中华胃肠外科杂志最新文献

In recent years, although we have made significant progress in the precise diagnosis and treatment of anal fistula, we still lack a thorough and in-depth understanding about the mechanism of formation, development, nonunion and recurrence of complex anal fistula. As a result, there is still a high failure rate, recurrence rate and the risk of the fecal incontinence after treatment. There is hardly any consensus on whatever treatment options, and the various treatment also means no established standard treatment for complex anal fistula. According to recent relevant literatures and personal experience, discuss recent pathbreaking updates in the management of complex anal fistula, we systematically summarize and generalize some critical issues in the diagnosis and treatment of complex anal fistula, including the pathogenesis, reasonable classification criteria, preoperative evaluation and surgical procedure selection. At the same time, we envision the future development directions.

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors in the gastrointestinal tract, and tyrosine kinase inhibitors (TKIs) have achieved great success in the treatment of GISTs. The role and value of surgery in advanced GISTs are still controversial. This article aims to review the progress related to surgery for advanced GIST in the context of targeted therapy, particularly exploring the issues related to the combination of surgery and targeted therapy. Studies have shown that selected advanced GISTs can benefit from surgery, but there is still a lack of universally accepted screening criteria and operational norms, and multiple factors affect the effectiveness of surgical treatment for advanced GISTs. Different surgical strategies should be developed for imatinib-resistant GISTs or multiple TKI-resistant GISTs. During the period when the tumors respond to imatinib, cytoreductive surgery is most likely to improve the survival of patients. Early or localized progression should be identified and promptly intervened with surgery. At present, there are few studies on sunitinib or regorafenib combined with surgery, and their feasibility and value are still controversial. Ripretinib combined with cytoreductive surgery may be a new breakthrough point.

Gastric cancer is a prevalent malignancy of the digestive system, and traditional laparoscopic radical gastrectomy remains a crucial treatment modality. However, the abdominal wound associated with specimen removal during this procedure conflicts with contemporary concept of minimally invasive surgery. Natural orifice specimen extraction surgery (NOSES) is an emerging minimally invasive surgical technique that has gained increasing utilization in patients with gastrointestinal tumors, owing to its benefits of reduced wound, accelerated postoperative recovery, and diminished postoperative pain. In recent years, the extensive application of NOSES technology for colorectal cancer in China has provided theoretical support for the minimally invasive treatment of gastric cancer. With the standardization of community health examinations in China, the incidence of early gastric cancer diagnoses is expected to rise, making NOSES surgery the likely future trend in the surgical treatment for early gastric cancer. However, this area remains under-explored both domestically and internationally. This paper aims to synthesize prior literature and review the historical development, current research status, advantages and disadvantages, technical challenges, and future directions of completely laparoscopic radical treatment of distal gastric cancer utilizing NOSES.

The close relationship between gastric cancer (GC) and type 2 diabetes mellitus (T2DM) has garnered significant attention. On one hand, T2DM may play a role in the development and progression of GC, correlating with poor patient outcomes. On the other hand, after radical surgery for GC, T2DM can be effectively managed, potentially improving tumor prognosis. In recent years, bariatric and metabolic surgery (BMS) has revolutionized T2DM treatment for obese and overweight patients. Comparative analyses reveal similarities between surgical approaches for gastric cancer and BMS, leading to the emergence of the onco-metabolic surgery (OMS) concept, which suggests that radical tumor resection and T2DM remission in GC patients can be potentially achieved through a single procedure. However, there are notable differences between OMS and BMS, including target populations, surgical details, and perioperative management. Therefore, optimizing the application of the OMS concept in GC patients holds significant clinical importance. This article provides a review to facilitate the better implementation of this concept in practice.

Objective: This study aimed to share preliminary experiences of single-incision plus two ports laparoscopic proximal gastrectomy with right-sided overlap and single-flap valvuloplasty (ROSF). Methods: Following the 6th edition of the Japanese Gastric Cancer Treatment Guidelines, proximal gastrectomy with lymphadenectomy was performed. Using a single-port approach, the esophagus was transected at least 2 cm above the tumor's upper margin with linear staplers. The stomach was then extracted through a periumbilical incision, and the proximal stomach was subsequently transected extracorporeally, while ensuring appropriate resection margins on both the greater and lesser curvatures. A single flap was created before returning the remnant stomach to the abdominal cavity and re-establishing pneumoperitoneum. The No.2 clip was used to grasp and elevate the esophageal stump. An incision was made at the right lower edge of the esophageal stump to guarantee that the esophageal lumen was open. The linear stapler was then inserted into the openings of the stomach and esophagus to perform a side overlap anastomosis with a length of 3 cm. Another barbed suture was used to close the common opening of the esophagus and the stomach, and the same barbed suture were used to suture the gastric wall to the lower edge of the muscle flap. The first barbed suture was then used to sequentially suture the proximal brim of the flap to the esophagus and the right brim of the flap to the right brim of the mucosal window. After completion of anastomosis, a drainage tube was inserted through the right upper port. This procedure was employed from November 2023 to March 2024 on five patients diagnosed with adenocarcinoma of the esophagogastric junction and upper stomach. The cohort consisted of three males and two females, with an age range of 62 to 75 years and a body mass index (BMI) of 13.7 to 24.2 kg/m². All cases were preoperatively staged as T1-2N0M0, confirmed by endoscopic biopsy and enhanced CT scans of the chest, abdomen, and pelvis. Results: All five patients successfully underwent the surgery. The median surgery time was 180-325 minutes, with the intraoperative blood loss of 30-50 ml. The number of lymph nodes harvested ranged from 18 to 27. The time to first flatus, and restore liquid diet and was 2.0-5.0 and 1.0-3.0 days, respectively. The postoperative length of stay was 9.0-11.0 days. The pain scores on the Numeric Rating Scale (NRS). On the first day, the pain scores were 3.0 in two cases, 2.0 in two cases, and 1.0 in one case. On the second day, the pain scores were 2.0 in two cases and 1.0 in three cases. On the third day, the pain scores were 1.0 in four cases and 2.0 in one case. No short-term postoperative complications were observed, and there were no perioperative deaths. Conclusion: Single-incision plus two ports laparoscopic proximal gastrectomy with ROSF is safe and feasible.