Abstract:The supra-pancreatic lymph nodes are a critical component of D2 lymphadenectomy.However,due to the complex anatomy of this region and its proximity to vital blood vessels and organs,it remains a challenging area in radical gastrectomy for gastric cancer.A thorough understanding of the anatomical boundaries of the various lymph node groups in the supra-pancreatic area,along with standardized lymph node dissection and clear exposure of relevant anatomical landmark boundaries,forms the foundation for quality control in supra-pancreatic lymph node dissection.Integrating the concept of meticulous dissection throughout the process of supra-pancreatic lymphadenectomy is crucial for safely and completely clearing lymph nodes in this region.This ensures the high-quality completion of D2 radical gastrectomy for gastric cancer.

Abstract:Objective To explore the clinical and pathological characteristics,treatment strategies,and outcomes of patients with locally advanced gastric cancer receiving neoadjuvant therapy.Methods A retrospective analysis was conducted on the data of patients with locally advanced gastric cancer(cT1-2N+M0 or cT3-4bNxMO)who received neoadjuvant therapy and underwent surgical resection at 22 hospitals,between January 2018 and December 2023.All patients completed at least one cycle of neoadjuvant therapy prior to surgery.Results A total of 3,892 patients were included in this study,including 2,945 males(75.7％)and 947 females(24.3％).The initial diagnosis age of patients was mainly concentrated in the age groups of 65-＜70 years(871 cases,22.4％),60-＜65 years(724 cases,18.6％),and 55-＜60 years(640 cases,16.4％).Among all patients,2,460(63.2％)received neoadjuvant chemotherapy,1,173(30.1％)received neoadjuvant chemotherapy combined with immunotherapy.The commonly used chemotherapy regimens in neoadjuvant treatment were SOX regimen(1,771 cases,45.6％),FLOT4 regimen(470 cases,12.1％),and XELOX regimen(412 cases,10.6％).The commonly used immunotherapeutic agents were sintilimab(577 cases,45.1％),tislelizumab(175 cases,13.7％),and toripalimab(123 cases,9.6％).The common number of cycles for neoadjuvant chemotherapy were three cycles(1,478 cases,38.0％),four cycles(1,083 cases,27.9％),and two cycles(866 cases,22.3％);while for neoadjuvant immunotherapy,the common number of cycles were three cycles(548 cases,42.9％),four cycles(317 cases,24.8％),and two cycles(245 cases,19.2％).The RO resection rate for the entire cohort was 98.4％,with 494 cases achieving pathological complete response(pCR)and 1,053 cases achieving major pathological response(MPR).The group receiving neoadjuvant chemotherapy combined with immunotherapy had significantly higher R0 resection rate(99.2％vs.97.8％,P=0.05),pCR rate(21.6％vs.9.5％,P＜0.01),and MPR rate(39.8％vs.23.6％,P＜0.01)compared to the group receiving neoadjuvant chemotherapy alone.The incidence rates of adverse reactions were 21.9％in the neoadjuvant chemotherapy group and 24.6％in the neoadjuvant chemotherapy combined with immunotherapy group(P=0.12),and the incidence rates of postoperative complications were 20.6％and 24.4％,respectively(P=0.34),with no statistically significant differences between the two groups.Conclusion In China,the proportion of neoadjuvant chemotherapy combined with immunotherapy shows a progressive upward trend in managing locally advanced gastric cancer.Compared with single neoadjuvant chemotherapy,the combination of chemotherapy and immunotherapy has shown higher R0 resection rate and pathological response rate,without increasing the incidence of adverse reactions and compromising surgical safety.

Abstract:Objective To evaluate the clinical effect of one anastomosis gastric bypass(OAGB)for the treatment of type 2 diabetes mellitus(T2DM).Methods A retrospective analysis was performed on data from 38 T2DM patients who underwent OAGB between January and August 2023 with a 1-year follow-up at Beijing Friendship Hospital.Changes in body weight,glycemic control,metabolism related indicators and gastroscopy findings before and after surgery were compared.Logistic regression was used to analyze the factors influencing complete T2DM remission.Results A total of 38 patients were included.The percentage of total weight loss(％TWL)and percent of excess weight loss(％EWL)of the patients at 1 year after surgery were(28.6±7.1)％and(124.6±57.9)％,respectively.The mean body mass index(BMI)decreased from 35.1±6.1 to 25.0±4.1 and mean glycated hemoglobin A1c(HbA1c％)decreased from(9.1±1.5)％to(5.6±1.0)％.All the above differences were statistically significant(P＜0.001).The level of total cholesterol,triglycerides,low-density lipoprotein and y-glutamyl transferase was reduced significantly after surgery than those before surgery(all P＜0.001).The complete T2DM remission rate was 65.8％(25/38)and was linearly related to the ABCD score(P=0.015).Duration(OR=0.829,P=0.016)and％TWL(OR=1.137,P=0.039)were independent factors influencing complete remission.Postoperative rates of anemia,hypoalbuminemia and bile reflux were 18.4％,13.2％and 31.3％,respectively,significantly higher than preoperative rates(all P＜0.001).Conclusion OAGB is an effective and safe treatment for T2DM.However,attention should be given to postoperative anemia,hypoalbuminemia and bile reflux.

Abstract:With the advancement of minimally invasive techniques,the concept of membrane anatomy has propelled gastric cancer surgery toward the goal of complete mesenteric excision.Due to its unique anatomical location(adjacent to the cardia,esophagus,and diaphragm),upper gastric cancer presents significant surgical challenges,high complication rates,and ongoing controversies in treatment strategies.Ensuring the integrity of key mesenteric structures,such as the left gastric vascular mesentery,splenic vascular mesentery,and left inferior phrenic artery mesentery,constitutes the core prerequisite for improving therapeutic efficacy.By implementing the surgical strategy of"complete mesenteric excision",combined with precise dissection along interfascial planes and vascular-guided operative principles,this approach effectively reduces intraoperative cancer cell spillage,decreases postoperative complication rates,and enhances the thoroughness of lymph node dissection alongside surgical safety.

Abstract:As a severe complication following gastric cancer surgery,the key to preventing pancreatic fistula lies in avoiding intraoperative pancreatic injury.Laparoscopic surgery may increase the risk of pancreatic fistula due to its limited field of view,restricted instrument maneuverability,and heat conduction from energy devices.However,recent clinical studies indicate that with technological advancements,laparoscopic surgery can serve as a protective factor against grade B or higher pancreatic fistulas,demonstrating that technical maturity can overcome its limitations.Anatomical features determine surgical difficulty.A positive pancreatic head process(PPH)significantly increases fistula risk,which preoperative CT identification can guide surgeons to avoid pancreatic damage.Key predictive indicators for laparoscopic postoperative fistulas include distance between the pancreatic surface and the root of the common hepatic artery(≥25 mm),vertical distance between the pancreas and aorta,and height from the pancreatic upper border to the root of the left gastric artery.These metrics reflect anatomical complexity during dissection.Superficial pancreatic steatosis elevates fistula risk,while increased visceral fat thickness is also a contributing factor.Risk reduction can be achieved by optimizing laparoscopic techniques,preoperative CT assessment of anatomical features,and targeted adjustment of surgical planes,effectively mitigating pancreatic fistula occurrence after gastric cancer surgery.

Abstract:Objective　To evaluate the efficacy of the stapled prolapsectomy(PPH) in treatment of third or fourth degree hemorrhoids.Methods　Analyze the date of the third or fourth degree hemorrhoids operated by PPH.Results　Total of a 33mm circular staplar,mean surgical time was 10 minutes,mean operation stay were 3.5 days,postoperative bleeding was noted in 6 cases (16.7%) at the day of 2rd and 7th day of the operation,they were cured by conservative method.12 patients had no pain at the day of the operation.Follow up for 1～5 months the treatment of effective.Conclusion　The new technique of PPH was a safe and effective treatment for third or fourth degree hemorrhoids and with the advantages of shorter time of inpatient stay and earlier return to normal activity,it may be an alternative for the conventional haemorrhoidectomy.