中华胃肠外科杂志最新文献

Objective: To evaluate the application value of a digital technology-based multiparameter vital signs monitoring system in perioperative comprehensive full-cycle surveillance. Methods: A comprehensive multidimensional vital signs monitoring system was developed through the integration of medical-grade wireless wearable devices, incorporating patch-type ambulatory electrocardiographic monitor, continuous glucose monitoring sensor, pulse oximeter, wireless digital thermometer, smart wristband, and bioelectrical impedance analyzer. This system facilitates continuous real-time acquisition of multiple physiological parameters including electrocardiogram, blood glucose, oxygen saturation, body temperature, physical activity, and body composition indices. The acquired data were systematically integrated and analyzed through a four-level digital architecture consisting of nurse mobile interfaces, bedside patient terminals, centralized ward monitoring displays, and hospital management information systems. One patient with gastric cancer complicated by diabetes mellitus was selected for full-cycle digital monitoring from preoperative evaluation to hospital discharge. The technical performance of the monitoring system was assessed in terms of data acquisition continuity and timeliness of abnormal event alerts. Results: The monitoring system effectively identified early postoperative abnormalities, such as decreased oxygen saturation and blood glucose fluctuations, providing timely guidance for clinical intervention. The built-in algorithm enabled visualization of perioperative stress levels through heart rate variability indices and continuous glucose monitoring data. The patient demonstrated good compliance with early postoperative mobilization, and the satisfaction score for monitoring management was 4 points based on the Likert 5-point scale. Conclusions: The multiparameter vital signs monitoring system enhanced the precision of perioperative management through continuous and dynamic physiological status assessment. Its modular design aligns with the principles of enhanced recovery after surgery, offering a novel technological solution for intelligent perioperative management.

The integration of immunotherapy into neoadjuvant treatment for locally advanced rectal cancer has markedly increased complete response rates, offering greater potential for organ preservation. However, the reduced restaging accuracy after immunotherapy has limited the applicability of the watch-and-wait strategy. As an organ-preserving approach that enables residual lesion removal and pathological assessment, local excision not only reduces the risk of local regrowth associated with watch-and-wait, but also enables full-thickness tumor bed sampling to determine pathological stage, regression pattern, and molecular characteristics, thereby supporting risk stratification and individualized decision-making. Moving forward, local excision is expected to achieve precise, risk-adapted organ preservation by optimizing surgical timing and techniques, and integrating multimodal parameters including imaging, pathology, and the tumor microenvironment, ultimately attaining the dual aim of maximizing both oncologic efficacy and functional preservation.

KRAS mutations are major oncogenic drivers in colorectal cancer (CRC), occurring in 35%-49% of cases; of which 3%-4% involve the KRAS G12C subtypes, characterized by a glycine-to-cysteine substitution at codon 12. This variant is associated with poor treatment response and reduced overall survival. Recent phase I/II trials of KRAS G12C inhibitors have shown promising results, and the phase III CodeBreaK 300 study confirmed that sotorasib combined with panitumumab significantly improved efficacy compared with standard treatment, establishing a new therapeutic option for KRAS G12C-mutant metastatic CRC. However, drug resistance inevitably develops, driven by mechanisms such as feedback activation of signaling pathways, secondary mutations, and epithelial-mesenchymal transition. Strategies under investigation include targeting alternative signaling pathways, developing next-generation inhibitors and specific degraders, and exploring multi-mechanism or multi-target combination strategies. This review systematically outlines the development of KRAS G12C inhibitors in mCRC, summarizes resistance mechanisms, and discusses emerging combination regimens, aiming to provide a theoretical basis and future directions for treatment optimization.

In the field of rectal cancer treatment, transanal local excision techniques (such as transanal endoscopic microsurgery [TEM] and transanal minimally invasive surgery [TAMIS]) have gradually become an important therapeutic option for patients with rectal cancer at various stages, owing to their minimally invasive characteristics and organ-preserving advantages. For low-risk T1 stage tumors, local excision can achieve radical tumor control while preserving organ function. For some patients with high-risk T1 stage or T2-3 stage rectal cancer, the efficacy of combined chemoradiotherapy and local excision is expected to be comparable to that of radical total mesorectal excision (TME). In patients with advanced rectal cancer who achieve clinical complete response (cCR) after neoadjuvant therapy, local excision can confirm the pathological remission status. However, it is necessary to balance the risk of surgical complications against the potential benefits of organ preservation with the "watch and wait" strategy. Currently, transanal local excision techniques have broad application prospects, and comprehensive assessment of patients' overall condition, implementation of multidisciplinary collaboration, and conduct of long-term follow-up are crucial to ensuring the safety of treatment.

Obesity and its related metabolic diseases have become a global public health challenge. Traditional weight loss methods have limited efficacy in patients with moderate to severe obesity, while bariatric surgery, although effective, carries a relatively high risk. Endoscopic weight loss techniques, due to their minimally invasive nature, safety, and reversibility, have gradually become an important supplement to obesity treatment. This article systematically reviews the research progress of gastric and small intestine-related endoscopic bariatric procedures, including intragastric balloon therapy, endoscopic sleeve gastroplasty, gastric bypass stents, and duodenal mucosal resurfacing.The authors believe that gastric-related procedures are suitable for patients whose primary goal is weight loss. Among these, the adjustable intragastric balloon offers the highest flexibility, being non-invasive and reversible with good short-term weight loss effects, making it suitable for bridging to bariatric surgery in patients with severe obesity. Endoscopic sleeve gastroplasty achieves weight loss effects closest to those of bariatric surgery, with favorable long-term weight loss outcomes, and is suitable for weight loss treatment in patients with contraindications to bariatric surgery. Gastric drainage procedures result in poor patient experience due to issues related to fistula tubes; moreover, the small sample size of studies on gastric-related endoscopic procedures means they are not considered representative. In contrast, small intestine-related procedures are more suitable for patients focusing on the improvement of metabolic diseases. Overall, endoscopic techniques exhibit significant short-term efficacy, but their long-term efficacy and standardization still require further research. In the future, it will be necessary to integrate artificial intelligence-assisted operations and individualized treatment strategies to optimize efficacy and expand clinical application.

The standardization of laparoscopic right hemicolectomy for colon cancer has been driven by advancements in anatomy and surgical technology, but controversies persist regarding lymph node dissection (LND) extent and surgical plane selection. In the concept of LND, both D3 radical resection and complete mesocolic excision (CME) theoretically define the left side of the superior mesenteric artery (SMA) as the boundary for lymphadenectomy, though their clinical values remain to be validated. China's RELARC study shows higher vascular injury rates,but it offers survival benefits in stage III patients. Regarding intestinal resection length, Japanese research confirms that most lymph node metastases are confined within 10 cm of the tumor, indicating that excessive resection may be unnecessary. Exploration of ileocecal-preserving techniques provides new directions for functional preservation. Controversies over LND boundaries focus on the left side of the superior mesenteric vein (SMV) versus the left side of the SMA. Although SMA-left dissection aligns better with lymphatic drainage anatomy, high-quality evidence is lacking. The multi-center RCT (MARCH study) conducted by our team is currently investigating its value for stage III patients. In precision diagnosis and treatment, preoperative imaging features, intraoperative lymphatic tracing, and radiomics models assist in lymph node assessment, but specificity remains insufficient. The application of membrane anatomy concepts in surgical plane selection still requires embryological research to clarify the structure of fused fascia. Future research should focus on standardizing dissection ranges, improving precision in metastasis prediction, and clarifying anatomical planes to promote more precise and personalized surgical approaches.