Polypoid lesions of gallbladder (PLG) are common benign gallbladder diseases. Although current domestic and international guidelines have reached consensus on using ultrasonography as the primary diagnostic approach, stratification of malignant risk, and generally adopting a diameter of ≥10 mm as the basic surgical threshold, certain controversies persist regarding the definition of surgical indications and follow-up management strategies. Problems and challenges include difficulties in preoperative differentiation, unclear management of low-risk polyps, and potential unnecessary surgeries. Currently, individualized assessment has become key to balancing “over-treatment” and “missed diagnosis of malignancy,” necessitating dynamic monitoring and intervention based on risk stratification to enhance the precision of PLG diagnosis, treatment, and follow-up management. With advancements in technologies such as artificial intelligence, the precision medicine system for PLG is expected to be progressively refined in the future.

The 2026 update of the Barcelona Clinic Liver Cancer (BCLC) staging system preserves the simplicity of its integrated framework encompassing staging, prognosis, and treatment, while incorporating the latest advances in the therapeutic landscape. A major highlight of this update is the introduction of the CUSE clinical decision-making framework, which addresses complexity, uncertainty, subjectivity, and emotional factors. By integrating the best available evidence and systematically evaluating these four dimensions, the framework is intended to guide multidisciplinary teams in making more scientifically grounded, patient-centered, and individualized treatment decisions. In terms of specific treatment recommendations, for BCLC stage 0/A hepatocellular carcinoma, stereotactic body radiotherapy and transarterial radioembolization have been newly introduced as important potentially curative treatment options in addition to surgical resection and ablation. For BCLC stage B disease, the update emphasizes that current evidence remains insufficient to support the routine use of locoregional therapy combined with systemic therapy. For BCLC stage C disease, the role of combination immunotherapy as the preferred first-line treatment has been further consolidated.

In recent years, the incidence of differentiated thyroid carcinoma (DTC) has shown a significant upward trend. In 2025, the American Thyroid Association updated management guidelines for adult patients with differentiated thyroid cancer, and reflect a more conservative and function-preserving philosophy in the field of surgical diagnosis and treatment. The new guidelines have broadened the indications for thyroid lobectomy, increasing the maximum tumor diameter from 1 cm to 2 cm for unilateral DTC without extrathyroidal extension or metastasis. Favor lobectomy as the preferred initial surgical approach for low-risk unilateral DTC with maximum tumor diameter 2-4 cm. For locoregional residual, clinically recurrent, or progressive disease, lymph node size is no longer the primary determinant for surgical decisions; instead, a comprehensive assessment is emphasized. The guidelines reinforce the role of intraoperative nerve monitoring in protecting the recurrent laryngeal nerve and the external branch of the superior laryngeal nerve, and add a new recommendation for parathyroid autotransplantation. Thyroid-stimulating hormone suppression therapy shows a “de-escalation” trend, and it is explicitly stated with high-certainty that remnant ablation is not routinely recommended for low-risk DTC patients. For DTC during pregnancy, a more conservative strategy is adopted, suggesting that surgery can be safely postponed until after delivery for most patients.

Papillary thyroid carcinoma (PTC) is the most common thyroid malignancy, and a subset of subtypes exhibits moderate to high aggressiveness; accurate recognition is pivotal for prognostic assessment and individualized management. The fifth edition of the World Health Organization (WHO) classification emphasizes an integrated histologic-molecular diagnostic paradigm and, for the first time, explicitly designates high-risk histologic subtypes, including the tall cell subtype, hobnail subtype, and columnar cell subtype. Although the diffuse sclerosing subtype and the solid/trabecular subtype are categorized as intermediate risk, they likewise carry a considerable risk of metastasis. Distinct molecular profiles characterize these subtypes: the diffuse sclerosing subtype frequently harbors RET fusions; the tall cell subtype commonly shows BRAF V600E and TERT promoter mutations; and the hobnail subtype is closely associated with TP53 mutations. High-grade PTC, defined by tumor necrosis and a high mitotic rate, demonstrates biological behavior approaching that of poorly differentiated thyroid carcinoma. Standardized pathologic diagnosis requires adequate sampling in combination with immunohistochemistry and molecular testing to minimize misdiagnosis or underdiagnosis. Molecular subtyping further informs risk stratification and selection of targeted therapies. Overall, the diagnosis of rare PTC subtypes is transitioning from morphology alone to integrated molecular pathology, thereby laying the foundation for precision medicine and individualized treatment.

To evaluate the efficacy of hyperthermic intraperitoneal chemotherapy (HIPEC) combined with systemic therapy in gastric cancer patients with peritoneal metastasis, and analyze its impact on tumor conversion and survival outcomes. Methods    A single-center retrospective study was conducted, enrolling 63 newly diagnosed gastric cancer patients with peritoneal metastasis treated at the Department of Gastric Surgery Ⅱ, Fudan University Shanghai Cancer Hospital, between December 2023 and February 2025. All patients received HIPEC treatment based on taxane drugs. Systemic chemoimmunotherapy was initiated within 2 weeks post-HIPEC, with follow-up assessments every 3 months. Multidisciplinary team evaluations determined eligibility for R0 resection. Primary outcome measures included therapeutic efficacy (disease control rate, objective response rate), R0 resection rate, and overall survival. Results    Among 63 patients ,there were 35 males and 28 females with median age at 55 (range 27-79) years. There were 4 cases in the simple HIPEC group, 7 cases in the HIPEC sequential chemotherapy group, 50 cases in the HIPEC sequential chemotherapy and immunotherapy group, and 2 cases in the HIPEC sequential chemotherapy, immunotherapy, and targeted therapy group. The overall objective response rate of all the patients was 49.2% (31/63), with a disease control rate of 71.4% (45/63). In the HIPEC sequential chemotherapy and immunotherapy group, partial remission was achieved in 26 cases (52.0%), 25.0% in the simple HIPEC group, and 40.0% in the HIPEC sequential chemotherapy group. There was no statistically significant difference between the three groups (P=0.370). By the follow-up cutoff, 14 patients (22.2%) achieved R0 resection criteria. Among them, 11 cases belonged to the HIPEC sequential chemotherapy-immunotherapy combination treatment group. The number of treatment cycles for patients who received R0 resection in the HIPEC sequential chemotherapy-immunotherapy group was significantly higher than that of patients who did not achieve conversion success in the same group, and the difference was statistically significant ［(6.09±1.52) vs. (3.69±1.27), P<0.05］. The cohort’s median survival was 14 months, with all R0 resection patients alive at last follow-up, whereas radiologically progressive patients had a median survival of 6 months. Conclusion    Paclitaxel-based HIPEC improves locoregional tumor burden in gastric cancer patients with peritoneal metastasis. The HIPEC-sequential chemoimmunotherapy strategy may create opportunities for conversion surgery and prolong survival in select patients.

Anaplastic thyroid carcinoma (ATC) is a rare but highly aggressive thyroid malignancy with an extremely poor prognosis, and the median survival time is only 4-6 months. Traditional therapeutic modalities, including surgery, radiotherapy, and chemotherapy, provide limited overall efficacy. With advances in molecular biology, the genomic landscape of ATC has been gradually elucidated. Common alterations include BRAF V600E, TP53 mutations, TERT promoter mutations, and gene fusions involving NTRK, RET, and ALK, affecting signaling pathways such as RAS/RAF/MEK/ERK and PI3K/AKT/mTOR. Targeted therapies against specific alterations (e.g., dabrafenib plus trametinib, larotrectinib, selpercatinib, pralsetinib) have markedly improved survival in selected patients. In the field of immunotherapy, programmed death-1 (PD-1) and programmed death-ligand 1 (PD-L1) inhibitors (e.g., spartalizumab, pembrolizumab), administered alone or in combination with targeted therapy or radiotherapy, have shown promising efficacy. Combined immunotherapy and targeted therapy, such as the PD-L1 inhibitor atezolizumab with vemurafenib and cobimetinib, has significantly prolonged survival in patients harboring BRAF V600E mutations. Supportive care, including airway management, nutritional support, and management of adverse effects, remains essential. Multidisciplinary collaboration and individualized precision therapy are central to optimizing ATC management. Future research should focus on mechanisms of resistance and therapeutic strategies for patients without BRAF mutations.

Objective To analyze the nationwide prospective registry data included in the China Colorectal Cancer Surgery Database (CCCD) after its upgrade in January 2020, with a particular focus on key indicators such as the MRI examination rate for rectal cancer and the proportion of neoadjuvant therapy, aiming to provide evidence-based medicine support for formulating domestic colorectal surgery treatment strategies and clinical practice. Methods The clinical and pathological data of colorectal cancer surgery patients collected in the CCCD database from January 2020 to September 2025 were included. After standardized collation, a comprehensive analysis of their clinical characteristics, surgical treatment plans, and short-term outcomes was conducted. Results The latest database update included 19,806 colorectal cancer cases from 86 centers, with a participation rate of 36.0% for municipal hospitals. Among colorectal cancer patients, the proportion of rectal cancer (50.2%) was higher than that of colon cancer (49.8%), Nearly 70.9% of rectal cancers were mid-low rectal cancers. The preoperative MRI examination of rectal cancer patients had a “DISTANCE” formatted reporting rate of 73.9%. Of all the colorectal cancer patients, 10.5% received neoadjuvant therapy preoperatively, with specific rates of 6.7% for colon cancer and 16.0% for rectal cancer. Notably, approximately 16.6% of patients with mid-low rectal cancer underwent neoadjuvant treatment. Additionally, the utilization rate of laparoscopic surgery reached 88.7%, among which total laparoscopic colorectal surgeries accounted for 48.5%. In terms of radical surgery, the R0 resection rate was 96.2%, while the R2 resection rate was 2.9%. The overall postoperative complication rate was 8.40%. Anastomotic leakage was identified as the most common major complication, with an incidence of 2.0%. Specifically, the leakage rate following mid-low rectal cancer surgery was 2.9%, whereas the rate for other sites (upper rectal cancer and colon cancer) was 1.7%. Conclusion The latest results from the CCCD database analysis indicate dynamic changes in the baseline situation and surgical treatment patterns of colorectal cancer in China in recent years, with an ongoing improvement in the level of standardized diagnosis and treatment. In the future, attention should be focused on the construction of multi-center standardized treatment protocols and the improvement of diagnostic and treatment capabilities in municipal hospitals, as well as further optimizing the follow-up data collection mechanism.

The treatment paradigm for intermediate to advanced hepatocellular carcinoma (HCC) is shifting from transarterial chemoembolization (TACE) monotherapy toward TACE-based combination strategies. Mechanistically, TACE remodels the tumor microenvironment (TME), thereby creating favorable conditions for systemic therapy. Targeted therapy normalizes tumor vasculature and enhances immune cell infiltration into the tumor by inhibiting angiogenesis and improving the TME. Immunotherapy further augments and sustains the antitumor immune response initiated by TACE and targeted agents through reversal of T-cell suppression, resulting in synergistic and durable systemic antitumor effects. Phase Ⅲ clinical trials have preliminarily demonstrated that TACE combined with targeted and immunotherapeutic agents significantly prolongs progression-free survival with a manageable safety profile. However, long-term survival benefits and tolerability in patients with impaired liver function require further validation. Future efforts should focus on optimizing treatment sequencing, frequency, and patient selection strategies, as well as exploring biomarker-guided individualized therapy to further improve clinical outcomes in intermediate-advanced HCC.

Sporadic medullary thyroid carcinoma (MTC) accounts for approximately 75%~80% of all MTC cases and frequently presents with lymph node or distant metastases at an early stage, leading to considerable variability in prognosis. Genetic studies have shown that about 60% of cases harbor RET somatic mutations, with the RET M918T mutation being the most common, indicating strong tumor aggressiveness; RAS mutations are generally mutually exclusive with RET alterations. Serum calcitonin (Ctn) is the most sensitive and specific biomarker, and preoperative levels can predict the risk of lymph node metastasis. The doubling times of Ctn and carcinoembryonic antigen (CEA) serve as key prognostic indicators. Ultrasonography combined with CT or MRI enhances the detection of metastatic lesions, while 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) and 68Ga-somatostatin receptor imaging are valuable for recurrence surveillance. Surgery remains the cornerstone of treatment, with most guidelines recommending total thyroidectomy with central lymph node dissection. In carefully selected low-risk patients, unilateral lobectomy may be considered, while lateral neck dissection should be individualized. For advanced or unresectable cases, targeted therapy has become an important option, with RET inhibitors demonstrating superior efficacy. Prognostic evaluation should integrate genetic mutation status and dynamic changes in Ctn and CEA to guide individualized follow-up and treatment. In the future, precision medicine strategies based on molecular features are expected to improve survival outcomes and quality of life in patients with sporadic MTC.

Intrathyroid thymic carcinoma (ITTC) is an extremely rare malignant tumor arising from ectopic thymic tissue within the thyroid, with histological features resembling thymic epithelial tumors. It predominantly affects middle-aged and elderly individuals and typically presents as a painless cervical mass. Imaging lacks specificity, and ITTC is often misdiagnosed as primary thyroid squamous cell carcinoma or anaplastic carcinoma. Definitive diagnosis relies on pathology and immunophenotyping; positivity for CD5, CD117, and p63/p40, along with negativity for thyroglobulin (Tg) and thyroid transcription factor-1 (TTF-1), provides critical diagnostic value. The Ki-67 index, combined with the extent of necrosis and mitotic activity, can be used for risk assessment. Surgical resection with R0 margins remains the cornerstone of treatment, with routine central lymph node dissection recommended, while lateral neck dissection is reserved for cases with confirmed metastasis or high-risk factors. Postoperative radiotherapy may improve local control in high-risk patients. In recurrent or progressive cases, programmed death-1 (PD-1)/programmed death-ligand 1 (PD-L1) inhibitors have shown potential efficacy in patients with high expression, and targeted therapies are under investigation. Overall, the precise management of ITTC requires integration of morphology, immunohistochemistry, and molecular data, with individualized treatment planning formulated by a multidisciplinary team (MDT). Future multicenter prospective studies are needed to clarify the optimal indications for radiotherapy, immunotherapy, and targeted therapy, and to validate the clinical value of molecular subtyping and dynamic monitoring.

Management strategies for asymptomatic gallstones in China differs from that of other countries. The international, mainstream guidelines advocate watchful waiting, while Chinese recommendations favor prophylactic cholecystectomy due to the high burden of gallbladder cancer. The core reason for this debate lies in balancing the immediate risks of surgery against the long-term risk of malignancy. Implementing a risk stratification system, coupled with dynamic re-assessment, is crucial for enabling personalized precision intervention. Future efforts should focus on transitioning from population-based guidelines to individualized care, ensuring timely intervention for high-risk populations.

Neoadjuvant/induction therapy is a vital part of the systemic management of pancreatic cancer, and its efficacy directly affects the surgical implementation and survival benefits. Currently, assessment tools for evaluating the response to neoadjuvant/induction therapy in clinical practice are limited. In addition to imaging response and tumor regression grading, CA19-9 is commonly used as a biomarker to assess the effectiveness of neoadjuvant/induction therapy, with changes in its levels closely associated with patient prognosis. Studies have shown that resectable patients with preoperative CA19-9 levels >500 kU/L have postoperative survival outcomes comparable to those of borderline resectable patients, suggesting that these patients may benefit more from neoadjuvant therapy to improve prognosis. Additionally, the absolute value, reduction rate, and dynamic changes in CA19-9 levels are used to assess treatment efficacy and guide the timing of surgery. Several studies have explored the optimal cutoff values for CA19-9, generally finding that a reduction of >50% or a return to normal levels is significantly associated with better prognosis, though a definitive cutoff has not yet been established. CA19-9 also has a potential role in guiding the choice of adjuvant chemotherapy regimens following neoadjuvant therapy in pancreatic cancer. Some studies indicate that changes in CA19-9 levels after neoadjuvant therapy can help determine the need for adjuvant therapy postoperatively. Specifically, for patients with a poor response, adjuvant therapy after surgery can significantly extend survival, while for those with a favorable response, postoperative adjuvant therapy may not provide a clear benefit. The role of CA19-9 in neoadjuvant/induction therapy for pancreatic cancer is gaining recognition, with its utility as a key indicator for assessing tumor response and guiding treatment strategies. Further high-quality evidence-based studies are required to optimize its application.

Preventive stoma is often created after low anterior resection for rectal cancer to reduce the risk of severe complications such as anastomotic leakage. However, 6%-23% of preventive stomas ultimately become permanent, severely affecting patients’ physiological and psychological well-being. Major risk factors for non-reversal of preventive stoma include anastomotic leakage, anastomotic stricture, local recurrence, and distant metastasis, while neoadjuvant chemoradiotherapy and impaired anal function may also increase the risk. Additional potential factors include advanced age, male sex, positive circumferential resection margin, malnutrition, advanced tumor stage, and high American Society of Anesthesiologists (ASA) classification. Anastomotic leakage is considered the most important risk factor, as it is associated with stricture due to inflammation and may also influence patients’ decisions against reversal due to fear of reoperation. Local recurrence and distant metastasis can cause mechanical intestinal obstruction, constituting contraindications for stoma reversal. Interventions including intraoperative indocyanine green fluorescence angiography, transanal decompression tube placement, and early endoscopic vacuum-assisted therapy can reduce complication risk; anastomotic strictures can be managed with endoscopic balloon dilation, stent placement, or redo anastomosis. Measures to improve anal function include conformal sphincter preserving operation, pelvic floor rehabilitation, sacral nerve stimulation, and transanal irrigation. Identifying and intervening in high-risk factors, optimizing perioperative management, and emphasizing functional rehabilitation are key to increasing stoma reversal rates and improving patients’ quality of life.

Primary thyroid lymphoma (PTL) is a rare form of extranodal lymphoma of the thyroid, accounting for 1%-5% of thyroid malignancies. It occurs predominantly in middle-aged and elderly women, with more than 80% of cases associated with Hashimoto’s thyroiditis. Patients typically present with a rapidly enlarging thyroid mass within a short period, often accompanied by compressive symptoms or B symptoms. Its clinical manifestations resemble those of anaplastic thyroid carcinoma or thyroiditis, leading to frequent misdiagnosis. Histologically, diffuse large B-cell lymphoma (DLBCL) is the most common subtype, followed by mucosa-associated lymphoid tissue (MALT) lymphoma, with significant differences in aggressiveness and prognosis between subtypes. Ultrasound-guided core needle biopsy combined with immunohistochemistry (e.g., CD20, Ki-67) and fluorescence in situ hybridization (FISH) for MYC, BCL2, and BCL6 constitutes the diagnostic gold standard. Treatment strategies are based on pathological subtype and disease stage. DLBCL is usually managed with R-CHOP chemotherapy combined with radiotherapy, while localized MALT lymphoma confined to the thyroid may be cured with definitive radiotherapy. Surgery is mainly reserved for urgent airway management or diagnostically challenging cases. Prognostic assessment relies on the International Prognostic Index (IPI), serum lactate dehydrogenase (LDH) levels, and positron emission tomography-computed tomography (PET/CT). Advanced age, DLBCL subtype, high IPI score, and TP53 mutation are adverse prognostic factors. Overall, PTL is highly sensitive to radiotherapy and chemotherapy; early-stage MALT lymphoma has an excellent prognosis, whereas aggressive DLBCL carries a poorer outcome. Multidisciplinary collaboration is essential to improve therapeutic efficacy and enhance patient survival and quality of life.

To investigate the clinicopathological features, therapeutic strategies, and prognostic factors of anaplastic thyroid carcinoma (ATC). Methods    A retrospective analysis was conducted on 64 patients with pathologically confirmed ATC treated at The First Affiliated Hospital of Zhengzhou University between January 2012 and January 2025. Clinical data included age, sex, symptoms, laboratory tests, tumor characteristics, metastasis, immunohistochemical markers, and treatment modalities. Survival was estimated by the Kaplan-Meier method, group differences were compared using the log-rank test, and independent prognostic factors were identified by the Cox proportional hazards regression model. Results    A total of 64 patients were enrolled, including 23 males (35.9%) and 41 females (64.1%), with a median age of 69 years and a median survival of 6.0 months. The 6-month, 1-year, and 2-year survival rates were 45.4%, 26.2%, and 18.7%, respectively. Univariate analysis showed that age ≥60 years, white blood cell count ≥10×10⁹/L, maximum tumor diameter ≥6 cm, extrathyroidal invasion, cervical and lateral neck lymph node metastasis, distant metastasis, advanced tumor stage, surgical treatment, radiotherapy, chemotherapy, and multimodal therapy were significantly associated with prognosis (P＜0.05). Multivariate analysis revealed that age ≥60 years (HR=2.724, 95%CI: 1.155-6.425, P=0.022), lateral neck lymph node metastasis (HR=3.630, 95%CI: 1.619-8.136, P=0.002), and distant metastasis (HR=3.902, 95%CI: 1.969-7.732, P＜0.001) were independent risk factors. Radiotherapy (HR=0.307, 95%CI: 0.134-0.703, P=0.005), chemotherapy (HR=0.435, 95%CI: 0.214-0.887, P=0.022), and aggressive multimodal therapy (HR=0.240, 95%CI: 0.120-0.481, P＜0.001) were independent protective factors. Conclusion    ATC carries an extremely poor prognosis. Age ≥60 years, lateral neck lymph node metastasis, and distant metastasis are independent adverse prognostic factors. Multidisciplinary multimodal treatment, particularly regimens including radiotherapy and chemotherapy, can significantly improve prognosis and provide important guidance for clinical decision-making.

Chronic pain following inguinal hernia repair surgery is one of the key concerns in clinical practice. The causes of postoperative chronic pain include surgical techniques, mesh usage, and patient-related factors. Laparoscopic surgery is more effective in reducing the incidence of chronic pain compared to open surgery. Additionally, patient factors such as gender and age significantly influence pain perception and recovery. Therefore, adopting individualized treatment strategies is crucial. Approaches such as psychological therapy, pharmacological treatment, local anesthetic blocks, and microwave ablation have shown positive effects, while surgical interventions can also help alleviate pain symptoms. Future research should further explore the detailed mechanisms of postoperative chronic pain and develop more accurate predictive models to identify high-risk patients for effective preventive measures. Moreover, advancements in surgical materials and techniques, along with optimized pain management strategies, will play a crucial role in improving postoperative recovery quality and reducing pain symptoms.