The treatment options for hernia have been becoming increasingly diverse. Coupled with the lack of high-quality clinical evidence and conflicts between the cognition and preferences of doctors and patients, a large number of “grey areas” in clinical decision-making have emerged. The traditional decision-making model is no longer suitable for clinical needs. Shared decision-making (SDM), a patient-centered decision-making model, provides an effective solution to this predicament. This article elaborates on the complexity of decision-making in hernia treatment, reviews the theoretical basis and SHARE implementation framework of SDM, summarizes its international evidence-based practices and application effects in hernia treatment, and at the same time analyzes the challenges faced by the implementation of SDM in the clinical practice of hernia and abdominal wall surgery in China, such as insufficient policy support, lack of training for medical staff, and the absence of localized decision-making support tools. It also proposes targeted coping strategies.

To explore the potential risk factors for mortality within 30 days after orthotopic liver transplantation (OLT) and provide scientific basis for formulating individualized perioperative intervention strategies and predicting postoperative risks.

This retrospective study included recipients who underwent OLT at Beijing Chao-Yang Hospital, Capital Medical University. Death within 30 days after surgery was defined as early postoperative mortality, and patients were grouped accordingly. General patient information, preoperative laboratory indicators, and intraoperative data were collected. Receiver operating characteristic (ROC) curves were used to determine the optimal cutoff values for each indicator. Least absolute shrinkage and selection operator (LASSO) regression was applied to screen factors relevant to early postoperative mortality, followed by univariate and multivariate Logistic regression analysis to identify independent risk factors. Restricted cubic spline (RCS) analysis was employed to examine the dose-response relationships between these factors and the risk of early mortality.

A total of 535 OLT recipients were included, among whom 36 (6.7%) experienced early postoperative mortality. Multivariate Logistic regression analysis revealed that intraoperative erythrocyte transfusion >1 650 ml (OR=3.313, 95% CI: 1.397-7.857), intraoperative urine volume≤1 115 ml (OR=3.245, 95% CI: 1.409-7.473), preoperative platelet count≤24.5×10⁹/L (OR=3.437, 95% CI: 1.194-9.895), and preoperative blood glucose≤4.8 mmol/L (OR=2.955, 95% CI: 1.286-6.791) were independent risk factors for early postoperative mortality after OLT. RCS analysis indicated that intraoperative erythrocyte transfusion volume and urine volume showed linear correlations with the risk of early postoperative mortality, while preoperative platelet count exhibited a nonlinear correlation with the risk of early postoperative mortality.

Low preoperative platelet count, preoperative hypoglycemia, high intraoperative erythrocyte transfusion volume, and low intraoperative urine volume are independent risk factors for early postoperative mortality. Preoperative measures should be taken to increase platelet counts above 24.5×10⁹/L, while the optimal range for perioperative blood glucose requires further clarification.

To analyze the risk factors for infectious complications following open hepatectomy in patients with hepatocellular carcinoma (HCC).

Clinical data of 63 patients with HCC who underwent elective open hepatectomy in Guangzhou Eighth People’s Hospital from January 2023 to October 2025 were retrospectively collected. Patients were divided into an infection group (15 patients) and a non-infection group (48 patients) based on the occurrence of postoperative infectious complications. Univariate analysis and multivariate Logistic regression analysis were used to identify independent risk factors.

Among the 63 patients, 15 (23.81%) developed postoperative infectious complications, including intra-abdominal infection in 8 cases (53.33%), surgical site infection in 6 cases (40.00%), and pulmonary infection in 1 case (6.67%). Univariate analysis showed statistically significant differences between the two groups in preoperative serum albumin, total bilirubin, ascites, nutritional risk screening 2002 (NRS 2002) score (NRS-2002≥3 points), and Child-Pugh grade (all P<0.05). Multivariate Logistic regression analysis revealed that low preoperative serum albumin (OR=0.70, 95% CI： 0.56–0.89, P=0.003) and high level of preoperative total bilirubin (OR=1.13, 95% CI： 1.03–1.24, P=0.011) were independent risk factors for infectious complications after open hepatectomy in HCC patients.

Low preoperative serum albumin level and high preoperative total bilirubin level are independent risk factors for infectious complications following open hepatectomy in patients with HCC. Perioperative monitoring and intervention targeting serum albumin and total bilirubin should be strengthened to reduce the risk of postoperative infection.

To investigate the clinical efficacy and safety of single-port laparoscopic-assisted precision breast-conserving surgery (SPE-BCS) in the treatment of early-stage breast cancer by comparing it with conventional open breast-conserving surgery (C-BCS).

The clinical data of female patients with stage Ⅰ–Ⅱ breast cancer who underwent SPE-BCS (60 patients) and C-BCS (80 patients) in Shanghai General Hospital, Shanghai Jiao Tong University, from July 2022 to July 2023 were retrospectively analyzed, including surgical procedures, operative time, intraoperative blood loss, postoperative complications, pathological resection margin status, and oncological outcomes. Postoperative cosmetic outcomes and quality of life were also assessed. The median follow-up time was 30 months.

Baseline characteristics were similar between the two groups. The SPE-BCS group had slightly shorter operative time and less intraoperative blood loss than the C-BCS group. Both groups had negative surgical margins and similar postoperative complication rates. Six months after surgery, patients in the SPE-BCS group had higher cosmetic satisfaction and higher BREAST-Q scores, indicating less postoperative pain and better chest wall comfort. During the follow-up, no local recurrence or distant metastasis occurred in either group.

SPE-BCS offers advantages such as smaller incisions, improved cosmetic results, avoiding heat damage while maintaining oncological efficacy. It is a feasible and safe alternative to C-BCS. With the widespread adoption of this technique and a shortened learning curve, this procedure is expected to become a new surgical procedure in breast-conserving treatment for early-stage breast cancer.

To construct an implementation model for the structured integration of medical humanities general education into residency training, tailored to clinical scenarios in general surgery, to verify its application effects, and to analyze the internal mechanism through which it enhances the comprehensive professional competency of resident physicians.

A quasi-experimental study design was employed. A total of 136 resident physicians who rotated in the Department of General Surgery at the First Affiliated Hospital of Sun Yat-sen University from July 2020 to June 2023 were selected as research subjects. They were non-randomly divided (based on rotation batches) into an observation group (n=60) and a control group (n=76). The observation group underwent a 5-month humanities-integrated teaching intervention based on a three-dimensional framework of “Curriculum-Scenario-Feedback” on the basis of conventional residency training, while the control group received conventional general surgery residency training. The teaching effects were comprehensively evaluated from multiple dimensions through end-of-rotation assessments, reflective journal text analysis, scenario simulation assessments, and specialized questionnaires.

The scores of the observation group in professional theory, skill operation, and case presentation were 8.9%, 8.4%, and 8.2%, higher than those of the control group respectively, with all differences statistically significant (P<0.001). The observation group scored significantly higher than the control group in the affective response and critical analysis dimensions of reflective journals, the information giving and shared decision-making items in scenario simulations, as well as in all dimensions of cognitive understanding, affective identification, behavioral intention, and teaching satisfaction (all P<0.05).

The structured integration model constructed in this study can effectively and synergistically enhance the clinical professional competence and medical humanities literacy of general surgery resident physicians. Its core mechanism involves: reducing cognitive load through systematic curriculum integration, strengthening the internalization of humanistic affect through learning communities, and promoting the transformation of humanistic behaviors via a formative evaluation closed-loop. This provides a practical plan for implementing evaluable and replicable medical humanities education within the surgical residency training system.

Pancreatic cancer presents significant challenges due to low early diagnosis rates, ineffective drug treatments, and drug resistance, innovative foundational therapies for pancreatic cancer still face numerous obstacles in transitioning from trials to widespread clinical application. This article systematically outlines the key challenges across multiple dimensions, including molecular subtypes of pancreatic cancer, tumor microenvironment, preclinical models, early detection, treatment strategies, and research translation. It proposes potential breakthrough directions: early screening and improved diagnostic efficiency; personalized treatment plans based on genetic profiling of patients; development of more relevant preclinical research models; optimization of multimodal treatment strategies; and enhanced efficiency in translating basic research to clinical applications. Among these areas, the lag in early screening along with insufficient precision in personalized treatment, represent the core focal points for current breakthroughs. Promoting collaborative innovation across four key dimensions of “model systems, diagnostic tools, treatment strategies, and clinical trial design”, can bring hope for prolonging the survival of patients with pancreatic cancer.

Cholangiocarcinoma (CCA) is a highly malignant tumour of the biliary tract system, characterised by its aggressive nature, poor prognosis, and complex pathogenesis. In recent years, particularly with the advancements in high-throughput sequencing technology, the role of changes in the biliary tract microbiota in the occurrence, development, and diagnosis of CCA has garnered significant attention. This review examines the specific changes in the biliary tract microbiota associated with CCA, underlying the mechanisms by which alterations in the biliary tract microbiota drive the development and progression of CCA, and the potential value of biliary tract microbiota intervention in the prevention and treatment of CCA. The aim is to explore new directions for the prevention and treatment strategies of CCA.

This review provides a comprehensive overview of multimodal prehabilitation in elderly patients with gastrointestinal cancer, highlighting recent advances and variations in clinical outcomes. The principal components of multimodal prehabilitation—including exercise training, nutritional optimization, psychological support, and comorbidity management—are systematically summarized. Evidence from randomized controlled trials demonstrates considerable heterogeneity in prehabilitation efficacy among elderly adults, largely attributable to differences in baseline physiological function and comorbid conditions. A multidimensional assessment framework is proposed to facilitate population stratification and the development of tailored prehabilitation strategies for distinct patient subgroups. Furthermore, the emerging role of artificial intelligence in individualized assessment and risk prediction is discussed, offering new perspectives for implementing precision prehabilitation in geriatric oncology.

Gastric cancer represents one of the most common malignant tumors worldwide and leading cause of cancer-related mortality. The emergence of immune checkpoint inhibitors (ICIs) has markedly influenced the therapeutic landscape of gastric cancer in recent years. Programmed cell death protein-1 and ligand 1 (PD-1/PD-L1) inhibitors not only demonstrate significant survival benefits in the first-line treatment of advanced gastric cancer, but also provide new strategies for perioperative management of locally advanced gastric cancer. This artical aims to outline the application of ICIs in first-line and perioperative treatment of gastric cancer, and to discuss key issues including mechanisms of resistance, management of immune-related adverse events, and heterogeneity of the tumor microenvironment. These insights may shed light on novel immunotherapeutic strategies, optimization of combination regimens, and advancement of precision and individualized treatment approaches.

The evolution of hernia repair surgery has been closely tied to advancements in materials science. Synthetic, non-absorbable meshes were widely applied and had achieved favorable clinical outcomes by significantly reducing recurrence rate. However, due to their inherent material properties, their permanent implantation is associated with specific complications, including foreign body sensation, chronic pain, adhesions to surrounding tissues, and mesh infection. Biological meshes, owing to their degradable nature, may significantly reduce the risk of these complications. The advantages of biological meshes include excellent biocompatibility, degradability, the capacity to induce tissue regeneration, and a favorable profile against infection. Nevertheless, their clinical application was limited by high costs, potential immune-mediated adverse reactions, and ongoing debate regarding their mechanical strength and long-term efficacy. This article provides a systematic review of the application of biological meshes in hernia repair, elaborating on their respective advantages and limitations in inguinal hernia, ventral hernia, hiatal hernia, and parastomal hernia repair. With the development of material technology and completion of multi-center, large-sample, long-term follow-up clinical trials, the application of biological meshes in hernia repair is expected to become more standardized. They will provide a new foundation for the precision management of hernia repair.

Enhanced recovery after surgery (ERAS) significantly improves patient outcomes by optimizing perioperative management strategies. As a core component of ERAS, multimodal analgesia (MMA) integrates analgesic agents and techniques with different mechanisms of action to achieve effective postoperative pain control while reducing opioid consumption and opioid-related adverse effects. This article systematically reviews the specific applications and clinical value of MMA across various surgical specialties, including abdominal, orthopedic, and thoracic surgeries. Current challenges—such as insufficiently individualized analgesic strategies and uneven implementation of advanced techniques—are analyzed, and future directions based on precision medicine, novel analgesic agents, and intelligent technologies are discussed. Clinical practice demonstrates that MMA facilitates early postoperative recovery through optimized analgesic regimens and represents critical foundation for the successful implementation of ERAS.