Objective:To summarize preliminary experience and outcomes of transoral robotic surgery (TORS) in hypopharyngeal cancer.Methods:Clinical data of 28 patients with hypopharyngeal cancer underwent TORS with Da Vinci Si or Xi surgical system in three medical centers(Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University and Eye & ENT Hospital of Fudan University) in China from Sep 2017 to Mar 2024 were respectively analyzed. All patients were males, aged from 47 to 82(62.5±7.1) years old. According to TNM staging of AJCC, the stages included T1 in 6 cases, T2 in 17 cases, T3 in 3 cases and T4 in 2 cases; N0 in 18 cases, N1 in 3 cases, N2 in 6 cases, N3 in 1 case. SPSS version 26 was applied, and with Kaplan-Meier surviving curves, overall survival, local control rate and disease-free survival for those patients were calculated.Results:All 28 patients underwent successfully their TORS, no any case with transfer opening or positive surgical margin. Two patients died within one month after surgery. Two patients experienced minor oral bleeding, and subsenquently was cured. The follow-up period ranged from 1 to 81 months, with an average of 24.8 months, in which, five patients(17.9%) died, five patients(17.9%) experienced local recurrence and four patients(14.3%) had distant metastases. The three year overall survival, local control rate and disease-free survival were 77.1%, 74.6% and 57.1%, respectively.Conclusion:In properly selected cases of hypopharyngeal cancer, TORS can offer acceptable survival and local control rates, which can be considered as a new useful option for the surgery of hypopharyngeal cancer.

Objective:To compare the safety, number of lymph nodes removed, rate of lymph node metastasis, and prognosis between proximal gastrectomy (PG) and total gastrectomy (TG) in patients with Siewert types II and III adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, clinical data of patients diagnosed with adenocarcinoma of the esophagogastric junction at Changzhi People's Hospital, affiliated with Changzhi Medical College, between December 2019 and November 2022, were collected. Patients who had received neoadjuvant therapy, had multiple malignant lesions in the stomach, had concomitant malignancies in other organs, had incomplete clinical data, or had been lost to follow-up were excluded. The study cohort comprised 308 patients, 99 in the PG group and 209 in the TG group. To reduce confounding bias, propensity score matching was performed, matching patients for age, sex, body mass index, tumor diameter, and pathological stage in a 1:1 ratio, resulting in 73 patients in each group. The primary outcomes assessed were operative details, number of lymph nodes dissected, rate of lymph node metastasis, postoperative complications, duration of hospital stay, and follow-up and survival outcomes.Results:The PG group had a significantly shorter median operative time than did the TG group (250 vs. 280 minutes, Z = -4.970, P<0.001), with fewer cases of intraoperative blood loss >100 mL (30.1%[22/73] vs. 46.6%[34/73], χ2=4.171, P=0.041), and a smaller number of lymph nodes removed (median 33 vs. 46, Z =-4.774, P<0.001); all of these differences are statistically significant (all P<0.05). Differences between the two groups in postoperative hospital stay and postoperative complications were not statistically significant (both P>0.05). Furthermore, no statistically significant differences were found between the PG and TG groups in the number of lymph nodes dissected or the lymph node metastasis rates at stations No. 1, No. 2, No. 3, No. 4sa, No. 4sb, and No. 7 (all P> 0.05). Among the 209 patients in the TG group, analysis of risk factors for metastasis to distal perigastric lymph nodes (No.4d, No.5, and No.6) showed that patients with tumor diameters ≤4 cm and T1–T3 stage disease had significantly lower rates of metastasis to these lymph nodes than did patients with tumor diameters >4 cm and/or T4 stage disease (0/78 vs. 12/131 [9.2%]); these differences are statistically significant ( P=0.014). The median duration of follow-up for the entire cohort was 26 months. The 3-year overall survival rates for the PG and TG groups were 62.5% and 63.3%, respectively; this difference is not statistically significant (χ 2=0.330, P = 0.565). Multivariate analysis showed that older age ( P = 0.035) and advanced pathological stage ( P = 0.018) were significant independent risk factors that affected overall survival in patients with Siewert type II and III adenocarcinoma of the esophagogastric junction. Conclusions:PG is safe and feasible for patients with Siewert types II and III adenocarcinoma of the esophagogastric junction. The number of lymph nodes dissected and metastasis status were similar in the TG and PG groups.

Objective:To investigate the application value of optimized mesenteric defect closure technique in laparoscopic-assisted right hemicolectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 26 patients who underwent laparo-scopic-assisted right hemicolectomy at Changzhi People′s Hospital Affiliated to Changzhi Medical College from May 2023 to June 2024 were collected. There were 11 males and 15 females, aged (65.7±1.8)years. All patients received optimized mesenteric defect closure using a combined extra-corporeal-laparoscopic suturing technique. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. Results:(1) Surgical and intraoperative conditions. All 26 patients underwent laparoscopic-assisted right hemicolectomy with optimized mesenteric defect closure. The time of optimized mesenteric defect closure was 9.8(8.8,12.8)minutes, time of digestive tract reconstruction was 10.0(8.7,13.0)minutes, operation time was (164±4)minutes, volume of intraoperative blood loss was 50(50,100)mL. One of the 26 patients had intraoperative mesenteric hematoma, which required no specific intervention. The patient recovered uneventfully and was discharged from hospital. (2) Postoperative conditions. The visual analog scale pain score of 26 patients on postoperative day 1 and day 3 were 5(4,5) and 3(2,3), respectively. Time to postoperative first anal flatus and bowel movement were both 3(3, 4)days. Time to postoperative first intake of liquid diet was 2(2,3)days, duration of postoperative abdominal drainage was 4(3,5)days, and duration of postoperative hospital stay was 9(8,12)days. The number of lymph node dissected in 26 patients was 25(18,27) and the number of positive lymph node was 1(0,2). Cases in stage Ⅰ, stage Ⅱ and stage Ⅲ of tumor TNM staging were 5, 6, 15. (3) Follow-up. All 26 patients were followed up for 15(range, 6?20)months. Of the 26 patients, one case had incom-plete intestinal obstruction on postoperative day 25, which was diagnosed as adhesive intestinal obstruction based on imaging examination and classified as Clavien-Dindo grade Ⅱ. The patient recovered and was discharged after conservative treatment. None of the 26 patients had bleeding, infection of incision, anastomotic leakage, internal hernia, or delayed gastric emptying. There was no tumor recurrence, metastasis or death.Conclusion:The optimized mesenteric defect closure tech-nique in combined extracorporeal-laparoscopic suturing procedure can be used in laparoscopic-assisted right hemicolectomy.

Objective:To compare the safety, number of lymph nodes removed, rate of lymph node metastasis, and prognosis between proximal gastrectomy (PG) and total gastrectomy (TG) in patients with Siewert types II and III adenocarcinoma of the esophagogastric junction.Methods:In this retrospective cohort study, clinical data of patients diagnosed with adenocarcinoma of the esophagogastric junction at Changzhi People's Hospital, affiliated with Changzhi Medical College, between December 2019 and November 2022, were collected. Patients who had received neoadjuvant therapy, had multiple malignant lesions in the stomach, had concomitant malignancies in other organs, had incomplete clinical data, or had been lost to follow-up were excluded. The study cohort comprised 308 patients, 99 in the PG group and 209 in the TG group. To reduce confounding bias, propensity score matching was performed, matching patients for age, sex, body mass index, tumor diameter, and pathological stage in a 1:1 ratio, resulting in 73 patients in each group. The primary outcomes assessed were operative details, number of lymph nodes dissected, rate of lymph node metastasis, postoperative complications, duration of hospital stay, and follow-up and survival outcomes.Results:The PG group had a significantly shorter median operative time than did the TG group (250 vs. 280 minutes, Z = -4.970, P<0.001), with fewer cases of intraoperative blood loss >100 mL (30.1%[22/73] vs. 46.6%[34/73], χ2=4.171, P=0.041), and a smaller number of lymph nodes removed (median 33 vs. 46, Z =-4.774, P<0.001); all of these differences are statistically significant (all P<0.05). Differences between the two groups in postoperative hospital stay and postoperative complications were not statistically significant (both P>0.05). Furthermore, no statistically significant differences were found between the PG and TG groups in the number of lymph nodes dissected or the lymph node metastasis rates at stations No. 1, No. 2, No. 3, No. 4sa, No. 4sb, and No. 7 (all P> 0.05). Among the 209 patients in the TG group, analysis of risk factors for metastasis to distal perigastric lymph nodes (No.4d, No.5, and No.6) showed that patients with tumor diameters ≤4 cm and T1–T3 stage disease had significantly lower rates of metastasis to these lymph nodes than did patients with tumor diameters >4 cm and/or T4 stage disease (0/78 vs. 12/131 [9.2%]); these differences are statistically significant ( P=0.014). The median duration of follow-up for the entire cohort was 26 months. The 3-year overall survival rates for the PG and TG groups were 62.5% and 63.3%, respectively; this difference is not statistically significant (χ 2=0.330, P = 0.565). Multivariate analysis showed that older age ( P = 0.035) and advanced pathological stage ( P = 0.018) were significant independent risk factors that affected overall survival in patients with Siewert type II and III adenocarcinoma of the esophagogastric junction. Conclusions:PG is safe and feasible for patients with Siewert types II and III adenocarcinoma of the esophagogastric junction. The number of lymph nodes dissected and metastasis status were similar in the TG and PG groups.

Objective:To investigate the application value of optimized mesenteric defect closure technique in laparoscopic-assisted right hemicolectomy.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 26 patients who underwent laparo-scopic-assisted right hemicolectomy at Changzhi People′s Hospital Affiliated to Changzhi Medical College from May 2023 to June 2024 were collected. There were 11 males and 15 females, aged (65.7±1.8)years. All patients received optimized mesenteric defect closure using a combined extra-corporeal-laparoscopic suturing technique. Observation indicators: (1) surgical and intraoperative conditions; (2) postoperative conditions; (3) follow-up. Measurement data with normal distribution were represented as Mean± SD, and measurement data with skewed distribution were represented as M( Q1, Q3) or M(range). Count data were described as absolute numbers. Results:(1) Surgical and intraoperative conditions. All 26 patients underwent laparoscopic-assisted right hemicolectomy with optimized mesenteric defect closure. The time of optimized mesenteric defect closure was 9.8(8.8,12.8)minutes, time of digestive tract reconstruction was 10.0(8.7,13.0)minutes, operation time was (164±4)minutes, volume of intraoperative blood loss was 50(50,100)mL. One of the 26 patients had intraoperative mesenteric hematoma, which required no specific intervention. The patient recovered uneventfully and was discharged from hospital. (2) Postoperative conditions. The visual analog scale pain score of 26 patients on postoperative day 1 and day 3 were 5(4,5) and 3(2,3), respectively. Time to postoperative first anal flatus and bowel movement were both 3(3, 4)days. Time to postoperative first intake of liquid diet was 2(2,3)days, duration of postoperative abdominal drainage was 4(3,5)days, and duration of postoperative hospital stay was 9(8,12)days. The number of lymph node dissected in 26 patients was 25(18,27) and the number of positive lymph node was 1(0,2). Cases in stage Ⅰ, stage Ⅱ and stage Ⅲ of tumor TNM staging were 5, 6, 15. (3) Follow-up. All 26 patients were followed up for 15(range, 6?20)months. Of the 26 patients, one case had incom-plete intestinal obstruction on postoperative day 25, which was diagnosed as adhesive intestinal obstruction based on imaging examination and classified as Clavien-Dindo grade Ⅱ. The patient recovered and was discharged after conservative treatment. None of the 26 patients had bleeding, infection of incision, anastomotic leakage, internal hernia, or delayed gastric emptying. There was no tumor recurrence, metastasis or death.Conclusion:The optimized mesenteric defect closure tech-nique in combined extracorporeal-laparoscopic suturing procedure can be used in laparoscopic-assisted right hemicolectomy.

Objective:To summarize preliminary experience and outcomes of transoral robotic surgery (TORS) in hypopharyngeal cancer.Methods:Clinical data of 28 patients with hypopharyngeal cancer underwent TORS with Da Vinci Si or Xi surgical system in three medical centers(Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University and Eye & ENT Hospital of Fudan University) in China from Sep 2017 to Mar 2024 were respectively analyzed. All patients were males, aged from 47 to 82(62.5±7.1) years old. According to TNM staging of AJCC, the stages included T1 in 6 cases, T2 in 17 cases, T3 in 3 cases and T4 in 2 cases; N0 in 18 cases, N1 in 3 cases, N2 in 6 cases, N3 in 1 case. SPSS version 26 was applied, and with Kaplan-Meier surviving curves, overall survival, local control rate and disease-free survival for those patients were calculated.Results:All 28 patients underwent successfully their TORS, no any case with transfer opening or positive surgical margin. Two patients died within one month after surgery. Two patients experienced minor oral bleeding, and subsenquently was cured. The follow-up period ranged from 1 to 81 months, with an average of 24.8 months, in which, five patients(17.9%) died, five patients(17.9%) experienced local recurrence and four patients(14.3%) had distant metastases. The three year overall survival, local control rate and disease-free survival were 77.1%, 74.6% and 57.1%, respectively.Conclusion:In properly selected cases of hypopharyngeal cancer, TORS can offer acceptable survival and local control rates, which can be considered as a new useful option for the surgery of hypopharyngeal cancer.

【Objective】 To evaluate the safety and efficacy of modified ultrasound-guided needle-like visible nephroscope (Needle perc) holmium laser lithotripsy in the treatment of 1-2 cm calyceal calculi, and provide a reference for the selection of clinical treatment methods. 【Methods】 The clinical data of 60 patients with single intrarenal calyceal calculi (the largest diameter 1~2 cm) treated in our hospital during Jan.2022 and May 2023 were retrospectively analyzed.The patients were divided into ureteroscopic holmium laser lithotripsy group (flexible ureteroscope group) and Needle perc group, with 30 patients in either group.The clinical data of the two groups were compared. 【Results】 Compared with the flexible ureteroscope group, the Needle perc group had shorter overall hospitalization time [(3.00±1.25) d vs. (4.00±1.25) d], shorter operation time [(44.63±5.42) min vs. (48.50±7.24) min], lower hospitalization expenses [(15 518±441) yuan vs. (16 872±903) yuan], higher stone-clearance rate [93.3% (28/30) vs. 50.7% (15/30), P<0.001], less increase of procalcitonin after operation [(0.02±0.01) vs. (0.12±0.18), P=0.007], and lower incidence of complications [3.3% (1/30) vs. 26.7% (8/30), P=0.030]. 【Conclusion】 The modified ultrasound-guided Needle perc holmium laser lithotripsy is safe and effective in the treatment of 1-2 cm lower calyceal calculi, with high stone removal rate and low complication rate.

Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.

Objective:To investigate the application value of intrathoracic Kamikawa anas-tomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction.Methods:The retros-pective and descriptive method was conducted. The clinical data of 3 patients with adenocarcinoma of esophagogastric junction who were admitted to Changzhi People ′s Hospital Affiliated to Changzhi Medical College from April to June 2022 were collected. All patients were male, aged 69 years, 60 years and 66 years, respectively. Patients underwent total laparoscopic proximal gastrectomy and lower esophageal resection with intrathoracic Kamikawa anastomosis through the abdominal-left diaph-ragmatic approach.Results:(1) Operative and postoperative situations. All the 3 patients success-fully underwent total laparoscopic proximal stomach and lower esophagus resection with intra-thoracic Kamikawa anastomosis through the abdominal-left diaphragmatic approach. The operation time was 5.3 hours, 5.3 hours and 4.8 hours, respectively. The digestive tract reconstruction time was 68 minutes, 62 minutes and 55 minutes, respectively. The volume of intraoperative blood loss was 80 mL, 30 mL and 100 mL, respectively. The postoperative first flatus time of 3 patients was on the third day after operation, and the first defecation time was on the postoperative fourth, sixth and third day. All the 3 patients underwent upper gastrointestinal imaging on the postoperative third and seventh day, and no anastomotic leakage, anastomotic stenosis or contrast agent reflux occurred. The indwelling time of abdominal drainage tube was 6 days, 7 days and 6 days, respectively. The indwel-ling time of thoracic drainage tube was 3 days, 5 days and 4 days, respectively. The duration of post-operative hospital stay was 14 days, 14 days, and 16 days, respectively. (2) Postoperative complica-tions and pathological examination. Of the 3 patients, 1 patient had postoperative pleural effusion of Clavien-Dindo grade Ⅰ, and 1 patient had bilateral pleural effusion of Clavien-Dindo grade Ⅰ. The postoperative pathological examination of 3 patients showed high-moderately differentiated adeno-carcinoma, moderately differentiated adenocarcinoma and moderately differentiated adenocarcinoma, respectively. The tumor maximum diameter of 3 patients was 3.0 cm, 3.5 cm and 3.5 cm, respec-tively. The ratio of the number of lymph node metastasis to the number of lymph node dissection was 0/43, 1/34 and 6/44, respectively. Postoperative pathological staging showed stage T3N0M0, T3N1M0, T3N2M0, respectively. (3) Follow-up. There was no reflux of contrast agent or anastomotic stenosis in upper gastrointestinal imaging of the 3 positions at 3 and 12 months after operation. No reflux esophagitis of LA-B grade or above was found by electronic gastroscopy at 3 and 12 months after operation. Nutritional indicators and quality of life were good in 3 patients. No tumor recur-rence or metastasis was found in chest and abdominal computed tonography at 12 months after operation, and anti-reflux structure was found after reconstruction of digestive tract in thoracic cavity.Conclusion:Intrathoracic Kamikawa anastomosis after laparoscopic proximal stomach and lower esophagus resection through the abdominal-left diaphragmatic approach for adenocarcinoma of esophagogastric junction is safe and feasible, with excellent anti-reflux effect.

In recent years, the rising incidence of adenocarcinoma of esophagogastric junction (AEG) and the subsequent surge in early detections have transformed the surgical treatment of AEG into a topic of substantial interest. The anatomical positioning of AEG, combined with the unique nature of its tumor biology, which encompasses two distinct surgical domains, the thoracic and abdominal cavities, has sparked numerous debates regarding the selection of treatment strategies. The comprehensiveness of lymph node dissection and the safety of digestive tract reconstruction are instrumental in shaping these strategies. The laparoscopic abdominal transhiatal (TH) approach offers a balance of addressing both these conside-rations. It ensures the oncological safety of inferior mediastinal lymph node dissection, while simultaneously performing abdominal lymph node dissection. This approach becomes a prime choice for AEG when the esophageal invasion length is ≤ 4 cm.When implementing the TH approach, surgeons have the ability to either augment the inferior mediastinal space or establish a direct connection between the abdomen and the left thoracic cavity by performing a strategic opening of the left diaphragm. Such a maneuver circumvents the need for traditional thoracotomy, thus enlarging the operating space and enhancing the surgical field of view. This method reduces chest trauma and enables a clearer and more comprehensive removal of inferior mediastinal lymph nodes. Moreover, ample operating space and sufficient esophageal dissection make high digestive tract reconstruction in the mediastinum or left thoracic cavity safer and more feasible. Our center has dubbed this approach the abdominal-left diaphragmatic (ALD) approach. Functional digestive tract reconstructions such as side overlap esophagogastrostomy （SOFY） anastomosis and double-flap technique can be progressively applied to a higher anastomosis plane through the ALD approach. Consequently, the ALD approach expands the indications for digestive tract reconstruction, ensures operational safety, and maintains an effective anti-reflux effect simultaneously.