Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.

Objective:To establish and assess the quality control and improvement system for metabolic and bariatric surgery in Beijing.Methods:Based on relevant documents from the National Health Commission and the Beijing Municipal Health Commission,and referencing the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) by the American Society for Metabolic and Bariatric Surgery,a quality control system was developed under the Beijing Quality Control and Improvement Center of Metabolic and Bariatric Surgery. The system incorporated on-site evaluations,data registration,and specialized training. From May to December 2023,on-site assessments were conducted at 21 hospitals in Beijing performing bariatric surgery,evaluating personnel qualifications,infrastructure,clinical workflows,and postoperative follow-up. A quality control database was created to collect real-time surgical data,and training was provided for data entry and professional skills. Assessment results were classified as excellent,qualified,or needing improvement,with rectification suggestions offered and follow-up visits conducted to track progress.Results:All 21 hospitals achieved a 100% compliance rate for surgical indications, 16 (76.2%) met standardized surgical operation criteria,and 14 (66.7%) had standardized postoperative management. However,only 5 (23.8%) achieved a 12-month postoperative follow-up rate of ≥60%,and 4 (19.1%) had established specialized databases. Key challenges included insufficient specialized staffing (19.1%), lack of multidisciplinary collaboration (47.6%), inadequate equipment (57.1%), and low follow-up rates (57.1%). The database collected data from over 2 000 patients across 111 fields. After rectification, specialized database coverage rose to 61.9% (13 hospitals). Multi-level training programs developed backbone physicians and specialized nurses,significantly addressing the shortage of specialized personnel.Conclusion:The quality control system established in this study,through the integration of on-site evaluation,data registration,and specialized training,effectively enhances the standardization of surgical practices and data management capabilities.

Objective:To unveil the dynamic molecular characteristics of colorectal cancer (CRC) progression, identify key molecules and signaling pathways driving disease development, and provide a theoretical basis for precision diagnosis and treatment.Methods:Differentially expressed genes (DEGs) were identified using DESeq2 based on the TCGA-CRC dataset (556 colorectal cancer samples) and three independent validation cohorts from the GEO database (GSE39582, GSE68468, GSE41258). Mfuzz time-series analysiswas applied to identify gene clusters with continuously upregulated expression during tumor progression. Functional enrichment analysis was performed using clusterProfiler, and protein-protein interaction (PPI) networks were constructed via the STRING online platform to pinpoint hub genes. Single-cell sequencing data (GSE132465/GSE144735) were integrated to resolve the cellular origins and intercellular communication of key genes. The prognostic value of genes was assessed using a univariate Cox proportional hazards model (likelihood ratio test), and single-cell sequencing data were analyzed using the Seurat pipeline with Wilcoxon rank-sum test to identify DEGs.Results:Time-series analysis identified Gene Cluster 4 (containing 186 genes) with a sustained upregulation trend across CRC stages from Ⅰ to Ⅳ. Functional enrichment revealed these genes were significantly involved in extracellular matrix (ECM) remodeling and pathways such as PI3K-Akt and MAPK signaling. PPI network analysis screened 10 hub genes ( COL10A1, THBS2, SPP1, etc.), whose high expression correlated significantly with poor patient prognosis. Single-cell sequencing demonstrated that these hub genes were predominantly expressed in fibroblast subpopulations, while SPP1 was enriched in macrophages. Cell-cell communication analysis confirmed that THBS2-CD47 and SPP1-CD44 were the primary pathways mediating fibroblast-immune/endothelial cell interactions. Conclusion:ECM-related genes are closely associated with the progression of CRC, in which the key molecules THBS2 and SPP1 may drive stromal-immune cell communication in the tumor microenvironment by mediating the THBS2-CD47 and SPP1-CD44 interaction pathways, thereby promoting the progression of CRC.

Surgical radical operation remains the cornerstone of colorectal cancer treatment, continuously evolving through technological advancements. Emerging innovative technologies, including neoadjuvant chemoradiotherapy with immunotherapy, robot-assisted surgery, and transanal total mesorectal excision, present promising treatment strategies. While these technological innovations bring benefits for patients, they simultaneously introduce potential challenges. This review summarizes the application of novel surgical technologies and therapeutic approaches in colorectal cancer management, synthesizing diagnostic and treatment methodologies for postoperative complications to inform standardized clinical practice.

In recent years, with continuous advancements in molecular biology and gene testing technologies, the diagnosis and treatment of colorectal cancer have been rapidly transitioning toward precision medicine. The application of molecular classification, target detection, and liquid biopsy technologies has driven ongoing updates to clinical guidelines. Multidisciplinary team colla-boration, innovations in precision surgical techniques, and the widespread adoption of neoadjuvant combination therapies have collectively promoted more individualized and scientific management of colorectal cancer. Looking ahead,the authors believe that as multi-omics biomarkers, organoid models, and artificial intelligence are increasingly integrated into clinical practice, precision diagnosis and treatment of colorectal cancer will deepen further, offering patients more efficient and personalized therapeutic options.

Objective:To analyze the clinical characteristics of locally advanced rectal cancer patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy combined with immunotherapy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 46 patients with locally advanced rectal cancer who were admitted to 6 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from June 2021 to November 2022 were collected. There were 29 males and 17 females, aged (61±4)years. Patients received neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitor therapy, and under-went radical total mesorectal excision during 6-12 weeks after radiotherapy. Observation indicators: (1) comparison of clinical characteristics between pCR and non-pCR patients;(2) postoperative complications and adverse reactions of pCR and non-pCR patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Comparison of clinical characteristics between pCR and non-pCR patients. Before neoadjuvant therapy, there were 14 cases aged ≥50 years and 6 cases aged <50 years in pCR patients, versus 25 cases and 1 case in non-pCR patients, showing a significant difference between the two groups ( P<0.05). After neoadjuvant therapy, cases in clinical stage T0, T1, T2, T3, T4 were 11, 1, 5, 3, 0 for pCR patients versus 7, 4, 2, 11, 2 for non-pCR patients, cases of tumor regression grade 1, 2, 3, 4 were 11, 8, 1, 0 for pCR patients versus 7, 14, 4, 1 for non-pCR patients, cases in low-risk, medium-risk, high-risk of neoadjuvant rectal scoring and grading were 20, 0, 0 for pCR patients versus 4, 18, 4 for non-pCR patients, respectively, showing significant differences in above indicators between the two groups ( Z=-2.256, -2.104, -5.458, P<0.05). (2) Postoperative complications and adverse reactions of pCR and non-pCR patients. Postoperative complications occurred in 2 cases of pCR patients and 5 cases of non-pCR patients, postoperative adverse reactions occurred in 11 cases of pCR patients and 10 cases of non-pCR patients, showing no significant difference between the two groups ( P>0.05). Conclusion:Compared with locally advanced rectal cancer patients aged ≥50 years, those aged <50 years have significant benefits from neoadjuvant chemoradiotherapy combined with immunotherapy. Clinical T staging and magnetic resonance imaging-detected tumor regression grade after neoadjuvant therapy have predictive value for patients with pCR .

Obesity,as a major global public health issue,has seen effective improvements in body weight and metabolic disorders through bariatric-metabolic surgeries such as Roux-en-Y gastric bypass(RYGB)and sleeve gastrectomy(SG).However,the management of postoperative complications remains a significant clinical challenge.Gastrointestinal leakage/fistula is one of the more severe complications,and current endoscopic treatment options include stent placement,double-pigtail stent internal drainage,over-the-scope clips,endoscopic suturing,tissue adhesive sealing,negative pressure drainage systems,and gastric wall incision.The combination with laparoscopic techniques can further enhance treatment efficacy.For SG-related torsion or stenosis,endoscopic balloon dilation is the first-line approach.In refractory cases,additional therapies such as endoscopic radial incision or modified gastric peroral endoscopic myotomy(G-POEM)may be required.G-POEM offers particular advantages in treating non-spiral stenosis but remains limited in practice due to technical complexity.Postoperative gastrointestinal bleeding requires stratified management:thermal coagulation or hemostatic clips can be used in acute bleeding;marginal ulcer bleeding at the gastrojejunostomy site after RYGB responds well to endoscopic treatment,while bleeding at the jejunojejunostomy site often requires enteroscopy or reoperation.Anatomical changes after RYGB increase the complexity of managing common bile duct stones.Among improved endoscopic retrograde cholangiopancreatography(ERCP)techniques,endoscopic ultrasound-guided transgastric ERCP has emerged as a minimally invasive and efficient option,though its long-term safety remains to be fully validated.For patients experiencing weight regain,endoscopic interventions include endoscopic sleeve gastroplasty and transoral outlet reduction(TORe),with TORe offering the dual benefits of narrowing the anastomosis and relieving dumping syndrome.The risk of gastroesophageal reflux disease increases after SG;balloon dilation can relieve reflux caused by anatomical stenosis,while emerging techniques such as anti-reflux mucosal resection and anti-reflux mucosal ablation are still under exploration.In refractory GERD cases,conversion to RYGB remains the mainstream solution.Overall,endoscopic techniques have significantly reduced reoperation rates through diverse strategies,but a balance must be maintained between procedural complexity and long-term efficacy.Future efforts should focus on device innovation,standardization of procedures,and multidisciplinary collaboration to improve the comprehensive management of complications following bariatric-metabolic surgery.

Surgical radical operation remains the cornerstone of colorectal cancer treatment, continuously evolving through technological advancements. Emerging innovative technologies, including neoadjuvant chemoradiotherapy with immunotherapy, robot-assisted surgery, and transanal total mesorectal excision, present promising treatment strategies. While these technological innovations bring benefits for patients, they simultaneously introduce potential challenges. This review summarizes the application of novel surgical technologies and therapeutic approaches in colorectal cancer management, synthesizing diagnostic and treatment methodologies for postoperative complications to inform standardized clinical practice.

In recent years, with continuous advancements in molecular biology and gene testing technologies, the diagnosis and treatment of colorectal cancer have been rapidly transitioning toward precision medicine. The application of molecular classification, target detection, and liquid biopsy technologies has driven ongoing updates to clinical guidelines. Multidisciplinary team colla-boration, innovations in precision surgical techniques, and the widespread adoption of neoadjuvant combination therapies have collectively promoted more individualized and scientific management of colorectal cancer. Looking ahead,the authors believe that as multi-omics biomarkers, organoid models, and artificial intelligence are increasingly integrated into clinical practice, precision diagnosis and treatment of colorectal cancer will deepen further, offering patients more efficient and personalized therapeutic options.

Objective:To analyze the clinical characteristics of locally advanced rectal cancer patients with pathological complete response (pCR) after neoadjuvant chemoradiotherapy combined with immunotherapy.Methods:The retrospective cohort study was conducted. The clinicopatholo-gical data of 46 patients with locally advanced rectal cancer who were admitted to 6 medical centers, including Beijing Friendship Hospital of Capital Medical University et al, from June 2021 to November 2022 were collected. There were 29 males and 17 females, aged (61±4)years. Patients received neoadjuvant chemoradiotherapy combined with immune checkpoint inhibitor therapy, and under-went radical total mesorectal excision during 6-12 weeks after radiotherapy. Observation indicators: (1) comparison of clinical characteristics between pCR and non-pCR patients;(2) postoperative complications and adverse reactions of pCR and non-pCR patients. Comparison of measurement data with normal distribution between groups was conducted using the t test. Comparison of measurement data with skewed distribution between groups was conducted using the Mann-Whitney U test. Comparison of count data between groups was conducted using the chi-square test or Fisher exact probability. Comparison of ordinal data between groups was conducted using the Mann-Whitney U test. Results:(1) Comparison of clinical characteristics between pCR and non-pCR patients. Before neoadjuvant therapy, there were 14 cases aged ≥50 years and 6 cases aged <50 years in pCR patients, versus 25 cases and 1 case in non-pCR patients, showing a significant difference between the two groups ( P<0.05). After neoadjuvant therapy, cases in clinical stage T0, T1, T2, T3, T4 were 11, 1, 5, 3, 0 for pCR patients versus 7, 4, 2, 11, 2 for non-pCR patients, cases of tumor regression grade 1, 2, 3, 4 were 11, 8, 1, 0 for pCR patients versus 7, 14, 4, 1 for non-pCR patients, cases in low-risk, medium-risk, high-risk of neoadjuvant rectal scoring and grading were 20, 0, 0 for pCR patients versus 4, 18, 4 for non-pCR patients, respectively, showing significant differences in above indicators between the two groups ( Z=-2.256, -2.104, -5.458, P<0.05). (2) Postoperative complications and adverse reactions of pCR and non-pCR patients. Postoperative complications occurred in 2 cases of pCR patients and 5 cases of non-pCR patients, postoperative adverse reactions occurred in 11 cases of pCR patients and 10 cases of non-pCR patients, showing no significant difference between the two groups ( P>0.05). Conclusion:Compared with locally advanced rectal cancer patients aged ≥50 years, those aged <50 years have significant benefits from neoadjuvant chemoradiotherapy combined with immunotherapy. Clinical T staging and magnetic resonance imaging-detected tumor regression grade after neoadjuvant therapy have predictive value for patients with pCR .