Quality analysis of surgical specimens of rectal cancer in the Chinese taTME registry coll-aborative database: a nationwide registered study / 中华消化外科杂志

Objective:To analyze the quality of surgical specimens of rectal cancer in the Chinese transanal total mesorectal excision (taTME) registry collaborative (CTRC) database.Methods:The retrospective and descriptive study was conducted. Based on the concept of real-world research, the clinicopathological data of 1 761 patients with rectal cancer in the CTRC database who underwent taTME in 40 medical centers, including the Beijing Friendship Hospital of Capital Medical University et al, from November 15, 2017 to December 31, 2022 were collected. There were 1 212 males and 549 females, aged 62(range, 53-68)years. Observation indicators: (1) preoperative examinations; (2) neoadjuvant therapy; (3) postoperative examinations. Measurement data with skewed distri-bution were represented as M(range). Count data were described as absolute numbers. Results:(1) Preoperative examinations. Of the 1 761 patients, 1 324 patients underwent preoperative pelvic magnetic resonance imaging examination, and the results showed that 4 cases as clinical T0 stage, 30 cases as clinical T1 stage, 250 cases as clinical T2 stage, 828 cases as clinical T3 stage, 141 cases as clinical T4 stage, 11 cases as clinical Tx stage, 60 cases missing clinical T staging data, 490 cases as clinical N0 stage, 373 cases as clinical N1 stage, 311 cases as clinical N2 stage, 86 cases as clinical Nx stage, 64 cases missing clinical N staging data, 156 cases with mesorectal fascia invasion, 223 cases with extraintestinal blood vessels invasion. The distance from lower margin of tumor to anal margin of 1 324 patients was 50(range, 40-60)mm. (2) Neoadjuvant therapy. Of the 1 761 patients, 873 patients underwent neoadjuvant therapy, including 17 cases receiving radiotherapy alone, 155 cases receiving chemotherapy alone, 43 cases receiving short-course simultaneous chemoradiotherapy, 26 cases receiving short-course simultaneous chemoradiotherapy and delayed surgery, 1 case receiving contact radiotherapy, 277 cases receiving long-course simultaneous chemoradiotherapy, 9 cases receiving other treatments, and 345 cases missing neoadjuvant therapy data. (3) Postoperative examinations. Of the 1 761 patients, 1 584 cases achieved R 0 resection, 23 cases achieved R 1 resection, 1 case achieved R 2 resection, and there were 153 cases missing surgical margin data. The tumor diameter, number of lymph nodes harvest and positive rate of intravascular tumor thrombus were 30(range, 20-45)cm, 13(range, 10-17) and 20.794%(330/1 587) in 1 761 patients. There were 1 647 patients with circumferential margin records, which showed positive in 51 cases, and the minimum distance from deep part of tumor to circumferential margin was 5(rang, 3-13)mm in 1 647 patients. There were 547 cases with distal margin records, which showed positive in 4 cases, and the distance from lower margin of tumor to distal margin was 20(10-25)mm in 547 cases. There were 1 698 patients with specimen integrity records, which showed intact specimen in 1 436 cases, fair specimen in 233 cases, poor specimen in 8 cases, unevaluated specimen in 21 cases, and there were 20 cases with rectal tube perforation. Of the 1 761 patients, cases as pathological T0 stage, Tis stage, T1 stage, T2 stage, T3 stage, T4 stage was 103, 23, 145, 515, 712, 179, respectively, and there were 4 cases of pathology that could not be evaluated and 80 cases missing pathological T staging data. Of the 1 761 patients, cases as pathological N0 stage, N1a stage, N1b stage, N1c stage, N2a stage, N2b stage was 1 117, 189, 133, 66, 109, 68, respectively, and there were 79 cases missing pathological N staging data. Of the 1 761 patients, there were 79 cases with distant metastasis, 1 591 cases without distant metastasis, and 91 cases without data of tumor metastasis. Of the 873 patients undergoing neoadjuvant therapy, there were 405 patients with tumor regression grade records including 105 cases as grade 1, 142 cases as grade 2, 91 cases as grade 3, 43 cases as grade 4, 24 cases as grade 5. Conclusions:In China, the quality of surgical specimens of taTME for rectal cancer is good with low positive rate of resection margin. It is recommended that using a formatted postoperative pathological report for good quality control of pathological report of surgical specimen.

Continue to improve the high-quality multi-center clinical research in colorectal surgery in China / 中华消化外科杂志

High-quality clinical research is an important method to improve clinical diagnosis and treatment, promote discipline construction, and expand the frontier of medicine. In recent years, multi-center clinical studies in colorectal surgery in China have increased, and the level of clinical research has gradually improved, accumulating a wealth of clinical research experience. Innovative research topics and scientific design are the foundations of high-quality clinical research. Standardization of surgical techniques and quality control at all steps of the study are key to high-quality research. At the same time, researchers should establish a data management system, select appropriate data collection systems, and conduct regular data checks and feedback to ensure the quality of research data. Fully utilizing the advantages of case resources and further enhancing clinical research capabilities will provide assistance in promoting high-quality clinical research in the field of colorectal surgery in China. The authors summarize the experience of high-quality clinical research in colorectal surgery at home and abroad, in order to further promote the development of high-quality clinical research in China.

Analysis of clinical characteristics of adolescents undergoing metabolic and bariatric surgery / 国际外科学杂志

Objective:To analyze the clinical characteristics of obese adolescents undergoing metabolic and bariatric surgery for the purpose to guide clinical decision-making and practice of metabolic and bariatric surgery in adolescents.Methods:The perioperative clinical profile of 123 adolescent patients under the age of 21 years who underwent metabolic and bariatric surgery in Beijing Friendship Hospital, Capital Medical University from 2018 to 2021 were extracted, and compared their clinical data with the overall data of 6807 patients in the 2021 GC-MBD Annual Report. Analyzed the clinical characteristics of adolescent weight loss metabolic surgery patients from multiple aspects such as preoperative complications, surgical methods, surgical outcomes, and follow-up. Statistical analysis was conducted using SPSS25.0 software.Results:Among adolescent bariatric surgery patients, the proportion of female patients (74.0%) was higher than that of male patients (26.0%). Except for the incidence of polycystic ovary syndrome (31.9%), which was higher than the overall rate, the proportion of other related diseases or symptoms was low and usually mild. The changes of systolic blood pressure ( Z=-5.73, P<0.001), body weight ( Z=-5.69, P<0.001), umbilical abdominal circumference ( Z=-2.40, P=0.017), glycosylated hemoglobin ( Z=-5.23, P<0.001), fasting insulin ( Z=-2.95, P<0.003), fasting C-peptide ( Z=-4.59, P<0.001), triglyceride ( Z=-2.75, P=0.006) at 3 months after operation were statistically significant compared with those before operation. The changes of systolic blood pressure ( Z=-3.42, P=0.001), body weight ( Z=-5.14, P<0.001), umbilical abdominal circumference ( Z=-2.86, P=0.004) and glycosylated hemoglobin ( Z=-2.67, P<0.008), fasting C-peptide ( Z=-2.09, P=0.037), high-density lipoprotein ( Z=-2.08, P=0.038) at 6 months after operation were statistically significant compared with those before operation. Conclusions:The outcomes of bariatric surgery in obese adolescents are similar to those in adults. The indications and timing of bariatric surgery need to be further explored. In view of the high proportion of females, poor self-management ability and low follow-up compliance of adolescent patients, it is urgent to construct a full-cycle care model suitable for adolescent patients with bariatric surgery to improve their self-management ability, follow-up compliance and long-term clinical outcomes.

A meta-analysis of cholelithiasis after metabolic and bariatric surgery / 国际外科学杂志

Objective:To analyze the incidence of gallstone formation after Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) by meta-analysis.Methods:English terms for this meta-analysis included "bariatric surgery, gastric bypass, Roux-n-Y gastric bypass, RYGB, sleeve gastrectomy, SG, cholelithiasis, cholecystectomy, gallstone". Researched articles in Pubmed, Medline and Embase databases were searched up to February 2023 and retrieved for further analysis. The quality of each article was evaluated with Newcastle-Ottawa Scale (NOS). Generated data were analyzed with Revman 5.4.Results:Nine relevant cohort studies were retrieved for this meta-analysis, including a total of 24 255 RYGB patients and 4 500 SG patients. All articles met the requirements after the quality evaluation of NOS. The meta-analysis results showed that the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P<0.001). In subgroup analysis, by administering ursodeoxycholic acid (UDCA) for gallstone prevention, the incidence had no difference between the two groups ( P=0.090), while in the study without UDCA, the incidence of gallstones after RYGB was higher than SG ( P=0.005). In the studies with follow-up time no more than 24 months, the incidence of postoperative gallstones in RYGB group was higher than that in SG group ( P=0.050), but there was no statistical difference when following-up beyond 24 months ( P=0.240). Conclusions:Within 2 years after surgery, RYGB patients have more chances to develop gallstones than SG patients. However, beyond 2-year follow-up, there is no difference between the two procedures. Prophylactical utilization of UDCA after RYGB can effectively reduce the incidence of gallstone formation.

Prevention and treatment of perioperative venous thromboembolism in colorectal cancer patients / 国际外科学杂志

Venous thromboembolism (VTE) is a common perioperative complication in patients with malignant tumors. Factors such as colorectal cancer itself and surgical treatment can increase the risk of perioperative VTE. In recent years, with the development of the concept of enhanced recovery after surgery, the understanding of cancer-associated venous thrombosis has deepened, and significant progress has been made in the risk assessment, prevention and treatment strategies of cancer-associated VTE. This article will review the pathogenesis, risk factors, risk assessment, prevention and treatment strategies of colorectal cancer-associated VTE, in order to provide evidence-based medical basis and research ideas for the standardized management and future research of colorectal cancer-associated VTE.

Effects of metabolic and bariatric surgery on bone metabolism in patients with obesity: A meta-analysis / 国际外科学杂志

Objective:To systematically evaluate the effect of bariatric and metabolic surgery on bone metabolism in obese patients.Methods:Search terms for the present meta-analysis included "bariatric surgery, metabolic surgery, sleeve gastrectomy, gastric bypass, bone metabolic indicators, bone mineral density", both in English and corresponding Chinese. PubMed, WOS, Cochrane, CNKI, and VIP databases were searched for longitudinal studies from the establishment of the database to September 20, 2022. The data on bone mineral density and bone metabolic markers in obese patients before and after bariatric surgery were extracted. RevMan5.4 and Stata17.0 software were used for Meta-analysis.Results:A total of 8 clinical studies with 420 patients were included. The results of the meta-analysis showed that compared with the preoperative baseline, lumbar spine bone mineral density ( WMD=0.05, 95% CI: -0.00~0.1), femoral neck bone mineral density( WMD=0.10, 95% CI: 0.05-0.15), hip bone mineral density( WMD=0.14, 95% CI: 0.10-0.17), and serum vitamin D 3 ( WMD=-4.87, 95% CI: -6.34--3.40)were decreased, while parathyroid hormone ( WMD=10.04, 95% CI: 5.32-14.76) was elevated after surgery. Conclusions:Current evidence demonstrates that metabolic and bariatric surgery can lead to decreased bone mineral density and impairs in bone metabolic markers early after surgery. Roux-en-Y gastric bypass surgery cause more adverse effects on bone metabolism than sleeve gastrectomy. The results imply that all patients undergoing metabolic and bariatric surgery should be monitored for bone metabolism and routinely take vitamin D and calcium supplements.

Management and outcomes of gastric leak after sleeve gastrectomy: results from the 2010-2020 national registry / 中华医学杂志(英文版)

BACKGROUND@#Management of gastric leak after sleeve gastrectomy (SG) is challenging due to its unpredictable outcomes. We aimed to summarize the characteristics of SG leaks and analyze interventions and corresponding outcomes in a real-world setting.@*METHODS@#To retrospectively review of 15,721 SG procedures from 2010 to 2020 based on a national registry. A cumulative sum analysis was used to identify a fitting curve of gastric leak rate. The Kaplan-Meier method and log-rank tests were performed to calculate and compare the probabilities of relevant outcomes. The logistic regression analysis was conducted to determine the predictors of acute leaks.@*RESULTS@#A total of 78 cases of SG leaks were collected with an incidence of 0.5% (78/15,721) from this registry (6 patients who had the primary SG in non-participating centers). After accumulating 260 cases in a bariatric surgery center, the leak rate decreased to a stably low value of under 1.17%. The significant differences presented in sex, waist circumference, and the proportion of hypoproteinemia and type 2 diabetes at baseline between patients with SG leak and the whole registry population ( P = 0.005, = 0.026, <0.001, and = 0.001, respectively). Moreover, 83.1% (59/71) of the leakage was near the esophagogastric junction region. Leakage healed in 64 (88.9%, 64/72) patients. The median healing time of acute and non-acute leaks was 5.93 months and 8.12 months, respectively. Acute leak (38/72, 52.8%) was the predominant type with a cumulative reoperation rate >50%, whereas the cumulative healing probability in the patients who required surgical treatment was significantly lower than those requring non-surgical treatment ( P = 0.013). Precise dissection in the His angle area was independently associated with a lower acute leak rate, whereas preservation ≥2 cm distance from the His angle area was an independent risk factor.@*CONCLUSIONS@#Male sex, elevated waist circumference, hypoproteinaemia, and type 2 diabetes are risk factors of gastric leaks after SG. Optimizing surgical techniques, including precise dissection of His angle area and preservation of smaller gastric fundus, should be suggested to prevent acute leaks.

Actively participate in international high-quality clinical trials for improving the research level of colorectal surgery in China / 中华消化外科杂志

The number of colorectal cancer patients in China ranks the top in the world, but there are few international guidelines for the diagnosis and treatment of colorectal cancer formulated by Chinese, nor high-level evidence-based medicine research of colorectal cancer from China. Transanal total mesorectal excision (taTME) is a new technology in the field of colorectal surgery in recent years. At present, clinical practice related to taTME has been carried out simul-taneously with clinical researches in the world. Based on the experience of participating in the top clinical trials in the field of international colorectal surgery, like the COLOR series prospective research, the authors introduce the organization and implementation of COLOR Ⅲ research in China. It is hoped that the COLOR series trials will become an example in the field of high-quality surgical clinical research, so as to improve the clinical research level of colorectal surgery in China.

Conduct high-quality clinical studies in rectal cancer surgery based upon the IDEAL frame-work and recommendations / 中华消化外科杂志

The idea, development, exploration, assessment, and long-term follow-up (IDEAL) framework and recommendations provide a guiding path for high-quality research and practice for surgical technology innovation. Transanal total mesorectal excision, as a new technology in the field of colorectal surgery, has evolved step by step following the IDEAL framework. At the technical design and development stage, the technique feasibility is verified. At the exploratory stage, small-scale clinical practice is conducted, standardized diagnosis and treatment and surgical technique are developed, and structured training is carried out. During the assessment stage, large-scale rando-mized controlled studies are conducted to confirm the safety and efficacy. Subsequently, long-term monitoring and follow-up of the technique is carried out in clinical practice. All the processes become good example in the field of surgical clinical research. The authors summarize the pioneering works of the research team in quality control, in order to provide references for peers.

Predictive value of visceral adipose for early major complications after rectal cancer surgery / 国际外科学杂志

Objective:To investigate the predictive value of visceral adipose for early major complications after rectal cancer surgery by CT scan.Methods:A retrospective case-control study method was used to recruit a total of 135 patients with rectal cancer who underwent radical resection at Beijing Friendship Hospital, Capital Medical University from January 2017 to June 2018. There were 89 males and 46 females, aged from 30 to 88 years, with a median age of 63 years. The patients were divided into complication group ( n=16) and control group ( n=119) according to whether serious complications occurred within 30 days after operation. Measurement data with normal distribution were expressed as Mean±SD, and comparison between groups was analyzed by using independent sample t-test. Measurement data with skewed distribution were represented as M ( Q1, Q3) and analyzed by using the Mann-Whitney U test. Count data were expressed as constituent ratio, and analyzed using the chi-square test or Fisher exact test. Logistic regression model was used to analyze the factors affecting the occurrence of early severe complications after radical resection of rectal cancer. The area under the receiver operating characteristic (ROC) curve (AUC) was used to analyze the predictive ability of the model for early severe complications after radical resection of rectal cancer. Results:Univariate analysis showed that there were significant differences in intraoperative blood loss [100 (62, 187) mL vs 50 (40, 100) mL, Z=-2.038, P=0.042], operation time [(325 (212, 375) min vs 260 (180, 310) min, Z=-2.04, P=0.041)], preoperative blood glucose [4.67 (4.44, 5.09) mmol/L vs 5.20 (4.80, 5.72) mmol/L, Z=-3.33, P=0.001] and visceral fat area/subcutaneous fat area (V/S) (1.23±0.54 vs 0.96±0.40, t=-2.39, P=0.018) between the complication group and the control group. Multivariate Logistic regression model showed that V/S ratio ( OR=3.978, 95% CI: 1.160-13.636, P=0.028) and preoperative blood glucose level ( OR=0.168, 95% CI: 0.055-0.512, P=0.002) were independent risk factors for early major complications after radical resection of rectal cancer. Conclusions:Visceral fat and preoperative blood glucose level are independent risk factors for early major complications after radical resection of rectal cancer, V/S is expected to be a predictor of early major complications after radical resection of rectal cancer.

Meta-analysis of the safety and efficacy assessment for the jejunostomy tube placement during the radical resection for gastric carcinoma / 国际外科学杂志

Objective:To investigate the safety and efficacy of indignant jejunostomy tube in radical resection of gastric carcinoma.Methods:Using "radical gastrectomy, esophagectomy, jejunostomy, enteral nutrition" as the Chinese search terms and "gastrectomy, esophagectomy, jejunostomy, jejunostomies, enteral nutrition" as the English search terms searched Pubmed, MEDLINE, EMbase, Web of Science, Cochrane Library, CNKI, VIP, Wanfang and CBMdisc. The Chinese and English literatures published at home and abroad on indwelling and non-indwelling jejunostomy tubes after radical resection of gastric carcinoma from January 2010 to December 2020 were collected, including randomized controlled trial and cohort studies. The main outcome measure was the length of hospital stay; the secondary outcome measure was the overall postoperative complication rate, postoperative pulmonary infection rate, intestinal obstruction rate, and body weight changes at 3 and 6 months after radical gastrectomy. Meta-analysis was conducted using RevMan 5.2 software.Results:Finally, 12 articles with a total of 2 173 patients were included. Compared with the non-indwelling jejunostomy tube group, the patients in the indwelling group had a longer hospital stay ( WMD=2.05, P=0.01) and a higher incidence of intestinal obstruction ( OR=11.67, P<0.001). The incidence of overall postoperative complications ( OR=1.24, P=0.31), the incidence of postoperative pulmonary infection ( OR=1.43, P=0.13) and 3 months after radical gastrectomy ( WMD=0.58, P=0.24), 6 months ( P>0.05), the difference were not statistically significant. Conclusions:Indwelling jejunostomy tube placement after radical gastrectomy of gastric carcinoma did not show more therapeutic advantages, but prolonged the length of hospital stay and the probability of intestinal obstruction. Therefore, selective jejunostomy tube placement rather than routine jejunostomy placement should be required.

Incidence and influencing factors of parastomal hernia in patients with permanent colostomy / 中华消化外科杂志

Objective:To investigate the incidence and influencing factors of parastomal hernia in patients with permanent colostomy.Methods:The retrospective cohort study was conduc-ted. The clinicopathological data of 72 patients with permanent colostomy in the Beijing Friendship Hospital of Capital Medical University from January 2016 to June 2020 were collected. There were 50 males and 22 females, aged (66±12)years. Observations indicators: (1) follow-up; (2) analysis of factors affecting the incidence of parastomal hernia; (3) comparison of the incidence of parastomal hernia in patients with different age. Follow-up was conducted using outpatient examination. Patients were followed up once every 12 months after surgery to detect the incidence of parastomal hernia up to September 2021. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was conducted using the t test. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers and percentages, and comparison between groups was conducted using the chi-square test. Univariate analysis was conducted using the corresponding statistical methods based on data type. Multivariate analysis was conducted using the Logistic regression model. Kaplan-Meier method was used to draw the parastomal hernia occurrence curve and calculate the incidence rate of parastomal hernia and Log-rank test was used to analyze the incidence of parastomal hernia. Results:(1) Follow-up. All 72 patients were followed up for 23(range, 12?76)months. During the follow-up, there were 31 patients developed parastomal hernia, with the incidence as 20.8%(15/72), 36.1%(26/72) and 43.1%(31/72) at postoperative 1 year, postoperative 2 year and postoperative 5 year, respectively. Of the 31 patients with parastomal hernia, there were 21 cases of type Ⅰ, 3 cases of type Ⅱ and 7 cases of type Ⅲ. Patients with parastomal hernia recovered with conservative treatment. (2) Analysis of factors affecting the incidence of parastomal hernia. Results of univariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were related factors affecting the incidence of parastomal hernia ( χ2=7.98, t=?2.95, 2.02, P<0.05). Results of multivariate analysis showed that age, subcutaneous fat thickness and rectus abdominis thickness were independent factors affecting the incidence of parastomal hernia ( odds ratio=4.07, 3.19, 0.07, 95% confidence interval as 1.46?11.32, 1.43?7.09, 0.01?0.84, P<0.05). (3) Comparison of the incidence of parastomal hernia in patients with different age. Of the 72 patients, there were 37 cases with age <65 years and 35 cases with age >65 years. Of the 31 patients with parastomal hernia, there were 10 cases with age<65 years and all of them with type Ⅰ parastomal hernia, and the incidence of parastomal hernia in postoperative 1 year and postoperative 2 year was 13.5%(5/37) and 27.0%(10/37), respectively. There were 21 cases with age ≥65 years and cases with type Ⅰ, type Ⅱ and type Ⅲ parastomal hernia were 11, 3 and 7, respectively. The postoperative 1 year and postoperative 2 year incidence of parastomal hernia in the 21 cases was 28.6%(10/35) and 45.7%(16/35), respectively. There was a significant difference in the incidence of parastomal hernia between patients<65 years and ≥65 years ( χ2=9.28, P<0.05). Conclusion:Age, subcutaneous fat thickness and rectus abdominis thickness are independent factors affecting the incidence of parastomal hernia.

Clinical value of magnetic resonance imaging in predicting pathological complete response after immunotherapy combined with neoadjuvant therapy for local advanced rectal cancer / 中华消化外科杂志

Objective:To investigate the clinical value of magnetic resonance imaging (MRI) in predicting pathological complete response (pCR) after immunotherapy combined with neo-adjuvant therapy for local advanced rectal cancer.Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 48 patients with local advanced rectal cancer who were admitted to Beijing Friendship Hospital of Capital Medical University from January 2020 to March 2022 were collected. There were 35 males and 13 females, aged 62(32?77)years. Of 48 patients, 30 patients received neoadjuvant therapy, 18 patients received immunotherapy combined with neoadjuvant therapy. All patients underwent total mesorectal excision. Observation indicators: (1) T staging on MRI and postoperative pathological examination after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy; (2) changes of apparent diffusion coefficients (ADC) in pCR and non-pCR patients after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy; (3) evaluation of predictive performance of MRI for pCR after immunotherapy combined with neoadjuvant therapy. Measurement data with normal distribution were represented as Mean± SD, and t test was used for comparison between groups. Measurement data with skewed distribution were represented as M(range). Count data were expressed as absolute numbers or percentages. Sensitivity, specificity and accuracy were used to evaluate the predictive performance. Results:(1) T staging on MRI and postoperative pathological examination after neoadjuvant therapy and immunotherapy combined with neoadjuvant therapy. Of the 30 patients receiving neoadjuvant therapy, 1 patient in stage T2 showed stage T2 on both MRI and postoperative pathological examination after neoadjuvant therapy, 16 patients in stage T3 showed stage T0, T1, T2, T3, T4 of 0, 1, 6, 9, 0 cases and 3, 0, 8, 4, 1 cases on MRI and postoperative pathological examination respectively after neoadjuvant therapy, 13 patients in stage T4 showed stage T0, T1, T2, T3, T4 of 0, 0, 1, 2, 10 cases and 1, 0, 4, 7, 1 cases on MRI and postoperative pathological examination respectively after neoadjuvant therapy. The pCR rate was 13.3%(4/30) and the accuracy rate of MRI was 43.33% for patients with neoadjuvant therapy. Of the 18 patients receiving immunotherapy combined with neoadjuvant therapy, 12 patients in stage T3 showed stage T0, T1, T2, T3, T4 in 4, 2, 2, 4,0 cases and 5, 1, 1, 5, 0 cases on MRI and postoperative pathological examination respectively after immunotherapy combined with neoadjuvant therapy, 6 patients in stage T4 showed stage T0, T1, T2, T3, T4 in 0, 0, 1, 3, 2 cases and 4, 0, 0, 2, 0 cases on MRI and postoperative pathological examination respectively after immunotherapy combined with neoadjuvant therapy. The pCR rate was 50.0%(9/18) and the accuracy rate of MRI was 38.89% for patients with neoadjuvant therapy. (2) Changes of ADC in pCR and non-pCR patients after neoadjuvant therapy and immunotherapy combined with neoadjuvant chemoradiotherapy. Of the 30 patients receiving neoadjuvant therapy, the ADC differences were 0.30±0.04 and 0.21±0.17 for 4 pCR and 26 non-pCR patients, respectively, showing a significant difference ( t=2.36, P<0.05). Of the 18 patients receiving immunotherapy combined with neoadjuvant therapy, the ADC change rates and ADC differences were 40%±14% and 0.39±0.14 for 9 pCR patients, versus 22%±13% and 0.21±0.12 of 9 non-pCR patients, showing significant differences in the above indicators ( t=2.86, 2.79, P<0.05). Receiver operation charac-teristic curve analysis of ADC change rate and ADC difference associated with pCR for 18 patients receiving immunotherapy combined with neoadjuvant therapy suggested that the areas under the curve were 0.81 (95% confidence interval as 0.60?1.00, P<0.05) and 0.86 (95% confidence interval as 0.70?1.00, P<0.05), with cutoff values as 0.23 and 0.36, respectively. (3) Evaluation of predictive performance of MRI for pCR after immunotherapy combined with neoadjuvant therapy. For the 18 patients receiving immunotherapy combined with neoadjuvant therapy, the sensitivity, specificity, accuracy were 33.33%, 88.89%, 61.11% of stage T0 on MRI for predicting pCR, 88.89%, 55.56%, 72.22% of down-staging of T staging on MRI for predicting pCR, and all 77.78% of ADC difference greater than the cutoff value for predicting pCR. Conclusions:Patients with local advanced rectal cancer who received immunotherapy combined with neoadjuvant therapy achieve a higher pCR rate. ADC difference and down-staging of T staging on MRI can predict pCR effectively.

Gender differences in clinicopathological characteristics and prognosis of rectal cancer patients under 50 years old / 国际外科学杂志

Objective:To explore whether there are gender differences in clinical and pathological characteristics and prognosis of young patients with rectal cancer (under 50 years old), and to analyze the risk factors affecting the prognosis of young patients with rectal cancer.Methods:The medical records of 85 young rectal cancer patients admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2020 were retrospectively collected. According to gender, they were divided into male group ( n=50) and female group ( n=35). The age was (43.67±5.50) years old, ranging from 26 to 50 years old. Primary outcome measures were sex, disease-free survival, and overall survival. Secondary outcomes were family history, body mass index (BMI), clinical stage, anemia, whether the female patient was menopausal, whether the female patient took oral estrogen, the location of the primary lesion, whether neoadjuvant therapy was performed, pathological stage, whether accompanied with vascular nerve invasion, and whether postoperative adjuvant therapy was performed. R4.0.2 software was used for statistical analysis. The measurement data with normal distribution in the collected data were expressed as mean±standard deviation ( ± s), and the comparison between groups was analyzed by t test. Count data were expressed as constituent ratio, and analyzed using the chi-square test or Fisher′s exact test. The survival curve was drawn by Kaplan-Meier method, and the difference in survival rate was tested by Log-rank test. Factors with statistical significance in univariate analysis were included in COX proportional regression model for multivariate analysis to screen independent risk factors affecting overall survival. Results:Compared with male patients, a higher proportion of young female patients with rectal cancer were diagnosed with anemia before surgery (42.9% vs 22.0%, P=0.040). The 1-year, 3-year and 5-year overall survival rates were 94.3%, 80.0% and 68.6% in young female patients, and 98.0%, 90.0% and 90.0% in young male patients, respectively. The median disease-free surival was 31.6 months for women and 34.4 months for men. Multivariate analysis showed that female( HR=3.799, 95% CI: 1.312-11.002, P=0.014)and BMI( HR=0.846, 95% CI: 0.724-0.989, P=0.036)were independent risk factors affecting the prognosis of young patients with rectal cancer. Conclusions:Young female patients have a worse prognosis than male patients. Female and BMI are independent risk factors for the prognosis of young rectal cancer patients, and gender should be the key research object of observation in young rectal cancer patients.

Study on the prognostic value of circulating tumor cells in colorectal cancer patients / 中华普通外科杂志

Objective:To explore the prognostic value of circulating tumor cell (CTC) for colorectal cancer.Method:We analyze the correlation between CTC and clinicopathological data, survival curve and overall survival.Results:The positive rates of preoperative and postoperative CTC in 181 colorectal cancer patients were 66.3% and 65.7% respectively ( χ2=0.012, P=0.912). The postoperative CTC positive rates for recurrence and non-recurrence of stage Ⅱ colorectal cancer were 29.2% and 8.0%, respectively ( χ2=4.303, P=0.038). The progress free survuval of CTC-positive and CTC-negative in postoperative stage Ⅱ colorectal cancer patients were 28.7 months and 34.0 months, respectively ( χ2=4.096, P=0.043). Conclusion:Postoperative CTC detection has predictive prognostic value for patients with stage Ⅱ colorectal cancer.

New consideration for data collection and application of clinical research under the back-ground of ligalization of data administration in China / 中华消化外科杂志

The medical data processed and analyzed in clinical research often contain a large number of personal information. Therefore, researchers should pay attention to the safety management of medical data during clinical research. The Data Security Law of People's Republic of China and the Personal Information Protection Law of People's Republic of China implemented on 1 st September and 1 st November 2021 respectively establish legal basis for data security and personal information protection and point out the direction for medical data security, which indicate that data governance has entered the 'strong regulatory era'. In the process of medical data collection and application of clinical research, respecting and protecting the privacy and safety of patients, ensuring the quality of medical data, safely managing medical data and carrying out high-quality clinical research will be an important test for the collection and application of clinical scientific research data under the new legal background.

Two-decade retrospect and prospect of colorectal surgery in China / 中华消化外科杂志

Since entering the 21st century, colorectal surgery in China has developed rapidly, with new technologies emerging and ideas innovating constantly. While conforming to the world trend, our colorectal surgery colleagues in China have actively carried out and popularized new technologies, conducted relevant high quality researches, and formulated corresponding surgical treatment guidelines and expert consensus for colorectal cancer based on the received evidence-based medical evidences. Nowdays, the treatment of colorectal cancer in China has entered the era of individualized precision minimally invasive medicine. The author makes a systematic review of colorectal surgery development in China in the past two decades, and furthermore prospects the future of colorectal surgery in China.

Retrospective cohort study on prognosis impact of preoperative obstruction in colorectal cancer / 国际外科学杂志

Objective:To investigate the effect of obstruction on the prognosis and possible mechanisms in colorectal cancer patients.Methods:Among 1574 cases of colorectal cancer who were treated in Beijing Friendship Hospital, Capital Medical University from January 2003 to December. 2014, 194 cases had preoperative intestinal obstruction. Firstly, described the clinical characteristics of 194 patients with obstruction, then COX multivariate regression analysis was performed on the 1574 colorectal cancer cohort to confirm whether the preoperative obstruction was independent predictor for the overall survival. Finally, propensity score matching method was used to match obstruction and non-obstruction cases, then compared overall survival difference.Results:In 194 cases of obstructive colorectal cancer, 60.3% and 37.1% of the tumors were located in the left and right respectively. The 55.7% of the patients had tumors larger than 5 cm in diameter, the median survival time was 39.7 months (95% CI: 28.3-60.4). Multivariate COX analysis, after adjusted for related confounding factors, found that preoperative obstruction is still an independent risk factor for poor prognosis ( HR=1.41, 95% CI: 1.01-1.97). After propensity score matching, 140 and 560 patients were included in the obstructive group and the non-obstructive group. The two groups were more balanced in most baseline characteristics. The median survival time of the two groups was 42.4 and 116.3 months ( P<0.001), the overall survival of obstructive patients was significantly worse than that of non-obstructive patients. Conclusions:Preoperative obstruction is an independent risk factor for poor prognosis of colorectal cancer. This may be due to the difficulty of surgery and low radical cure rate for obstructive colorectal cancer.

Application of parathyroid test paper in identifying parathyroid gland in thyroid surgery / 国际外科学杂志

Objective:To compare the diagnostic efficiency of colloidal gold dipstick method (PTH dipstick method) with that of doctors’ experience method based on nano-carbon method for rapid identification of parathyroid gland in thyroidectomy of thyroid cancer.Methods:From March to July 2020, 90 patients underwent thyroid surgery in the Friendship Hospital, Capital Medical University participated in the experimental study, and 155 samples underwent empirical judgment, parathyroid dipstick and pathological examination. All operations were performed by senior specialists. SPSS statistics 17.0 software was used for statistical analysis.Results:Seventy-four cases of parathyroid gland confirmed by both pathology and empirical judgment, and 81 cases of non-parathyroid gland confirmed by pathology; 130 cases of parathyroid glands confirmed by both PTH dipstick method and pathology, and 22 cases of non-parathyroid glands confirmed by pathology. The accuracy rate of PTH dipstick method was 85.53% which was much higher than that of empirical judgment method (47.74%). The data were statistically significant ( χ2=49.14, P<0.05). The sensitivity of PTH method was 95.89%, the specificity of PTH method was 75.94%, and the Youden index was 0.7183. The sensitivity of empirical judgment method was 81.3%, the specificity of empirical judgment method was 47.74%, and the Youden index was 0.2904. Conclusions:The diagnostic efficiency of the PTH method is higher than that of empirical judgment method to identify parathyroid gland in thyroid surgery. The two methods can be used together to increase the protection of parathyroid gland during operation.

Relationship between systematic immune-inflammation index and clinicopathological charac-teristics for colorectal cancer / 中华消化外科杂志

Objective:To investigate the relationship between systematic immune-inflamma-tion index(SII) and clinicopathological characteristics for colorectal cancer.Methods:The retrospec-tive cohort study was conducted. The clinicopathological data of 513 patients with colorectal cancer who were admitted to the Beijing Friendship Hospital of Capital Medical University from February 2019 to May 2021 were collected. There were 311 males and 202 females, aged (64±12)years. Observation indicators: (1) SII of colorectal cancer and relationship between SII and clinicopatholo-gical characteristics; (2) influencing factors for SII in colorectal cancer patients. According to the median of SII as the cutoff value, the patients were divided into high SII and low SII patients. Measurement data with normal distribution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Count data were represented as absolute numbers or percen-tages, and comparison between groups was conducted using the chi-square test. Measurement data with skewed distribution were represented as M( P25, P75), and comparison between groups was analyzed using the non-parameter rank sum test. Comparison of ordinal data was analyzed using the Mann-Whitney U non-parameter test. Variables with statistically significant differences between groups were included for further analysis. Pearson correlation coefficient analysis was used for continuous data, and Wilcoxon or Kruskal-Willas analysis was used for categorical data and Bonferroni correction was performed. Univariate and multivariate linear regression analyses were conducted. Results:(1) SII of colorectal cancer and relationship between SII and clinicopathological charac-teristics: the SII of 513 patients was 355(253,507). Taking the median SII 355 as the cutoff value, 257 of 513 patients with SII>355 had high SII and 256 cases with SII≤355 had low SII. Of high SII patients, the Karnofsky performance status(KPS) score, preoperative albumin(Alb), CA125, cases with tumor located at left or right hemicolon, tumor diameter, cases with laparoscopic assisted surgery or laparotomy (surgical approach), cases in stage T0, T1, T2, T3, T4 (pathological T staging), cases in stage Ⅰ, Ⅱ, Ⅲ, Ⅳ (pathological TNM staging) were 87±17, (37±5)g/L, 8.80 U/mL(5.90 U/mL, 14.15 U/mL), 174, 83, (5.2±2.8)cm, 208, 44, 5, 19, 25, 131, 63, 34, 98, 94, 14. The above indicators of low SII patients were 91±13, (38±4)g/L, 7.20 U/mL(5.40 U/mL, 10.03 U/mL), 200, 56, (4.0±1.9)cm, 221, 24, 8, 39, 35, 118, 45, 61, 84, 79, 12. There were significant differences in above indicators between the two groups ( t=-2.770, -3.211, Z=-3.799, χ2=7.050, t=5.324, χ2=6.179, Z=-3.390, -2.227, P<0.05). Results of Pearson correlation coefficient analysis showed that SII was positively correlated with the tumor diameter ( r=0.390, P<0.05), and negatively correlated with preoperative Alb ( r=-0.200, P<0.05). Results of Wilcoxon analysis showed that SII was 447(311,720), 352(251,493) in patients with tumor located at right hemicolon and left hemicolon, 439(284,640), 345(243,481) in patients undergoing laparotomy and laparoscopic assisted surgery, respectively. There were signi-ficant differences in SII between patients with tumor located at right and left hemicolon,between patients undergoing laparotomy and laparoscopic assisted surgery ( P<0.05). Results of Kruskal-Willas analy-sis showed that SII was 289(201,463), 296(210,398), 329(252,446), 369(265,505), 434(274,631) in patients with pathological T staging as stage T0, stage T1, stage T2, stage T3, stage T4, respectively, and 307(226,400), 380(260,503), 381(272,563), 376(273,634) in patients with patho-logical TNM staging as stage Ⅰ, stage Ⅱ, stage Ⅲ, stage Ⅳ, respectively. There were significant differences in SII between patients with different pathological T staging and between patients with different pathological TNM staging ( P<0.05). (2) Influencing factors for SII in colorectal cancer patients: results of univariate analysis showed that KPS score, preoperative Alb, CA125, tumor location, tumor diameter, patholo-gical N staging, pathological TNM staging were related factors for SII in colorectal cancer patients ( Beta=-3.5, -15.8, 3.7, 106.3, 51.8, 115.1, 104.7, 141.2,95% confidence interval as -5.7 to -1.3, -22.6 to -9.1, 1.8 to 5.5,34.6 to 177.9, 38.5 to 65.2, 40.5 to 189.7, 11.2 to 198.2, 46.9 to 235.9, P<0.05). Multivariate analysis showed that tumor location and tumor diameter were independent influencing factors for SII in colorectal cancer patients ( Beta=79.5, 42.5, 95% confidence interval as 8.4 to 150.7, 26.6 to 58.4, P<0.05). Conclusions:The SII is correlated with tumor location, tumor diameter, preoperative Alb, pathological T staging, pathological TNM staging. Preoperative hypoproteinemia indicates a high SII score. The longer of tumor diameter, right hemicolon tumor and high TNM staging indicate the more serious immune-inflammatory imbalance. Tumor location and tumor diameter are independent influencing factors for SII in colorectal cancer patients.