中华胃肠外科杂志最新文献

Percutaneous endoscopic gastrostomy / jejunostomy (PEG/J) is a relatively safe and effective minimally invasive surgical approach to establish long-term enteral nutrition (EN) channels. Due to the good compliance and the reduced incidence of reflux and aspiration pneumonia, PEG/J is the preferred way for long-term EN and has been widely used in clinical applications. However, few technical guidelines or expert consensus guiding the clinical practice of PEG/J have been published. The formation of "Chinese expert consensus on clinical application of percutaneous endoscopic gastrostomy / jejunostomy (2024 edition)" is led by the Committee of Parenteral and Enteral Nutrition, Chinese Research Hospital Association. This consensus is based on the latest clinical evidence as well as the clinical experience of Chinese experts. This consensus is divided into PEG/J indications and contraindication, perioperative management, operational techniques, prevention, and treatment of related complications and other issues. All recommendations and their strengths were carried out by expert-voting method and presented as the basic framework of "Recommended Opinions (level of evidence and strength of recommendation) and Summary of Evidence". This consensus is registered on the International Practice Guide Registration Platform (IPGRP-2022CN329).

Gastric cancer is one of the most common malignant tumors in China. Currently, the surgery-based procedure is still the most acceptable strategy for treating gastric cancer. As an important part of standardized management, appropriate specimen processing following surgery is receiving more and more attention across the world. With the release of guidelines and consensus on the specimens processing after gastric cancer surgery, several centers in China have started to follow this standard procedure. However, due to differences in understanding the consensus and the degree of surgery practice, the results are variable. This paper will focus on reviewing every aspect of the processing procedure, with the hope that the concept and skill involved can be popularized in clinical operations. Hopefully this will help promote the development of high-quality gastric cancer surgery in China.

The establishment of a high-quality gastric cancer database significantly improves the efficiency and standardization of diagnosis and treatment of this disease. Our center has developed a specialized, single-center gastric cancer database and initiated the China Gastrointestinal Cancer Surgery Union, catalyzing the exploration of multi-center databases. This article encapsulates multi-level experience and provides a detailed overview of the quality control methods we implement in both constructing and managing the gastric cancer database. Utilizing an electronic medical record system and a multi-disciplinary treatment (MDT) approach, we have designed the database in a modular and multi-nodal manner. A synthesis of automatic retrieval of structured data and manual entry, coupled with a rigorous MDT system and real-time supervision at various nodes, bolster our real-time quality control efforts. Ensuring data security and digitized management plans alongside real-time review protocol and a multi-level review system, we maintain the highest standards in the initiation and management of the database. Through the establishment of the China Gastrointestinal Cancer Surgery Union platform, we endorse the concept that multi-center database construction should be driven by research objectives, consider data accessibility, while placing an emphasis on building inter-center consensus on data quality control. Moving forward, it is crucial that the development of multi-center databases promotes uniformity in medical standards across centers, cultivates stable public data sharing platforms, ensures robust data security protocols, routinely conducts data quality assessments, and bolsters multi-center cooperation and exchanges to promote the homogeneity of medical standards.

The incidence of gastric cancer ranks fifth among malignant tumors worldwide, with the fourth highest mortality rate. A noteworthy characteristic of our country is the high prevalence of advanced-stage patients of approximately 40%. Advanced-stage gastric cancer carries an unfavorable prognosis with median survival of around one year. Diagnosis methods for advanced-stage gastric cancer (such as laparoscopic exploration, molecular profiling, and artificial intelligence) are still being continuously improved, while chemotherapy remains the primary treatment. With the rapid development of medical science, the role of surgical intervention in advanced-stage gastric cancer is becoming increasingly prominent. Therefore, as gastric tumor surgeons, we should consider how to use a combination of treatments, including surgery, chemotherapy, targeted therapy, immunotherapy, and interventional therapy, based on different pathological stages and the heterogeneity of tumors. With a multidisciplinary approach involving experts from various fields, we can collectively improve the survival rate and quality of life for advanced-stage patients. This article provides a brief overview of the current advances in the diagnosis and treatment of advanced-stage gastric cancer, and discusses therapeutic decision primarily from the perspective of surgeons.

Objective: To evaluate the value of implementing a modified reverse puncture procedure for esophagojejunostomy during totally laparoscopic total gastrectomy. Methods: This was a descriptive case series. Relevant clinical data, including the operative procedure, recovery, and pathological findings of 35 patients with gastric cancer who had undergone esophagojejunostomy with a modified reverse puncture technique during totally laparoscopic total gastrectomy in the Department of Gastrointestinal Surgery, Fujian Provincial Hospital, from June 2022 to January 2023, were prospectively collected and retrospectively analyzed. The age of all patients in the group was (64.9±8.0) years old, with 22 males (62.9%) and a body mass index of (23.2±2.4) kg/m². The tumors were located in the upper and middle parts of the stomach in 24 cases (68.6%) and in the junction of the esophagus and stomach in 11 cases (31.4%). Important technical aspects of the modified reverse puncture procedure are as follows. (1) Site of the esophageal incision: a transverse incision is made across the right lateral wall of the esophagus at the expected site of esophageal disjunction. (2) Technique for inserting an anvil: after threading a silk thread through the tip of anvil, the end of the thread is knotted and fixed as the traction thread, after which an anvil is inserted into the esophagus through the esophageal incision, leaving the end of the traction line exposed. Next, a 60-mm linear cutter is placed through the right midclavicular trocar to straighten the opened esophagus vertically, after which the rod of the anvil is pulled out of a small incision that has been made in the esophagus by pulling the traction thread, thus completing anvil placement. (3) Jejunal binding: the jejunum on the central bar of the stapler is fastened with silk thread to the stump of the jejunum, and then tied to the output loop of the jejunum with a gauze strip. Results: All 35 surgeries were successful, with no mortality or conversion to laparotomy. The operation time, anvil insertion time, and digestive tract reconstruction time were (232.7±34.4), (8.5±1.4), and (40.5±4.8) minutes, respectively. The intraoperative blood loss was 100 (20-250) mL and the incision was (5.3±0.9) cm long. The upper surgical margin was negative in all patients and the mean distance between the upper and tumor margins was (3.5±1.2) cm. The mean number of lymph nodes dissected per patient was 33.9±7.1. The times to initial ambulation, initial passage of flatus , postoperative fluid intake, and length of postoperative hospital stay were (3.2±1.1), (3.7±1.5), (4.6±2.3), and (9.8±3.2) days, respectively. Postoperative complications occurred in five patients: one case of anastomotic leak, two of anastomotic stenosis, one of pulmonary infection, and one of incomplete intestinal obstruction, all of which were successfully managed conservatively. Conclusion: Esophagojejunostomy using a mo

The publication of Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) has widely accelerated the standardization and homogenization on the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). In China, the surgical outcomes of AEG, the universality and practicability of this consensus has also been affirmed after the clinical practice during the past 5 years. Due to the persistent increasing incidence of AEG, the specificity on anatomic site, clinicopathological characteristics, molecular biological characteristics, AEG had been always the hotspot of many clinical trials and more clinical evidences had been published. However, its definition, classification, staging, surgical approach, resection pattern, extent of lymphadenectomy, and the digestive tract reconstruction etc. remain controversial. In light of the above, it is necessary to update the 2018 edition of consensus. The Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2024 edition) is generated based on the currently available and best clinical evidence, the latest global guidelines or consensuses, and the opinions from the Chinese expert panel. The present consensus focuses on the key points of surgical treatment and issues in dispute, and provides scientific recommendations. The goal of this expert consensus was to improve the homogeneity in understanding and practice between Chinese thoracic and gastrointestinal surgeons, and to further standardize surgical treatment of AEG. Those pending issues in this consensus need high-quality clinical research to further investigate.

Objective: To investigate the feasibility and safety of implementing modified tubular gastric side-overlap anastomosis in laparoscopic proximal gastrectomy. Methods: In this retrospective, descriptive case series, we analyzed clinical data of seven patients who had undergone laparoscopic proximal gastrectomy and gastrointestinal reconstruction with modified tubular gastric side-overlap anastomosis from October 2022 to March 2023 in the Second Affiliated Hospital of Fujian Medical University. The study patients comprised five men and two women aged 57-72 years and of body mass index 18.5-25.7 kg/m². All seven patients had preoperative gastroscopic and pathological evidence of esophagogastric junction cancer and all were found by preoperative enhanced computed tomography and/or endoscopic ultrasonography to have stage CT1-2N0M0 tumors. The main steps in the reconstruction of a modified tubular gastric side-overlap anastomosis are as follows: (1) mobilizing the lower esophagus and opening the left pleura to expand the space; (2) severing the esophagus with a linear cutter stapler; (3) creating a 3-cm-wide tubular stomach along the greater curvature; (4) creating a 5-cm guide line on the lesser curvature of the anterior wall of the tubular stomach and a small opening below the guide line; (5) rotating the esophageal stump 90° counterclockwise and making a small opening on the right posterior wall of the esophageal stump, along with using a 45-mm linear cutter stapler for esophagogastric side-to-side anastomosis under the guidance of the gastric tube and guide line ; (6) closing the common opening using barbed sutures; (7) embedding the cut edge of the esophageal stump such as to closely oppose it to the esophagus; (8) using barbed sutures to continuously suture the lower esophagus bilaterally to the anterior wall of the tubular stomach; and (9) closing the opened esophageal hiatus and pleura. The main outcome measures were intraoperative (operation time, digestive tract reconstruction time, closing the common opening time, intraoperative blood loss, and number of dissected lymph nodes), postoperative (time to passage of flatus , time to liquid diet, time to ambulation, length of postoperative hospital stay, and postoperative complications), pathological (maximum diameter of the tumor and pathological stage) and findings on follow-up. Results: Laparoscopic proximal gastrectomy with reconstruction of a modified tubular gastric side-overlap anastomosis was successfully completed in all seven patients; no conversion to laparotomy was required and there were no postoperative complications. The operation time, digestive tract reconstruction time, and closing of common opening time were 187-229, 61-79, and 7-9 minutes, respectively. Intraoperative blood loss was 15-23 ml and the number of dissected lymph nodes was 14-46 per case. Time to passage of flatus, time to liquid diet, time to ambulation, and postoperative hospi

Numerous studies have confirmed that D2 lymphadenectomy is the standard surgery for locally advanced gastric cancer. Standardized lymph node dissection plays a crucial role in ensuring surgical quality and efficacy. It is recommended to perform D2 lymph node dissection according to the 6th edition of the Japanese gastric cancer treatment guidelines. For lymph nodes beyond the scope of D2 lymph node dissection, such as No.10, 13, 14v, 16 and mediastinal lymph nodes, selective D2+ lymph node dissection can be performed, which may be advantageous for some patients. Currently, omentectomy is the standard surgical procedure for locally advanced gastric cancer. However, the clinical significance of gastrectomy with preservation of the greater omentum requires further validation through large-scale clinical trials. Standardized ex vivo lymph node dissection is important for accurate postoperative staging, and it is recommended to harvest more than 30 lymph nodes to avoid staging deviation.

After nearly 30 years of exploration and practice, minimally invasive surgical techniques represented by laparoscopic technology have become an important means for the surgical treatment of gastric cancer. In China, laparoscopic radical resection for locally advanced gastric cancer has been extensively carried out. However, there are still controversies regarding the gastric resection range and methods for advanced gastric cancer. By reviewing relevant domestic and foreign guideline documents and combining team practice experience, this article elaborates on the key points of quality control of laparoscopic gastric resection range for locally advanced gastric cancer from aspects such as tumor localization and gastric resection range for upper, middle and lower gastric tumors. It aims to provide reference for carrying out and promoting laparoscopic radical gastrectomy more safely.

Due to the unique nature of its anatomical location, the adenocarcinoma of esophagogastric junction (AEG) has been a subject of controversy and disagreement including its definition, staging, and treatment strategies. Chinse expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2018 Edition) had been released in September 2018 and had played a pioneering role in unifying thoracic and general surgeons in China on surgical treatment strategies for AEG. Over the past five years, the emergence of several clinical research results on AEG has provided new clinical evidence for the selection of key surgical treatment strategies. Therefore, to further standardize the surgical treatment of AEG in China, Chinese Expert Consensus on Surgical Treatment of Adenocarcinoma of Esophagogastric Junction in China (2024 Edition) was released in 2024 by Chinese expert panel including 25 gastrointestinal surgeons and 24 thoracic surgeons. Based on the highest-level clinical research evidence in recent 5 years, this consensus ultimately formulates 29 recommendations on hotspots and key points on surgical treatment of AEG and summary 5 issues that are still awaiting further exploration. This review will provide a summary and detailed interpretation of the recommendations outlined in this consensus.