Humans ; Diagnosis, Differential ; Constriction, Pathologic/diagnosis* ; Bile Duct Neoplasms/diagnosis* ; Endoscopy, Digestive System

The postoperative 30-day mortality and morbidity of gastric cancer surgery has markedly improved over the past years due to minimally invasive techniques, perioperative rehabilitation programs and centralization of care. However, there is still need for improvement as postoperative complications may have a serious negative impact on the efficacy of surgical treatment of gastric cancer. High-quality clinical research is a very important tool to analyze treatment outcomes and evaluate new treatment strategies. The meticulous registration of gastric cancer patient data is the basis of high-quality surgical research. In the past 11 years, the Dutch upper gastrointestinal cancer audit (DUCA) database has vast experience in data registration and maintenance of patients with upper gastrointestinal cancer. The effective measures it has taken in data registration, data quality control, data application and use, and data security have maintained quality at a high level. These data has been used for medical care quality monitoring and scientific research leading to a positive impact on the postoperative short-term outcomes of patients with upper gastrointestinal cancer. The work of DUCA may be a good incentive for the setup of population-based databases and clinical research in other countries.
Humans ; Stomach Neoplasms/surgery* ; Digestive System Surgical Procedures ; Treatment Outcome ; Postoperative Complications

As the main cause of secondary operation and postoperative death, the incidence of intraperitoneal infectious complications varies significantly in different medical centers in China. Due to the lack of national data, it is not possible to assess and develop appropriate diagnosis and treatment strategies properly. To provide a high-quality data platform for complication registration and clinical research, a multicenter prospective database for the Prevalence of Abdominal Complications After GastroEnterological surgery was established. Based on the Hospital Information System (HIS)of 20 medical centers in China, the electronic case reporting form (e-CRF) listed on the website was used to collect medical information of patients undergoing gastric or colorectal cancer surgery. The data were verified by on-site auditing, and data cleaning was performed by R software. After the data cleaning, the data in the database was checked and evaluated by the principle investigators and data administrators. When all data queries and questions were corrected and answered, the database was locked to establish a multicenter prospective database for postoperative abdominal infectious complications (the PACAGE database). The PACAGE database has rich information resources and high data quality and is a good data platform for complication registration and clinical research.
Humans ; Prevalence ; Data Accuracy ; Postoperative Complications/etiology* ; Abdomen/surgery* ; Digestive System Surgical Procedures/adverse effects*

Understanding of a variety of membranous structures throughout the body,such as the fascia,the serous membrane,is of great importance to surgeons. This is especially valuable in abdominal surgery. With the rise of membrane theory in recent years,membrane anatomy has been widely recognized in the treatment of abdominal tumors,especially of gastrointestinal tumors. In clinical practice. The appropriate choice of intramembranous or extramembranous anatomy is appropriate to achieve precision surgery. Based on the current research results,this article described the application of membrane anatomy in the field of hepatobiliary surgery,pancreatic surgery,and splenic surgery,with the aim of blazed the path from modest beginnings.
Humans ; Mesentery/surgery* ; Digestive System Surgical Procedures ; Fascia/anatomy & histology*

Pancreatic surgery is the most complex type of abdominal surgery,with high technical requirements and long learning curve,and the quality of surgery is directly related to the prognosis of the patients. In recent years,more and more indicators have been used to evaluate the quality of pancreatic surgery,such as operation time,intraoperative blood loss,morbidity,mortality, prognosis and so on,and different evaluation systems have been established,including benchmarking,auditing,outcome evaluation based on risk factor adjustment and textbook outcomes. Among them,the benchmark is the most widely used to evaluate surgical quality and is expected to become the standard for comparison among peers. This article reviews existing quality evaluation indicators and benchmarks for pancreatic surgery and anticipates its future application prospects.
Humans ; Benchmarking ; Digestive System Surgical Procedures ; Outcome Assessment, Health Care ; Blood Loss, Surgical ; Risk Factors

Surgery is the primary treatment for esophageal cancer, but the postoperative complication rate remains high. Therefore, it is important to prevent and manage postoperative complications to improve prognosis. Common perioperative complications of esophageal cancer include anastomotic leakage, gastrointestinal tracheal fistula, chylothorax, and recurrent laryngeal nerve injury. Respiratory and circulatory system complications, such as pulmonary infection, are also quite common. These surgery-related complications are independent risk factors for cardiopulmonary complications. Complications, such as long-term anastomotic stenosis, gastroesophageal reflux, and malnutrition are also common after esophageal cancer surgery. By effectively reducing postoperative complications, the morbidity and mortality of patients can be reduced, and their quality of life can be improved.
Humans ; Quality of Life ; Postoperative Complications/prevention & control* ; Anastomotic Leak/etiology* ; Esophageal Neoplasms/surgery* ; Prognosis ; Esophagectomy/adverse effects* ; Digestive System Fistula/surgery* ; Retrospective Studies

ISR is the most widely used anal-preserving operation for ultra-low rectal cancer. It can be divided into total ISR, subtotal ISR and partial ISR according to the resection range of internal sphincter. The advantage of ISR is that it can preserve the sphincter while ensuring the safety of oncology for ultra-low rectal cancer, representing the state of the art. However, it still needs to face the problem that the quality of life will decline due to poor postoperative anal function. The conformal sphincter-preserving operation (CSPO) is a functional anal-preserving surgery improved on the basis of ISR. It is superior to ISR in the postoperative anal function and patients' quality of life. So it can be a new choice for ultra-low rectal cancer.
Humans ; Quality of Life ; Rectal Neoplasms/surgery* ; Anal Canal/surgery* ; Digestive System Surgical Procedures/methods* ; Anastomosis, Surgical ; Treatment Outcome

The theory of membrane anatomy has been widely used in the field of colorectal surgery. The key point to perform high quality total mesorectal excision (TME) and complete mesocolic excision (CME) is to identify the correct anatomical plane. Intraoperative identification of the various fasciae and fascial spaces is the key to accessing the correct surgical plane and surgical success. The landmark vessels refer to the small vessels that originate from the original peritoneum on the surface of the abdominal viscera during embryonic development and are produced by the fusion of the fascial space. From the point of view of embryonic development, the abdominopelvic fascial structure is a continuous unit, and the landmark vessels on its surface do not change morphologically with the fusion of fasciae and have a specific pattern. Drawing on previous literature and clinical surgical observations, we believe that tiny vessels could be used to identify various fused fasciae and anatomical planes. This is a specific example of membrane anatomical surgery.
Humans ; Mesentery/surgery* ; Colonic Neoplasms/surgery* ; Colorectal Surgery ; Digestive System Surgical Procedures ; Peritoneum/surgery* ; Rectal Neoplasms/surgery* ; Laparoscopy

Objective: To report the perioperative management and robot-assisted minimally invasive surgery results of one case with malignant tumor of anal canal combined with severe abdominal distention. Methods: A 66-year-old male suffer from adenocarcinoma of anal canal (T3N0M0) with megacolon, megabladder and scoliosis. The extreme distention of the colon and bladder result in severe abdominal distention. The left diaphragm moved up markedly and the heart was moved to the right side of the thoracic cavity. Moreover, there was also anal stenosis with incomplete intestinal obstruction. Preoperative preparation: fluid diet, intravenous nutrition and repeated enema to void feces and gas in the large intestine 1 week before operation. Foley catheter was placed three days before surgery and irrigated with saline. After relief of abdominal distention, robotic-assisted abdominoperineal resection+ subtotal colectomy+colostomy was performed. Results: Water intake within 6 hours post-operatively; ambulance on Day 1; anal passage of gas on Day 2; semi-fluid diet on Day 3; safely discharged on Day 6. Conclusion: Robotic-assisted minimally invasive surgery is safe and feasible for patients with malignant tumor of anal canal combined with severe abdominal distention after appropriate and effective preoperative preparation to relieve abdominal distention.
Male ; Humans ; Aged ; Anal Canal/surgery* ; Colon/surgery* ; Colectomy ; Anus Diseases/surgery* ; Adenocarcinoma/surgery* ; Digestive System Abnormalities/surgery*

Intersphincteric resection (ISR) is the ultimate sphincter-preserving surgical technique for low rectal cancer. Accurate preoperative diagnosis and staging, appropriate selection of surgical approaches and technique, standardized perioperative management, and postoperative rehabilitation are the keys to ensuring the oncological effect and functional preservation of ISR. To date, there is still a lack of standardized guidance on the clinical implementation of ISR in China. Therefore, based on the latest evidence from literature, expert experience, and the intervention situation in China, the Chinese Society of Colorectal Surgery, Chinese Society of Surgery, Chinese Medical Association organized domestic experts in colorectal surgery to discuss and produce "Chinese expert consensus on intersphincteric resection for low rectal cancer (2023 edition)". This consensus focuses on definition, classification, related pelvic anatomy, operational techniques, postoperative complications, and long-term oncological and functional outcomes, and aims to guide the standardized clinical practice of ISR in the operation of low rectal cancer in China.
Humans ; Laparoscopy/methods* ; Consensus ; Anal Canal/surgery* ; Digestive System Surgical Procedures/methods* ; Rectal Neoplasms/surgery* ; Treatment Outcome