To investigate the safety and efficacy of three synchronous surgical methods (traditional open surgery, laparoscopic surgery, and laparoscopy-assisted surgery) in the treatment of patients with colorectal cancer liver metastases (CRLM).

A retrospective analysis was conducted on 146 patients with CRLM who underwent synchronous resection in the First Affiliated Hospital of Anhui Medical University between January 2010 and June 2023. The patients were divided into three groups based on the surgical methods: open surgery group (94 cases, open radical resection of colorectal cancer + open hepatectomy for liver metastases), laparoscopic surgery group (39 cases, laparoscopic radical resection of colorectal cancer + laparoscopic hepatectomy for liver metastases), and laparoscopy-assisted surgery group (13 cases, laparoscopic radical resection of colorectal cancer + open hepatectomy for liver metastases). Baseline characteristics, intraoperative conditions (operation time, blood loss, blood transfusion volume), postoperative recovery (postoperative hospital stay, time to first flatus and defecation, liver function), and complication rates were compared among the three groups. All patients were followed up until January 31, 2024, and disease-free survival (DFS) and overall survival (OS) were compared.

Significant differences were observed among the three groups in body mass index, primary tumor location, and primary tumor T stage (P<0.05). The operation time in the open surgery group was significantly shorter than that in the other two groups (P<0.001). The postoperative stay in the laparoscopic group was significantly shorter than that in the laparoscopy-assisted group and the open surgery group (P<0.05). The overall incidence of postoperative complications in the open surgery group was significantly higher than that in the other two groups (P<0.001). Survival analysis showed no significant difference in DFS among the three surgical methods (P=0.654), while the laparoscopy-assisted surgery group had the longest OS (P=0.03).

Open surgery, laparoscopic surgery, and laparoscopy-assisted synchronous surgery can achieve comparable efficacy in the treatment of CRLM. Laparoscopic surgeries demonstrate significant advantages in early postoperative recovery and the reduction of postoperative complication rates.

To explore the factors influencing the technical difficulty of laparoscopic conformal sphincter-preservation operation (CSPO) for low rectal cancer (LRC) based on anatomical foundations.

A case-control study was conducted. Data from 60 patients were analyzed with LRC who underwent laparoscopic CSPO for LRC in the Joint Logistics Support Force 980th Hospital from January 2022 to January 2025 following neoadjuvant therapy. The cases were grouped according to the difficulty of the surgery, with 26 cases in the high-difficulty surgery group and 34 cases in the normal surgery group. The differences in general information, anatomical indicators, pathological data, and post-chemotherapy indicators between the two groups were compared.

Compared to the normal surgery group, the high-difficulty surgery group exhibited shorter distance from the lower edge of the tumor to the anal margin (t=-2.354, P<0.05), longer maximum tumor diameter (t=2.544, P<0.05), shorter circumferential margin distance (t=-6.568, P<0.001), and smaller ischial tuberosity diameter (t=-2.232, P<0.05).

The distance from the lower edge of the tumor to the anal margin, the maximum tumor diameter, the circumambulatial margin distance, and the diameter of the ischial tuberosity are the key factors affecting the technical difficulty of laparoscopic CSPO for LRC after neoadjuvant therapy. Accurate preoperative assessment of these anatomical and oncological indicators can help to optimize surgical planning and improve the safety and effectiveness of anus-preserving surgery.

To evaluate the development and implementation effects of a standardized sterile supply management protocol in the interventional ultrasound department, and to provide evidence-based references for improving infection control quality in analogous interventional settings.

A single-center retrospective pre-post-controlled study was conducted, with January 1, 2022, designated as the protocol implementation date. Quality control indicators were compared between the pre-implementation period (from January to December 2021, 9 938 procedures) and the post-implementation period (from January to December 2022, 11 079 procedures). The protocol was developed using a four-step methodology comprising evidence synthesis, expert consensus, pilot implementation, and iterative revision. It encompassed seven core domains: receipt and acceptance inspection, classification and storage, expiration date and lot number management, use of sterile drapes and probe covers, inventory counting and handover procedures, adverse event reporting, and staff training and competency assessment. Primary outcome measures included the sterile item defect detection rate, suspected contamination event rate (further stratified by procedural infection risk), hand hygiene compliance rate, first-attempt training assessment pass rate, timely adverse event response rate, and infection control audit score.

No statistically significant difference was observed in procedure-type distribution between the two periods, confirming comparability. All baseline infection risk factors were comparable between the two periods. Following protocol implementation, the sterile item defect detection rate decreased from 1.26% to 0.35% (χ²=55.51, P<0.001), and the suspected contamination event rate declined from 0.18% to 0.06% (χ²=6.13, P=0.013), with the reduction most pronounced in high-risk procedures (0.36% to 0.09%, χ²=6.86, P=0.009). Hand hygiene compliance improved from 81.20% to 96.56% (χ²=36.24, P<0.001), and the timely adverse event management rate increased from 62.50% to 95.65% (Fisher’s exact test, P=0.043). The infection control inspection score rose from (94.94±0.53) to (98.63±0.36) (Z=-3.73, P<0.001). The first-attempt training assessment pass rate improved from 80.00% to 94.12% (Fisher’s exact test, P=0.133), demonstrating a clinically meaningful upward trend that did not reach statistical significance. The insufficient sample size was the primary reason.

The evidence-based four-step sterile item management protocol developed for the interventional ultrasound department significantly reduces sterile item defects and contamination events (particularly in high-risk procedures), and improves hand hygiene compliance and infection control inspection scores. This approach represents a generalizable, department-level quality improvement pathway applicable to similar interventional ultrasound practice settings.

Enterostomy is a key surgical procedure for treating various colorectal, pelvic, and abdominal diseases. However, its postoperative complications cannot be overlooked. Stoma outlet obstruction (SOO), as a common and challenging complication, severely affects patients’ postoperative recovery, nutritional status, quality of life, and may lead to readmission or even emergency surgery. This review aims to systematically integrate current clinical research on SOO, thoroughly exploring its epidemiology, pathophysiological mechanisms, multidimensional risk factors, clinical diagnostic methods, and comprehensive prevention and management strategies. By synthesizing existing literature, this article aims to provide clinicians with comprehensive understanding of SOO, with the goal of optimizing perioperative patient management, reducing complication rates, and improving patient outcomes.

Currently, patients with tumors located in the right colon are commonly treated with laparoscopic radical right hemicolectomy. Although laparoscopic techniques have made surgery more visual and precise, the varied morphology and variable course of the right colic vessels often pose challenges for surgeons, and improper manipulation may lead to unnecessary intraoperative injuries. Therefore, to better address and overcome the issues of vascular variations and reduce intraoperative injury, we conducted a literature review on the surgical approaches and anatomical guidance for laparoscopic right hemicolectomy, aiming to identify more reasonable, simplified, and individualized surgical approaches.

The organ-specific immunosuppressive microenvironment of colorectal liver metastasis (CRLM) is a key cause of immunotherapy resistance. Based on single-cell RNA sequencing and spatial transcriptomics, we found that SPP1⁺ macrophages formed a functional axis with cancer-associated fibroblast (CAF) in CRLM foci, and constructed an immunosuppressive niche through metabolic reprogramming, extracellular matrix remodeling, and signal cross-talk. It is accompanied by myeloid cell expansion, T cell exhaustion, and up-regulation of immune checkpoint molecules. There are still core controversies and gaps in the current field: the developmental pathway of “Kupffer cell derivation” and “monocyte derivation” of SPP1⁺ macrophages is still controversial. The gap between the preclinical efficacy and clinical transformation of metabolic intervention needs to be urgently narrowed. The origin of TCR clonotypes of Tregs and the quantitative relationship between interleukin (IL-10) concentration gradient and CD8⁺ T cell depletion are still unclear. In view of the above mechanisms, this paper reviews the strategies such as precise targeting of immunosuppressive cells and synergistic metabolic-immune intervention, and prospects the direction of multi-omics guided individualized treatment, which provides theoretical support for overcoming the dilemma of immunotherapy for CRLM.

Chimeric antigen receptor (CAR)-T cell therapy has revolutionized the treatment paradigm for hematologic malignancies, but its success in solid tumors, especially gastrointestinal (GI) cancers including gastric, colorectal, and pancreatic cancers, remains limited. Multiple complex resistance mechanisms constitute major obstacles to its advancement. We classify resistance mechanisms into three categories: tumor-intrinsic factors, immunosuppressive tumor microenvironment, and intrinsic limitations of CAR-T cells themselves. For each resistance mechanism, we discuss corresponding cutting-edge strategies, including next-generation armored CAR-T designs, rational combination therapies with immunomodulators, and novel approaches targeting epigenetic regulation and cellular metabolism.

Thyroid cancer (TC) is one of the most common endocrine malignancies, showing rapidly increasing incidence. The phosphatidylinositol 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway is a crucial pathway that interacts with various key cell signaling molecules. It is responsible for a wide range of cellular activities in TC, including cell proliferation, apoptosis, invasion, metastasis and epithelial-mesenchymal transition. In addition, the PI3K/AKT pathway also plays a crucial role in the response to TC ¹³¹I therapy. Researches have shed light on the significant role of noncoding RNAs (ncRNAs), which include microRNA (miRNA), long noncoding RNA (lncRNA), and circular RNA (circRNA), in regulating key signaling pathways, including the PI3K/AKT pathway. Conversely, PI3K/AKT also regulates the expression of ncRNA. Therefore, this review aims to comprehensively discuss the pivotal role of ncRNAs in regulating the PI3K/AKT pathway, as well as their roles in the biological functions of TC. In addition, we also attempt to elucidate the complex feedback loops that exist between these components.

To systematically evaluate the efficacy and safety of mesh (synthetic, biological or absorbable) reinforcement versus suture-only repair in the surgical treatment of hiatal hernia (HH).

A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang Data, CBMdisc and VIP Chinese Journal Service Platform from inception to September 10, 2025 for randomized controlled trials (RCTs) comparing mesh-augmented HH repair with suture-only repair. After screened studies, data were extracted and assessed the risk of bias using the Cochrane RoB 2 tool. Meta-analysis was performed using RevMan 5.4.1 software. The primary outcome was radiologically or endoscopically confirmed anatomical recurrence. Secondary outcomes included incidence of dysphagia, reoperation rate, intraoperative complications, et al. Pooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) were calculated using fixed-effect or random-effects models. Pre-specified subgroup analyses were conducted based on mesh material (absorbable or non-absorbable).

A total of 10 publications reporting outcomes from 8 RCTs follow-up were included, involving 768 patients. The mesh group consisted of 421 patients, while the suture group 347 patients. Regarding the reduction of postoperative anatomical recurrence rates, eight RCTs reported short-term (<1 year) recurrence. The initial meta-analysis indicated moderate heterogeneity among studies (I²=57%, P=0.02). Under a random-effects model, the mesh group demonstrated significant reduction in short-term recurrence risk (pooled OR=0.41, 95% CI: 0.18-0.92, P=0.03). Three RCTs reported mid- to long-term anatomical recurrence rates (follow-up >3 years), involving 215 patients in the mesh group and 211 in the suture group. No heterogeneity was observed among these studies (I²=0, P=0.77). A subgroup analysis based on mesh absorbability showed no significant difference between absorbable and non-absorbable meshes in the effect of reducing short-term recurrence (P=0.45). There was no statistically significant difference in hospital stay length between the two groups (P=0.485). Due to significant heterogeneity in data reporting formats, no quantitative pooled analysis was performed for this outcome.

In the surgical treatment of HH, the benefits of mesh reinforcement exhibit clear material-dependency and time-dependency. Non-absorbable synthetic mesh significantly reduces short-term recurrence risk, whereas the efficacy of absorbable biological mesh remains unconfirmed. Furthermore, evidence regarding the long-term durability of mesh is insufficient. Future high-quality RCTs with extended follow-up are required to validate the long-term outcomes of different mesh types.