In the surgical oncology, the prognosis of patients is mainly dependent on the surgical radicality, with conventional R 0 resection long regarded as the cornerstone of gastric cancer. However, under the precision surgical era, technologies such as genomics, proteomics, and the application of big data and artificial intelligence (AI) have driven the transformation of gastric cancer treatment from the "experience-driven" to the "data-driven" model. This thus poses novel challenges to the conventional R 0 resection, which has prevailed for nearly five decades. The authors combine relevant clinical research to review and anticipate how the classic concept of R 0 resection can adapt to the latest research advancements in molecular pathological diagnosis, imaging analysis, AI-assisted decision-making, and perioperative comprehensive treatment under the AI empowered precision surgical era.

In the surgical oncology, the prognosis of patients is mainly dependent on the surgical radicality, with conventional R 0 resection long regarded as the cornerstone of gastric cancer. However, under the precision surgical era, technologies such as genomics, proteomics, and the application of big data and artificial intelligence (AI) have driven the transformation of gastric cancer treatment from the "experience-driven" to the "data-driven" model. This thus poses novel challenges to the conventional R 0 resection, which has prevailed for nearly five decades. The authors combine relevant clinical research to review and anticipate how the classic concept of R 0 resection can adapt to the latest research advancements in molecular pathological diagnosis, imaging analysis, AI-assisted decision-making, and perioperative comprehensive treatment under the AI empowered precision surgical era.

With the developing technique of the diagnosis and treatment of early gastric cancer, the quality of early gastric cancer diagnosis and treatment is coming into focus, and is crucial to improve the overall management of gastric cancer. It is necessary to establish a quality control system to ensure the quality of diagnosis and treatment for EGC. Based on the summary of the diagnosis and treatment status and technological progress of early gastric cancer, this paper proposes the quality control strategy, content and plan for the diagnosis and treatment process of EGC from the aspects of multidisciplinary diagnosis and treatment, clinical diagnosis technology, endoscopic and surgical treatment, pathological diagnosis and follow-up, with a view to expound the rationality, standardization and quality guarantee of the diagnosis and treatment process for early gastric cancer.

With the developing technique of the diagnosis and treatment of early gastric cancer, the quality of early gastric cancer diagnosis and treatment is coming into focus, and is crucial to improve the overall management of gastric cancer. It is necessary to establish a quality control system to ensure the quality of diagnosis and treatment for EGC. Based on the summary of the diagnosis and treatment status and technological progress of early gastric cancer, this paper proposes the quality control strategy, content and plan for the diagnosis and treatment process of EGC from the aspects of multidisciplinary diagnosis and treatment, clinical diagnosis technology, endoscopic and surgical treatment, pathological diagnosis and follow-up, with a view to expound the rationality, standardization and quality guarantee of the diagnosis and treatment process for early gastric cancer.

Objective:To investigate the application value of antegrade splenic superior region dissection first in laparoscopic total gastrectomy of obesity gastric cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 21 obesity patients with gastric cancer who underwent laparoscopic total gastrectomy in Renji Hospital of Shanghai Jiaotong University School of Medicine from July 2018 to October 2023 were collected. There were 16 males and 5 females, aged (58±13)years. All 21 patients underwent laparoscopic total gastrec-tomy with antegrade splenic superior region dissection first. Observation indicators: operation time, volume of intraoperative blood loss, laparotomy conversion, intraoperative splenic hemorrhage or gastric hemorrhage, lymph node dissection, time to postoperative first flatus, time to postoperative initial liquid food intake, duration of postoperative hospital stay, postoperative complication. Measure-ment data with normal distribution were represented as Mean± SD, and count data were expressed as absolute numbers. Results:All 21 patients underwent laparoscopic total gastrectomy success-fully, with the operation time of (283±47)minutes, time for splenogastric ligament and vascular manage-ment of (34±12)minutes, volume of intraoperative blood loss of (143±86)mL, and no laparotomy conversion. There was no intraoperative splenic hemorrhage or gastric haemorrhage. The total number of lymph node dissected in 21 patients was 375, with the number of lymph node dissected as (21±9)per case. Time to postoperative first flatus, time to postoperative initial liquid food intake and duration of postoperative hospital stay in 21 patients were (3.1±0.7)days, (4.0±0.8)days and (10.1±3.0)days, respectively. There were 2 patients with postoperative complications, including 1 case of incision infection and 1 case of lung infection. The 2 patients with postoperative com-plications were recovered and discharged after conservative treatment. There was no death during the postoperative 30 days.Conclusion:The application of antegrade splenic superior region dissec-tion first in laparoscopic total gastrectomy is safe and feasible, which can reduce surgical difficulty.

Due to its unique anatomical location, there are many unresolved issues in the diagnosis and treatment of esophagogastric junction (EGJ) cancer, which is not only a hot topic of concern in various related disciplines, but also a controversial topic among scholars in both the East and the West academia. The 15 th International Gastric Cancer Congress in 2023 focuses on EGJ cancer, organi-zing consensus voting among experts from various disciplines on surgery, digestive endoscopy, and oncology issues before the conference. Multiple sub venues are also set up to discuss related issues. Meanwhile, Japanese scholars have proposed that the lymph node dissection process for EGJ cancer, modified based on the lymph node dissection therapeutic value index, is expected to be updated in the new version of the Japanese gastric cancer treatment guideline. The perioperative treatment of EGJ cancer highlights the differences in concepts and measures between the East and the West academia. Asian scholars focus on neoadjuvant chemotherapy based on DOS treatment plan, while European and American scholars hope to find the best perioperative treatment plan from the neoadjuvant chemoradiotherapy of CROSS research. However, the new adjuvant therapy regimen with the addition of immune checkpoint inhibitors has only established advantages in tumor regression and decline, and has not yet shown significant benefits in long-term survival. It cannot be denied that the diagnosis and treatment of EGJ cancer are still constantly exploring and advancing. In the future, we look forward to more new evidence-based medicine to provide ideas and expand our horizons for minimally invasive, precise, individualized, and comprehensive clinical diagnosis and treatment. Based on our understanding and insights into the differences and controversies between Eastern and Western scholars in the background, concepts, technologies, and treatment plans of EGJ cancer, the authors elaborate and analyze the hot issues of EGJ cancer diagnosis and treatment, combined with the latest content of the 2023 IGCC and other international conferences, in order to bring more thinking and analysis to colleagues and better guide clinical work.

Due to its unique anatomical location, there are many unresolved issues in the diagnosis and treatment of esophagogastric junction (EGJ) cancer, which is not only a hot topic of concern in various related disciplines, but also a controversial topic among scholars in both the East and the West academia. The 15 th International Gastric Cancer Congress in 2023 focuses on EGJ cancer, organi-zing consensus voting among experts from various disciplines on surgery, digestive endoscopy, and oncology issues before the conference. Multiple sub venues are also set up to discuss related issues. Meanwhile, Japanese scholars have proposed that the lymph node dissection process for EGJ cancer, modified based on the lymph node dissection therapeutic value index, is expected to be updated in the new version of the Japanese gastric cancer treatment guideline. The perioperative treatment of EGJ cancer highlights the differences in concepts and measures between the East and the West academia. Asian scholars focus on neoadjuvant chemotherapy based on DOS treatment plan, while European and American scholars hope to find the best perioperative treatment plan from the neoadjuvant chemoradiotherapy of CROSS research. However, the new adjuvant therapy regimen with the addition of immune checkpoint inhibitors has only established advantages in tumor regression and decline, and has not yet shown significant benefits in long-term survival. It cannot be denied that the diagnosis and treatment of EGJ cancer are still constantly exploring and advancing. In the future, we look forward to more new evidence-based medicine to provide ideas and expand our horizons for minimally invasive, precise, individualized, and comprehensive clinical diagnosis and treatment. Based on our understanding and insights into the differences and controversies between Eastern and Western scholars in the background, concepts, technologies, and treatment plans of EGJ cancer, the authors elaborate and analyze the hot issues of EGJ cancer diagnosis and treatment, combined with the latest content of the 2023 IGCC and other international conferences, in order to bring more thinking and analysis to colleagues and better guide clinical work.

Peritoneal metastasis is one of the important causes of death in patients with gastrointestinal cancer and is also a difficult point in clinical diagnosis and treatment.How to predict the occurrence of peritoneal metastasis in patients with high-risk factors,advance the threshold of diagnosis and treatment before the occurrence of peritoneal metastasis,and improve the survival benefit of patients is an unsolved problem in clinical work.In the case of low positive rate of cytology and difficulty in diagnosing occult peritoneal metastasis,new molecular markers and detection techniques for early diagnosis of peritoneal metastasis need to be verified.Peritoneal lavage fluid has the characteristics of less leukocyte-derived cell-free DNA interference,higher concentration of circulating tumor DNA(ctDNA),and direct contact with the primary lesion or potential peritoneal metastasis at physical distance,making it a unique advantage in gastrointestinal cancer.At present,the detection methods of ctDNA in peritoneal lavage fluid include digital PCR,epigenetic-based analysis,and next-generation sequencing.With the iteration of technology,the application of next-generation sequencing and personalized panels to ctDNA detection has not only shown great potential in predicting postoperative peritoneal metastasis,but also promoted the idea of preventive escalation treatment of peritoneal metastasis.This article reviews the current application of ctDNA to peritoneal lavage fluid in predicting peritoneal metastasis of gastrointestinal cancer.

OBJECTIVE To explore the effects and potential mechanism of veratramine （VTM） on the proliferation of human glioblastoma U251 cells. METHODS The network pharmacology methods were adopted to screen the targets of ferroptosis related to the effects of VTM on glioblastoma， and to conduct gene ontology and Kyoto Encyclopedia of Genes and Genosomes enrichment analysis. Using U251 cells as the object， CCK-8 assay， the observation of cell morphological changes， DCFH-DA fluorescence probe method， FerroOrange fluorescence probe method and Western blot assay were used to validate the inhibitory effects of VTM on U251 cell proliferation and its possible mechanism. RESULTS Totally 462 targets of ferroptosis related to the effects of VTM on glioblastoma were screened out； they mainly enriched in biological processes such as oxidative stress and apoptosis， and cellular components such as cytoplasmic vesicles and mitochondrial membranes； they affected molecular functions such as iron ion （Fe2+） binding and DNA transcription processes， as well as iron death and phosphoinositide 3-kinase/protein kinase B signaling pathways. VTM with 40， 60， 80， 100， 120 and 140 μmol/L could significantly reduce the cell survival rate （P＜ 0.01）； VTM with 40， 80 and 120 μmol/L could cause cell atrophy and nuclear fragmentation， significantly inhibit the clone formation， increase the levels of intracellular reactive oxygen species （ROS） and Fe2+ levels， increase the expressions of nuclear factor-erythroid 2-related factor 2 （Nrf2） and heme oxygenase 1 （HO-1） protein to different extents， while down-regulate the expression of glutathione peroxidase 4 （GPX4） protein （P＜0.05 or P＜0.01）. CONCLUSIONS VTM can inhibit the proliferation of U251 cells， and promote the accumulation of intracellular ROS and Fe2+， thus inducing ferroptosis； its mechanism might be related to the regulation of the Nrf2/HO-1/GPX4 signaling pathway.

Objective:To investigate the short-term efficacy of laparoscopic total gastrec-tomy with hand-sewn esophagojejunostomy versus Roux-en-Y anastomosis.Methods:The propen-sity score matching and retrospective cohort study was conducted. The clinicopathological data of 159 patients who underwent laparoscopic total gastrectomy in Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine from October 2014 to July 2021 were collected. There were 107 males and 52 females, aged 63(range, 28?79)years. Of 159 patients, 71 cases undergoing totally laparoscopic total gastrectomy with hand-sewn esophagojejunostomy were allocated into totally laparoscopic group and 88 cases undergoing laparoscopic-assisted total gastrectomy with Roux-en-Y anastomosis were allocated into laparoscopic-assisted group, respectively. Observation indicators: (1) propensity score matching and comparison of general data of patients between the two groups after matching; (2) intraoperative and postoperative conditions; (3) perioperative complications. Propensity score matching was done by the 1:1 nearest neighbor matching method. Measurement data with normal distribution were expressed as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were expressed as M(range), and the Mann-Whitney U test was used for comparison between groups. Count data were expressed as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test or Fisher's exact probability method. The rank sum test was used for comparison of ordinal data. Results:(1) Propensity score matching and comparison of general data of patients between the two groups after matching. Of 159 patients, 112 cases were successfully matched, including 56 cases in the totally laparoscopic group and 56 cases in the laparoscopic-assisted group. Before propensity score matching, age, cases with tumor located in cardia or gastric body in the totally laparoscopic group were 61(range, 30?76)years, 26, 45, respectively. The above indicators in the laparoscopic-assisted group were 65(range, 28?79)years, 50, 38, respectively. There were significant differences in the above indicators between the two groups ( Z=?2.89, χ2=6.43, P<0.05). After propensity score matching, the males and females, age, body mass index, cases of American Society of Anesthesiologists classification Ⅰ, Ⅱ, Ⅲ and Ⅳ, tumor diameter, cases with tumor located in cardia or gastric body, cases in TNM stage Ⅰ, Ⅱ and Ⅲ of patients in the totally laparoscopic group were 40, 16, (62±9)years, (22.7±2.8)kg/m 2, 22, 26, 7, 1, 3.5(range, 0.6?17.0)cm, 24, 32, 22, 9, 25. The above indicators of patients in the laparoscopic-assisted group were 38, 18, (62±10)years, (22.7±3.2)kg/m 2, 19, 32, 5, 0, 4.0(range, 0.6?15.0)cm, 23, 33, 21, 7, 28, respectively. There was no significant difference in the above indicators between the two groups ( χ2=0.17, t=?0.09, ?0.04, Z=?0.12, ?0.82, χ2=0.04, Z=?0.42, P>0.05). The elimination of age and tumor location confounding bias ensured comparability between the two groups. (2) Intraoperative and postoperative conditions: after propensity score matching, the total operation time, time of esophagojejunostomy, postopera-tive 24-hour pain numerical score and time to first out-off bed activities were (310±49)minutes, (37±10)minutes, 2.3±0.8 and (2.4±0.7)days for patients in the totally laparoscopic group, versus (344±77)minutes, (44±12)minutes, 3.1±1.2 and (2.9±1.0)days in the laparoscopic-assisted group, showing significant differences between the two groups ( t=?2.85, ?3.05, ?4.20, ?3.10, P<0.05). (3) Perioperative complications: after propensity score matching, 6 cases of the patients in the totally laparoscopic group had Clavien-Dindo grade 2 or higher complications, including 2 cases of anas-tomotic leak, 1 case of anastomotic stenosis, 1 case of pleural effusion, 1 case of abdominal infection and 1 case of intestinal obstruction. The incidence of Clavien-Dindo grade 2 or higher complications was 10.7%(6/56). In the laparoscopic-assisted group, 5 patients had Clavien-Dindo grade 2 or higher complications, including 2 cases of anastomotic leak, 1 case of abdominal infection, 1 case of intestinal obstruction and 1 case of cholangitis. The incidence of Clavien-Dindo grade 2 or higher complications was 8.9%(5/56). There was no significant difference in the incidence of Clavien-Dindo grade 2 or higher complications between the two groups ( χ2=0.10, P>0.05). Patients with anas-tomotic leak were improved after puncture and drainage, secondary surgery and conservative treat-ment, and other complications were improved after symptomatic treatment. Conclusions:Com-pared with Roux-en-Y anastomosis in laparoscopic total gastrectomy, the time of hand-sewn esophagojejunostomy and esophago-jejunal anastomosis are shorter, patients have less postopera-tive pain and faster postoperative recovery. Both methods have good peri-operative safety.