The “IHPBA-APHPBA clinical practice guidelines’: International Delphi consensus recommendations for gallbladder cancer” were developed by 45 global experts organized by the International Hepato-Pancreato-Biliary Association (IHPBA) and the Asia Pacific Hepato-Pancreato-Biliary Association (APHPBA) using the Delphi consensus method. The objective of these guidelines is to provide unified standards for clinical practice in gallbladder cancer. The guidelines focus on controversial issues on surgical treatment, the standardization of terminology, and resectability assessment, while comparing these recommendations to existing guidelines both domestically and internationally. Among the high-risk factors for gallbladder cancer, the consensus emphasizes the roles of dietary factors, environmental pollutants, and cholelithiasis, but clearly states that gallbladder adenomyomatosis is not a risk factor, which differs from domestic guidelines. For asymptomatic cholelithiasis patients, the consensus does not support prophylactic cholecystectomy to reduce the risk of gallbladder cancer, whereas domestic guidelines suggest elective surgery for high-risk patients. The treatment standards for gallbladder polyps are consistent with domestic guidelines: polyps with a diameter ≥1 cm should be removed; those ≥2 cm or with suspicious characteristics should undergo preoperative CT examination. Regarding pathological examination, the consensus recommends routine pathological examination for all gallbladder resection specimens to reduce the risk of misdiagnosis. In terms of surgical nomenclature and scope, radical cholecystectomy is defined as hepatectomy combined with lymphadenectomy of the hepatoduodenal ligament; extended radical cholecystectomy includes extensive hepatectomy and resection of extrahepatic organs or vessels. For incidental gallbladder cancer, patients with T1a stage can be observed, while those with T1b stage should undergo further surgery, but this decision should be based on the patient’s overall health condition. The extent of liver resection is determined by staging: wedge resection can be performed for T2 stage, while for T3 stage, there is a divergence between wedge resection and liver resection of the Ⅳb-Ⅴ segments. For lymphadenectomy, the consensus reached global agreement for the first time: patients with T1b stage and above should undergo standard D2 lymphadenectomy (No.8, No.12, No.13a lymph nodes), and if there is metastasis to the lymph nodes around the abdominal aorta (No.16b1), it is considered distant metastasis and surgery should be abandoned. Minimally invasive surgery is only recommended for early-stage cases, and routine use in advanced gallbladder cancer is not recommended. The consensus also introduces for the first time the evaluation criteria for borderline resectable/locally advanced gallbladder cancer (BR/LA-GBC), including hilar obstruction, lymph node metastasis, or vascular invasion. PET/CT is recommended for staging in locally advanced cases and for assessing response to neoadjuvant therapy. For metastatic cases, the consensus recommends palliative chemotherapy and palliative surgery should only be considered when necessary. These guidelines promote the standardization of gallbladder cancer management by regulating surgical treatment processes and definitions. However, due to regional healthcare differences, some recommendations should be applied flexibly in practice.

Japanese Guidelines for Colorectal Cancer Treatment (2024 Edition) were officially released in July 2024. Building upon the core content of the 2022 edition, the new guidelines incorporate necessary revisions and optimizations across multiple areas, including endoscopic treatment, surgical procedures, pharmacotherapy, and radiotherapy. The guidelines notably update the staging and treatment strategies for colorectal cancer and adjust novel therapeutic approaches for colorectal cancer with high microsatellite instability and BRAF gene mutations to better reflect the latest research advancements. In terms of treatment strategy, the guidelines encompass the most recent recommendations for both early colorectal cancer (Stage 0-Ⅲ) and advanced colorectal cancer (Stage Ⅳ), emphasizing precision and individualized therapy. In addition, the guidelines have updated the indications for total neoadjuvant therapy and non-operative management in rectal cancer, and have introduced particle radiotherapy as a treatment option for refractory recurrent rectal cancer. Regarding the treatment of Stage Ⅳ colorectal cancer, the guidelines revise the treatment strategies for hematogenous metastases, recommending radical resection when feasible, and incorporating radiotherapy ablation and stereotactic body radiotherapy as treatment options. The pharmacotherapy section updates targeted therapy regimens for unresectable or recurrent colorectal cancer.  Furthermore, the guidelines adjust immunotherapy indications for colorectal cancer with mismatch repair deficiency and high tumor mutation burden, recommending pembrolizumab as the primary treatment option. In the radiotherapy section, a comparison between preoperative and postoperative chemoradiotherapy is introduced, and indications for preoperative radiotherapy are optimized to reduce the risk of local recurrence. Additionally, for recurrent colorectal cancer, the guidelines update strategies for combining local and systemic treatments, offering more detailed recommendations for managing local recurrence of rectal cancer and distant metastatic lesions. 

On March 15th 2025, the Japan Gastric Cancer Association released the 7th edition of Japanese Gastric Cancer Treatment Guidelines. New clinical questions were raised and updated in laparoscopic surgery for gastric cancer, functional preservation surgery and extended surgery, perioperative chemotherapy, chemotherapy based on biomarkers, long-term complications after gastrectomy, treatment strategies for the elderly and palliative treatment methods. In particular, the recommendation of laparoscopic total gastrectomy and minimally invasive surgery for esophagogastric junction cancer has been further clarified and improved. In terms of function preserving gastrectomy, a new surgical method of subtotal gastrectomy has been proposed. However, there is still a lack of clear recommendations in perioperative treatment and conversion therapy. From the application of biomarker detection means and the emergence of new targeted drugs, to the attention to the strategies of surgical, endoscopic and chemotherapy protocols for elderly patients with gastric cancer, all reflect the ideas of accurate diagnosis and treatment of gastric cancer and individualized treatment, while the attention paid to postoperative long-term complications indicates the pursuit of long-term survival and quality of life for patients.

Recurrent hiatal hernia (HH) after initial repair remains a high recurrence rates and its reoperation requires personalized strategies integrating anatomical, technical, and patient-specific factors. Key recurrence mechanisms include collagen metabolism dysfunction, excessive suture tension, and suboptimal mesh selection, compounded by obesity, advanced age, and Barrett's esophagus. Indications for reoperation include refractory symptoms (GERD-HRQL score ≥20), large hernia volume (>500 cm³), or acute complications (e.g., gastric volvulus). Technical advancements such as biosynthetic mesh (e.g., P4HB) and robotic-assisted surgery reduce recurrence rates to 4.8%, while keyhole-shaped mesh lowers recurrence risk by 50% compared to U-shaped configurations. Postoperative management emphasizes imaging surveillance (annual CT) and lifestyle modifications (weight control, smoking cessation), cutting secondary recurrence. Future innovations include smart meshes, genetic biomarkers, and AI-driven surgical planning, though multicenter trials are needed to validate long-term outcomes.

In recent years, various guidelines and consensus have provided new comments into the treatment strategies for recurrent inguinal hernia. International guidelines recommend avoiding the previous approach and emphasize the importance of preventing recurrence. Various domestic guidelines and consensus in China have proposed more targeted treatment strategies for different groups, while emphasizing individualized treatment strategies based on surgeons’ experience and patients’ conditions. In the future, with the development of laparoscopic technology and repair materials, the prevention and treatment strategies for recurrent inguinal hernia will continue to evolve.

Postoperative hernia recurrence remains a significant challenge, influenced by multidimensional factors including patient-specific characteristics, surgical techniques, mesh materials, and perioperative management. Patient-specific factors such as obesity, and smoking elevate recurrence risk through metabolic dysfunction and impaired tissue repair, necessitating preoperative weight loss, glycemic control, and smoking cessation. Technical factors emphasize fascial closure integrity and mesh selection in contaminated environments. Material science highlights optimal mesh sizing, drug-loaded coatings, and biomechanical compatibility. Perioperative management includes prehabilitation and digital recurrence prediction systems. Future directions require integrating multidimensional strategies for personalized therapy to minimize recurrence risk.

Parastomal hernia (PSH) is one of the challenges in hernia surgery, and the treatment of recurrent PSH is even more challenging, with different approaches from those for primary PSH. Risk factors for recurrent PSH include advanced age, obesity, immunosuppression, increased intra-abdominal pressure, and postoperative wound infection. Preoperative CT assessment should be completed, and the possibility of stoma repositioning or relocation should be considered. The surgical difficulty of recurrent PSH is greater, with more complications, and the surgical methods are uncertain. It is recommended that individualized surgical plans be developed by hernia specialists based on the patient’s previous repair method, comorbidities, and physical condition.

The treatment of obesity combined with recurrent ventral hernia (RVH) is a major challenge in clinical practice. Understanding the physiological characteristics of RVH in obesity patients and developing an appropriate recurrent ventral hernia repair (RVHR) strategy based on accurate preoperative evaluation and adequate preoperative preparation (including weight loss) are of great significance for improving the effectiveness of RVHR and reducing the risk of complications. The complexity of RVHR in obesity patients determines that it should be carried out by experienced hernia and abdominal wall surgeon teams. The application of new technologies and mesh will provide important help in further optimizing the results of RVHR in the near future.

Intestinal fistulas are a common complication of Crohn’s disease (CD) and can lead to severe conditions such as intra-abdominal infections, sepsis, and necrotizing fasciitis, with a complex treatment process and a high mortality rate. CD-related intestinal fistulas are of various types and are typically classified into two major categories, enteroenteric and enterocutaneous fistulas, in clinical practice. In addition to the general pathophysiological characteristics of intestinal fistulas, CD-related fistulas are often associated with intestinal inflammation, malnutrition, and the side effects of therapeutic drugs, which complicate clinical management. With the development of novel drugs such as biologics and other advanced technologies, non-surgical treatment options for CD-related fistulas are emerging. However, surgical treatment remains the mainstay of therapy. A comprehensive treatment approach combining medical and surgical strategies, along with thorough disease assessment and prehabilitation, is essential to formulate the optimal treatment plan and maximize patient benefits.

Enterocutaneous fistula is a common complication following gastrointestinal surgery, with a high mortality rate. Its occurrence typically results from the leakage of digestive fluids, leading to intra-abdominal infections, sepsis, multiple organ failure, and other severe complications. The pathophysiological characteristics of enterocutaneous fistula are closely related to its treatment. Based on different pathophysiological changes, enterocutaneous fistula can be classified into critical and stable types. Critical enterocutaneous fistulas typically occur in the early stages of the disease and have a higher mortality rate, while stable enterocutaneous fistulas refer to those in which the condition has been initially controlled, primarily facing issues such as fluid loss. The occurrence of enterocutaneous fistula can also trigger a series of complications, including increased intra-abdominal pressure, pulmonary infections, and renal failure. Early detection is crucial for the diagnosis of enterocutaneous fistula. Direct signs, such as the leakage of digestive fluids and changes in symptoms of intra-abdominal infection, as well as indirect signs like digestive enzyme corrosion, can all serve as diagnostic criteria. The timeliness of diagnosis plays a decisive role in formulating an effective treatment plan, which can significantly reduce the mortality rate. With the continuous advancement of endoscopic technology, treatment methods for enterocutaneous fistula have become more diverse. New techniques, such as endoscopic negative pressure therapy and mucosal debridement, provide more possibilities for the self-healing of the fistula. In terms of treatment, the management of enterocutaneous fistulas requires a staged approach. In the critical phase, the primary goal should be lifesaving, utilizing comprehensive measures such as fluid management, anti-infection therapy, and infection source control. As the condition stabilizes, the focus of treatment shifts to promote self-healing, reduce the need for surgical intervention, and provide nutritional support and pre-rehabilitation therapy. Although staged treatment strategies have shown preliminary success in practice, the treatment of enterocutaneous fistulas still faces many challenges, particularly in terms of personalized treatment and long-term management. Future research should further explore the pathophysiological characteristics of enterocutaneous fistulas and optimize treatment plans to achieve higher cure rates and better patient outcomes.

Celiac axis stenosis (CAS) is one of the risk factors for severe complications following pancreaticoduodenectomy (PD). CAS is significantly associated with complications such as pancreatic fistula, bile leakage, hepatic ischemia, and delayed gastric emptying, and may increase perioperative mortality. The diagnosis of CAS primarily relies on CT, MRI or angiography, with a stenosis >50% confirming the diagnosis. Its etiology is categorized into extraluminal compression (e.g., median arcuate ligament compression) and intraluminal lesions (e.g., atherosclerotic plaques). As the aging population increases, the proportion of CAS related to atherosclerosis has significantly risen. Notably, CAS is often coexistent with superior mesenteric artery (SMA) stenosis, where collateral circulation relies on the blood vessels in the pancreatic head region (e.g., gastroduodenal artery, GDA) to maintain blood supply to the celiac artery. During PD, transection of the GDA disrupts the collateral circulation, leading to ischemia of the liver, spleen, and remnant pancreas, thereby causing severe complications. Management strategies for CAS should be individualized. Preoperative imaging evaluation should focus on signs of narrowing at the celiac artery origin and abnormal vasculature in the pancreatic head region. For CAS caused by arterial plaques, endovascular stent placement or balloon dilation may be considered; for median arcuate ligament compression, ligament release surgery should be performed intraoperatively. If CAS is discovered intraoperatively, the GDA may be preserved or vascular reconstruction (such as celiac artery reimplantation) may be performed. For cases where the GDA cannot be preserved, postoperative vigilance for liver, spleen, and remnant pancreas is crucial, with timely vascular intervention if needed. Although some cases have been reported to recover without intervention, multivariate analysis indicates that severe CAS is an independent risk factor for postoperative hepatic hypoperfusion and pancreatic fistula. With the increasing proportion of elderly individuals in China, the number of pancreatic disease patients concomitant with CAS is expected to rise. Pancreatic surgeons should strengthen preoperative imaging assessments, identify CAS early, and develop intervention strategies to reduce the risk of postoperative complications. Multidisciplinary collaboration and the establishment of standardized treatment protocols are crucial directions for optimizing outcomes in these patients in the future.

Intestinal fistula, a formidable complication in the late stage of severe acute pancreatitis (SAP), significantly elevates mortality through mechanisms including intra-abdominal infection induction, exacerbation of homeostatic imbalances, and increased nutritional risk. Its pathogenesis is multifactorial, involving mechanical compression/enzymatic erosion by peripancreatic necrotic tissues, intestinal ischemia and iatrogenic injury from invasive interventions. Early diagnosis requires a heightened clinical awareness and the judicious use of diagnostic modalities, including computed tomography (CT), fistulography, and endoscopy, to delineate the anatomical location of the fistula. Surgical management adheres to a staged therapeutic paradigm: during the conservative treatment phase, infection source control remains the cornerstone, supplemented by enteral nutrition, organ function support, and other adjunctive measures to promote spontaneous fistula closure; in the definitive surgical phase, the therapeutic approach is dictated by the anatomical location of the fistula, with conservative management prioritized for upper gastrointestinal fistulas, such as those involving the stomach and duodenum, and more aggressive surgical intervention for colonic fistulas.

Intestinal fistula is a catastrophic complication after incisional hernia repair. Patients are often accompanied by abdominal wall and abdominal cavity infections of varying degrees, and subsequent sepsis, systemic inflammatory response syndrome (SIRS) and septic shock seriously threaten the safety of patients. Different from the conventional treatment of intestinal fistula, the artificial mesh retained in incisional hernia repair increases the difficulty of the subsequent management of intestinal fistula. Abdominal infection caused by intestinal fistula is the initial factor of high mortality. Early diagnosis and timely and effective surgical intervention are the key to reducing the mortality of patients. The management of intestinal fistula after incisional hernia is complicated and challenging. The stepped treatment strategy based on the concept of damage control surgery (DCS) combined with the pathophysiological characteristics of intestinal fistula provides an important idea for the treatment of intestinal fistula after incisional hernia.

To explore the efficacy and safety of applying immune checkpoint inhibitors combined with surgery in patients with stage Ⅳ gastric cancer or esophagogastric junction adenocarcinoma. Methods    The clinical data of 112 patients with gastric cancer or esophagogastric junction adenocarcinoma who were treated with immune checkpoint inhibitors before surgery at 5 centers in Shanghai between May 2021 and August 2023 were retrospectively analyzed. The study cohort comprised 43 patients with stage cⅣA and 69 patients with stage cⅣB. All patients received immune checkpoint inhibitors targeting the programmed cell death-1. Chemotherapy regimens mainly included SOX, XELOX regimen,  etc. Targeted therapeutic drugs include trastuzumab and apatinib. Observation indicators include treatment-related adverse events, operation conditions and operation-related complications, the short-term efficacy, and the prognosis. Results    In the whole group of 112 patients, the main treatment-related adverse events were bone marrow suppression and fatigue, among which grade Ⅲ and above adverse events accounted for 30.4% (34/112), and the main immune-related adverse events were rash and hypothyroidism with an incidence of immune-related adverse events was 19.6% (22/112). The median treatment period before surgery was 4 (4,6) , and the R0 resection rate reached 82.1% (92/112). The incidence of surgery-related complications was 14.3% (16/112), mainly including anastomotic leakage and chylous leakage. There were 13 cases with grade Ⅰ to Ⅱ complications (11.6%), 3 cases with grade Ⅲ complications (2.7%), and no case with grade Ⅳ or above complications. In the whole group, ORR was 79.5% (89/112), pCR rate was 20.5% (22/112), and MPR  rate was 44.6% (50/112). The median follow-up time of the whole group was 22.6 (95%CI 19.8-25.4) month, the median overall survival (OS) was 37.3 (95%CI 20.6-54.0) months, and the median progression free survival (PFS) was 22.5  (95%CI 15.8-29.2) months. The 1- and 2-year OS rates were 86.6% and 65.0%. The 1- and 2-year PFS rates were 73.2% and 44.9%. Conclusion    For patients with stage Ⅳ gastric cancer or adenocarcinoma of esophagogastric junction, preoperative application of immune checkpoint inhibitors combined with surgery has a good therapeutic effect and prognosis. The incidence of treatment-related adverse reactions and surgery-related complications are acceptable.

The treatment of recurrent inguinal hernias presents specific challenges. Both open and laparoscopic inguinal hernia repair (LIHR) demonstrates inferior outcomes compared to primary hernia repair. Current guidelines exhibit consensus regarding LIHR for recurrences following anterior repairs. However, the conventional preference of open surgery for recurrences after posterior repair has been questioned and challenged in recent years. Chinese expert consensus on key issues of laparoscopic inguinal hernia surgery emphasizes that such recurrent cases are no longer contraindications for LIHR and could be safely and more effectively performed by experienced surgeons. LIHR offers unique diagnostic advantages through intra-abdominal exploration, which cannot be replaced by other surgical procedures. Transabdominal preperitoneal (TAPP) repair is recommended as the preferred procedure, which could manage most recurrent cases. Conversion to open surgery should be considered for difficult situations. The existing mesh should be reutilized appropriately during LIHR and not removed unless in a specific scenario. The new meshes are tailored for local repair of the recurrence area instead of covering the entire myopectineal orifice. Surgeons are advised to utilize peritoneal folds or hernia sacs for a complete covering for the mesh, reserving intraperitoneal onlay mesh (IPOM) or transabdominal partially extraperitoneal (TAPE) techniques for specific cases. Emerging evidence suggests potential benefits from defect closure techniques and robotic-assisted platforms.

How to effectively repair large incisional hernias of the abdominal wall, reconstruct the abdominal wall, and reduce postoperative complications has long been a challenge for hernia and abdominal wall surgeons. Combining tissue separation techniques with mesh reinforcement often achieves good therapeutic outcomes and effective abdominal wall reconstruction. However, recurrence still occurs, and subsequent management is particularly difficult. A comprehensive analysis of the overall condition is necessary to select appropriate treatment strategies and surgical approaches.    

To summarize the metabolic and bariatric surgery cases performed in multiple regions of China in 2024. Methods    Based on the data registration work of the Greater China Metabolic and Bariatric Surgery Database (GC-MBD), this registry report evaluate the prevalence of metabolic and bariatric surgery in multiple regions of China, as well as the follow-up data from 2018 to 2024. Demographic characteristics, obesity-related diseases, surgery information and follow-ups data were statistically described and analyzed. Results    In 2024, 68 centers from 24 provinces/province-level municipalities in China registered a total of 7 762 valid cases to GC-MBD. The patients’ median (minimum, maximum) BMI before the surgery was 38.6 (25.1, 82.1). The cases of female patients were 5 463 (70.5%), with median (minimum, maximum) age of 33 (12, 69) years, while the cases of male patients were 2 283 (29.5%), with median (minimum, maximum) age of 32 (10, 69) years. Among all valid cases, 22.1% of patients had history of type 2 diabetes, 90.5% of patients had history of fatty liver disease, 50.7% of patients had history of hypertension, 53.1% of patients had obstructive sleep apnea syndrome (OSAS), and 17.1% of female patients had history of polycystic ovary syndrome (PCOS). Among all procedures, 87.60% were sleeve gastrectomy (SG), 3.59% were sleeve gastrectomy with transit bipartition (SG-TB), 3.43% were Roux-en-Y gastric bypass (RYGB), 2.56% were one anastomosis gastric bypass (OAGB), 2.14% were sleeve gastrectomy with jejuno-jenunal bypass (SG-JJB), 0.44% were single-anastomosis duodenal-ileal bypass with sleeve gastrectomy/one anatomosis duodenal switch (SADI-S/OADS), 0.05% were sleeve gastrectomy with duodenojejunal bypass (SG-DJB), 0.01% were sleeve gastrectomy with loop duodenojejunal bypass (SG-LDJB), and 0.18% were other operation types. There were significant differences in the trends of excess weight loss rate (%EWL) and total weight loss rate (%TWL) over time among different obesity severity groups (mild, moderate, severe, and very severe) (P=0.004, P<0.001). Conclusion    Based on the analysis of the 2024 registry report, patients who underwent metabolic and bariatric surgery in China are mainly middle-aged and young, with a majority of female patients and a high proportions of obesity-related diseases before surgery. SG still is the mainstream surgical procedure in China. The weight loss level in the mid-to-long term after surgery is significant, with differential characteristics observed among different severities of obesity. The 2024 registry report reflects the disciplinary development trends of metabolic and bariatric surgery in China, providing an important basis for comparison with previous annual and international data.

In March 2025, the Japanese Gastric Cancer Association (JGCA) unveiled the 7th edition of the Japanese Gastric Cancer Treatment Guidelines. This edition synthesizes cutting-edge, high-level evidence from recent clinical research to establish globally relevant standards for gastric cancer management. Structured around clinical questions (CQs), the Guidelines systematically address critical challenges in surgical techniques, perioperative care, and pharmacological therapies, prioritizing clarity and actionable recommendations for clinical practice. By framing recommendations around these CQs, the document not only refines existing protocols but also highlights emerging therapeutic paradigms, offering a forward-looking perspective on precision oncology in gastric cancer treatment.

Pancreatic cancer is characterized by high malignancy and a lack of effective early diagnostic tools, resulting in most patients being diagnosed at an unresectable advanced stage, with a 5-year survival rate of approximately 13%. Traditional gemcitabine-based chemotherapy and single-targeted therapies (e.g., EGFR inhibitors, KRAS inhibitors) have shown limited efficacy, primarily due to the dense collagenous stroma and cancer-associated fibroblasts forming a drug-resistant barrier, as well as the high degree of tumor heterogeneity. Systems biology enables precise molecular subtyping through the integration of multi-omics data and, when combined with network pharmacology, facilitates the identification of multi-target combination strategies aimed at overcoming drug resistance and the immunosuppressive tumor microenvironment. Digital twin platforms can simulate tumor progression and drug responses in individual patients, thus guiding personalized therapeutic optimization. Clinical trials have demonstrated that KRAS G12D inhibitor MRTX1133, KRAS G12C inhibitors adagrasib and sotorasib, and the PARP inhibitor olaparib exhibit synergistic antitumor activity in specific molecular contexts. Multi-target combination strategies, in conjunction with artificial intelligence and real-time dynamic monitoring, hold promises for improving treatment efficacy and clinical outcomes in pancreatic cancer.

The Japanese Gastric Cancer Association officially released the latest revised 7th edition of the “Japanese Gastric Cancer Treatment Guidelines” in March 2025. This version was revised and updated based on the latest clinical research results and exploration while inheriting the essence of the previous version of the guidelines. The guidelines comprehensively cover important topics in the field of gastric cancer treatment such as endoscopic treatment, surgical treatment, and medical treatment, and further enrich the Clinical Question (CQ) section based on these clinical topics.

The liver is the most common metastatic site of pancreatic cancer, and patients with liver metastases have poor prognosis. In recent years, the application of systemic therapies and local treatment modalities has improved survival outcomes in this patient population. Currently, chemotherapy regimens based on gemcitabine and fluorouracil remain the primary therapeutic approach. Targeted therapies, such as PARP inhibitors (e.g., olaparib) and KRAS inhibitors, have shown promising efficacy in patients with specific genetic alterations. While immunotherapy demonstrates significant benefits in MSI-H/dMMR subtypes, its overall effectiveness remains limited, and combining immunotherapy with chemotherapy may represent a future direction for treatment optimization. In terms of local therapy, the “conversion therapy” model has enabled surgical resection in selected patients, significantly improving their prognosis. Additionally, local treatment modalities such as radiofrequency ablation, interventional therapy, and radiotherapy have enhanced local control rates in patients with liver metastases. Despite these advances, challenges remain, including limited treatment options, inconsistent definitions of oligometastasis, and a lack of consensus on surgical indications. Future efforts should focus on developing novel targeted therapies and immunocombination strategies, refining multidisciplinary management approaches, and ultimately transforming pancreatic cancer liver metastases into a chronic manageable condition.

Abdominal adhesions are the most common complications following abdominal surgery, with an incidence rate of up to 90%, especially in complex abdominal diseases such as intestinal fistula, where extensive and dense adhesions are more likely to form. Precise assessment of abdominal adhesions is crucial for optimizing treatment and reducing the risk of complications. Current methods for evaluating abdominal adhesions include clinical assessment, imaging evaluation, laboratory marker detection, and surgical exploration. Clinical assessment provides clues about adhesions through medical history collection and physical examination but struggles to accurately determine the location and severity of adhesions. Among imaging evaluations, ultrasound can display the movement of intra-abdominal organs and visceral sliding signs but performs poorly in visualizing deep adhesions; conventional computed tomography (CT) can only indirectly suggest the presence of adhesions; dynamic magnetic resonance imaging (Cine MRI) can achieve an accuracy rate of up to 90% by capturing dynamic organ activities. Laboratory markers such as C-reactive protein (CRP) and interleukin-6 (IL-6) correlate with adhesion severity but lack specificity. Although surgical exploration is the “gold standard”, it is not suitable for routine diagnosis due to its invasiveness. Abdominal adhesion scoring systems include the American Society for Reproductive Medicine adhesion classification, the Nair scoring system, and the Clinical Adhesion Score (CLAS). The latter integrates multidimensional parameters such as adhesion-related complications and reoperation difficulty, with an inter-observer reliability of up to 0.95. Precise assessment of abdominal adhesions can guide surgical approach selection, predict the risk of postoperative complications, and direct anti-adhesion strategy application. Future research directions include integrating multi-omics analysis to explore specific molecular networks, establishing comprehensive multi-modal data evaluation systems, developing risk-stratified assessment systems, and researching novel anti-adhesion materials and drugs. Despite certain progress in the assessment of abdominal adhesion, there remain challenges including low sensitivity, insufficient specificity, and the lack of unified standards. Developing precise, non-invasive or minimally invasive assessment methods, establishing risk prediction models, and promoting clinical translational research are key to improving patient clinical outcomes.

Pancreatic cancer is among the most lethal malignancies of the digestive system, with an overall 5-year survival rate of only 13%. In recent years, advances in tumor molecular biology have shifted therapeutic strategies from a “one-size-fits-all” approach to molecular subtype-based, targeted, and personalized therapies. Concurrently, the widespread implementation of multidisciplinary team (MDT) collaboration and full-cycle patient management has optimized the comprehensive treatment paradigm, aiming to balance undertreatment and overtreatment. However, the high heterogeneity of pancreatic cancer, limited availability of targeted approaches for key driver genes, intrinsic and acquired resistance mechanisms, and the immunosuppressive tumor microenvironment continue to significantly hinder the advancement of precision molecular classification and individualized treatment, leading to no substantial improvement in patient prognosis to date and enormous challenges in clinical diagnosis and treatment. Current research indicates correlations between molecular subtypes (including classical, basal-like, quasi-mesenchymal, and squamous) and clinical phenotypes. Liquid biopsy technologies—such as circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and exosomes—are being explored for early diagnosis and real-time disease monitoring. In targeted therapy, research is centered on KRAS and resistance mechanisms. Immunotherapy must overcome the challenges of low immunogenicity and an immunosuppressive tumor microenvironment, with various combination strategies undergoing clinical investigation. Artificial intelligence (AI) and big data are expected to enhance diagnostic imaging, molecular subtyping, and intraoperative navigation. Future directions should focus on strengthening interdisciplinary collaboration and integrating molecular classification, targeted and immunotherapeutic strategies, and AI technology to realize precision, comprehensive treatment for pancreatic cancer.

Radiotherapy is a common treatment for pelvic malignancies, but cumulative radiation doses may lead to radiation-induced intestinal injury (RII). Enteric fistula, a severe complication of RII, significantly impacts patients’ quality of life. Due to the distinct pathophysiological mechanisms of acute and chronic RII, stage-specific therapeutic strategies should be adopted for enteric fistula. For acute RII with enteric fistula, the guiding principle should be “damage control”, prioritizing rapid infection management through minimally invasive interventions. In chronic RII with enteric fistula, definitive resection of the radiation-injured “culprit lesions” is the primary goal. Since RII-associated enteric fistula often involves adjacent pelvic organs, a holistic pelvic perspective combined with multidisciplinary collaboration is essential for comprehensive evaluation and individualized treatment planning. Enterostomy diversion plays a pivotal role in staged surgical management and its reasonable application can provide a window for secondary definitive resection. For patients with multi-visceral fistulas or complex fistulas, multi-visceral resection or total pelvic exenteration may ultimately be required.

To observe the clinical characteristics and therapeutic effects of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer, and to explore the potential beneficial population of NAC for gastric cancer. Methods    Clinical data of patients with locally advanced gastric cancer after NAC undergoing D2 radical gastrectomy between June 2017 and December 2022 at Fudan University Shanghai Cancer Center were analyzed retrospectively. According to the postoperative pathological evaluation, they were divided into the NAC benefit group (n=157) and the non-benefit group (n=110). The clinical characteristics between the benefit group and the non-benefit group before and after NAC were compared and the logistic regression model was used to identify predictive factors for benefit group. Results    There were statistically significant differences in cN stage, Lauren classification, signet ring cell carcinoma type, and serum expression of tumor marker CA19-9 and CA72-4 (P<0.05) between the two groups before NAC. The postoperative pathological examination results showed that there were also significant differences in tumor size, ypT and ypN stages, vascular invasion, and neural invasion (P<0.05) between the two groups. The differences in overall survival time and relapse-free survival time between patients were also statistically significant, with longer survival time in the benefit group (P<0.05). Multivariate analysis revealed that early cN stage (OR=0.087, 95%CI 0.019-0.401, P=0.002), non-diffuse type (OR=0.625, 95%CI 0.431-0.906, P=0.013), non-signet ring cell carcinoma (OR=3.178, 95%CI 1.701-5.937, P<0.001) were identified as independent predictors of the benefit of NAC in patients with locally advanced gastric cancer. Conclusion    The characteristics of patients with locally advanced gastric cancer who benefit from NAC include early cN stage, non-diffuse type, non-signet ring cell carcinoma, low expression of serum tumor marker, small tumor diameter, and absence of vascular invasion and neural invasion. Early cN stage, non-diffuse type and non-signet ring cell carcinoma are independent predictive factors for the benefit of NAC in patients with locally advanced gastric cancer. Joint analysis of these factors contributes to timely adjust the comprehensive treatment strategy for patients with locally advanced gastric cancer.

The 7th edition of the Japanese Gastric Cancer Treatment Guidelines has established updated clinical guidelines regarding gastrectomy procedures, lymph node dissection, and minimally invasive surgical approaches (laparoscopic/robotic surgery) based on current evidence, a thorough understanding and mastery of these new treatment guidelines is crucial for clinical surgical practice.