In recent years, with the advancement of preoperative assessment techniques, neoadjuvant therapies, and surgical techniques, the anastomosis level in laparoscopic and robotic-assisted colorectal cancer surgery has been lowered, and the sphincter preservation rate has increased. However, anastomosis-related complications remain a significant factor affecting surgical procedures and postoperative functional recovery, and they significantly impact patient prognosis. This article evaluates anastomosis quality based on multiple criteria and focuses on the causes, clinical manifestations, and prevention-treatment methods of three common complications: anastomotic leakage, stenosis, and bleeding. It aims to provide references for clinicians to better prevent and manage these complications, improve prognosis, and enhance patients' quality of life.

In recent years, with the advancement of preoperative assessment techniques, neoadjuvant therapies, and surgical techniques, the anastomosis level in laparoscopic and robotic-assisted colorectal cancer surgery has been lowered, and the sphincter preservation rate has increased. However, anastomosis-related complications remain a significant factor affecting surgical procedures and postoperative functional recovery, and they significantly impact patient prognosis. This article evaluates anastomosis quality based on multiple criteria and focuses on the causes, clinical manifestations, and prevention-treatment methods of three common complications: anastomotic leakage, stenosis, and bleeding. It aims to provide references for clinicians to better prevent and manage these complications, improve prognosis, and enhance patients' quality of life.

With the rapid development of medical technology and the improvement of people's health awareness, the detection rate of benign gastric tumors and early gastric cancer has increased significantly. Under the premise of ensuring the safety of oncology, challenges for surgeons present is how to adopt precise and reasonable treatment plans according to the characteristics of gastric tumors to minimize surgical trauma and complications, improve postoperative quality of life, and achieve individualized and precise treatment. Laparoscopic surgery and digestive endoscopy are currently the two main methods for treating gastric tumors. However, they both have advantages and shortcomings. The combination of laparoscopy and digestive endoscopy for the treatment of gastric tumors has become a new way to treat gastric tumors. This operation not only fully exploits the advantages of laparoscopy and digestive endoscopy, but also complements the shortcomings of each. This article reviews the surgical technique categories, indications, technical improvements, and perspectives of laparoscopy combined with digestive endoscopy in the treatment of gastric tumors.

With the rapid development of medical technology and the improvement of people's health awareness, the detection rate of benign gastric tumors and early gastric cancer has increased significantly. Under the premise of ensuring the safety of oncology, challenges for surgeons present is how to adopt precise and reasonable treatment plans according to the characteristics of gastric tumors to minimize surgical trauma and complications, improve postoperative quality of life, and achieve individualized and precise treatment. Laparoscopic surgery and digestive endoscopy are currently the two main methods for treating gastric tumors. However, they both have advantages and shortcomings. The combination of laparoscopy and digestive endoscopy for the treatment of gastric tumors has become a new way to treat gastric tumors. This operation not only fully exploits the advantages of laparoscopy and digestive endoscopy, but also complements the shortcomings of each. This article reviews the surgical technique categories, indications, technical improvements, and perspectives of laparoscopy combined with digestive endoscopy in the treatment of gastric tumors.

Objective: To explore the feasibility, safety and long-term efficacy of laparoscopic total gastrectomy combined with distal pancreaticosplenectomy for the treatment of T4b gastric cancer. Methods: A retrospective cohort study was performed. Clinical data of consecutive patients with T4b gastric cancer invading pancreatic tail undergoing laparoscopic or open total gastrectomy combined with distal pancreaticosplenectomy from January 2010 to December 2014 were analyzed retrospectively. Enrollment criteria: (1) primary gastric cancer confirmed by pathology as T4b adenocarcinoma; (2) chest+abdominal+pelvic enhanced CT indicated cancer invading pancreatic tail without distant metastasis, and R0 resection was evaluated as feasible before operation; (3) physical status was ECOG score 0 to 2, and was tolerant to operation. Patients with peritoneal implant metastasis and tumor invasion of other organs during operation, or changes in surgical methods for other reasons were excluded. All the operations were performed by the same surgical team, which had the experiences of more than 100 cases of laparoscopic and 100 cases of open radical gastrectomy with D2 lymph node dissection. The choice of surgical procedure was discussed by the surgeon and the patient, and decided according to the patient′s intension. Patients were divided into the laparoscopic group and open group according to the surgical method. Intraoperative and perioperative findings were compared between the two groups. The 3-year disease-free survival rate were analyzed with Kaplan-Meier survival curve and compared by using log-rank test. Results: A total of 37 consecutive patients were enrolled, including 21 in the laparoscopic group and 16 in the open group, and no one receiving laparoscopic procedure was converted to open surgery. The baseline data of two groups were comparable (all P>0.05). Compared with the open group, the laparoscopic group had significantly longer operation time [(264.0±35.1) minutes vs. (226.6±49.9) minutes, t=2.685, P=0.011], significantly less intraoperative blood loss [(65.7±37.4) ml vs. (182.2±94.6) ml, t=-4.658, P<0.001], significantly shorter time to postoperative flatus [(2.8±0.7) days vs. (4.1±0.7) days, t=-5.776, P<0.001] and significantly shorter postoperative hospital stay [(13.3±2.8) days vs. (16.6±4.3) days, t=-2.822, P=0.008]. Morbidity of postoperative complications, including anastomotic leakage, pancreatic fistula, abdominal abscess, intraperitoneal hemorrhage and duodenal stump leakage, in two groups was similar [19.0% (4/21) vs. 4/16, P=0.705]. There were no cases of anastomotic bleeding or stenosis. The 30-day postoperative mortality was 0 in the laparoscopic group and 1/16 in the open group, respectively (P=0.432). The 3-year disease-free survival rates were 38.1% and 37.5% in the laparoscopic and open group, respectively (P=0.751). Conclusion Laparoscopic total gastrectomy combined with distal pancreaticosplenectomy performed by experienced surgeons for T4b gastric cancer is safe and effective.

Prostate cancer (PCa) patients who progress to metastatic castration-resistant PCa (mCRPC) mostly have poor outcomes due to the lack of effective therapies. Our recent study established the orphan nuclear receptor ROR

Presacral recurrence, a special recurrence type in rectal cancer after surgical treatment, refers to recurrent cancer invading the presacral soft tissue or the bony structure of sacrum. It is also a major constituent of recurrent rectal cancer (15.63% to 41.67%). Reports show that presacral recurrence rate is about 2.8% to 4.8%, and it is associated with clinic staging, pathological type, surgical approach, (neo) adjuvant radiochemotherapy, tumor distance from the anus, positive circumferential margin, lymph node metastasis, and unilateral lateral lymph node dissection. CT and MRI are important for the detection of presacral recurrence. Presacral recurrence is always combined with local recurrence in other parts and distant organ metastasis. Therefore, we divide that into the following 3 types: 1) presacral recurrence with distant metastasis; 2) presacral recurrence with pelvic wall or lateral lymph node metastasis, or with recurrence of pelvic organs or anastomosis; and 3) simple presacral relapse. According to MDT evaluation. We adopt corresponding treatment scheme and surgical approach depending on the types mentioned above. When tumor recurred in the sacrum and located lower than S2/3 articular surface, then resection of recurrent tumor combined with sacrococcygeal should be the treatment of choice. For presacral recurrence with anterior invasion, combined total pelvic exenteration were available. For presacral recurrence with lateral pelvic wall invasion, internal iliac arteriovenous resection and lateral lymph node dissection and para-aortic lymph node dissection should be carried out. R0 resection may improve the 5-year overall survival rate of these patients.

Presacral recurrence, a special recurrence type in rectal cancer after surgical treatment, refers to recurrent cancer invading the presacral soft tissue or the bony structure of sacrum. It is also a major constituent of recurrent rectal cancer (15.63% to 41.67%). Reports show that presacral recurrence rate is about 2.8% to 4.8%, and it is associated with clinic staging, pathological type, surgical approach, (neo) adjuvant radiochemotherapy, tumor distance from the anus, positive circumferential margin, lymph node metastasis, and unilateral lateral lymph node dissection. CT and MRI are important for the detection of presacral recurrence. Presacral recurrence is always combined with local recurrence in other parts and distant organ metastasis. Therefore, we divide that into the following 3 types: 1) presacral recurrence with distant metastasis; 2) presacral recurrence with pelvic wall or lateral lymph node metastasis, or with recurrence of pelvic organs or anastomosis; and 3) simple presacral relapse. According to MDT evaluation. We adopt corresponding treatment scheme and surgical approach depending on the types mentioned above. When tumor recurred in the sacrum and located lower than S2/3 articular surface, then resection of recurrent tumor combined with sacrococcygeal should be the treatment of choice. For presacral recurrence with anterior invasion, combined total pelvic exenteration were available. For presacral recurrence with lateral pelvic wall invasion, internal iliac arteriovenous resection and lateral lymph node dissection and para-aortic lymph node dissection should be carried out. R0 resection may improve the 5-year overall survival rate of these patients.

According to multicenter randomized controlled trials, laparoscopic radical resection of colon cancer has the same short and long term clinical efficacy as traditional open surgery. In laparoscopic radical resection of right semicolon cancer, it is important to separate the embryonic plane of the root, and to ligate and cut off the central vascular roots. Only by separation along the membrane space can one achieve minimally invasive operation with no bleeding, and ensure the integrity of the excision of the mesangium and avoid damage of internal fascia and other organs. The mesangial distribution of the right semicolon is adjacent to the mesangium of the stomach and is connected to the mesentery of the small intestine. The pancreaticoduodenum locates between the right semicolon mesentery and the retroperitoneal subperitoneal fascia. In particular, the relationship between the anterior and posterior Treitz fascia of the pancreaticoduodenum and the Toldt space is complex, which is closely related to the feasibility of complete mesocolic excision(CME). This article introduces the distribution of intermembranous space and mesangial bed in the right semicolon, presenting the problem in CME surgery. In addition, there are key points in identifying the gap between the membranes based on the author’s experience and we propose a new evaluation criteria for membrane surgical specimens, which has certain guiding significance for radical CME surgery for right semicolon cancer.

According to multicenter randomized controlled trials, laparoscopic radical resection of colon cancer has the same short and long term clinical efficacy as traditional open surgery. In laparoscopic radical resection of right semicolon cancer, it is important to separate the embryonic plane of the root, and to ligate and cut off the central vascular roots. Only by separation along the membrane space can one achieve minimally invasive operation with no bleeding, and ensure the integrity of the excision of the mesangium and avoid damage of internal fascia and other organs. The mesangial distribution of the right semicolon is adjacent to the mesangium of the stomach and is connected to the mesentery of the small intestine. The pancreaticoduodenum locates between the right semicolon mesentery and the retroperitoneal subperitoneal fascia. In particular, the relationship between the anterior and posterior Treitz fascia of the pancreaticoduodenum and the Toldt space is complex, which is closely related to the feasibility of complete mesocolic excision(CME). This article introduces the distribution of intermembranous space and mesangial bed in the right semicolon, presenting the problem in CME surgery. In addition, there are key points in identifying the gap between the membranes based on the author’s experience and we propose a new evaluation criteria for membrane surgical specimens, which has certain guiding significance for radical CME surgery for right semicolon cancer.