Abstract:Intrathyroid thymic carcinoma(ITTC)is an extremely rare malignant tumor arising from ectopic thymic tissue within the thyroid,with histological features resembling thymic epithelial tumors.It predominantly affects middle-aged and elderly individuals and typically presents as a painless cervical mass.Imaging lacks specificity,and ITTC is often misdiagnosed as primary thyroid squamous cell carcinoma or anaplastic carcinoma.Definitive diagnosis relies on pathology and immunophenotyping;positivity for CD5,CD1 17,and p63/p40,along with negativity for thyroglobulin(Tg)and thyroid transcription factor-1(TTF-1),provides critical diagnostic value.The Ki-67 index,combined with the extent of necrosis and mitotic activity,can be used for risk assessment.Surgical resection with RO margins remains the cornerstone of treatment,with routine central lymph node dissection recommended,while lateral neck dissection is reserved for cases with confirmed metastasis or high-risk factors.Postoperative radiotherapy may improve local control in high-risk patients.In recurrent or progressive cases,programmed death-1(PD-1)/programmed death-ligand 1(PD-L1)inhibitors have shown potential efficacy in patients with high expression,and targeted therapies are under investigation.Overall,the precise management of ITTC requires integration of morphology,immunohistochemistry,and molecular data,with individualized treatment planning formulated by a multidisciplinary team(MDT).Future multicenter prospective studies are needed to clarify the optimal indications for radiotherapy,immunotherapy,and targeted therapy,and to validate the clinical value of molecular subtyping and dynamic monitoring.

Abstract:Objective To investigate the clinicopathological features,therapeutic strategies,and prognostic factors of anaplastic thyroid carcinoma(ATC).Methods A retrospective analysis was conducted on 64 patients with pathologically confirmed ATC treated at The First Affiliated Hospital of Zhengzhou University between January 2012 and January 2025.Clinical data included age,sex,symptoms,laboratory tests,tumor characteristics,metastasis,immunohistochemical markers,and treatment modalities.Survival was estimated by the Kaplan-Meier method,group differences were compared using the log-rank test,and independent prognostic factors were identified by the Cox proportional hazards regression model.Results A total of 64 patients were enrolled,including 23 males(35.9％)and 41 females(64.1％),with a median age of 69 years and a median survival of 6.0 months.The 6-month,1-year,and 2-year survival rates were 45.4％,26.2％,and 18.7％,respectively.Univariate analysis showed that age ≥60 years,white blood cell count ≥10×109/L,maximum tumor diameter ≥6 cm,extrathyroidal invasion,cervical and lateral neck lymph node metastasis,distant metastasis,advanced tumor stage,surgical treatment,radiotherapy,chemotherapy,and multimodal therapy were significantly associated with prognosis(P＜0.05).Multivariate analysis revealed that age ≥60 years(HR=2.724,95％CI:1.155-6.425,P=0.022),lateral neck lymph node metastasis(HR=3.630,95％CI:1.619-8.136,P=0.002),and distant metastasis(HR=3.902,95％CI:1.969-7.732,P＜0.001)were independent risk factors.Radiotherapy(HR=0.307,95％CI:0.134-0.703,P=0.005),chemotherapy(HR=0.435,95％CI:0.214-0.887,P=0.022),and aggressive multimodal therapy(HR=0.240,95％CI:0.120-0.481,P＜0.001)were independent protective factors.Conclusion ATC carries an extremely poor prognosis.Age ≥60 years,lateral neck lymph node metastasis,and distant metastasis are independent adverse prognostic factors.Multidisciplinary multimodal treatment,particularly regimens including radiotherapy and chemotherapy,can significantly improve prognosis and provide important guidance for clinical decision-making.

Abstract:Oncocytic carcinoma of the thyroid(OCA)is a rare malignant tumor arising from thyroid follicular cells,characterized by cytoplasm enriched with abundant eosinophilic granules.It exhibits highly aggressive behavior and a high risk of recurrence,posing major challenges in clinical management.Research has demonstrated that mitochondrial DNA mutations and alterations in the MAPK pathway(RAS/RAF/MEK/ERK)are critically involved in tumorigenesis,while activation of the PI3K/AKT/mTOR pathway contributes to invasiveness and therapeutic resistance.Diagnosis primarily relies on fine-needle aspiration(FNA),but the heterogeneity of Hürthle cells limits its accuracy.The integration of molecular marker detection and imaging modalities can improve diagnostic reliability.Surgical resection remains the cornerstone of treatment,with total thyroidectomy recommended in cases of large tumors or lymph node metastasis.The efficacy of radioactive iodine(RAI)therapy is limited due to poor iodine uptake.In recent years,multikinase inhibitors(MKIs)and immune checkpoint inhibitors have shown therapeutic potential in advanced or recurrent cases.Prognosis is closely correlated with tumor size,lymph node involvement,and vascular invasion,necessitating long-term surveillance with serum thyroglobulin measurement and imaging follow-up.Multidisciplinary team(MDT)management plays an essential role in optimizing individualized treatment strategies.Overall,diagnostic and therapeutic approaches for OCA are advancing toward precision and integration,with molecular studies and emerging targeted therapies offering new opportunities to improve survival and quality of life.

Abstract:Metastatic thyroid tumor(MTT)refers to a secondary thyroid malignancy originating from other organ cancers through hematogenous spread,lymphatic dissemination,or direct invasion.Common primary tumors include renal cell carcinoma,lung cancer,breast cancer,gastrointestinal malignancies,and melanoma.Clinical manifestations of MTT lack specificity,often mimicking primary thyroid carcinoma,with presentations such as thyroid nodules or cervical masses.Hematogenous spread is the most frequent metastatic route,followed by lymphatic spread and direct invasion.At the molecular level,alterations such as BRAF,KRAS,and EML4-ALK mutations and signaling pathway abnormalities are implicated.Diagnosis relies on imaging,fine-needle aspiration(FNA),and immunohistochemical markers.Thyroglobulin(Tg),thyroid transcription factor-1(TTF-1),carbonic anhydrase Ⅸ(CAⅨ),Napsin A,PAX8,GATA3,and S-100 are valuable in differentiating primary from metastatic tumors.Treatment strategies depend on the type of primary tumor and the extent of metastasis.Surgery can improve local control and relieve compressive symptoms,while resection of isolated metastases combined with treatment of the primary lesion may prolong survival.Systemic therapies include chemotherapy,radiotherapy,targeted therapy,and immunotherapy,with some patients benefiting from molecularly guided regimens.Prognosis varies substantially with the primary tumor:patients with renal cell carcinoma have relatively better survival,whereas those with lung cancer,gastrointestinal malignancies,or melanoma exhibit poorer outcomes.Overall,the management of MTT requires a multidisciplinary approach integrating pathology and molecular testing to achieve individualized therapy and improved patient survival.

Abstract:Objective To investigate the incidence and influencing factors of exocrine pancreatic insufficiency(PEI)during the perioperative period in patients undergoing pancreaticoduodenectomy(PD).Methods A prospective study was conducted,enrolling 266 patients who underwent PD at the Pancreas Center of the First Affiliated Hospital with Nanjing Medical University between August 2023 and November 2024.Fecal elastase-1(FE-1)levels were measured preoperatively and one month postoperatively,with PEI defined as FE-1＜200 μg/g.Based on the patient's pathological type,postoperative complications,and nutritional indicators,risk factors for PEI were analyzed using univariate and multivariate logistic regression.Results(1)Preoperative PEI(n=177):The incidence was 32.2％(57/177),highest in pancreatic head carcinoma patients(45.2％,42/93).Multivariate logistic regression analysis indicated that preoperative diabetes mellitus(OR=1 1.49,95％CI 2.36-67.45,P=0.004),pancreatic head carcinoma(OR=3.16,95％CI 1.28-8.26,P=0.015),tumor volume ≥6 cm3(OR=2.99,95％CI 1.23-7.57,P=0.017),male gender(OR=3.05,95％CI 1.20-8.25,P=0.022),preoperative main pancreatic duct diameter ≥6 mm(OR=2.86,95％CI 1.11-7.60,P=0.031),and preoperative BMI＜24(OR=2.96,95％CI 1.17-8.07,P=0.027)were independent risk factors for preoperative PEI in PD patients.(2)Postoperative PEI(n=208):The incidence increased to 85.5％(178/208),reaching 93％(93/100)in pancreatic head carcinoma patients.Multivariate logistic regression analysis indicated that preoperative FE-1≥500 μg/g(OR=4.03,95％CI 1.23-15.80,P=0.028)and postoperative pancreatic fistula(OR=0.24,95％CI 0.07-0.73,P=0.015)reduced the risk of postoperative PEI.(3)Perioperative changes:FE-1 levels,body weight,BMI,total cholesterol,albumin,serum calcium,serum magnesium,hemoglobin,25-hydroxyvitamin D,and vitamin B12 all decreased significantly postoperatively compared with preoperative levels(P＜0.05).Conclusion The incidence of PEI increased after PD compared to preoperatively.Diabetes mellitus,main pancreatic duct dilation,larger tumor size,lower preoperative BMI,pancreatic head carcinoma,and male sex are high-risk factors for preoperative PEI;whereas patients with lower preoperative FE-1 levels and those without postoperative pancreatic fistula should also be monitored for postoperative PEI,pancreatic enzyme replacement therapy should be initiated when necessary.The comprehensive deterioration of nutritional indicators in PD patients postoperatively indicates the need for early intensified nutritional therapy.

Abstract:Objective To explore the predictive value and diagnostic efficacy of clinical characteristics,hematological indicators and composite indicators for anastomotic leakage(AL)after laparoscopic anterior resection of the rectum in patients with colorectal cancer,and construct an early diagnosis model.Methods The clinical data of 1195 rectal cancer patients who underwent laparoscopic anterior rectal resection at the Department of Gastric and Colorectal Surgery,General Surgery Center of the First Hospital of Jilin University between January 2019 and June 2024 were retrospective analyzed,with 839 cases in the training group and 356 cases in the validation group.Clinical characteristic indicators of patients and hematological parameters before and 1-3 days after surgery were collected.Patients were divided into the AL group and the non-AL group based on the occurrence of AL.3 machine learning algorithms were employed to screen for differential characteristic indicators,and a multivariate Logistic regression was used to construct an early diagnosis model of AL,with the model effect verified in the validation group.Results A total of 83 of 1195 patients were diagnosed with AL,accounting for 7.0％.3 machine learning algorithms identified 8 differential indicators(WBC,CAR on the second day after surgery and WBC,PNI,NLR,dNLR,WLR,CAR on the third day after surgery).The model constructed by multivariate Logistic regression was composed of WBC,WLR and CAR on the third day after surgery,with P values of 0.008,0.004 and＜0.0001,respectively,and OR values of 1.2(95％CI 1.08-1.35),1.05(95％CI 1.01-1.08)and 1.61(95％CI 1.39-1.87),respectively.In the training group,the area under the ROC curve of the model was 0.851(95％CI 0.786-0.916),with a sensitivity of 75.9％and a specificity of 86.9％.In the validation group,the area under the ROC curve could also reach 0.808(95％CI 0.719-0.900),with a sensitivity of 86.2％and a specificity of 67.3％.Conclusion WBC,WLR and CAR on the third day after surgery are independent risk factors for AL after laparoscopic anterior resection of the rectum.The Logistic regression model constructed by these indicators can be used for early and accurate diagnosis of AL,providing a clinical basis for early intervention in AL patients.

Abstract:Objective To evaluate the safety and anal efficacy of total laparoscopic ultra-low sphincter preservation using partial resection of partial dentate line and full-thickness anal canal after rectal eversion.Methods A retrospective analysis was conducted on clinical data from patients with low rectal cancer(≤1 cm from the dentate line)who underwent the described procedure by the same surgical team at the Colorectal Surgery Department of the Cancer Hospital,Chinese Academy of Medical Sciences,between April 2021 and July 2023.Partial resection of the dentate line and the entire layer of the anal canal under the eversion field of view was adopted.Data including Intraoperative data and perioperative complications was collected,and anal function(LARS and Wexner scores)were recorded to evaluate anal function.Results 16 patients included in the study received operation successfully,with no conversions to open surgery.The median tumor distance from the anal verge was 3.0(2.0-3.5)cm.The mean operative time was(179.5±94.9)min,with a median blood loss of 33(10-100)mL.The anastomosis was 2.5(1.0-3.0)cm from the anal verge,and all surgical margins were negative.Two perioperative complications occurred:one case of postoperative hematochezia on day 9 requiring emergency interventional hemostasis,and one case of perianal abscess managed conservatively.The median time to stoma reversal was 7.5(3-13)months.With a median follow-up of 24 months,no local recurrence was observed.The mean LARS score at 2 years after stoma reversal was 13.5±4.2,and the mean Wexner score was 4.2±1.9,indicating good anal function.Conclusion Total laparoscopic ultra-low anterior resection with partial dentate line and full-thickness anal canal resection under everted vision is a feasible option for sphincter preservation in patients with extremely low rectal cancer,demonstrating favorable oncological outcomes and anal function.However,further studies are needed to evaluate its long-term efficacy and advantages over traditional techniques.

Abstract:Biliary tract cancers(BTC)constitute a highly heterogeneous group of malignancies within the digestive system,characterized by marked biological aggressiveness.Pre-operative treatment can downstage tumors and enhance resectability,whereas post-operative therapy aims to eradicate occult micrometastases and delay relapse.Gemcitabine-based chemotherapy remains the therapeutic backbone,yet recent trials evaluating multimodal regimens combining cytotoxic agents with immune-checkpoint inhibitors or tyrosine-kinase inhibitors in neoadjuvant,conversion,and adjuvant settings have shown encouraging improvements in R0 resection rates and survival outcomes.Future studies should standardize peri-operative immuno-combination protocols and response-assessment metrics,implement personalized strategies grounded in molecular subtyping and immune profiling,harmonize definitions of"borderline resectable"and"unresectable",and develop predictive biomarkers to identify patients most likely to benefit and to optimize dosing sequences.

Abstract:In radical gastrectomy for gastric cancer,standardized dissection of the infrapyloric lymph nodes(No.6)is crucial.Based on the vascular system of infrapyloric region,the infrapyloric lymph nodes are systematically divided into three subgroups:No.6v(around the right gastroepiploic vein),No.6a(around the right gastroepiploic artery),and No.6i(around the infrapyloric arteries).During the dissection procedure,the surgeon must accurately identify the vascular course,using adjacent structures such as the duodenum,pancreas,and mesocolon as anatomical landmarks,and select the correct dissection plane within the mesenteric space.The vascular branches should be meticulously ligated in sequence,and each subgroup of lymph nodes should be thoroughly dissected while avoiding damage to adjacent organs.Advanced technologies including robotic surgical systems,CT-based 3D vascular reconstruction,fluorescence imaging,and nanocarbon tracing navigation,enhance the precision and safety of lymph node dissection.

Abstract:The D2 plus complete mesogastrectomy,based on the membrane anatomy theory,significantly enhances the thoroughness and safety of lymph node dissection by utilizing the natural embryonic developmental planes.In the No.11p lymph node area,dissection along the avascular plane between the Treitz fascia and the splenic arterial vascular sheath enables en bloc resection of lymph node adipose tissue,preventing residual micrometastases.For No.12 lymph node dissection,precise separation of the extra-Glissonian plane ensures complete skeletonization of the proper hepatic artery,reducing the risk of tumor cell shedding.The concept of membrane anatomy emphasizes operating anterior to the splenic arterial sheath to avoid the area posterior to the pancreas where the splenic vein courses.During No.12 lymph node dissection,protection of the portal vein and common bile duct relies on identifying the layers within the hepatoduodenal ligament to prevent excessive deep dissection.During No.11p lymph node dissection,adhering closely to the splenic arterial sheath prevents incision into the pancreatic parenchyma,thereby reducing the risk of pancreatic fistula.Thorough dissection of No.11p and No.12 lymph nodes is crucial for preventing local recurrence.The"complete mesogastric excision"principle of membrane anatomy minimizes intraperitoneal tumor cell dissemination,creating favorable conditions for subsequent adjuvant therapy.

Abstract:The precise dissection of the vagus nerve has become a critical element in the technical chain of function-preserving gastrectomy(FPG).At the technical level,innovations such as intraoperative nerve monitoring combined with navigation by indocyanine green fluorescence,optimization of surgical approaches,robotic surgical systems,and artificial intelligence(AI)-assisted surgical planning and navigation systems have significantly enhanced the precision and feasibility of vagus nerve preservation.However,controversies persist:while preservation of the hepatic branch has become a consensus,preservation of the celiac branch still requires more high-quality evidences due to its technical difficulty and potential impact on the thoroughness of lymph node dissection.Future research directions include:determining the safety of implementing nerve-preserving,reduced surgery or even exempt from surgery in patients achieving significant downstaging after neoadjuvant therapy,as well as evaluating the oncological safety of nerve preservation in advanced gastric cancer.In conclusion,precise vagus nerve preservation is crucial for improving the postoperative quality of life of gastric cancer patients.Advancing personalized and precision surgery requires the continued integration of technological progress combined with evidence-based medicine.

Abstract:During gastrectomy for gastric cancer,the short gastric vessels are a challenge in radical resection due to their complex anatomy and proximity to the splenic hilum and pancreatic tail,which can easily lead to intraoperative bleeding and postoperative complications.In distal gastrectomy,only 2 short gastric vessels at the inferior pole of the spleen need to be managed.These vessels are relatively long with a large operative space,and safe and effective lymph node dissection and vascular ligation can be achieved with minimal surgical skills.However,in proximal gastrectomy or total gastrectomy,the short gastric vessels at the superior pole of the spleen are short with a narrow operative space.The traditional bottom-up approach is prone to bleeding,and hemostasis is difficult in such cases.Adopting a"short gastric vessels first"strategy can address splenic hilum bleeding caused by visual field obstruction and excessive traction on the short gastric vessels under the traditional approach.This strategy improves surgical safety while ensuring the quality of lymph node dissection.

Abstract:The number of obese patients with gastric cancer is increasing day by day.Due to their unique physiological and anatomical characteristics,concurrent medical diseases,and the impact of neoadjuvant chemotherapy and immunotherapy,they face problems such as difficulties in perioperative management and high surgical complexity.When performing surgery on obese patients with gastric cancer,surgeons should conduct adequate preoperative imaging evaluation and surgical planning,deeply understand the inherent anatomical layers and the concept of membrane anatomy obscured by fat,and skillfully use various instruments and energy devices for delicate operations.Meanwhile,certain techniques should be adopted to reduce the operational difficulty for assistants,so as to achieve continuous,stable and effective exposure of the surgical field.During the operation,surgeons should be patient and meticulous,avoid rough traction and blind separation,and always pay attention to protecting important tissue structures and adjacent organs.Furthermore,more emphasis should be placed on perioperative management and comprehensive treatment,so as to achieve proper perioperative management and reduce the incidence of postoperative complications.

Abstract:Although neoadjuvant therapy significantly im-proves tumor control rates and pathological complete response(pCR)rates,the tissue edema and fibrosis it induces obscure the anatomical planes of the gastric mesentery,thereby increas-ing surgical complexity and complication risks(e.g.,increased intraoperative blood loss and prolonged operation time).The tissue alterations primarily manifest as:(1)Edema causing dif-ficulties in identifying anatomical planes,obvious exudation in the surgical area,and tissues being prone to tearing.(2)Fibro-sis leading to the disappearance of anatomical spaces,making dissection difficult and increasing the risk of collateral dam-age.To address these challenges,the following surgical quality control strategies are recommended:(1)Precise clinical stag-ing to avoid overtreatment.(2)Prudent implementation of func-tion-preserving surgery.Standard gastrectomy with D2 lymph-adenectomy should still be adhered to currently.Exploration of reduced or omitted surgery should only be considered for spe-cific patient groups.(3)Prioritize dissection of normal tissue ar-eas,avoid entering incorrect anatomical planes,employ suc-tion devices for assistance,and enhance team collaboration.Future efforts should focus on establishing an intraoperative tissue alteration evaluation system,advancing multimodal pre-cision staging,exploring pathways for function-preserving sur-gery in clinical research,and optimizing perioperative treat-ment through multidisciplinary collaboration.

Abstract:The core advancements in refined anatomical research within gastric surgery involve:encompassing refined classification of the vascular and lymphatic systems,nerve preservation mechanisms,the application of membrane anatomy theory,individualized dissection strategies for splenic hilar lymph nodes,adaptability of minimally invasive techniques,and progress in function-preserving surgeries.Meanwhile,it details research progress in complication prevention and control,such as early warning for anastomotic leaks and postoperative gastric emptying disorders.The precision of gastric surgery fundamentally relies on an in-depth understanding of vascular,neural,lymphatic,and membrane anatomy.Therefore,future research necessitates integrating traditional anatomy with membrane anatomy theory,establishing multi-dimensional anatomical databases,and further combining artificial intelligence with real-time navigation technologies to advance the development of individualized and minimally invasive surgical techniques,ultimately improving patient quality of life.

Abstract:Objective To analyze the influencing factors of major pathological response(MPR)in patients with locally advanced gastric cancer undergoing neoadjuvant immunotherapy combined with chemotherapy and to establish a predictive model.Methods The clinical data of 48 patients with locally advanced gastric cancer undergoing neoadjuvant immunotherapy combined with chemotherapy admitted to the Department of Gastric Surgery of the First Affiliated Hospital of Soochow University between January 2022 and May 2025 were prospectively collected.The effect of neoadjuvant immunotherapy combined with chemotherapy was evaluated based on the tumor regression grade in postoperative pathology,and the patients were divided into the MPR group(23 cases)and the non-MPR group(25 cases).The parameters before and after neoadjuvant therapy were compared between the two groups.The predictive factors of MPR were analyzed,and a nomogram and Bayesian regression model were constructed.Results There were significant statistical differences between the MPR group and the non-MPR group in cN stage,the proportion of signet ring cell carcinoma,Lauren classification,CPS score,ypT stage and ypN stage(P＜0.05).Multivariate regression analysis showed early cN stage(OR=0.753,95％CI 0.430-0.872,P=0.025),non-signet ring cell carcinoma(OR=1.873,95％CI 1.451-2.314,P=0.043),and CPS≥5 points(OR=2.241,95％CI 1.692-2.868,P=0.023)was an independent protective factor for predicting MPR.The nomogram model constructed based on the above three factors had a C-index of 0.781(95％CI 0.613-0.927).The Bayesian regression model showed the area under the ROC curve for predicting MPR was 0.736(95％CI 0.579-0.883).Conclusion The nomogram and Bayesian regression model based on cN staging,whether it is signet ring cell carcinoma and CPS score can effectively screen the sensitive population of neoadjuvant immunotherapy for gastric cancer with high clinical application value.

Abstract:Objective To observe the safety and perioperative efficacy of total laparoscopic stomach-partitioning gastrojejunostomy in the treatment of advanced gastric cancer combined with gastric outlet obstruction(GOO).Methods The clinical data of 45 patients with advanced gastric cancer combined with GOO admitted to the Department of Gastrointestinal Nutrition and Hernia Surgery of the Second Hospital of Jilin University between September 2021 and June 2023 were retrospectively analyzed,and they were divided into the group of stomach-partitioning gastrojejunostomy(using total laparoscopic stomach-partitioning gastrojejunostomy,n=16)and the group of conventional gastrojejunostomy(using total laparoscopic conventional gastrojejunostomy,n=29)based on the intraoperative gastrojejunal anastomosis methods.Compare the perioperative clinical indexes of the two groups and analyze the effects of different surgical methods on the perioperative recovery of GOO patients.Results The differences between patients in the stomach-partitioning gastrojejunostomy group and the conventional gastrojejunostomy group were not statistically significant in terms of intraoperative bleeding,first time of out-of-bed activity,discharge albumin,discharge GOOSS,and the incidence of postoperative complications(P＞0.05).Compared with the conventional gastrojejunostomy group,patients in the stomach-partitioning gastrojejunostomy group had a longer operation time and a shorter time to to the following:first postoperative water intake,postoperative drain and gastric tube removal,gastroenterography gastric half-emptying,gastric complete-emptying,first postoperative enteral nutrition,and discharge after surgery,with statistically significant differences(P＜0.05);despite one patient in the stomach-partitioning gastrojejunostomy group had gastroparesis,the difference was not statistically significant(P＞0.05).Conclusion Compared with total laparoscopic conventional gastrojejunostomy,total laparoscopic stomach-partitioning gastrojejunostomy has obvious advantages in the recovery of the postoperative gastrointestinal function,postoperative hospitalization time,and postoperative feeding time without increasing the intraoperative bleeding and postoperative complications although the increased difficulty of the operation led to a prolonged operative time,and it is recommended for popularization and application.