With obesity rates climbing worldwide, metabolic and bariatric surgery has evolved over seven decades into a pivotal therapeutic approach for treating severe obesity and related disorders. Recent research highlights that new anti-diabetic and weight-loss drugs, especially GLP-1 receptor agonists (GLP-1 RA), are catalyzing a paradigm shift in obesity management. Within this context, the key scientific challenge in metabolic surgery is thoroughly investigating how pharmacological interventions and surgical procedures work together in weight management, especially evaluating if new drugs can match bariatric surgery's long-term effectiveness, complication management, and metabolic changes. Resolving this interdisciplinary debate will influence precision medicine in obesity treatment and reshape future multidisciplinary care models for metabolic disorders.

Objective:To evaluate safety and efficacy of B-type suture method ileostomy.Methods:Clinical data from 204 patients undergoing laparoscopic low anterior resection combined with protective ileostomy was analysed. Patients were divided into B-type suture ileostomy group ( n=67) and traditional ileostomy group ( n=137). Results:compared with traditional ileostomy group, B-type suture ileostomy group showed statistically significant differences in total operation time [(164±26) min vs. (172±24) min, t=2.229, P=0.027], ileostomy time [(12.7±2.3) min vs. (14.8±2.2) min, t=-6.565, P<0.001], blood loss [(57±20) ml vs. (69±31) ml, t=-2.797, P=0.006], postoperative hospital stay [(10.2±1.9) d vs. (11.8±2.3) d, t=-4.851, P<0.001], specimen incision infection rate (0 vs. 5.1%, P=0.047), postoperative body pain [82 (79-84) vs. 78 (76-80), Z=-5.805, P<0.001], and ileostomy incorporation time [(46±11) min vs. (51±12) min, t=-2.540, P=0.012]. Conclusion:B-type suture ileostomy for prophylactic ileostomy in laparoscopic low anterior resection for rectal cancer is safe and feasible.

Objective:To investigate whether glycated haemoglobin A1c (HbA1c) can be used as a predictor of mortality risk in patients with influenza pneumonia.Methods:This study was a single-center retrospective study, and enrolled patients with influenza pneumonia in the Emergency Department and in-patient departments of Beijing Chaoyang Hospital, Capital Medical University from 2017 to 2019. Gender, age, underlying diseases, influenza virus nucleic acid or antigen results, chest X-ray or chest CT reports, routine blood test, biochemical indicators, HbA1c and procalcitonin (PCT) were collected, and all subjects were divided into survival and death groups based on 28-day mortality. The differences between the two groups were compared and Cox regression was used to analyze risk factors for 28-day mortality.Results:In this study, 122 patients with influenza pneumonia were included, and 94 (77.0%) cases were divided into the survival group and 28 (23.0%) cases into the death group. Univariate analysis showed that lymphocyte counts [0.49 (0.33, 0.73) vs. 0.77 (0.49, 1.23) ×10 9/L, Z= -3.008, P=0.003] were lower and HbA1c levels [6.5 (6.1, 7.1) vs. 6.1 (5.7, 6.8) %, Z= 2.203, P= 0.028] and PCT levels [0.64 (0.20, 6.43) vs. 0.16 (0.05, 0.87) μg/L, Z=2.594, P=0.009] were higher in dead patients compared with those in the survivors. Cox multivariate regression and survival analysis found that after adjusting for age, lymphocyte counts ( HR=0.260, 95% CI: 0.087-0.773, P=0.015) and HbA1c levels ( HR=1.295, 95% CI:1.007-1.666, P=0.044) were independent risk factors for 28-day mortality. Conclusions:HbA1c is an independent risk factor for predicting 28-day mortality in patients with influenza pneumonia.

Objective:To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer.Methods:This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients.Results:(1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant ( P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ 2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups ( P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ 2 = 4.009, P = 0.044). Conclusion:In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications.

Objective:To investigate the short-term efficacy of robotic and laparoscopic surgery for treatment of mid-low rectal cancer.Methods:This was a retrospective cohort study of clinical data of patients with mid-low rectal cancer (caudad edge of tumor less than 10 cm from the anal verge) treated with laparoscopic or robotic radical surgery in the Northern Jiangsu People's Hospital Affiliated to Nanjing University from July 2019 to November 2021. Patients whose anus had not been completely preserved, with malignant obstruction or perforation, with poor anal function indicated by preoperative low anterior resection syndrome (LARS) scores, or with incomplete follow-up information were excluded. The inclusion criteria were met by 973 patients. After matching participants in a 1:2 propensity ratio with a caliper width of 0.02 standard deviations to reduce bias between patients caused by baseline imbalances, 175 patients were included in the robotic surgery group(RS) and 350 patients in the laparoscopic surgery group(LS). Baseline characteristics did not differ significantly between these two groups. The primary objectives were to compare oncological prognoses between the two groups, including disease-free survival (DFS), overall survival (OS), and anal function as assessed by the low anterior resection syndrome (LARS) scoring system, 6 months and 12 months postoperatively. Secondary outcomes included postoperative quality of life using the quality-of-life questionnaire C30 (QLQ-C30) and the QLQ-CR38 to establish a new scale, these being evaluated 6 and 12 months postoperatively. Higher functional module scores indicate better patient function, whereas lower symptom module scores indicate milder symptoms. Additionally, we compared the incidence of perioperative-related complications in the study patients.Results:(1) Oncological outcomes: The 2-year DFS and OS rates were 89.7% and 93.1%, respectively, for the robotic group and 86.0% and 91.7%, respectively, for the laparoscopic group. These differences are not statistically significant ( P=0.230 for DFS, P=0.570 for OS). (2) Anal function: Among patients who had not undergone ileostomy, anal function was better in the robotic than in the laparoscopic group 6 months postoperatively (severe LARS: 9.8% [14/143] vs. 19.2% [56/292], χ 2 = 6.712; P = 0.035). However, 12 months postoperatively, anal function did not differ significantly between the two groups. In patients with an ileostomy, anal function did not differ significantly between the two groups at 6 or 12 months postoperatively (both P > 0.05). (3) Postoperative quality-of-life: Compared with the laparoscopic group, the robotic group had better scores in the following aspects of quality of life: physical functioning (mean score 77.1±6.9 vs. 71.7±5.6, t =8.965, P=0.005), role in functioning (mean score 73.4±5.3 vs. 71.6±5.1, t = =3.851, P = 0.010), urinary tract complications (mean score 17.5±1.5 vs. 23.4±1.6, t = 41.40, P =0.001), and gastrointestinal symptoms (mean score 21.2±2.1 vs. 26.6±1.9, t = 29.40, P =0.001). These differences are all statistically significant (all P <0.05). By 12 months postoperatively, there were no statistically significant differences in functional or symptom modules of quality-of-life between the two groups (both P >0.05). (4) Perioperative complications: There was no statistically significant difference in intraoperative complications between the two groups ( P > 0.05). The incidence of postoperative urinary retention was significantly higher in the laparoscopic than the robotic group (5.0% [19/350] vs. 1.7% [3/175], χ 2 = 4.009, P = 0.044). Conclusion:In our study, robotic radical surgery for rectal cancer achieved short-term oncological outcomes similar to those achieved by laparoscopic radical surgery for rectal cancer. However, robotic radical surgery had advantages in terms of anal function and postoperative quality of life, while also reducing the incidence of perioperative urinary complications.

Objective:To investigate the risk factors for postsurgical gastroparesis syndrome (PGS) after laparoscopic complete mesocolic excision (CME) for right colon cancer.Methods:The clinical data of 358 patients who underwent laparoscopic CME for right colon cancer were retrospectively analyzed. Univariate and multivariate logistics regression were used to analyze the independent risk factors for PGS.Results:PGS occurred in 19 patients (4.8%). Logistic regression analysis showed that preoperative anxiety score (PAS-7)≥14 ( OR=6.450, P=0.039), preoperative serum albumin<35 g/L ( OR=9.302, P=0.011), colon cancer at hepatic flexura ( OR=9.782, P=0.007), No.206 group lymph node dissection ( OR=8.317, P=0.004), and intra-abdominal infection ( OR=5.755, P=0.043) were independent risk factors for PGS. Conclusion:Patient's preoperative health status, tumor location, scope of lymph node dissection and postoperative intra-abdominal infection are all risk factors related to PGS after CME for right colon cancer.

Objective:To evaluate the safety and feasibility of laparoscopic selective lateral lymph node dissection (LLND) for radical resection of rectal cancer.Methods:From Dec 2018 to Jul 2020, at the Department of Gastrointestinal Surgery of Northern Jiangsu People's Hospital laparoscopic radical resection of rectal cancer was performed in 32 cases and radical resection plus selective LLND in 26 cases.Results:The operation time in the LLND group was significantly longer than that in the simple radical resection group [247(179-405) min vs. 146(118-258) min, Z=-5.169, P<0.001], but there was no significant difference in intraoperative bleeding [68(45-500) ml vs. 56(25-500) ml, Z=-1.598, P=0.110], postoperative ventilation time [2.5(1-6) d vs. 3.0(1-6) d, Z=-0.120, P=0.905], postoperative hospital stay [9.0(7-17) d vs. 9.5(6-14) d, Z=-1.050, P=0.294] and hospitalization costs [(49 000±3 000) RMB vs. (48 000±3 000) RMB, t=-1.072, P=0.289] between the two groups. The incidence of postoperative complications in the two groups was 19% and 27% respectively (χ 2=0.551, P=0.458). The number of lateral lymph node dissection in LLND group was 8(6-16), 5 of 26 patients had lateral lymph node metastasis, with a metastasis rate of 19%. Conclusion:Laparoscopic radical resectim plus selective LLND for rectal cancer harvests more lateral lymph node metastasis without causing higher complications .

Objective:To compare laparoscopic-assisted distal gastrectomy (LADG) and laparoscopy-assisted pylorus-preserving gastrectomy (LAPPG) for early gastric cancer (EGC). Methods:Firty-two EGC patients from Sep 2018 to Aug 2020 in Northern Jiangsu People's Hospital were divided into LAPPG group ( n=21) and LADG group ( n=31). Results:The average operation time in the LAPPG and LADG groups was (173±30) min and (144±31)min, respectively ( t=3.34, P=0.002). The average levels of Hb and albumin (ALB) in the LAPPG group were (128.7±16.0) g/L and (41.2±4.8) g/L respectively 3 months after gastrectomy, ( t=2.482, P=0.016 and t=2.097, P=0.041) compared to LADG group at (118.2±14.1) g/L, (38.4±4.7) g/L. According to the Clavien-Dindo classification, the incidence of complications above grade Ⅱ was 19.0% in LAPPG group and 22.6% in LADG group, and the difference was not statistically significant ( χ2=0.007, P=0.934). The PGSAS-45 questionnaire scoring results show that LAPPG scores were lower in the dumping syndrome and life dissatisfaction subscales ( t=-2.706, P=0.008 and t=-2.893, P=0.004) Conclusion:LAPPG procedure for the treatment of EGC patients is safe and feasible, promoting early postoperative nutritional recovery. In adition to less dumping syndrome and better postoperative quality of life .

Objective:To explore the clinical value of laparoscopic abdominoperineal resection(LAPR) with pelvic peritoneum closure for patients with low rectal cancer.Methods:The clinicopathological data of 90 patients with low rectal cancer who underwent laparoscopic abdominoperineal resection from Mar 2014 to Jan 2019 at the Subei People's Hospital of Jiangsu Province were retrospectively analyzed. These patients were divided into closed pelvic floor peritoneum group (study group, n=42) and without pelvic floor peritoneum group (control group, n=48) . Results:The postoperative hospital stay of the study group was shorter than that of the control group[(10.8±3.0) d vs. (12.4±3.1) d, t=2.569, P=0.013]. There was no statistically significant difference in the operation time , intraoperative blood loss , time to first flatus ,first time of getting out of bed between the two groups. Perineal incision infection and perineal incision dehiscence occurred in 2 cases and 1 case in the study group, and 10 cases and 9 cases in the control group respectively (χ 2= 5.007, P=0.025; χ 2=6.077, P=0.033). In the study group, there were 0 cases of perineal hernia, 1 case of pelvic floor peritoneal hernia and 2 cases of adhesive intestinal obstruction, while those in the control group were 7 cases, 8 cases and 9 cases, respectively (χ 2=6.642, P=0.013; χ 2=5.079, P=0.033; χ 2=4.085, P=0.043). Conclusion:Laparoscopic abdominoperineal resection with pelvic peritoneum closure significantly reduces the incidence of postoperative perineal-related complications and shorten postoperative hospital stay.

Objective:Surgical site infection (SSI) can markedly prolong postoperative hospital stay, aggravate the burden on patients and society, even endanger the life of patients. This study aims to investigate the national incidence of SSI following abdominal surgery and to analyze the related risk factors in order to provide reference for the control and prevention of SSI following abdominal surgery.Methods:A multicenter cross-sectional study was conducted. Clinical data of all the adult patients undergoing abdominal surgery in 68 hospitals across the country from June 1 to 30, 2020 were collected, including demographic characteristics, clinical parameters during the perioperative period, and the results of microbial culture of infected incisions. The primary outcome was the incidence of SSI within postoperative 30 days, and the secondary outcomes were ICU stay, postoperative hospital stay, cost of hospitalization and the mortality within postoperative 30-day. Multivariable logistic regression was used to analyze risk factors of SSI after abdominal surgery.Results:A total of 5560 patients undergoing abdominal surgery were included, and 163 cases (2.9%) developed SSI after surgery, including 98 cases (60.1%) with organ/space infections, 19 cases (11.7%) with deep incisional infections, and 46 cases (28.2%) with superficial incisional infections. The results from microbial culture showed that Escherichia coli was the main pathogen of SSI. Multivariate analysis revealed hypertension (OR=1.792, 95% CI: 1.194-2.687, P=0.005), small intestine as surgical site (OR=6.911, 95% CI: 1.846-25.878, P=0.004), surgical duration (OR=1.002, 95% CI: 1.001-1.003, P<0.001), and surgical incision grade (contaminated incision: OR=3.212, 95% CI: 1.495-6.903, P=0.003; Infection incision: OR=11.562, 95%CI: 3.777-35.391, P<0.001) were risk factors for SSI, while laparoscopic or robotic surgery (OR=0.564, 95%CI: 0.376-0.846, P=0.006) and increased preoperative albumin level (OR=0.920, 95%CI: 0.888-0.952, P<0.001) were protective factors for SSI. In addition, as compared to non-SSI patients, the SSI patients had significantly higher rate of ICU stay [26.4% (43/163) vs. 9.5% (514/5397), χ 2=54.999, P<0.001] and mortality within postoperative 30-day [1.84% (3/163) vs.0.01% (5/5397), χ 2=33.642, P<0.001], longer ICU stay (median: 0 vs. 0, U=518 414, P<0.001), postoperative hospital stay (median: 17 days vs. 7 days, U=656 386, P<0.001), and total duration of hospitalization (median: 25 days vs. 12 days, U=648 129, P<0.001), and higher hospitalization costs (median: 71 000 yuan vs. 39 000 yuan, U=557 966, P<0.001). Conclusions:The incidence of SSI after abdominal surgery is 2.9%. In order to reduce the incidence of postoperative SSI, hypoproteinemia should be corrected before surgery, laparoscopic or robotic surgery should be selected when feasible, and the operating time should be minimized. More attentions should be paid and nursing should be strengthened for those patients with hypertension, small bowel surgery and seriously contaminated incision during the perioperative period.