Gastric cancer is a high-incidence malignancy that poses a serious threat to public health in China, ranking among the top three cancers in both incidence and mortality. The majority of patients are diagnosed at an advanced stage, resulting in limited treatment options and poor prognosis. To address key challenges in gastric cancer diagnosis and treatment, a research team led by Professor Jiafu Ji at Peking University Cancer Hospital has focused on the project "Development and Dissemination of Precision Medicine Approaches in Gastric Cancer Management". Through a series of high-quality multicenter clinical studies, the team established a set of new international standards in perioperative treatment, individua-lized drug selection, intelligent noninvasive diagnostics, and novel immunotherapy strategies. These advances have significantly improved treatment efficacy and reduced surgical trauma, achieving key technological breakthroughs in diagnosis, therapy, and mechanistic understanding, and systematically enhancing outcomes for gastric cancer patients. The project ' s findings had a broad international impact, including hosting China ' s first International Gastric Cancer Congress. Through nationwide dissemination, they have promoted the development of precision diagnosis and treatment of gastric cancer as a discipline, and led the formulation of the National Health Commission's guidelines for gastric cancer diagnosis and treatment. In recognition of its achievements, the project was awarded the First Prize of the 2024 Chinese Medical Science and Technology Award.
Stomach Neoplasms/genetics* ; Humans ; Precision Medicine/methods* ; China ; Immunotherapy/methods*

OBJECTIVE: To compare the clinical efficacy of acupuncture with Neiguan (PC6)-to-Waiguan (TE5) and esmolol on hemodynamics during anesthesia induction and postoperative nausea and vomiting. METHODS: A total of 100 patients undergoing elective laparoscopic hernia repair or gynecological surgery under general anesthesia were randomly divided into an acupuncture group (50 cases, 3 cases were eliminated) and an esmolol group (50 cases, 2 cases were eliminated). In the acupuncture group, before anesthesia induction, patients were applied to acupuncture with Neiguan (PC6)-to-Waiguan (TE5), and the needles were retained for 15 min on the right side and 30 min on the left side. Patients in the esmolol group were intravenously injected with 20 mg esmolol hydrochloride injection 5 min before anesthesia induction. The systolic blood pressure (SBP) and heart rate (HR) of the two groups were recorded at 5 min after entering the operating room (T₀), before anesthesia induction (T₁), after anesthesia induction (T₂), before tracheal intubation (T₃) and 1 min after tracheal intubation (T₄). The visual analogue scale (VAS) scores of pain and the incidence of nausea and vomiting in the two groups were observed at the time of entering postanesthesia care unit (PACU) (T₅), leaving PACU (T₆), 6 h after operation (T₇) and 24 h after operation (T₈). The dosage of anesthesia-related drugs in the two groups was counted. RESULTS: The SBP and HR of the two groups at T₂, T₃ and T₄ were lower than those at T₁ (P<0.05). SBP and HR at T₃ in the acupuncture group were higher than those in the esmolol group (P<0.05). Compared with the esmolol group, in the acupuncture group, the VAS scores of pain at T₆ and T₇ were decreased (P<0.05), the incidence of nausea and vomiting at T₇ and T₈ and the nausea and vomiting visual analogue scale (NVAS) scores were decreased (P<0.05). Compared with the esmolol group, the dosage of propofol in the acupuncture group was decreased (P<0.05). CONCLUSION Acupuncture with Neiguan (PC6)-to-Waiguan (TE5) can relieve hemodynamic fluctuations during anesthesia induction, reduce postoperative pain and nausea and vomiting, and reduce the dosage of propofol. The curative effect is better than that of esmolol.
Humans ; Female ; Adult ; Middle Aged ; Acupuncture Points ; Male ; Hemodynamics ; Propanolamines/administration & dosage* ; Postoperative Nausea and Vomiting/drug therapy* ; Young Adult ; Heart Rate ; Aged ; Blood Pressure ; Acupuncture Therapy

BACKGROUND: Neoadjuvant therapy enhances the possibility of achieving radical resection and improves the prognosis for locally advanced gastric cancer (GC). However, there is a lack of evidence regarding the optimal extent of resection for locally advanced proximal GC after neoadjuvant therapy. METHODS: In this study, 330 patients underwent resection in Peking University Cancer Hospital, with curative intent after neoadjuvant therapy for histologically confirmed proximal GC from January 2009 to December 2022. RESULTS: In this study, 45 patients underwent proximal gastrectomy (PG), while 285 underwent total gastrectomy (TG). After propensity-score matching, 110 patients (71 TG and 39 PG) were included in the analysis. No significant differences between PG and TG regarding short-term outcomes and long-term prognosis were found. Specifically, PG demonstrated comparable overall survival to TG ( P = 0.47). Subgroup analysis revealed that although not statistically significant, PG showed a potential advantage over TG in overall survival for patients with tumor-long diameters less than 4 cm ( P  = 0.31). However, for those with a long diameter larger than 4 cm, TG had a better survival probability ( P  = 0.81). No substantial differences were observed in baseline characteristics, surgical safety, postoperative recovery, and postoperative complications. CONCLUSION For locally advanced proximal GC with objective response to neoadjuvant therapy (long diameter <4 cm), PG is an alternative surgical procedure.
Humans ; Stomach Neoplasms/drug therapy* ; Gastrectomy/methods* ; Neoadjuvant Therapy/methods* ; Male ; Female ; Middle Aged ; Propensity Score ; Aged ; Adult ; Retrospective Studies

Objective:To evaluate the effect of Bu-Zhong-Yi-Qi-Tang (BZYQT) combined with low molecular weight heparin (LMWH) on lower limb deep vein thrombosis (DVT) after fracture fixation in aged rabbits.Methods:Thirty-two elderly New Zealand rabbits of either sex, aged 36 months, weighing 3.5-4.0 kg, were divided into 4 groups ( n=8 each) using the random number table method: control group (C group), fracture fixation group (F group), low molecular weight heparin group (L group) and BZYQT combined with LMWH group (BL group). A model of fixation surgery for right femoral shaft fracture was established in anesthetized rabbits in F, L and BL groups. Starting from postoperative day 1, BL group received BZYQT at 3.6 ml/kg via gavage, F and L groups received normal saline at 3.6 ml/kg via gavage, L and BL groups received subcutaneous injection of LMWH at 200 IU/kg, and all the administrations were performed daily at 08: 00 for 7 consecutive days. On postoperative day 7, ultrasound examination was performed to assess lower limb DVT. Blood samples were collected from the marginal ear vein for determination of the serum concentrations of cortisol (COR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and endothelin-1 (ET-1) by enzyme-linked immunosorbent assay. Femoral vein specimens were obtained under anesthesia for microscopic examination of the pathological changes of the femoral vein lumen and endothelial tissues (by HE staining) and of the morphology of vascular endothelial cells (by the transmission electron microscopy). Results:Compared with C group, the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly increased in F, L and BL groups, and the incidence of lower limb DVT within 7 days after surgery was significantly increased in F and L groups ( P<0.05). Compared with F group, the incidence of lower limb DVT within 7 days after surgery was significantly decreased in L and BL groups, and the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly decreased ( P<0.05), and the pathological damage was significantly reduced in BL group. Compared with L group, the incidence of lower limb DVT and concentration of IL-6 were significantly decreased ( P<0.05), and pathological damage was significantly alleviated in BL group. Conclusions:BZYQT combined with LMWH can prevent the occurrence of lower limb DVT after fracture fixation in aged rabbits.

Objective:To evaluate the effect of Bu-Zhong-Yi-Qi-Tang (BZYQT) combined with low molecular weight heparin (LMWH) on lower limb deep vein thrombosis (DVT) after fracture fixation in aged rabbits.Methods:Thirty-two elderly New Zealand rabbits of either sex, aged 36 months, weighing 3.5-4.0 kg, were divided into 4 groups ( n=8 each) using the random number table method: control group (C group), fracture fixation group (F group), low molecular weight heparin group (L group) and BZYQT combined with LMWH group (BL group). A model of fixation surgery for right femoral shaft fracture was established in anesthetized rabbits in F, L and BL groups. Starting from postoperative day 1, BL group received BZYQT at 3.6 ml/kg via gavage, F and L groups received normal saline at 3.6 ml/kg via gavage, L and BL groups received subcutaneous injection of LMWH at 200 IU/kg, and all the administrations were performed daily at 08: 00 for 7 consecutive days. On postoperative day 7, ultrasound examination was performed to assess lower limb DVT. Blood samples were collected from the marginal ear vein for determination of the serum concentrations of cortisol (COR), tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6) and endothelin-1 (ET-1) by enzyme-linked immunosorbent assay. Femoral vein specimens were obtained under anesthesia for microscopic examination of the pathological changes of the femoral vein lumen and endothelial tissues (by HE staining) and of the morphology of vascular endothelial cells (by the transmission electron microscopy). Results:Compared with C group, the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly increased in F, L and BL groups, and the incidence of lower limb DVT within 7 days after surgery was significantly increased in F and L groups ( P<0.05). Compared with F group, the incidence of lower limb DVT within 7 days after surgery was significantly decreased in L and BL groups, and the concentrations of serum COR, TNF-α, IL-6 and ET-1 were significantly decreased ( P<0.05), and the pathological damage was significantly reduced in BL group. Compared with L group, the incidence of lower limb DVT and concentration of IL-6 were significantly decreased ( P<0.05), and pathological damage was significantly alleviated in BL group. Conclusions:BZYQT combined with LMWH can prevent the occurrence of lower limb DVT after fracture fixation in aged rabbits.

Objective:This study aims to analyze the economic impact of postoperative complications after colorectal cancer surgery.Methods:A retrospective cohort study was conducted. Patients with a preoperative pathological diagnosis of colorectal cancer who met surgical indications and underwent surgical treatment were included, while those with incomplete hospitalization cost data were excluded. From March 2017 to March 2022, three hundred and ninety-two colorectal cancer patients treated at Peking University Cancer Hospital and Institute Gastrointestinal Cancer Center I, were enrolled. Descriptive statistics were performed on the incidence of complications, hospitalization costs, and postoperative length of stay. A cohort was established based on the presence of postoperative complications (POC) and absence of postoperative complications (non-POC) to study economic differences. Propensity score matching analysis was employed to reduce potential confounding factors.Results:Among 392 colorectal cancer patients, 90 (23.0%) developed POC (POC group), while 302 were in the non-POC group. Significant statistical differences were found between the two groups in terms of operation duration, extent of resection, and stoma creation (all P < 0.05); other baseline indicators showed no significant differences (all P>0.05). The median hospitalization cost for patients with postoperative anastomotic leakage was 115 973 yuan, an increase of 38 941 yuan (50.5%) over the non-POC group's 77 059 yuan; the median hospitalization cost for patients with mechanical obstruction was 111 477 yuan, an increase of 34 418 yuan (44.7%) over the non-POC group; and the median hospitalization cost for patients with wound infection was 95 860 yuan, an increase of 18 801 yuan (24.4%) over the non-POC group. The median postoperative length of stay for patients with anastomotic leakage, mechanical obstruction, and wound infection was 22.0 days, 22.0 days, and 18.5 days, respectively, compared to 9.0 days in the non-POC group, extending by 13.0 days, 13.0 days, and 9.5 days. After propensity score matching, each group had 68 patients, and there were no statistically significant differences in preoperative and intraoperative observations between the two groups (all P>0.05); compared to the non-POC group, the hospitali- zation costs in the POC group significantly increased (89 165 yuan vs. 75 437 yuan, P<0.001), and the postoperative length of stay also significantly extended (14.0 days vs. 8.0 days, P<0.001). Conclusions:The occurrence of POC after colorectal cancer surgery significantly increases hospitalization costs and length of stay. This study provides specific and accurate reference data for subsequent health economic decision-making. This is the first detailed economic impact analysis of postoperative complications of colorectal cancer with a large sample size, which includes an economic impact analysis for each POC and subgroup.

In recent years, along with the rapid progress of innovative drugs, novel devices, frontier technologies, and artificial intelligence, the therapeutic model for tumors has undergone tremendous changes, with a greater emphasis on precise diagnosis and treatment of clinical issues. Nevertheless, in clinical practice, numerous problems still impede the implementation of precise treatment. This article intends to be guided by the crucial clinical issues in the diagnosis, surgery, and drug treatment of gastric cancer, to explore the strategies of precise diagnosis and treatment for gastric cancer and the frontier research directions, thereby providing new concepts and potential research directions for further enhancing the precision, efficacy of gastric cancer diagnosis and treatment, and the quality of life of patients.

Objective:To investigate the clinical efficacy and prognostic factors of neoadju-vant chemotherapy (NACT) and radical resection on adenocarcinoma of esophagogastric junction (AEG) and gastric adenocarcinoma (GC).Methods:The propensity score matching and retrospec-tive cohort study was conducted. The clinicopathological data of 263 patients with AEG and GC who were admitted to Peking University Cancer Hospital from March 2017 to March 2022 were collected. There were 204 males and 59 females, aged (60±10)years. Of the 263 patients, 81 cases with AEG were set as the AEG group, and 182 cases with GC were set as the GC group. Observation indicators: (1) propensity score matching and comparison of clinicopathological characteristics of patients between the two groups after matching; (2) evaluation of the efficacy of NACT and pathological conditions; (3) intraoperative and postoperative conditions; (4) follow-up; (5) analysis of factors affecting prognosis of patients. Comparison of measurement data with normal distribution between groups was conducted using the independent sample t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney rank sum test. Comparison of count data between groups was conducted using the chi-square test. Comparison of ordinal data between groups was conducted using the nonparametric rank sum test. The Cox proportional hazard model was used for univariate and multivariate analyses. The Kaplan-Meier method was used to calculate survival rate and draw survival curve. The Log-rank test was used for survival analysis. Propensity score matching was done by the 1:1 nearest neighbor matching method with a caliper value of 0.02. Results:(1) Propensity score matching and comparison of clinicopathological charac-teristics of patients between the two groups after matching. Of 263 patients, 156 cases were succe-ssfully matched, including 78 cases in the AEG group and 78 cases in the GC group. After propensity score matching, the elimination of age and degree of tumor differentiation confounding bias ensured comparability between the two groups. (2) Evaluation of the efficacy of NACT and pathological condi-tions. After propensity score matching, cases with pathological complete response were 2 in the AEG group, versus 9 in the GC group, showing a significant difference between the two groups ( χ2=4.793, P<0.05). (3) Intraoperative and postoperative conditions. After propensity score matching, the operation time of AEG group was 225(200,283)minutes. The resection range (whole stomach, distal stomach, proximal stomach) were 68, 0, 10, respectively. The digestive tract reconstruction methods (Roux-en-Y, Billroth Ⅰ/Ⅱ/Uncut Roux-en-Y, esophageal residual gastric, double channel) were 68, 0, 5, 5, respectively. Duration of postoperative hospital stay was 12(10,16)days. Total hospi-talization expense was (114 400±4 828)yuan. The above indicators of the GC group were 200(174,234)minutes, 22, 55, 1, 21, 56, 0, 1, 10(9,11)days, (98 790±2 549)yuan, respectively. There were significant differences in the above indicators between the two groups ( Z=-3.813, χ2=85.875, 88.487, Z=-4.060, t=2.524, P<0.05). Cases of complication and cases of serious complication were 32 and 9 in the AEG group, versus 22 and 5 in the GC group, showing no significant difference between the two groups ( χ2=2.832, 1.256, P>0.05). (4) Follow-up. All 156 patients after propensity score matching were followed up after surgery, with a follow-up time of 51(range, 3-84)months. Number of death in the AEG group and GC group were 26 and 25 during the follow-up. The postoperative 3-, 5-year overall survival rate were 70.4%, 58.3% in patients of the AEG group, versus 75.7%, 62.6% in patients of the GC group, showing no significant difference in overall survival between the two groups ( χ2=0.141, P>0.05). (5) Analysis of factors affecting prognosis of patients. Results of multivariate analysis showed that NACT, average tumor diameter after NACT, vascular tumor emboli were independent factors affecting prognosis of patients with AEG and GC after NACT and radical resection before propensity score matching ( hazard ratio=1.864, 1.807, 4.551, 95% confidence interval as 1.137-3.056, 1.124-2.903, 2.709-7.645, P<0.05). Conclusions:Compared with patients of GC, patients of AEG have a lower proportion of pathological complete response after NACT, but there is no signifi-cant difference in the incidence of complication and survival of patients with AEG and GC after NACT and radical resection. NACT, average tumor diameter after NACT, vascular tumor emboli are indepen-dent factors affecting prognosis of patients with AEG and GC after NACT and radical resection.

In the era of intelligence and individualization, gastric cancer surgery is under-going multidimensional advancements. The authors focus on the cutting-edge progress and future challenges of artificial intelligence (AI) in the diagnosis and decision-making, treatment and drug development, as well as postoperative rehabilitation in gastric cancer surgery. In terms of diagnosis, AI integrates imaging, liquid biopsy, pathology, and multimodal technologies to enhance diagnostic comprehensiveness and accuracy. Regarding decision-making, AI assists in formulating personalized treatment plans, conducting risk assessments, and predicting prognoses. In the treatment domain, AI facilitates the advancement of individualized surgical approaches, supports postoperative follow-up, and aids in physician education and training. In drug development, the introduction of virtual cell models and AlphaFold has improved the efficiency and accuracy of mechanistic and clinical research. For postoperative rehabilitation guidance, AI provides personalized recommendations to optimize treatment outcomes.AI holds great promise in gastric cancer surgery across diagnosis and decision-making, treatment and drug development, and postoperative rehabilitation. However, current AI technologies face challenges such as data sharing and privacy protection, multicenter research and model generalization, human-machine collaboration, interpretability, ethical considerations, sustaina-bility, and widespread adoption. Addressing these challenges will require collective efforts to fully leverage AI′s advantages in gastric cancer diagnosis and treatment.

On the occasion of the 110th Anniversary of the establishment of the Chinese Medical Association, the third conference of the Fourth Editorial Board of Chinese Journal of Digestive Surgery, and the Second Elite Group of Chinese Journal of Digestive Surgery, was successfully held in Kunming on July 4, 2025. This conference systematically summarizes the development experience of the journal over the past 20 years from three aspects: the role of ecological construction of thought in the discipline construction of digestive surgery, the display of the latest academic achievements in the field of digestive surgery, the development difficulties, and breakthrough paths of the discipline, and strategically plans the path of discipline construction in the new era.