Cancer-related sarcopenia is mainly characterized by protein degradation and muscle depletion caused by catabolism, leading to a decrease in the quality, strength, and function of skeletal muscles. Pancreatic cancer has the highest incidence of cancer-associated sarcopenia. More than 80% of pancreatic cancer patients have the Kirsten rat sarcoma viral oncogene homolog (KRAS) mutations, which promote the progress of sarcopenia. The authors systematically elaborate the interaction mechanism between KRAS-mutant pancreatic cancer and sarcopenia, mainly in four aspects: (1) KRAS driven metabolic reprogramming leads to depletion of muscle energy reserves, affecting the redistribution of muscle fiber energy and resulting in unidirectional energy flow for cancer cell proliferation. (2) By altering the cytokine profile, activating the ubiquitin protease system and the autophagy lysosome pathway, the cancer cells promote myotube degradation, inhibit muscle regeneration, disrupt muscle homeostasis, and lead to unidirectional flow of nutrients to support tumor growth. (3) Oxidative stress caused by cancer cells damages skeletal muscles. (4) Cancer cells induce immune cell remodeling in skeletal muscle. Meanwhile, the authors review the treatment progress of KRAS-mutant pancreatic cancer-related sarcopenia. With the deepening research of KRAS-mutant pancreatic cancer-related sarcopenia, targeted therapy and personalized intervention are expected to become important means to improve the prognosis and quality of life of patients.

Function-preserving gastrectomy has gained popularity in recent times for having less postoperative morbidity while able to maintain the oncological efficacy of conventional gastrec-tomies. Articles obtained from online databases through PubMed using keywords "function-preser-ving surgery" "pylorus-preserving surgery" "proximal gastrectomy" and "fluorescence-guided surgery". The evolution of gastrectomies was aimed to improve the patients′ overall outcome, including onco-logy, safety, quality of life, and functional performance. It was traditionally believed that extensive resection of tissues surrounding the primary tumour would give the best possible outcomes. However, with the help of technology today, more evidence has surfaced proving that it is no longer necessary. Oncological safety studies have shown that limited lymph node resection is adequate in early gastric cancer. Technology aid has come a long way to complement how to approach oncology surgery. Improved optics and display technology have increased the adoption of more minimally invasive surgery. Fluorescence-guided surgery has further complemented surgeons with real-time information for better on-table decisions. Clinical practice guidelines are now recommending function-preser-ving surgery as part of an accepted surgical option with detailed indications. A few ongoing studies further strengthen the evidence to suggest that functional-preserving surgery is a reliable choice to improve overall outcome for patient care in early gastric cancer.

Minimally invasive surgery represented by laparoscopy has been carried out for more than 30 years, and the technological development has tended to be flat. Currently, the techno-logy is still improving and innovating on the platform of laparoscopy, from traditional laparoscopy to reduced port and single port laparoscopy, from transabdominal to natural orifice transluminal tech-niques, from standard definition and high-definition to 3D and 4K ultra high definition fluorescence guided laparoscopy. The booming development of robotic surgery is also based on the platform of laparoscopy. From the perspective of disease treatment, there is no revolutionary change, such as changing the long-term efficacy of tumor treatment. In this era of technological prosperity but uncertainty, the future of minimally invasive surgery may not be a single technological innovation, but the organic integration and common development of multiple technologies. The authors will focus on the advantages and challenges of various minimally invasive technologies, and look forward to the application prospects of artificial intelligence in precision technology and decision-making in minimally invasive surgery, in order to open up new paths for the sustainable development of mini-mally invasive surgery, overcome current confusion, and move towards a more accurate, efficient, and popularized future.

Gallbladder cancer (GBC) is the most common malignancy of the biliary system in China, characterized by high malignancy, low surgical resection rate, high postoperative recurrence, and poor responsiveness to chemotherapy and radiotherapy. Improving the prognosis of GBC relies on early diagnosis, standardized surgical treatment, and effective comprehensive therapeutic strate-gies. Achieving these goals necessitates in-depth epidemiological studies of GBC, as well as the exploration of new mechanisms involving systemic regulatory factors and the tumor microenviron-ment in the initiation and progression of GBC. It will help address the clinical challenges associated with this malignancy that improving the scope of surgical radical resection and diagnosis and treatment process for GBC in each stage and strengthening basic and translational research related to GBC to uncover its underlying biological principles.

Patients with pancreatic surgery have a high incidence of preoperative malnutri-tion, large surgical trauma, and many postoperative complications. The practice of enhanced recovery after surgery is difficult. After nearly 20 years of development, the concept of enhanced recovery after surgery (ERAS) has formed mature guidelines and consensus in pancreatic surgery. However, its application is faced with problems such as large central differences, low level of evidence-based, and insufficient completion of rehabilitation processes. The growth of publications in journals on related topics has stagnated, and the research heat has a trend of ebbing. Based on the literature at home and abroad, the authors analyze the bottleneck of application of enhanced recovery after surgery in pancreatic cancer from the aspects of process management, pre-rehabilitation and nutrition management, and look forward to the future research direction.

As high-quality, evidence-based medical research continues to update, the diag-nosis and treatment of mid and low rectal cancer presents complex patterns, adapting to the require-ments of real-world study. In the process of building real-world database and data collection, the selection of database fields, the structured design of imaging reports, as well as quality control during and after data collection, will significantly impact the quality of real-world data and its generated evidence. The authors hope to provide references for subsequent real-world database construction through the experience of constructing a national multicenter database for mid and low rectal cancer.

Acute care surgery (ACS) is an emerging discipline integrating trauma, emergency, intensive care unit (ICU) and surgical rescue in the general surgery. ACS mainly diagnoses and treats critically ill patients with acute abdomen, trauma, and postoperative complications. ACS can solve the problem of insufficient emergency, trauma, and critical patient treatment capabilities caused by excessive differentiation in general surgery. After more than ten years of development, there are specialized academic organizations, specialized training programs, and specialized training materials for ACS. China has established the Chinese Society of Acute Care Surgery of Chinese Medical Doctor Association in 2023. The ACS department integrates the general surgery ward and ICU into one department for the treatment of critically ill patients, with specialized physicians possessing both surgical and intensive care capabilities. The operation mode of ACS can ensure the continuity and integrality of treatment for critically ill patients and improve the treatment results of the acute ill patients.

Objective:To investigate the influence of diabetes mellitus (DM) and high-sen-sitivity C-reactive protein (Hs-CRP) on the risk of digestive system malignancy.Methods:The pro-spective cohort study was conducted. The clinical data of 93 928 participants who participated health examination in 9 hospitals at Tangshan, including Kailuan General Hospital Affiliated to North China University of Science and Technology et al, in 2006 were selected. According to the presence or absence of DM and the level of Hs-CRP, all participants were divided into 4 groups, including the DM(-)CRP(-) group defined as absence of DM and Hs-CRP ≤3 mg/L, the DM(-)CRP(+) group defined as absence of DM and Hs-CRP>3 mg/L, the DM(+)CRP(-) group defined as presence of DM and Hs-CRP ≤3 mg/L, and the DM(+)CRP(+) group defined as presence of DM and Hs-CRP >3 mg/L. The data of participants were collected by a fixed team of physicians. The first physical examination in 2006 was taken as the starting point for follow-up. The end event of follow-up was defined as the occurrence of digestive system malignancy or death, and the follow-up was up to December 31, 2021. Observation indicators: (1) comparison of clinical data among the 4 groups of participants; (2) the incidence and cumulative incidence rate of digestive system malignancy in participants; (3) influence of DM and Hs-CRP level on the risk of digestive system malignancy; (4) the combined influence of DM and Hs-CRP level on the risk of digestive system malignancy; (5) sensitivity analysis. Comparison of measurement data with normal distribution among multiple groups was conducted using the one-way analysis of variance. For pairwise comparison, least significant difference test was used for homogeneity of variance, and Dunnett′s T3 test was used for heterogeneity of variance. Comparison of measurement data with skewed distribution among multiple groups was conducted using the Kruskal-Wallis rank sum test, and Dunn-Bonferroni test was used for pairwise comparison. Comparison of count data among multiple groups was conducted using the chi-square test, and Bonferroni test was used among multiple comparisons. The Kaplan-Meier method was used to plot cumulative incidence curve, and Log-rank test was used for cumulative incidence rate analysis. The Cox proportional risk model was used for multivariate analysis. All models were adjusted for relevant confounders. Results:(1) Comparison of clinical data among the 4 groups of participants. Of the 93 928 participants, there were 70 743 cases in the DM(-)CRP(-) group, 14 644 cases in the DM(-)CRP(+) group, 6 425 cases in the DM(+)CRP(-) group, and 2 116 cases in the DM(+)CRP(+) group. There were significant differences in gender, age, fasting blood glucose, Hs-CRP, triglyceride, alanine aminotransferase, body mass index, marrital status, smoking, drinking, high school degree or above, physical exercise, high salt diet, high fat diet, positive hepatitis B virus surface antigen, fatty liver, liver cirrhosis, gallstone, taking hypoglycemic drugs, taking lipid-lowering drugs among the 4 groups of participants ( P<0.05). (2) The incidence and cumulative incidence rate of digestive system malignancy in participants. At the end-up of follow-up, 2 008 cases developed digestive system malignancy in the 93 928 participants, including 717 cases of colorectal cancer, 456 cases of liver cancer, 396 cases of gastric cancer, 195 cases of esophageal cancer, 144 cases of pancreatic cancer, 65 cases of gallbladder cancer or extrahepatic cholangiocarcinoma, 35 cases of small bowel cancer. The cumulative incidence rates of digestive system malignancy were 2.19%, 2.42%, 2.86%, 3.59% in participants of the DM(-)CRP(-) group, DM(-)CRP(+) group, DM(+)CRP(-) group, DM(+)CRP(+) group, respectively, showing a significant difference among the 4 groups ( χ2=31.72, P<0.05). (3) Influence of DM and Hs-CRP level on the risk of digestive system malignancy. After adjusting for the confounding factors of the participants, results of multivariate analysis showed that DM and Hs-CRP >3 mg/L were independent influencing factors for the incidence of digestive system malignancy ( hazard ratio=1.32, 1.19, 95% confidence interval as 1.13-1.56, 1.06-1.33, P<0.05). Futher analysis showed that there was a significant difference in interaction between DM and Hs-CRP >3 mg/L ( P<0.05). (4) The combined influence of DM and Hs-CRP level on the risk of digestive system malign-ancy. After adjusting for confounding factors, results of multivariate analysis showed that using the DM(-)CRP(-) group as the control group, the risk of incidence of digestive system malignancy increased in the DM(-)CRP(+) group, DM(+)CRP(-) group, and DM(+)CRP(+) group, respectively ( hazard ratio=1.14, 1.23, 1.79, 95% confidence interval as 1.01-1.29, 1.02-1.48, 1.38-2.31, P<0.05). In the site-specific analysis of digestive system malignancy, using the DM(-)CRP(-) group as the control group, the risk of incidence of liver cancer increased in the DM(-)CRP(+) group ( hazard ratio=1.37, 95% confidence interval as 1.07-1.75, P<0.05), the risk of incidence of liver cancer and pancrea-tic cancer increased in the DM(+)CRP(-) group ( hazard ratio=1.60, 1.74, 95% confidence interval as 1.16-2.21, 1.00-3.02, P<0.05), the risk of incidence of small bowel cancer, pancreatic cancer and colorectal cancer increased in the DM(+)CRP(+) group ( hazard ratio=5.05, 2.31, 2.23, 95% confidence interval as 1.57-16.21, 1.00-5.31, 1.54-3.24, P<0.05). (5) Sensitivity analysis. After adjusting for confounding factors of excluding 3 types of participants (103 cases of digestive system malignancy within 1 year of follow-up, 2 370 cases of taking glucose-lowering drugs, and 915 cases of taking lipid-lowering drugs), results of multivariate analysis showed that using the DM(-)CRP(-) group as the control group, the risk of incidence of digestive system malignancy increased in the DM(+)CRP(-) group, and DM(+)CRP(+) group, respectively ( hazard ratioexcluding cases of digestive system malignancy within 1 year of follow-up=1.26, 1.66, 95% confidence interval as 1.04-1.52, 1.26-2.18, P<0.05; hazard ratioexcluding cases taking glucose-lowering drugs=1.23, 1.75, 95% confidence interval as 1.02-1.49, 1.31-2.33, P<0.05; hazard ratioexcluding cases taking lipid-lowering drugs=1.24, 1.80, 95% confidence interval as 1.03-1.49, 1.39-2.34, P<0.05). Conclusions:DM and Hs-CRP >3 mg/L are independent influencing factors for the incidence of digestive system malignancy. There is an interation and synergistic effect between DM and Hs-CRP to promote the incidence of digestive system malignancy.

Liver diseases, particularly cirrhosis and cancer, significantly threat human health for a long time, and their diagnosis and treatment are important topics in medical research. Tradi-tional diagnostic and therapeutic approaches have focused on biochemical properties of liver diseases, yet often neglecting the mechanical microenvironment of liver at molecular, cellular, and tissue levels. This oversight makes it difficult to meet clinical needs. Recent advancements in biomechanics and mechanobiology have underscored the importance of mechanical properties of liver in understanding disease mechanisms, presenting profound implications for both basic research and clinical practice. However, there is still a lack of in-depth exploration of the mechanical properties of liver in both basic research and clinical treatment, making it unclear of the specific mechanisms and application scenarios. The authors propose and introduce the emerging field of liver mechanomedicine, examine the biomechanical properties of liver and their alterations during disease progression, elucidate mechanobiological mechanisms of cellular mechanical responses and signal transduction, explore the application of mechanical characteristics in the diagnosis and treatment of liver diseases, aiming to provide a new perspective for basic research and clinical practice.

Gastric cancer(GC) ranks among the most prevalent cancers and is a leading cause of cancer-related mortality globally. Recently, artificial intelligence(AI) has enhanced the dia-gnosis and treatment of GC, as well as the accuracy and sensitivity of personalized treatment strategies due to its efficient computational and learning capabilities. The authors review the clinical applications of AI-based medical imaging and digital pathology in GC diagnosis and treatment, inclu-ding early screening and diagnosis, differential diagnosis, lymph node and peritoneal metastasis, molecular typing, monitoring of treatment efficacy, and prognostic assessment. In addition, future directions and challenges in the field are discussed, emphasizing the importance of integrating AI technology into clinical practice.