In today′s increasingly serious problem of obesity, dietary changes, physical activity, drugs and bariatric surgery play different roles in the field of obesity management. Compared with minimally invasive surgery, the application of endoscopic surgery to carry out bariatric and metabolic treatment with less trauma, faster recovery, fewer complications and lower cost has gradually become a new discipline in the field of obesity management. This article will focus on the history, current status and latest progress of endoscopic surgery for obesity management and look forward to its future development.

In the era of immunotherapy, the perioperative treatment of locally advanced esophagogastric junction cancer has gradually changed from traditional two-drug or three-drug chemotherapy to immunotherapy combined with chemotherapy. The clinical trials carried out at present have achieved positive results in pathological response, downstaging and long-term survival. However, whether it is possible to challenge the traditional radical principle of gastrectomy for gastric cancer in primary lesion resection and regional lymph node dissection, to preserve organ function and reduce surgical trauma is more controversial. Appropriate patients are selected by preoperative precise molecular diagnosis. After neoadjuvant immunotherapy combined with chemotherapy, the surgical approach is optimized, and the primary lesion is resected and the metastatic lymph node dissection or regional lymph node dissection is performed, to preserve more no metastatic lymph nodes to maintain the activity of T cells and the specific killing function against tumor cells. Long-term survival benefits and improved quality of life will ultimately be achieved.Based on the latest clinical and basic research findings, the authors elaborate on the relevant hotspots and controversies of perioperative immunotherapy combined with chemotherapy for esophagogastric junction cancer, aiming to better guide clinical practice in the future.

In the era of immunotherapy, the perioperative treatment of locally advanced esophagogastric junction cancer has gradually changed from traditional two-drug or three-drug chemotherapy to immunotherapy combined with chemotherapy. The clinical trials carried out at present have achieved positive results in pathological response, downstaging and long-term survival. However, whether it is possible to challenge the traditional radical principle of gastrectomy for gastric cancer in primary lesion resection and regional lymph node dissection, to preserve organ function and reduce surgical trauma is more controversial. Appropriate patients are selected by preoperative precise molecular diagnosis. After neoadjuvant immunotherapy combined with chemotherapy, the surgical approach is optimized, and the primary lesion is resected and the metastatic lymph node dissection or regional lymph node dissection is performed, to preserve more no metastatic lymph nodes to maintain the activity of T cells and the specific killing function against tumor cells. Long-term survival benefits and improved quality of life will ultimately be achieved.Based on the latest clinical and basic research findings, the authors elaborate on the relevant hotspots and controversies of perioperative immunotherapy combined with chemotherapy for esophagogastric junction cancer, aiming to better guide clinical practice in the future.

Objective:To investigate the application value of antegrade splenic superior region dissection first in laparoscopic total gastrectomy of obesity gastric cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 obesity patients with gastric cancer who underwent laparoscopic total gastrectomy in Renji Hospital of Shanghai Jiaotong University School of Medicine from July 2018 to October 2023 were collected. There were 16 males and 5 females, aged (58±13)years. All 21 patients underwent laparoscopic total gastrec-tomy with antegrade splenic superior region dissection first. Observation indicators: operation time, volume of intraoperative blood loss, laparotomy conversion, intraoperative splenic hemorrhage or gastric hemorrhage, lymph node dissection, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay, postoperative complication. Measure-ment data with normal distribution were represented as Mean± SD, and count data were expressed as absolute numbers. Results:All 21 patients underwent laparoscopic total gastrectomy success-fully, with the operation time of (283±47)minutes, time for splenogastric ligament and vascular manage-ment of (34±12)minutes, volume of intraoperative blood loss of (143±86)mL, and no laparotomy conversion. There was no intraoperative splenic hemorrhage or gastric haemorrhage. The total number of lymph node dissected in 21 patients was 375, with the number of lymph node dissected as (21±9)per case. Time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay in 21 patients were (3.1±0.7)days, (4.0±0.8)days and (10.1±3.0)days, respectively. There were 2 patients with postoperative complications, including 1 case of incision infection and 1 case of lung infection. The 2 patients with postoperative com-plications were recovered and discharged after conservative treatment. There was no death during the postoperative 30 days.Conclusion:The application of antegrade splenic superior region dissec-tion first in laparoscopic total gastrectomy is safe and feasible, which can reduce surgical difficulty.

Due to its unique anatomical location, there are many unresolved issues in the diagnosis and treatment of esophagogastric junction (EGJ) cancer, which is not only a hot topic of concern in various related disciplines, but also a controversial topic among scholars in both the East and the West academia. The 15 th International Gastric Cancer Congress in 2023 focuses on EGJ cancer, organi-zing consensus voting among experts from various disciplines on surgery, digestive endoscopy, and oncology issues before the conference. Multiple sub venues are also set up to discuss related issues. Meanwhile, Japanese scholars have proposed that the lymph node dissection process for EGJ cancer, modified based on the lymph node dissection therapeutic value index, is expected to be updated in the new version of the Japanese gastric cancer treatment guideline. The perioperative treatment of EGJ cancer highlights the differences in concepts and measures between the East and the West academia. Asian scholars focus on neoadjuvant chemotherapy based on DOS treatment plan, while European and American scholars hope to find the best perioperative treatment plan from the neoadjuvant chemoradiotherapy of CROSS research. However, the new adjuvant therapy regimen with the addition of immune checkpoint inhibitors has only established advantages in tumor regression and decline, and has not yet shown significant benefits in long-term survival. It cannot be denied that the diagnosis and treatment of EGJ cancer are still constantly exploring and advancing. In the future, we look forward to more new evidence-based medicine to provide ideas and expand our horizons for minimally invasive, precise, individualized, and comprehensive clinical diagnosis and treatment. Based on our understanding and insights into the differences and controversies between Eastern and Western scholars in the background, concepts, technologies, and treatment plans of EGJ cancer, the authors elaborate and analyze the hot issues of EGJ cancer diagnosis and treatment, combined with the latest content of the 2023 IGCC and other international conferences, in order to bring more thinking and analysis to colleagues and better guide clinical work.

Due to its unique anatomical location, there are many unresolved issues in the diagnosis and treatment of esophagogastric junction (EGJ) cancer, which is not only a hot topic of concern in various related disciplines, but also a controversial topic among scholars in both the East and the West academia. The 15 th International Gastric Cancer Congress in 2023 focuses on EGJ cancer, organi-zing consensus voting among experts from various disciplines on surgery, digestive endoscopy, and oncology issues before the conference. Multiple sub venues are also set up to discuss related issues. Meanwhile, Japanese scholars have proposed that the lymph node dissection process for EGJ cancer, modified based on the lymph node dissection therapeutic value index, is expected to be updated in the new version of the Japanese gastric cancer treatment guideline. The perioperative treatment of EGJ cancer highlights the differences in concepts and measures between the East and the West academia. Asian scholars focus on neoadjuvant chemotherapy based on DOS treatment plan, while European and American scholars hope to find the best perioperative treatment plan from the neoadjuvant chemoradiotherapy of CROSS research. However, the new adjuvant therapy regimen with the addition of immune checkpoint inhibitors has only established advantages in tumor regression and decline, and has not yet shown significant benefits in long-term survival. It cannot be denied that the diagnosis and treatment of EGJ cancer are still constantly exploring and advancing. In the future, we look forward to more new evidence-based medicine to provide ideas and expand our horizons for minimally invasive, precise, individualized, and comprehensive clinical diagnosis and treatment. Based on our understanding and insights into the differences and controversies between Eastern and Western scholars in the background, concepts, technologies, and treatment plans of EGJ cancer, the authors elaborate and analyze the hot issues of EGJ cancer diagnosis and treatment, combined with the latest content of the 2023 IGCC and other international conferences, in order to bring more thinking and analysis to colleagues and better guide clinical work.

China has the number of cases and deaths of gastric cancer ranking first in the world every year. Gastric cancer is a heterogeneous disease with significant individual differences and poor prognosis. In recent years, with the development of multi-omics technology, by analyzing different molecular subtypes and underlying mechanisms of gastric cancer, more and more targets and molecular features related to gastric cancer have been identified, targeted or immunotherapeu-tic drugs based on these molecular features have been partially applied in the clinical treatment of gastric cancer. In this article, the authors summarize the latest research progress based on the molecular characteristics of gastric cancer, elaborate on the current status and prospects of precise therapy strategies for gastric cancer, in order to provide new theoretical basis for improving the comprehensive treatment efficacy and prognosis of gastric cancer.

Objective:To compare the efficacy of single-agent versus multi-agent adjuvant chemotherapy after radical gastrectomy for elderly patients with stage Ⅲ gastric cancer.Methods:The propensity score matching and retrospective cohort study were conducted. The clinicopatholo-gical data of 456 elderly patients with stage Ⅲ gastric cancer who underwent D 2 radical resection in the Renji Hospital affiliated to Shanghai Jiaotong University School of Medicine from January 2016 to December 2020 were collected. There were 343 males and 113 females, aged 71(range, 65?89)years. Of the 456 patients, 274 cases undergoing single-agent adjuvant chemotherapy after surgery were divided into single-agent chemotherapy group, 182 cases undergoing double-agent or triple-agent adjuvant chemotherapy after surgery were divided into multi-agent chemotherapy group. Observa-tion indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) adverse events during chemotherapy; (3) follow-up. Propensity score matching was done by the 1∶1 ratio, with the caliper value of 0.05. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were described as absolute numbers, and comparison between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the non-parameter rank sum test. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-Rank test was used for survival analysis. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 456 patients, 306 cases were successfully matched, including 153 cases in the single-agent chemotherapy group and 153 cases in the multi-agent chemotherapy group. The elimination of age, age-adjusted Charlson comorbidity index, pathological TNM staging confounding bias ensured comparability between the two groups after propensity score matching. (2) Adverse events during chemotherapy. In terms of hematological adverse events, 6 cases in the single-agent chemotherapy group and 16 cases in the multi-agent chemotherapy group had neutropenia, showing a significant difference in the neutropenia ( χ2=4.90, P<0.05). In terms of non-hematological adverse events, cases with anorexia and nausea were 77 and 50 for the single-agent chemotherapy group, versus 96 and 69 for the multi-agent chemotherapy group, showing significant differences between the two groups ( χ2=4.80, 4.96, P<0.05). (3)Follow-up. All the 306 patients were followed up for 48(range, 8?61)months. The 5-year overall survival rates of the single-agent chemotherapy group and the multi-agent chemotherapy group were 36.08% and 38.31%, respectively, showing no significant difference between the two groups ( hazard ratio=0.93, 95% confidence interval as 0.70?1.20, P>0.05). Results of further analysis showed that the 5-year overall survival rates were 32.41% and 39.40% for 97 patients of the single-agent chemotherapy group and 97 patients with double-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=1.20, 95% confidence interval as 0.82?1.70, P>0.05). The 5-year overall survival rates were 43.15% and 37.11% for 56 patients of the single-agent chemotherapy group and 56 patients with triple-agent regimen of the multi-agent chemotherapy group, respectively, showing no significant difference between them ( hazard ratio=0.81, 95% confidence interval as 0.65?1.00, P>0.05). Conclusions:For adjuvant chemotherapy in elderly patients with stage Ⅲ gastric cancer, there is no significant survival advantage of double-agent or triple-agent chemotherapy over single-agent oral chemotherapy. However, there is a higher incidence of neutropenia, anorexia, ausea.

Due to the unique position and biological behaviors of adenocarcinoma of esophagogastric junction (AEG), the pattern of treatment has gradually changed from surgery alone leading by surgeons to comprehensive treatment by multidisciplinary teams including thoracic surgeons, oncologists, radiotherapy physicians, anesthetists and so on. The development of laparoscopic surgery makes the jointed operation possible by laparoscopy and thoracoscopy. The concept of enhanced recovery after surgery could further promote minimally invasive surgery in AEG. Meanwhile, with the continuous innovation of neoadjuvant chemotherapy, popularization of neoadjuvant radiotherapy and bold attempt of targeted therapy and immunotherapy, the resection rate, pathologic release rate and long-term survival of AEG have already achieved inspiring effects.

The incidence of adenocarcinoma of esophagogastric junction (AEG) is increasing worldwide annually. Surgical resection still plays the most important role in multi-modality therapy for AEG. However, due to the specialities of tumor location and biological features, general surgeons and thoracic surgeons do not reach an agreement on regional lymph-adenectomy, extents of resection, surgical approaches, etc. The development of minimally invasive surgery makes it possible to operate by laparoscopy and thoracoscopy. With the promotion of neoadjuvant therapy, a multidisciplinary team will be essential for optimal diagnosis and treatment in the near future. From the developmental perspective of a general surgeon, the authors summarize current status and controversies of the diagnosis and treatment of AEG, and inspect its research advances.