中华胃肠外科杂志最新文献

Sphincter-preserving therapy for low rectal cancer has always been a difficult and hot topic in colorectal cancer. Advanced understanding of the biological behavior of rectal cancer and the pelvic fascial anatomy have laid the theoretical foundation for sphincter preservation, shifting the surgical paradigm from radical resection alone toward both oncological safety and function preservation. Guided by the principle of TME and supported by minimally invasive technologies, a variety of surgical methods including low anterior resection(LAR), Bacon, intersphincteric resection(ISR), conformal sphincter-preservation operation(CSPO) and transanal total mesorectal excision(taTME), have progressively pushed the sphincter-preserving surgery to the limit in the inheritance of history. In addition to surgery, non-surgical management based on the "Watch & Wait" strategy provides a new sphincter-preserving option for selected patients. Meanwhile, the rise of immunotherapy is reshaping the pattern of sphincter-preserving treatment in the future. The continuous trial and exploration of immunotherapy combined with neoadjuvant therapy in protein mismatch repair proficient(pMMR)/microsatellite stable(MSS) patients is expected to further improve the overall rate of sphincter preservation rate and organ preservation. In the future, sphincter-preserving treatment for low rectal cancer will be more patient-centered. By integrating the advantages of precision medicine and multidisciplinary collaboration, and giving full play to the potential of artificial intelligence, patients will achieve the best balance between oncology safety and function preservation.

In recent years, artificial intelligence (AI) has achieved groundbreaking progress in the field of medicine, particularly in the diagnosis and treatment of colorectal cancer (CRC). In terms of data analysis, AI-assisted diagnosis and treatment has significantly improved the sensitivity of colonoscopy and the accuracy of pathological diagnosis, thereby providing robust support for CRC diagnosis. Regarding data utilization, AI demonstrates unique advantages in precision medicine, prognosis prediction, and recurrence follow-up, leveraging its powerful data processing capabilities to explore more possibilities for CRC treatment. AI is increasingly becoming a pillar of the medical field. However, AI still faces significant challenges, including a shortage of high-quality datasets, barriers in medical insurance reimbursement, and insufficient algorithm generalization. The challenges confronting AI have gradually shifted from technical issues such as algorithm optimization and sample collection during the initial development phase to societal concerns including ethical review, insurance reimbursement barriers, and economic benefits during the application phase.

In the over-century-long history of colorectal tumor surgery, achieving organ function preservation has consistently been a central topic. Currently, advancements in surgical techniques, updates in surgical platforms, and the development of multidisciplinary comprehensive treatment models have collectively driven the inheritance and evolution of theories and technologies for organ function preservation. Regarding innovations in surgical procedures, the progression from abdominoperineal resection to total mesorectal excision represents a developmental inheritance, shifting from mere radical tumor resection to preserving anal and neurological functions. In terms of surgical platform innovations, the evolution from 2D laparoscopy to robotic platforms has provided clearer surgical fields and more precise manipulation, offering a crucial platform guarantee for functional preservation. As for innovations in treatment strategies, the development from neoadjuvant chemoradiotherapy to immunotherapy and the "watch-and-wait" strategy reflects an evolution in treatment concepts, elevating organ preservation to the new height of "surgical exemption". In the future, with continuous progress in fields such as artificial intelligence, medical-engineering integration, and equipment research and development, organ function preservation in colorectal tumor surgery will enter a new stage of multidisciplinary integrated development, leading to more innovative achievements and clinical translations.

Rectal prolapse is a common pelvic floor disorder. Its pathogenesis primarily involves the degeneration and impairment of the supporting tissues of the rectum, leading to their laxity and consequent displacement of the rectum. As the pelvic cavity is a complex system consisting of gynecology, urology, and coloproctology, rectal prolapse often coexists with other pelvic relaxation disorders, such as perineal descent, pelvic floor hernias, and uterovaginal prolapse. Traditionally, pelvic-related disciplines have operated independently, creating disciplinary boundaries that restricted perspectives to single specialties. This compartmentalization focuses narrowly on repairing specific anatomical structures while neglecting the integrity of the pelvic floor system, thereby hampering the diagnosis and comprehensive management of pelvic floor disorders. This is a key reason for the high recurrence rates and poor long-term outcomes associated with traditional surgical approaches. The Integral Theory Paradigm (ITP) views the pelvic floor as an indivisible functional unit, emphasizing pelvic floor dysfunction caused by laxity of muscles, fasciae, and ligaments. By providing an interdisciplinary theoretical foundation, it has significantly advanced systematic innovations in the research, diagnosis, and treatment of pelvic floor disorders. Since the 21st century, with the development of the Integral Theory and membrane anatomy, the adoption of autologous fascial ligament reconstruction techniques has brought new prospects for the surgical management of rectal prolapse.

Complex anal fistula remains a particularly challenging clinical condition, the primary difficulty in its management lies in the risk of damage to the anal sphincters, which is associated with a high incidence of treatment failure, recurrence and impairment of anal function, potentially leading to varying degrees of fecal incontinence in severe cases. Currently, there is no established gold-standard for the treatment of complex anal fistula, and efforts to identify effective therapeutic approaches continue. With advancements in medical science, the diagnosis and management of complex anal fistula have gradually transitioned from empirical medicine to evidence-based medicine, with continuous emergence of new theories and clinical evidence. This article reviews the relevant literature and systematically summarizes recent evidence-based medical findings on complex anal fistula, explores the driving factors in the evolution of diagnostic and therapeutic paradigms, and analyzes current clinical controversies and focal points. Furthermore,it elaborates on evidence-based diagnosis and treatment strategies, including preoperative precise assessment and selection of surgical techniques, with the aim of providing clinical practical guidance and promoting the advancement of diagnostic and therapeutic standards for complex anal fistula.

The treatment of sacrococcygeal pilonidal disease (SPD) remains challenging due to its high recurrence rate and treatment-related complications. An ideal treatment plan for SPD should be simple to perform, reduce recurrence rates, enable patients to quickly return to normal daily activities, and be associated with a low incidence of complications. Various surgical techniques have been employed for the treatment of SPD, but discrepancies and controversies persist in current clinical practice. Non-surgical treatment is suitable for asymptomatic SPD patients. For patients in the acute abscess phase, drainage is the primary therapeutic goal, with avoidance of midline incisions. Minimally invasive procedures may be considered for patients with localized lesions after weighing the recurrence risk, aiming for faster recovery and better cosmetic outcomes. For recurrent SPD or cases with extensive lesions, excision followed by secondary healing or combined with flap techniques is required to pursue a lower recurrence risk. Based on clinical experience and literature review, this article summarizes the treatment strategies for different types of SPD, providing a reference for clinicians in formulating diagnosis and treatment plans.

Anorectal abscess is a common anorectal disease. In daily clinical practice, there are certain controversies regarding the clinical examination and diagnosis of anorectal abscesses, the selection of surgical methods for different types of abscesses, postoperative management, and treatment strategies for special types of anorectal abscesses.In recent years, there have been new advances in the clinical diagnosis and treatment of anorectal abscess. To promote the development of the specialty and standardize and improve the diagnosis and treatment level of specialist doctors, the Colorectal Physician Branch of the Chinese Medical Doctor Association organized experts in this field. Based on summarizing new research progress in this field at home and abroad, and after repeated discussions by expert group members, nine important clinical questions were summarized. Nineteen recommendations were formed targeting clinical diagnosis and examination strategies, surgical method selection, postoperative management, and treatment strategies for special types of anorectal abscesses, aiming to provide important guidance for specialist physicians, medical personnel, and patients who wish to understand the treatment of related diseases included in the guidelines.