Abstract:Hepatocellular carcinoma(HCC)is one of the major malignancies under intensive control efforts in China,with a five-year survival rate remains to be improved.Early diagnosis and stage-guided comprehensive management are key measures to improve prognosis.For early-stage patients,curative surgery remains the primary approach to achieving long-term survival,while postoperative adjuvant therapies are increasingly moving toward precision and individualization.For intermediate and advanced stages,emphasis has shifted to conversion therapy and the combined use of locoregional and systemic treatments.In recent years,the rapid advancement of systemic therapies has significantly improved survival in advanced HCC and reshaped the therapeutic landscape.At present,treatment paradigm for advanced HCC has gradually evolved toward immunotherapy-based combination regimens.Overall,comprehensive management of HCC is trending toward"precision in locoregional therapy,earlier application of systemic therapy,and individualized full-course management".Within the multidisciplinary team framework,individualized strategies that integrate tumor stage,molecular characteristics,and patient condition are of critical importance for further improving survival outcomes.

Abstract:In October 2024,the National Health Commission released Clinical Practice Guidelines for the Obesity Diagnosis and Treatment(2024 Edition),which leads to significant implications for clinical diagnosis and treatment of obesity,and potentially impacts the future trend of metabolic and bariatric surgery.The guidelines reflect a more comprehensive and scientific understanding of obesity as a standalone disease.Based on this understanding,the role of metabolic and bariatric surgery in obesity management will be further strengthened,and homogeneous management of obesity will be more widely implemented in future.With the rapid advancement of anti-obesity medications,future solutions for obesity therapy will involve the combined application of multiple treatment modalities,enhance treatment efficiency and improve patient outcomes.As practitioners in the field of metabolic and bariatric surgery,surgeons will need to pragmatically adapt to the discipline's evolution,expand their knowledge and skillsets,and upgrade themselves from surgeon to metabolic and bariatric specialists proficient in various obesity treatment approaches.

Abstract:Chronic pain following inguinal hernia repair surgery is one of the key concerns in clinical practice.The causes of postoperative chronic pain include surgical techniques,mesh usage,and patient-related factors.Laparoscopic surgery is more effective in reducing the incidence of chronic pain compared to open surgery.Additionally,patient factors such as gender and age significantly influence pain perception and recovery.Therefore,adopting individualized treatment strategies is crucial.Approaches such as psychological therapy,pharmacological treatment,local anesthetic blocks,and microwave ablation have shown positive effects,while surgical interventions can also help alleviate pain symptoms.Future research should further explore the detailed mechanisms of postoperative chronic pain and develop more accurate predictive models to identify high-risk patients for effective preventive measures.Moreover,advancements in surgical materials and techniques,along with optimized pain management strategies,will play a crucial role in improving postoperative recovery quality and reducing pain symptoms.

Abstract:In the field of gastric cancer surgery,the surgical concept and principles of complete mesogastric excision are currently under exploration and practice.Based on the embryology of the stomach and membrane anatomy theory,understanding the development of the ventral and dorsal mesogastric,the formation of fusion fasciae,changes in vascular courses,and lymph node distribution,the surgical concept of complete mesogastric excision is followed.By en bloc resection of the mesogastric while preserving the pancreas and major blood vessels within it,standardized D2 lymph node dissection can be achieved.The concept of complete mesogastric excision is expected to play a role similar to that of total mesorectal excision and complete mesocolic excision,promoting the improvement of gastric cancer surgical quality.

Abstract:Objective To analyze the clinical characteristics,diagnostic approaches,and therapeutic outcomes of de-layed post-pancreatectomy hemorrhage(DPPH)following distal pancreatectomy(DP),in order to guide clinical decision-making.Methods A retrospective review based on the clinical data of 63 patients who developed DPPH after DP be-tween July 2018 and December 2023 at our center was conducted.According to the International Study Group for Pancre-atic Surgery(ISGPS)classification,29 cases were grade B(ISGPS-B group)and 34 were grade C(ISGPS-C group).Rel-evant risk factors,clinical features,and management strategies of DPPH were evaluated.Results Of these,22 under-went spleen-preserving DP(Kimura,n=19;War-shaw,n=3)and 41 underwent DP with splenectomy.Five patients(7.9％)died from DPPH-related causes.Sentinel bleeding was observed in 21 grade C cases(61.8％).The incidence rate of clinically rel-evant pancreatic fistula and intra-abdominal infec-tions in the ISGPS-C group was higher than that in the ISGPS-B group,and the difference was statisti-cally significant(94.1％vs.75.9％,P=0.039;55.9％vs.24.1％,P=0.020).The bleeding site was clearly localized in 34 cases(54.0％),with the gastroduodenal artery(n=7),splenic artery(n=6),and portal venous system(n=6)being the most common.The localization rates of contrast-enhanced CT and digital subtraction angiography(DSA)were 31.0％(13/42)and 60.9％(14/23),respectively(P=0.019).Hemosta-sis success rates were 80.0％(12/15)for endovascular embolization under DSA and 69.2％(18/26)for reoperation(P=0.716).In three cases of DPPH(one splenic artery stump hemorrhage and two celiac trunk hemorrhages),selective embo-lization of the celiac trunk was performed under DSA,with intraoperative angiography confirming adequate hepatic arte-rial supply,and all patients recovered uneventfully.Conclusion The gastroduodenal artery is a common bleeding site after DP.DSA provides higher localization accuracy and therapeutic efficacy,and should be considered the preferred di-agnostic and therapeutic strategy for DPPH following DP.

Abstract:Objective To evaluate the clinical utility of continuous dynamic testing using the Metagenomic Capture(MetaCAP)next-generation sequencing technique in severe acute pancreatitis(SAP)patients complicated by prolonged organ failure(Pro-OF).Methods A prospective analysis was conducted on 65 SAP patients with Pro-OF from Xiangya Hospital of Central South University and Hunan Medical College General Hospital between January 2024 and September 2025.All patients underwent weekly peripheral blood MetaCAP dynamic detection to assess its di-agnostic efficacy and prognostic value.Results Among the 65 Pro-OF patients,a total of 101 blood MetaCAP tests were performed,with a posi-tivity rate of 51.5％(52/101),significantly higher than the positivity rate of traditional blood culture(25.7％,P=0.005).The overall concordance rate between MetaCAP pathogen detection results and microbiological culture results from various sampling sites was 90.9％,with concordance rates of 85.2％and 67.9％for peripancreatic and respiratory specimens,respectively.When organ failure duration exceeded two weeks,the MetaCAP positivity rate surged from 27.5％to 61.1％,whereas white blood cell count,C-reactive protein,and procalcitonin levels showed no similar trends.In patients undergoing continuous MetaCAP dynamic monitoring,mortality was significantly higher in those with persistently positive results compared to those with persistently negative results(58.8％vs.11.1％,P=0.036).Conclusions In patients with SAP,prolonged duration of organ failure is associated with an increased risk of bloodstream infection(BSI),predominantly originating from peripancreatic and respiratory infections.Continuous dy-namic monitoring of blood samples using MetaCAP not only provides accurate guidance for clinical anti-infective therapy,but also holds significant prognostic value for SAP patients complicated with Pro-OF.

Abstract:Objective To investigate the safety and feasibility of remote-controlled surgical robot for radical resection of right colon cancer.Methods On November 6,2024,the Colorectal Surgery Department of the General Surgery Department of the Chinese PLA General Hospital remotely performed a robot-assisted radical resection of right hemifacial colon cancer using a mobile operation platform.The patient was a 48-year-old female.The preoperative pathological examination results indicated moderately differentiated adenocarcinoma(in the ascending colon).Results The operation went smoothly.The operation time was 177 min,the intraoperative bleeding was about 50 mL,and there was no bleeding complication.The average bidirectional network delay during the operation was 40 ms,and there were no incidents such as network disconnection,frame loss,and network attack.The operation was smooth and there was no obvious sense of delay.The patient discharged on the 7th day.The postoperative pathological examination results showed that lymph node dissection was complete,mesentery was intact,and no cancer was found in peri-circumferential and proximal distal margins.Conclusion Completing robotic radical resection of right half colon cancer based on mobile operating platform is safe and feasible,the network signal is stable,the operation is smooth,and it is worthy of further practice and research.

Abstract:Objective To investigate the mid-term metabolic outcomes and changes in nutritional status of adolescents with severe obesity undergoing laparoscopic sleeve gastrectomy(LSG).Methods A retrospective analysis was conducted on the clinical data of 93 adolescent patients who underwent LSG at Shanghai Sixth People's Hospital between July 2017 and July 2022.Weight changes,glycemic metabolism indicators(HbA1c and HOMA-IR),and the dynamics of iron defi-ciency,anemia,and vitamin D deficiency were collected and compared from preoperation to up to 3 years postoperatively.Mixed-effects models were used to analyze longitudinal data trends.Results A total of 93 patients were included for baseline analysis,with follow-up data available for 64,49,and 33 patients at 1,2,and 3 years postoperatively,respec-tively.Significant weight loss was achieved,with a mean percentage of excess weight loss(％EWL)of 99.7％at 2 years post-surgery.Glycemic metabolism improved,with mean HbA1c decreasing from 6.2％at baseline to 5.0％at 2 years,and HOMA-IR from 1 1.6 to 3.6(both P＜0.001).However,the prevalence of iron deficiency showed a significant upward trend(trend P=0.002),increasing from 6.5％at baseline to 33.3％at 3 years.More importantly,the prevalence of anemia also showed a significant upward trend(trend P=0.015),reaching 24.2％at 3 years.In contrast,the high preoperative preva-lence of vitamin D deficiency(91.4％)showed a continuous and significant downward trend postoperatively(trend P＜0.001).Conclusion For adolescents with severe obesity,LSG provides significant and durable weight loss and metabolic improvement.However,the risk of postoperative iron deficiency and even clinical anemia is signifi-cantly increased,highlighting the importance of long-term,systematic,multidisciplinary nutritional monitoring and management for these patients.

Abstract:With the rise of adolescent obesity,metabolic and bariatric surgery(MBS)yields clear and durable improvements in weight and comorbidities;however,ethical decision-making,growth and development,and healthcare equity remain contested.We propose an"ethics-clinical integrated"framework:(1)anchor decisions in the four principles,operationalized as parental permission plus adolescent assent;(2)shift indications from BMI-only to phenotype-and risk-driven criteria,supported by multidisciplinary team(MDT)assessment and standardized perioperative management;(3)implement long-term surveillance plans for growth/bone health,nutrition,and psychological well-being,with predefined risk-mitigation strategies.We advocate early referral for evaluation when BMI ≥140％of the 95th percentile or when severe obesity-related complications are present,prioritizing sleeve gastrectomy or Roux-en-Y gastric bypass as preferred options where appropriate.To promote justice and access,we recommend standardized referral and payment pathways and active reduction of stigma and delays.This framework aims to maximize net benefit while ensuring safety,thereby enhancing the standardization and accessibility of MBS for adolescents.

Abstract:Adolescent compliance management after metabolic and bariatric surgery is a systematic project involving physiological,psychological,and social aspects.The family,as the most central support system,plays a decisive role in determining the long-term effectiveness of the surgery.The family-hospital collaborative management model enhances preoperative cognitive building,intraoperative support,and postoperative dynamic follow-up.It transforms the emotional and behavioral support from families into motivation for adolescents' compliance,while hospitals provide scientific guidance to families with their professional expertise,creating a synergistic effect where"1+1＞2".Only by respecting the autonomy of adolescents and understanding the practical challenges faced by families can a truly sustainable collaborative ecosystem be established,offering solid support for the long-term prevention and management of adolescent obesity.

Abstract:Adolescent obesity has become a serious public health issue.Adolescents are at a unique stage of physiological and psychological development,where lifestyle interventions and pharmacological treatments show limited effectiveness for some severely obese cases.While bariatric surgery yields significant results,it carries risks such as high invasiveness and potential complications.Endoscopic bariatric therapies offer a minimally invasive,reversible,and effective new option for treating ado-lescent obesity,bridging the gap between lifestyle interventions and surgical procedures.In the future,the field of endoscopic bariatric treatment for adolescents will advance toward greater precision,systematization,and humanization.Through multidis-ciplinary collaboration,a comprehensive management system will be established,while psychological support and family in-volvement will enhance overall health outcomes.

Abstract:With the increasing of metabolic and bariatric surgery(MBS)performed in adolescents,the failure of MBS becomes an important issue that surgeons have to face.The management of MBS failures should follow a systematic and step-by-step principle.Based on comprehensive and in-depth evaluation by the multidisciplinary team(MDT)group,the reasons for surgical failure can be identified and develop individualized treatment.Lifestyle improvement is the foundation for management of adolescent MBS failure,and if necessary,anti-obesity medications can be used as adjuvant therapy.When non-surgical treatment is ineffective and there are indications for surgery,careful consideration may be given to revision surgery.Establishing an effective lifetime follow-up and support system is of great significance for further improving the results of MBS in adolescents.

Abstract:Adolescents with obesity often have psychological problems and lower treatment adherence,so perioperative management needs to incorporate continuous psychological and behavioral interventions and build a systematic and lifelong postoperative follow-up system.Techniques such as cognitive-behavioral therapy,family-involved psychological interventions,mindfulness-based stress reduction,and virtual reality(VR)-assisted treatments can improve the psychological health and treatment adherence of adolescents with obesity.Postoperative follow-up management should focus on nutritional status and growth and development.Using telemedicine,smart wearable devices,and other technological means,combined with multidimensional incentive strategies,can effectively enhance follow-up adherence and reduce the risks of weight regain and nutritional deficiencies.The perioperative management of adolescent bariatric surgery needs to move towards multidisciplinary collaboration,comprehensive intervention,and precise individualization to provide safer,more effective,and more comprehensive bariatric surgical treatment for adolescents with obesity.

Abstract:In recent years,weight-loss medications such as glucagon-like peptide-1 receptor agonist,and PHEN/TPM have brought breakthrough progress in the treatment of adolescent obesity.By targeting appetite control centers or inhibiting neurotransmitter re-uptake,they significantly improve clinical outcomes in obese adolescents.These drugs not only effectively reduce body weight but also ameliorate metabolic issues such as insulin resistance and dyslipidemia.However,their long-term safety,cost accessibility,and individualized medication strategies still require improvement.Moving forward,it is necessary to advance long-term follow-up studies and establish real-world databases to support personalized treatment.Medication therapy should be integrated with lifestyle interventions,building a"family-medical-society"tripartite management model to achieve precise prevention and management of adolescent obesity.

Abstract:Objective To investigate the clinical features and the efficacy of radical surgical resection in the treatment of aggressive fibromatosis(AF)of abdominal wall.Methods The clinical and follow-up data of 80 patients with AF of abdominal wall admitted to the Department of Gastrointestinal Surgery of Shandong Provincial Hospital between January 2011 and January 2024 were retrospectively analyzed,and the surgical details,short-and long-term outcomes,pathological features,and factors associated with recurrence were statistically analyzed.Results Four patients(5％)underwent simple tumor excision,69 patients(86.25％)underwent radical tumor resection plus abdominal wall reconstruction,5 patients(6.25％)underwent combined tumor and organ resection plus abdominal wall reconstruction,and 2 patients underwent tumor resection plus autologous tissue transplantation plus abdominal wall reconstruction.The operative time was 165(25-725)minutes,and intraoperative blood loss was 35(5-250)mL.Postoperatively,2 patients(2.5％)developed abdominal wall infection,and 3 patients(3.75％)developed abdominal wall hernia or bulging.The median postoperative follow-up was 60(7-163)months.Three patients experienced recurrence,for a recurrence rate of 3.8％.Among all patients,63 completed abdominal wall function grading,and 87.3％had no obvious limitations in physical activity(abdominal wall function grade 4 or 5).One patient(1.25％)died due to rapid tumor enlargement invading multiple intra-abdominal organs after multiple surgeries.Recurrent-type AF and positive surgical margins were significantly associated with postoperative recurrence(P＜0.05);multivariable analysis indicated that recurrent-type AF was an independent risk factor for postoperative re-recurrence(P=0.011).Conclusion Abdominal wall AF is more common in young women,with most patients having a history of abdominal surgery.Recurrent cases are prone to postoperative recurrence.Radical surgical resection combined with abdominal wall reconstruction is a safe,feasible and reliable method for the treatment of abdominal wall AF.

Abstract:Objective To explore the effects of a social cognitive theory(SCT)-based exercise intervention on physical activity and related outcomes in adolescents after bariatric surgery.Methods A total of 70 adolescent patients who had undergone bariatric metabolic surgery and entered the follow-up management stage for 4 weeks postoperatively at the De-partment of Bariatric and Metabolic Surgery,the First Affiliated Hospital of Nanjing Medical University,between June 2023 and June 2024,were enrolled.They were randomly assigned to an experimental group(n=35)and a control group(n=35)using a random number table method.The control group received routine postoperative exercise guidance,while the intervention group received an SCT-based 16-week structured program focused on cognitive construction,behavioral ex-ecution,and environmental support.Outcomes,including physical activity levels,body composition,and psychosocial measures,were compared before and after the intervention.Results Compared with the control group,the intervention group showed significant improvements after the intervention in duration of moderate-to-vigorous physical activity(P=0.027),step count(P=0.010),BMI(P=0.037),excess weight loss rate(P=0.024),and the improvement in skeletal muscle mass percentage(P=0.043),quality of life(P=0.016),and exercise behavior intention(P=0.038),with statistically signifi-cant differences between the groups.However,no significant differences were observed between the groups in calorie ex-penditure,total activity duration,body fat percentage,or exercise self-efficacy(P＞0.05).Conclusion SCT-based exer-cise interventions are effective in enhancing physical activity participation and psychosocial function in adolescents after bariatric surgery.This approach is feasible and adaptable,offering theoretical and practical support for postoperative be-havioral management in this population.

Abstract:The release of'Perioperative Multidisciplinary Clinical Management Guidelines for Liver Resection(2025 Edition)'marks a milestone in hepatobiliary surgery.Addressing the ongoing challenge of relatively high complication rates following liver resection(15％-50％),these guidelines aim to establish a standardized management system in the era of multidisciplinary team(MDT)care.A core highlight is the elevation of MDT collaboration to a central position for the first time,comprehensively deepening the fine-grained control of the entire process from preoperative assessment,intraoperative management to postoperative rehabilitation.Innovatively,the guidelines introduce the concept of prehabilitation,optimizing patients condition proactively through preoperative exercise,nutritional,and psychological interventions.Integrating enhanced recovery after surgery(ERAS)principles with the latest evidence-based evidence,they provide authoritative and practical systematic guidance for reducing surgical risks and improving patient outcomes.

Abstract:Metabolic bariatric surgery(MBS)for adolescents is an effective treatment for severe obesity,but its clinical application is fraught with controversy and challenges.From an ethical perspective,careful consideration must be given to balancing patient autonomy with guardian involvement and the suitability of surgery for special populations.Regarding patient selection,criteria for factors such as BMI thresholds and preoperative health status require further clarification,and multi-dimensional assessments of physiological and psychological factors complicate decision-making.Regarding surgical procedure selection,long-term outcomes vary among different procedures,and the safety and efficacy of certain procedures require further research validation.Postoperative complications may include nutritional deficiencies,impacts on bone health,and the need for reoperation,while adolescents'compliance also poses challenges to long-term outcomes.While cost-benefit ratios may become evident in the long term,initial costs are high.These issues highlight the necessity of multidisciplinary collaboration and individualized management in adolescent MBS to better align with adolescents'growth and developmental characteristics and health needs,thereby providing robust safeguards for surgical safety and long-term efficacy.

Abstract:Bariatric surgery serves as an effective treatment for adolescent obesity,but its successful implementation requires systematic management.Indications for surgery should be strictly determined,with a recommendation for adolescents aged 13 and above who have severe obesity with associated comorbidities.A comprehensive preoperative assessment of developmental status,metabolic indicators,and psychosocial factors is essential,supported by a multidisciplinary team.Postoperative management priorities include:(1)Lifestyle modification:focusing on the critical 6-12-month behavioral reshaping period.(2)Nutritional monitoring:adopting a stepwise approach to track micronutrient levels.(3)Psychological intervention:implementing phased dietary adjustment,emotional management,and social adaptation training.(4)Special issue management:enhancing reproductive health guidance and follow-up care.By establishing a medical-family-social support network and implementing personalized intervention strategies,long-term surgical outcomes can be ensured,promoting holistic physical and psychological recovery.Multidisciplinary collaboration remains the cornerstone of treatment quality assurance.