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.

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.

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.

To explore the clinical and pathological characteristics, treatment strategies, and outcomes of patients with locally advanced gastric cancer receiving neoadjuvant therapy. Methods    A retrospective analysis was conducted on the data of patients with locally advanced gastric cancer (cT1-2N+M0 or cT3-4bNxM0) who received neoadjuvant therapy and underwent surgical resection at 22 hospitals, between January 2018 and December 2023. All patients completed at least one cycle of neoadjuvant therapy prior to surgery. Results    A total of 3,892 patients were included in this study, including 2,945 males (75.7%) and 947 females (24.3%). The initial diagnosis age of patients was mainly concentrated in the age groups of 65-＜70 years (871 cases, 22.4%), 60-＜65 years (724 cases, 18.6%), and 55-＜60 years (640 cases, 16.4%). Among all patients, 2,460 (63.2%) received neoadjuvant chemotherapy, 1,173 (30.1%) received neoadjuvant chemotherapy combined with immunotherapy. The commonly used chemotherapy regimens in neoadjuvant treatment were SOX regimen (1,771 cases, 45.6%), FLOT4 regimen (470 cases, 12.1%), and XELOX regimen (412 cases, 10.6%). The commonly used immunotherapeutic agents were sintilimab (577 cases, 45.1%), tislelizumab (175 cases, 13.7%), and toripalimab (123 cases, 9.6%). The common number of cycles for neoadjuvant chemotherapy were three cycles (1,478 cases, 38.0%), four cycles (1,083 cases, 27.9%), and two cycles (866 cases, 22.3%); while for neoadjuvant immunotherapy, the common number of cycles were three cycles (548 cases, 42.9%), four cycles (317 cases, 24.8%), and two cycles (245 cases, 19.2%). The R0 resection rate for the entire cohort was 98.4%, with 494 cases achieving pathological complete response (pCR) and 1,053 cases achieving major pathological response (MPR). The group receiving neoadjuvant chemotherapy combined with immunotherapy had significantly higher R0 resection rate (99.2% vs. 97.8%, P=0.05), pCR rate  (21.6% vs. 9.5%, P<0.01), and MPR rate  (39.8% vs. 23.6%, P<0.01) compared to the group receiving neoadjuvant chemotherapy alone. The incidence rates of adverse reactions were 21.9% in the neoadjuvant chemotherapy group and 24.6% in the neoadjuvant chemotherapy combined with immunotherapy group (P=0.12), and the incidence rates of postoperative complications were 20.6% and 24.4%, respectively (P=0.34), with no statistically significant differences between the two groups. Conclusion    In China, the proportion of neoadjuvant chemotherapy combined with immunotherapy shows a progressive upward trend in managing locally advanced gastric cancer. Compared with single neoadjuvant chemotherapy, the combination of chemotherapy and immunotherapy has shown higher R0 resection rate and pathological response rate, without increasing the incidence of adverse reactions and compromising surgical safety.

Tumor vaccines activate T cell-mediated immunity by targeting pancreatic cancer-associated antigens or neoantigens and have become a research focus. Current strategies include mRNA vaccines, dendritic cell (DC) vaccines, peptide vaccines, and whole-cell vaccines. Personalized mRNA vaccines can rapidly encode patient-specific neoantigens, inducing durable CD8⁺ T cell responses; fixed-target mRNA vaccines directed against KRAS mutations have demonstrated favorable immunogenicity. DC vaccines load tumor antigens to activate both CD4⁺ and CD8⁺ T cells; when combined with chemotherapy or immune checkpoint inhibitors, they can modulate the tumor microenvironment and enable partial conversion to resectable disease. Peptide vaccines targeting antigens such as MUC1 and WT1 have shown limited efficacy; whole-cell vaccines (e.g., GVAX), in combination with immune checkpoint inhibition or stereotactic radiotherapy, hold promise for enhanced antitumor activity. Efficacy assessment requires integration of overall survival, progression-free survival, recurrence-free survival, and immunological biomarkers. The immunosuppressive tumor microenvironment and low response rates in pancreatic cancer remain major challenges. Future directions should optimize antigen selection, adjuvants, and combination regimens, while leveraging artificial intelligence to improve neoantigen prediction, thereby providing new avenues for clinical application of tumor vaccines in pancreatic cancer.

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.

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.

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.

Locally advanced pancreatic cancer (LAPC), defined by tumor invasion of major peripancreatic vessels or critical structures, has traditionally been considered unresectable and is associated with a poor prognosis. Conversion therapy can downstage tumors in selected patients, enabling opportunities for radical (R0) resection and significantly improving survival. Preoperative selection of surgical candidates requires the comprehensive evaluation of contrast-enhanced computed tomography (CT), positron emission tomography-CT (PET-CT), changes in carbohydrate antigen 19-9 (CA19-9) levels, and patient performance status, and the application of the four-dimensional criteria of anatomy, biology, clinical condition, and duration of chemotherapy (the “ABCD” criteria). Surgical strategies include an artery-first approach with periadventitial dissection to enhance vascular control, with distal pancreatectomy and celiac axis resection (DP-CAR) or arterial reconstruction performed when necessary. Portal vein (PV) and superior mesenteric vein (SMV) resection and reconstruction follow the International Study Group of Pancreatic Surgery (ISGPS) classification, employing direct patch repair, end-to-end anastomosis, or interposition grafting as appropriate. Lymphadenectomy should encompass the Heidelberg triangle and level Ⅲ peripancreatic mesenteric nodal stations to reduce the risk of local recurrence. Given the high morbidity and mortality associated with these procedures, priority should be given to patients demonstrating favorable biological response and good tolerance, and surgeries should be performed by experienced multidisciplinary teams to balance radicality with safety.

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.

Postoperative adjuvant therapy for pancreatic cancer has become the core component of comprehensive management. The mainstream regimens include gemcitabine monotherapy, gemcitabine combined with capecitabine, modified FOLFIRINOX, and gemcitabine combined with S-1. Full-dose and full-cycle chemotherapy is crucial to improving survival benefits for patients. Biomarkers such as circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA), as well as technologies such as patient-derived organoid (PDO) drug sensitivity testing and artificial intelligence-assisted transcriptomic analysis, provide important support for precise and individualized adjuvant therapy. Adjuvant radiotherapy, targeted therapy, and immunotherapy show potential in high-risk patients. Future research should focus on head-to-head comparisons of multiple regimens and molecular stratification guidance to optimize combination therapy strategies and continuously enhance survival benefits for patients.

With the advancement of minimally invasive surgical techniques, robotic hepato-pancreato-biliary surgery (RHPBS) has been increasingly adopted worldwide. Given the complexity of hepato-pancreato-biliary procedures and the substantial heterogeneity among patients, expert panels reviewed 285 related studies and formulated a consensus on indications, safety, training systems, and surgical quality assessment for RHPBS. The consensus highlighted that RHPBS currently remains in the exploratory phase under the IDEAL framework and that factors such as advanced age, obesity, or prior abdominal surgery should not be considered absolute contraindications. RHPBS shows potential advantages in liver and pancreatic resections, particularly in procedures involving vascular reconstruction and biliary-enteric anastomosis. The panel emphasized the need for a standardized training system, emergency preparedness protocols, and a set of normative surgical quality assessment metrics. Furthermore, future research priorities were proposed, including surgical risk assessment and integration of artificial intelligence-assisted systems. While RHPBS demonstrates favorable short-term outcomes and potential cost-effectiveness in selected scenarios, its generalizability in complex surgical indications requires validation through higher-quality evidence.

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.

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.

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.

To analyze the influencing factors of major pathological response (MPR) in patients with locally advanced gastric cancer undergoing neoadjuvant immunotherapy combined with chemotherapy and to establish a predictive model. Methods    The clinical data of 48 patients with locally advanced gastric cancer undergoing neoadjuvant immunotherapy combined with chemotherapy admitted to the Department of Gastric Surgery of the First Affiliated Hospital of Soochow University between January 2022 and May 2025 were prospectively collected. The effect of neoadjuvant immunotherapy combined with chemotherapy was evaluated based on the tumor regression grade in postoperative pathology, and the patients were divided into the MPR group (23 cases) and the non-MPR group (25 cases).The parameters before and after neoadjuvant therapy were compared between the two groups. The predictive factors of MPR were analyzed, and a nomogram and Bayesian regression model were constructed. Results  There were significant statistical differences between the MPR group and the non-MPR group in cN stage, the proportion of signet ring cell carcinoma, Lauren classification, CPS  score, ypT stage and ypN stage (P<0.05). Multivariate regression analysis showed early cN stage (OR=0.753, 95%CI 0.430-0.872, P=0.025), non-signet ring cell carcinoma (OR=1.873, 95%CI 1.451-2.314, P=0.043), and CPS≥5 points (OR=2.241, 95%CI 1.692-2.868, P=0.023) was an independent protective factor for predicting MPR. The nomogram model constructed based on the above three factors had a C-index of 0.781 (95%CI 0.613-0.927). The Bayesian regression model showed the area under the ROC curve for predicting MPR was 0.736 (95%CI 0.579-0.883). Conclusion    The nomogram and Bayesian regression model based on cN staging, whether it is signet ring cell carcinoma and CPS score can effectively screen the sensitive population of neoadjuvant immunotherapy for gastric cancer with high clinical application value.

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.

To explore the predictive value and diagnostic efficacy of clinical characteristics, hematological indicators and composite indicators for anastomotic leakage (AL) after laparoscopic anterior resection of the rectum in patients with colorectal cancer, and construct an early diagnosis model. Methods    The clinical data of 1195 rectal cancer patients who underwent laparoscopic anterior rectal resection at the Department of Gastric and Colorectal Surgery, General Surgery Center of the First Hospital of Jilin University between January 2019 and June 2024 were retrospective analyzed, with 839 cases in the training group and 356 cases in the validation group. Clinical characteristic indicators of patients and hematological parameters before and 1-3 days after surgery were collected. Patients were divided into the AL group and the non-AL group based on the occurrence of AL. 3 machine learning algorithms were employed to screen for differential characteristic indicators, and a multivariate Logistic regression was used to construct an early diagnosis model of AL, with the model effect verified in the validation group.  Results    A total of 83 of 1195 patients were diagnosed with AL, accounting for 7.0%. 3 machine learning algorithms identified 8 differential indicators (WBC, CAR on the second day after surgery and WBC, PNI, NLR, dNLR, WLR, CAR on the third day after surgery). The model constructed by multivariate Logistic regression was composed of WBC, WLR and CAR on the third day after surgery, with P values of 0.008, 0.004 and <0.0001, respectively, and OR values of 1.2 (95%CI 1.08-1.35), 1.05 (95%CI 1.01-1.08) and 1.61 (95%CI 1.39-1.87), respectively. In the training group, the area under the ROC curve of the model was 0.851 (95%CI 0.786-0.916), with a sensitivity of 75.9% and a specificity of 86.9%. In the validation group, the area under the ROC curve could also reach 0.808 (95%CI 0.719-0.900), with a sensitivity of 86.2% and a specificity of 67.3%. Conclusion    WBC, WLR and CAR on the third day after surgery are independent risk factors for AL after laparoscopic anterior resection of the rectum. The Logistic regression model constructed by these indicators can be used for early and accurate diagnosis of AL, providing a clinical basis for early intervention in AL patients.

Pancreatic cancer carries a dismal prognosis, with a 5-year survival rate of approximately 10%. Due to the lack of effective early screening methods, most patients present with locally advanced, vessel-involving tumors or distant metastases at diagnosis, rendering clinical management challenging. Under a multidisciplinary team (MDT) model, precision radiotherapy techniques have achieved multiple advances in recent years. Neoadjuvant or definitive stereotactic body radiotherapy (SBRT) combined with effective chemotherapy regimens can achieve high R0 resection rates and significantly prolong overall survival (OS). Magnetic resonance-guided radiotherapy (MRgRT) and stereotactic MR-guided adaptive radiotherapy (SMART) with online adaptive planning have further elevated the biological effective dose (BED) to >70 Gy while maintaining grade ≥3 toxicity rates below 3%. Clinical research has shown significant improvements in local control and delay to second-line treatment. Current challenges include defining the optimal radiotherapy window, individualizing target volumes and dose prescription, and integrating biomarker-guided immunotherapy or targeted combinations. Future efforts should establish evidence-based standardized combined radiotherapy regimens, investigate tumor microenvironment and DNA repair-related resistance mechanisms, and advance multimodal combinations with immune checkpoint inhibitors and targeted agents, to offer safer and more effective comprehensive treatment pathways for pancreatic cancer patients.

To investigate the incidence and influencing factors of exocrine pancreatic insufficiency (PEI) during the perioperative period in patients undergoing pancreaticoduodenectomy（PD）. Methods    A prospective study was conducted, enrolling 266 patients who underwent PD at the Pancreas Center of the First Affiliated Hospital with Nanjing Medical University between August 2023 and November 2024. Fecal elastase-1 (FE-1) levels were measured preoperatively and one month postoperatively, with PEI defined as FE-1<200 μg/g. Based on the patient's pathological type, postoperative complications, and nutritional indicators, risk factors for PEI were analyzed using univariate and multivariate logistic regression. Results    (1) Preoperative PEI（n=177）：The incidence was 32.2% (57/177), highest in pancreatic head carcinoma patients (45.2%, 42/93). Multivariate logistic regression analysis indicated that preoperative diabetes mellitus （OR=11.49，95%CI 2.36-67.45，P=0.004），pancreatic head carcinoma（OR=3.16，95%CI 1.28-8.26，P=0.015），tumor volume ≥6 cm3（OR=2.99，95%CI 1.23-7.57，P=0.017），male gender（OR=3.05，95%CI  1.20-8.25，P=0.022），preoperative main pancreatic duct diameter ≥6 mm（OR=2.86，95%CI 1.11-7.60，P=0.031），and preoperative BMI<24（OR=2.96，95%CI 1.17-8.07，P=0.027） were independent risk factors for preoperative PEI in PD patients. (2) Postoperative PEI（n=208）：The incidence increased to 85.5%（178/208），reaching 93%（93/100） in pancreatic head carcinoma patients. Multivariate logistic regression analysis indicated that preoperative FE-1≥500 μg/g（OR=4.03，95%CI 1.23-15.80，P=0.028） and postoperative pancreatic fistula（OR=0.24，95%CI 0.07-0.73，P=0.015） reduced the risk of postoperative PEI. (3) Perioperative changes：FE-1 levels, body weight, BMI, total cholesterol, albumin, serum calcium, serum magnesium, hemoglobin, 25-hydroxyvitamin D, and vitamin B12 all decreased significantly postoperatively compared with preoperative levels (P<0.05). Conclusion    The incidence of PEI increased after PD compared to preoperatively. Diabetes mellitus, main pancreatic duct dilation, larger tumor size, lower preoperative BMI, pancreatic head carcinoma, and male sex are high-risk factors for preoperative PEI; whereas patients with lower preoperative FE-1 levels and those without postoperative pancreatic fistula should also be monitored for postoperative PEI，pancreatic enzyme replacement therapy should be initiated when necessary. The comprehensive deterioration of nutritional indicators in PD patients postoperatively indicates the need for early intensified nutritional therapy.