 23 patients. Specifically, this approach was chosen due to two primary reasons: the perforator distance from the vascular pedicle being excessively long in 18 cases, and suboptimal characteristics of the main pedicle in 5 cases. Two types of flap configurations were employed. For 15 patients, a unilateral remedial pedicled rectus abdominis myocutaneous flap was used, with an average flap size of (21.5±0.8) cm in length and (11.2±1.3) cm in width. All flaps demonstrated adequate blood supply without the need for additional vascular anastomosis. For the remaining 8 patients, a combination of a unilateral remedial pedicled rectus abdominis myocutaneous flap and a contralateral free lower abdominal flap was utilized, resulting in an average flap size of (29.3±0.7) cm in length and (12.0±1.8) cm in width. In these cases, the inferior epigastric vessels of the free lower abdominal flap were successfully anastomosed to the internal thoracic vessels of the recipient site, ensuring all flaps survived postoperatively. The survival rate of flaps in 23 patients was 100% (23/23), and the patient satisfaction rate was 100% (23/23). Postoperative evaluation revealed that the reconstructed breasts exhibited satisfactory shape and texture, with no instances of flap contracture or deformation. The reconstructed breasts were largely symmetrical with the contralateral side, leaving only linear scars at the donor and recipient sites. Importantly, there was no significant impact on abdominal wall function, and no adverse reactions such as flap contracture or impaired abdominal wall function were observed in any of the patients.Conclusion:When the characteristics of the perforating vessels in the lower abdomen are suboptimal, the use of a remedial pedicled rectus abdominis myocutaneous flap technique for breast reconstruction can ensure satisfactory outcomes and significantly enhance surgical safety.

Objective To explore the safety and feasibility of mechanical thrombectomy as the first-line endovascular strategy in patients with non-acute symptomatic long-segment internal carotid artery occlusion(ICAO)undergoing revascularization.Methods This study retrospectively and consecutively enrolled non-acute symptomatic long-segment ICAO patients treated in the Department of Neurology,First Hospital of Jilin University,between January 2019 and August 2023,with mechanical thrombectomy as the preferred endovascular modality.Baseline and clinical data were collected,including sex,age,stroke-related risk factors(hypertension,diabetes,dyslipidemia,coronary artery disease,prior stroke,smoking and alcohol use history),admission National Institutes of Health stroke scale(NIHSS)score,pre-operative modified Rankin scale(mRS)score,time from last symptom onset to femoral puncture,time from imaging confirmation to femoral puncture,high-resolution MRI,right-sided ICAO,stump morphology(absent,tapered,flat/blunt,irregular),distal backfilling patterns(above ophthalmic segment,cavernous/clinoid segment,below cavernous segment),pathogenesis(atherosclerosis,dissection),types of anesthesia(local,general),procedure time(time frame from femoral puncture to recanalization or final angiography),site of the original occlusion in successfully recanalized cases,surgical techniques(aspiration+balloon angioplasty,aspiration+balloon angioplasty+stent-retriever thrombectomy,aspiration+balloon angioplasty+stent placement,aspiration+balloon angioplasty+stent-retriever thrombectomy+stent placement),stent placement(yes/no),number of stents implanted,and number of cases with retrieved thrombus,observed indicators.Observed indicators including ratio of technical successful recanalization(immediately post-procedure most severely stenosed site stenosis rate＜50%,expanded thrombolysis in cerebral infarction[eTICI]grade≥2c),intraoperative complications(distal embolization,symptomatic intracranial hemorrhage,arterial perforation)rate,perioperative mortality rate,30-day stroke recurrence,and 90-day mRS score.Compare the baseline data,clinical data and observational indicators of the patients with successful and unsuccessful recanalization.Base on the original occlusion site,successfully recanalized patients were subclassified into isolated extracranial,isolated intracranial,and tandem lesions patients,and their baseline characteristics and observation indicators were compared.Results(1)A total of 65 patients were enrolled(57 men,8 women;age 39-80 years;median 59[52,65]years)in this study.Technical success was achieved in 52cases(80%).Perioperative complications occurred in 4 patients(6.2%),with 3 distal embolization cases(4.6%),1(1.5%)developed symptomatic intracranial hemorrhage,and no arterial perforations were observed.There was no perioperative mortality.The 30-day stroke recurrence rate was 7.7%(5/65).90-day mRS scores ranged from 0 to 4,with a median of 1.0(0.0,1.5).(2)Baseline and clinical characteristics as well as outcome indicators did not differ significantly between patients with successful versus unsuccessful recanalization in the cohort undergoing mechanical thrombectomy for non-acute symptomatic long-segment intracranial carotid artery occlusion(all P＞0.05).(3)Among successfully recanalized patients,17(32.7%)had isolated extracranial lesions,18(34.6%)had isolated intracranial lesions,and 17(32.7%)had tandem lesions.All cases in the extracranial lesions group had original lesion site at the origin of internal carotid artery(C1,17/17).The intracranial group most often had orginal lesion sites at the C4 segment(9/18),whereas tandem lesions predominantly involved C1 plus C4-C5(16/17).Among the three groups,patients with isolated intracranial lesions were younger(57[48,61]years vs.60[52,64],63[58,69]years,P=0.050),and had a lower proportion of right-sided ICAO(4/18 vs.11/17 vs.11/17,P=0.032),while patients with tandem lesions required a greater number of stents(2.0[1.0,2.0]vs.1.0[1.0,1.5],1.0[0.8,2.0],P=0.013).Significant differences were observed in the proportion of patients with retrieved thrombus decreased progressively from patients with isolated extracranial,isolated intracranial to tandem lesions(17/17 vs.17/18 vs.12/17,P=0.024).No significant differences were observed among lesion-site groups with respect to medical history,stump morphology,distal retrograde flow,procedural technique,procedure duration,anesthesia method,or outcome indicators(all P＞0.05).Conclusions This study suggested that utilizing mechanical thrombectomy as the first-line endovascular therapy for non-acute symptomatic long-segment ICAO is safe and feasible.The original occlusive sites of non-acute symptomatic long-segment ICAO predominantly involve the cervical origin and the cavernous segment of the internal carotid artery.The conclusions of this study require further validation.

Objective To explore the safety and feasibility of mechanical thrombectomy as the first-line endovascular strategy in patients with non-acute symptomatic long-segment internal carotid artery occlusion(ICAO)undergoing revascularization.Methods This study retrospectively and consecutively enrolled non-acute symptomatic long-segment ICAO patients treated in the Department of Neurology,First Hospital of Jilin University,between January 2019 and August 2023,with mechanical thrombectomy as the preferred endovascular modality.Baseline and clinical data were collected,including sex,age,stroke-related risk factors(hypertension,diabetes,dyslipidemia,coronary artery disease,prior stroke,smoking and alcohol use history),admission National Institutes of Health stroke scale(NIHSS)score,pre-operative modified Rankin scale(mRS)score,time from last symptom onset to femoral puncture,time from imaging confirmation to femoral puncture,high-resolution MRI,right-sided ICAO,stump morphology(absent,tapered,flat/blunt,irregular),distal backfilling patterns(above ophthalmic segment,cavernous/clinoid segment,below cavernous segment),pathogenesis(atherosclerosis,dissection),types of anesthesia(local,general),procedure time(time frame from femoral puncture to recanalization or final angiography),site of the original occlusion in successfully recanalized cases,surgical techniques(aspiration+balloon angioplasty,aspiration+balloon angioplasty+stent-retriever thrombectomy,aspiration+balloon angioplasty+stent placement,aspiration+balloon angioplasty+stent-retriever thrombectomy+stent placement),stent placement(yes/no),number of stents implanted,and number of cases with retrieved thrombus,observed indicators.Observed indicators including ratio of technical successful recanalization(immediately post-procedure most severely stenosed site stenosis rate＜50%,expanded thrombolysis in cerebral infarction[eTICI]grade≥2c),intraoperative complications(distal embolization,symptomatic intracranial hemorrhage,arterial perforation)rate,perioperative mortality rate,30-day stroke recurrence,and 90-day mRS score.Compare the baseline data,clinical data and observational indicators of the patients with successful and unsuccessful recanalization.Base on the original occlusion site,successfully recanalized patients were subclassified into isolated extracranial,isolated intracranial,and tandem lesions patients,and their baseline characteristics and observation indicators were compared.Results(1)A total of 65 patients were enrolled(57 men,8 women;age 39-80 years;median 59[52,65]years)in this study.Technical success was achieved in 52cases(80%).Perioperative complications occurred in 4 patients(6.2%),with 3 distal embolization cases(4.6%),1(1.5%)developed symptomatic intracranial hemorrhage,and no arterial perforations were observed.There was no perioperative mortality.The 30-day stroke recurrence rate was 7.7%(5/65).90-day mRS scores ranged from 0 to 4,with a median of 1.0(0.0,1.5).(2)Baseline and clinical characteristics as well as outcome indicators did not differ significantly between patients with successful versus unsuccessful recanalization in the cohort undergoing mechanical thrombectomy for non-acute symptomatic long-segment intracranial carotid artery occlusion(all P＞0.05).(3)Among successfully recanalized patients,17(32.7%)had isolated extracranial lesions,18(34.6%)had isolated intracranial lesions,and 17(32.7%)had tandem lesions.All cases in the extracranial lesions group had original lesion site at the origin of internal carotid artery(C1,17/17).The intracranial group most often had orginal lesion sites at the C4 segment(9/18),whereas tandem lesions predominantly involved C1 plus C4-C5(16/17).Among the three groups,patients with isolated intracranial lesions were younger(57[48,61]years vs.60[52,64],63[58,69]years,P=0.050),and had a lower proportion of right-sided ICAO(4/18 vs.11/17 vs.11/17,P=0.032),while patients with tandem lesions required a greater number of stents(2.0[1.0,2.0]vs.1.0[1.0,1.5],1.0[0.8,2.0],P=0.013).Significant differences were observed in the proportion of patients with retrieved thrombus decreased progressively from patients with isolated extracranial,isolated intracranial to tandem lesions(17/17 vs.17/18 vs.12/17,P=0.024).No significant differences were observed among lesion-site groups with respect to medical history,stump morphology,distal retrograde flow,procedural technique,procedure duration,anesthesia method,or outcome indicators(all P＞0.05).Conclusions This study suggested that utilizing mechanical thrombectomy as the first-line endovascular therapy for non-acute symptomatic long-segment ICAO is safe and feasible.The original occlusive sites of non-acute symptomatic long-segment ICAO predominantly involve the cervical origin and the cavernous segment of the internal carotid artery.The conclusions of this study require further validation.

The free inferior epigastric artery perforator flap is currently a highly regarded autologous breast reconstruction technique. However, in clinical practice, the anatomical characteristics of the lower abdominal vasculature and surrounding tissue structures do not always permit ideal perforator flap harvesting. In many cases, it becomes necessary to preserve a larger rectus abdominis muscle cuff to ensure reliable blood supply to the flap through the perforating vessels. Compared with various forms of rectus abdominis myocutaneous flaps that all require incision of the anterior sheath and intramuscular vascular pedicle dissection, the superficial inferior epigastric artery (SIEA) perforator flap significantly reduces donor-site morbidity. Nevertheless, the anatomical variability of the superficial inferior epigastric vessels increases surgical uncertainty. Based on clinical observations, this study establishes a comprehensive clinical strategy algorithm. Primarily focusing on different configurations of free rectus abdominis flaps, it incorporates additional preparation of free SIEA perforator flaps when anatomical conditions permit. The objectives are to ensure reliable perfusion of the lower abdominal flap while minimizing donor-site damage and reducing surgical complexity.

Objective:To evaluate the efficacy and safety of remedial pedicled rectus abdominis myocutaneous flap transplantation for breast reconstruction.Methods:This retrospective study included 23 female breast cancer patients who underwent autologous breast reconstruction with a remedial pedicled rectus abdominis myocutaneous flap at Hunan Cancer Hospital from June 2022 to June 2023. The patients' ages ranged from 24 to 56 years, with a mean age of (43.2±1.3) years. All patients had previously undergone mastectomy and tumor resection before receiving the remedial pedicled rectus abdominis myocutaneous flap reconstruction. Follow-up was conducted through outpatient visits and telephone interviews, with a median follow-up period of 10 (6-15) months. Observation indicators included survival rate of flaps, patient satisfaction rate and aesthetic outcomes. Adverse reactions including but not limited to flap contracture and deformation, during and following the surgical procedure were also recorded.Results:The remedial pedicled rectus abdominis myocutaneous flap technique was utilized for autologous breast reconstruction in 23 patients. Specifically, this approach was chosen due to two primary reasons: the perforator distance from the vascular pedicle being excessively long in 18 cases, and suboptimal characteristics of the main pedicle in 5 cases. Two types of flap configurations were employed. For 15 patients, a unilateral remedial pedicled rectus abdominis myocutaneous flap was used, with an average flap size of (21.5±0.8) cm in length and (11.2±1.3) cm in width. All flaps demonstrated adequate blood supply without the need for additional vascular anastomosis. For the remaining 8 patients, a combination of a unilateral remedial pedicled rectus abdominis myocutaneous flap and a contralateral free lower abdominal flap was utilized, resulting in an average flap size of (29.3±0.7) cm in length and (12.0±1.8) cm in width. In these cases, the inferior epigastric vessels of the free lower abdominal flap were successfully anastomosed to the internal thoracic vessels of the recipient site, ensuring all flaps survived postoperatively. The survival rate of flaps in 23 patients was 100% (23/23), and the patient satisfaction rate was 100% (23/23). Postoperative evaluation revealed that the reconstructed breasts exhibited satisfactory shape and texture, with no instances of flap contracture or deformation. The reconstructed breasts were largely symmetrical with the contralateral side, leaving only linear scars at the donor and recipient sites. Importantly, there was no significant impact on abdominal wall function, and no adverse reactions such as flap contracture or impaired abdominal wall function were observed in any of the patients.Conclusion:When the characteristics of the perforating vessels in the lower abdomen are suboptimal, the use of a remedial pedicled rectus abdominis myocutaneous flap technique for breast reconstruction can ensure satisfactory outcomes and significantly enhance surgical safety.