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.

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.

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.

Acute appendicitis (AA) is a common surgical acute abdomen. Compared with younger patients, elderly patients with AA present unique epidemiological characteristics and prognoses, including higher rates of mortality, perforation, and postoperative complications, as well as an increased risk of concurrent colorectal and appendiceal cancer, but lower diagnostic accuracy. Currently, two main international guidelines are available for the diagnosis and management of AA in the elderly: The SIFIPAC/WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition) and the EAES rapid guideline: appendicitis in the elderly. Due to atypical clinical symptoms in elderly patients, the application of conventional clinical scoring systems such as the Alvarado score, Appendicitis Inflammatory Response (AIR) score, and Adult Appendicitis Score (AAS) is limited. The guidelines recommend computed tomography (CT) scan for elderly patients with an Alvarado score ≥5 to confirm the diagnosis; contrast-enhanced CT is particularly helpful in identifying appendiceal perforation. The core of the treatment strategy is to differentiate between uncomplicated and complicated appendicitis. For elderly patients with CT-confirmed uncomplicated appendicitis who are unwilling to undergo surgery and can accept the risk of recurrence, non-operative management with antibiotics is a feasible option, with a success rate of >70%. For complicated appendicitis with an abscess, percutaneous drainage combined with non-operative management is recommended. Laparoscopic appendectomy is recommended as the preferred surgical approach for elderly patients with AA owing to its advantages of minimal trauma, fewer complications, and shorter hospital stay. Furthermore, considering the significantly increased incidence of colorectal cancer in elderly patients with AA, the guidelines strongly recommend that all elderly patients with AA should undergo colonoscopic screening.

Hepatic hemangioma (HH) is a common benign focal liver lesion, and optimal clinical management depends on imaging-based accurate typing, risk stratification, and intervention decision-making. The diagnostic framework is built on the coordinated use of ultrasound (US), contrast-enhanced ultrasound (CEUS), multi-detector computed tomography (MDCT), and magnetic resonance imaging (MRI). Typical imaging findings include peripheral nodular enhancement in the arterial phase, progressive centripetal fill-in from the portal venous to delayed phases, and the “light-bulb sign” on T2-weighted imaging (T2WI). High signal intensity on diffusion-weighted imaging (DWI) is mainly related to the T2 shine-through effect, while an elevated apparent diffusion coefficient (ADC) suggests a benign nature. Approximately 15%-20% of lesions present atypical patterns, such as sclerosed hemangioma, giant lesions with central necrosis/liquefaction, and flash-filling hemangioma, which are prone to be confused with hepatocellular carcinoma (HCC), liver metastases, and focal nodular hyperplasia (FNH); therefore, comprehensive interpretation integrating enhancement kinetics, hepatobiliary-phase findings, and quantitative parameters is required. Spectral computed tomography, hepatobiliary-specific contrast-enhanced MRI, radiomics, three-dimensional visualization, indocyanine green (ICG) fluorescence navigation, and artificial intelligence (AI) are driving preoperative assessment from experience-based judgment toward objective quantification, supporting lesion margin delineation, resectability evaluation, procedure selection, and complication risk prediction. Surveillance is preferred for asymptomatic, small, and imaging-typical lesions, whereas individualized intervention for giant, progressive, or high-risk lesions may improve patient benefit while avoiding overtreatment.

As the most common benign liver tumor in clinical practice, the treatment mode of hepatic hemangioma (HH) has gradually evolved from traditional surgical resection to minimally invasive intervention. Among them, transarterial embolization (TAE) has become one of the mainstream treatment methods by virtue of its advantages such as minimal invasiveness, repeatability, and maximum preservation of functional liver parenchyma, but its standardized application still has many controversies in clinical practice. In terms of the definition of indications, in addition to symptomatic HH, concomitant thrombocytopenic purpura, and spontaneous rupture and hemorrhage as recognized absolute indications for intervention, the strategy of implementing prophylactic TAE intervention for asymptomatic giant HH with a diameter >10 cm to avoid the potential risk of organ compression is gradually gaining recognition in the academic community. Preoperative multimodal imaging evaluation is crucial for efficacy prediction. Lesions with typical enhancement and without central arterioportal shunts (APS) show more significant volume reduction after TAE. In terms of technical implementation specifications, the synergistic regimen of bleomycin or pingyangmycin-lipiodol emulsion combined with particulate embolic agents is dominant. Intraoperatively, superselective intubation relying on microcatheters is required, and the core concept of “incomplete embolization with drug retention” is implemented to promote the long-term retention of sclerosing agents in the hepatic sinusoids to destroy endothelial cells. For postoperative efficacy evaluation, it is urgently necessary to abandon the Response Evaluation Criteria in Solid Tumors (RECIST), which is mainly applicable to cell-proliferative malignant tumors, and turn to constructing a primary imaging evaluation system centered on the lesion volume reduction rate (>50%), supplemented by the improvement of clinical symptoms. In addition, in the context of multidisciplinary treatment decision-making, TAE has an absolute safety advantage over thermal ablation when dealing with giant lesions >10 cm; in the face of complex and refractory cases, adopting a sequential treatment mode of TAE combined with delayed thermal ablation or surgical resection can effectively play the role of increasing efficacy and reducing toxicity, comprehensively improving the long-term clinical benefits of patients.

Objective To summarize metabolic and bariatric surgery practice in China in 2025. Methods Based on data from the Greater China Metabolic and Bariatric Surgery Database (GC-MBD), metabolic and bariatric surgery performed in different regions in 2025 and follow-up data from 2018 to 2025 were statistically analyzed. Demographic characteristics, obesity-related diseases, surgical information and follow-up outcomes were descriptively analyzed. Results In 2025, 64 centers from 24 provinces, autonomous regions and municipalities in China registered 10 404 valid cases in GC-MBD. The median of preoperative body mass index (BMI) was 39.1 (25.4, 94.9). Female patients accounted for 7045 cases (70.4%), with a median age of 33 (9, 72) years; male patients accounted for 2 964 cases (29.6%), with a median age of 31 (10, 68) years. Among all valid cases, 37.6% had type 2 diabetes mellitus, 92.5% had metabolic associated fatty liver disease, 53.0% had hypertension, 77.6% had obstructive sleep apnea syndrome, and 67.2% of female patients had polycystic ovary syndrome before surgery. Regarding operative procedures, sleeve gastrectomy (SG) accounted for 87.37%, sleeve gastrectomy with transit bipartition (SG-TB) for 5.39%, one-anastomosis gastric bypass (OAGB) for 2.10%, Roux-en-Y gastric bypass (RYGB) for 1.91%, sleeve gastrectomy with jejunojejunal bypass (SG-JJB) for 0.86%, single-anastomosis duodeno-ileal bypass with sleeve gastrectomy/one-anastomosis duodenal switch (SADI-S/OADS) for 0.54%, sleeve gastrectomy with loop duodenojejunal bypass (SG-LDJB) for 0.02%, and other procedures for 0.37%. In addition, gastric bypass stenting, intragastric balloon implantation (IGB), and endoscopic sleeve gastroplasty (ESG) accounted for 1.39%, 0.03%, and 0.02%, respectively. At 12 months after surgery, the mean percentage of total weight loss (%TWL) was 28.7%, and the median percentage of excess weight loss (%EWL) was 110.9%. Conclusion The 2025 data showed that patients undergoing metabolic and bariatric surgery in China were mainly young and middle-aged adults, with a predominance of women and a high prevalence of preoperative obesity-related diseases. SG remained the predominant procedure. Weight loss reached a relatively high level at 6 to 12 months after surgery and remained favorable thereafter. This annual report reflects the development of metabolic and bariatric surgery in China and provides an important basis for comparison with previous annual and international data.

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.

Objective To explore the effects of perioperative nutritional management in colorectal cancer surgery under the concept of enhanced recovery after surgery (ERAS) based on ambulatory surgery model, and to provide reference and basis for its application. Methods A retrospective analysis was conducted on patients undergoing colorectal cancer radical surgery at the First Affiliated Hospital of China Medical University from October 1, 2023, to December 1, 2024. The study group received ambulatory laparoscopic colorectal cancer surgery and perioperative nutritional management based on the concept of ERAS, while the control group underwent traditional laparoscopic colorectal cancer surgery with conventional nutritional treatment. Results A total of 76 colorectal cancer patients were included in the study (38 in the study group and 38 in the control group). Before the intervention, there was no statistically significant difference in baseline data between the two groups (P>0.05), indicating comparability. After receiving the one-week intervention prior to surgery, the study group showed significant improvement in nutritional indicators compared to their pre-intervention levels(P<0.05). Nutritional indicators were compared between the two groups at preoperative day 1, postoperative day 1, day 7, and 1 month, with the study group outperforming the control group in all aspects (P<0.05). The study group also had a shorter time to first postoperative feeding, time to first postoperative flatus, and length of hospital stay compared to the control group (P<0.05), while there was no statistically significant difference in the incidence of postoperative complications between the two groups (P>0.05). Conclusion ERAS perioperative nutritional management in colorectal cancer surgery patients under the ambulatory surgery model has significant clinical effects, which can not only improve nutritional indicators, but also promote postoperative recovery, which is safe and feasible.

Post acute pancreatitis diabetes mellitus is a common long term complication of acute pancreatitis (AP), with a 5 year cumulative incidence of approximately 40%. Diagnosis requires exclusion of pre existing diabetes and confirmation ≥ 90 days after an AP episode according to the American Diabetes Association criteria. High risk groups include younger patients, those with recurrent, severe, or necrotising AP, and individuals with pancreatic exocrine insufficiency, intrapancreatic fat deposition or metabolic syndrome. The pathogenesis is multifactorial, encompassing β cell injury, autoimmune activation, inflammation driven insulin resistance and disruption of the gut-islet axis. Management priorities include aggressive fluid resuscitation and anti inflammatory therapy during the acute phase to limit residual damage; periodic glycaemic screening during convalescence; and metformin as the first line glucose lowering agent, with early insulin and pancreatic enzyme replacement when needed to optimise glycaemic control and nutrition.For patients undergoing total pancreatectomy, autologous islet transplantation may be considered to optimize long-term outcomes.