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.

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.

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.

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.

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.    

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.

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.

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.

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.

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.

To standardize the comprehensive diagnosis and treatment of obesity in China, the National Health Commission has issued the “National Clinical Practice Guideline on Obesity Management （2024 Edition）”. The guidelines detail various intervention and treatment methods for obesity, with the surgical section elaborating on the classification of bariatric and metabolic surgeries, indications, contraindications, preoperative preparation, recommended surgical procedures, discharge criteria, principles of postoperative nutritional management, postoperative follow-up, and prevention of postoperative complications. The guideline aims to direct medical institutions in the standardized implementation of surgical treatments for obesity.

To investigate the clinical efficacy of laparoscopic duodenal total pancreatic head resection (LDPTPHR). Methods    A retrospective analysis was conducted on the perioperative and postoperative follow-up data of 70 patients who underwent LDPTPHR and 70 patients who underwent laparoscopic pancreaticoduodenectomy (LPD) at the Department of Hepatobiliary and Pancreatic Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology between April 2020 and June 2024. Results    There was a statistically significant difference in the maximum tumor diameter between the LDPTPHR group and the LPD group ［2.4 (2.0, 3.3) cm vs. 3.0 (2.3, 3.7) cm, P=0.001］. The LDPTPHR group had shorter operation time ［(205.6±30.4) min vs. (246.7±36.8) min, P<0.001］, shorter gastric tube retention time ［25.2 (23.0, 29.9) h vs. 44.7 (40.3, 49.0) h, P<0.001］, earlier postoperative drinking time ［34.1 (29.9, 36.3) h vs. 53.0 (48.7, 57.1) h, P<0.001］, earlier postoperative eating time ［41.6 (39.5, 44.8) h vs. 61.5 (56.3, 65.7) h, P<0.001］, lower proportion of Clavien-Dindo complication grades (Z=2.597, P=0.009), earlier removal of pancreaticojejunostomy abdominal drainage tube ［10.0 (9.0, 12.0) d vs. 12.0 (11.0, 14.0) d, P<0.001］, and shorter postoperative hospital stay ［(11.4±3.1) d vs. (16.4±2.9) d, P<0.001］ compared with the LPD group. At the last follow-up, the ECOG PS score of the LDPTPHR group was better than that of the LPD group (χ2=5.414, P=0.020), with a statistically significant difference. There was no statistically significant difference in the pancreaticojejunostomy time, intraoperative blood loss, incidence of pancreatic fistula, incidence of biliary fistula, incidence of chylous fistula, incidence of delayed gastric emptying, incidence of abdominal infection, postoperative bleeding rate, incidence of common bile duct stones, incidence of biliary stricture, 30 d readmission rate, and reoperation rate between the two groups (P>0.05). Conclusion  In the treatment of low-grade malignant, borderline and benign diseases of the pancreatic head, LDPTPHR is safe and feasible compared with LPD.

With advancements in endoscopic techniques, an increasing number of T1 colorectal cancers (CRCs) can be treated with endoscopic resection. However, the presence of lymph node metastasis (LNM) remains a critical determinant for the necessity of additional radical surgery. Current guidelines recommend risk stratification based on histopathological features, yet these criteria lack standardization and exhibit limited predictive accuracy. Beyond established pathological markers, emerging evidence highlights the prognostic value of horizontal invasion width, perineural invasion, and immune microenvironment characteristics. In predictive modeling, conventional statistical approaches using clinicopathological features show moderate utility but require refinement. Molecular biomarkers, such as miRNA signatures, DNA methylation profiles, and proteomic patterns, demonstrate superior potential, though clinical adoption is hindered by cost constraints. Artificial intelligence (AI)-driven models, which minimize subjective bias and enable automated analysis, significantly enhance predictive performance by integrating histopathological imaging with multimodal data. In conclusion, optimal LNM risk assessment in T1 CRC necessitates a combination of traditional pathology and novel biomarkers. AI and multi-omics approaches represent promising avenues for precision stratification. Future efforts should focus on optimizing model generalizability and clinical applicability to guide personalized therapeutic decision-making.

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.

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.

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.

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.

To investigate the prognosis differences between the patients moderate-high risk gastrointestinal stromal tumors (GIST) treated by the surgeons from the specialized treatment group and the non-specialized treatment group. Methods    The clinicopathological and prognostic data of 643 patients with moderate-high risk GIST diagnosed and treated at Union Hospital of Tongji Medical College of Huazhong University of Science and Technology between January 2013 and December 2023 were retrospectively collected. The attending doctors who cumulatively treated more than 100 cases of new-onset GIST were defined as the specialized treatment group, and the attending doctors who cumulatively treated less than 100 cases of new-onset GIST were defined as the non-specialized treatment group. The baseline and prognostic data between patients from the two groups was compared. Survival analysis was performed by Kaplan-Meier method (Log-rank test). Multivariate analysis was performed using the Cox regression analysis model. Results    Compared with the non-specialized treatment group, the proportion of patients ≤60 years old in the specialized treatment group was higher (65.2% vs. 54.7%, P=0.008), the proportion of laparoscopic surgery for GIST with tumor diameter >5 cm in the specialized treatment group was higher (62.7% vs. 46.7%, P<0.001), the proportion of tumor mitotic figures greater than 10 /50HPF in the specialized treatment group was lower (17.4% vs. 26.6%, P=0.024), the incidence of postoperative complications of grade Ⅲ and above in the specialized treatment group was lower (4.4% vs. 9.9%, P=0.010), the proportion of patients receiving genetic testing in the specialized treatment group was higher(88.5% vs. 34.3%, P<0.001), the proportion of patients receiving imatinib (IM) adjuvant therapy after surgery in the specialized treatment group was higher (91.9% vs. 48.5%, P<0.001), the proportion of patients receiving IM concentration monitoring in the specialized treatment group was higher (51.7% vs. 29.0%, P<0.001), the proportion of patients receiving IM dose adjustment in the specialized treatment group was higher (7.8%vs.1.3%, P<0.001), the effective follow-up rate of patients in the specialized treatment group was higher (92.2% vs. 87.1%, P=0.040), and the proportion of patients taking medication as prescribed by the doctor in the specialized treatment group was higher (63.3% vs. 28.2%, P<0.001), with statistically significant differences. Multivariate analysis showed that adjuvant treatment (HR=0.534, 95%CI 0.306-0.931, P=0.027) and specialized treatment (HR=0.320, 95%CI 0.161-0.638, P=0.001) were independent protective factors affecting the overall survival rate of patients. The 3-year recurrence free survival rate (94.4% vs. 88.4%, P=0.010), the 3-year overall survival rate (97.8% vs. 90.6%, P<0.001), and the 5-year overall survival rate (96.7% vs. 86.6%, P<0.001) were significantly higher in the specialized treatment group, while The 5-year recurrence free survival rate showed no significant difference (89.6% vs. 85.8%, P>0.05). Conclusion  The specialized treatment group is more precise and standardized in the overall management of GIST , which can further improve the prognosis of GIST 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.

Pancreatic cancer ranks among the most lethal malignancies worldwide. Most patients are no longer candidates for surgery at diagnosis, making systemic therapy the cornerstone of management. Currently, chemotherapy remains the foundational regimen for systemic treatment, yet conventional regimens face limitations such as suboptimal response and significant toxicity. Recent years have witnessed groundbreaking advances in pancreatic cancer therapeutics, including innovations in chemotherapy formulations, development of classic target agents, discovery of novel targets, application of antibody-drug conjugates, exploration of immunotherapy, and breakthroughs in cancer vaccines and cellular therapies. These developments offer new perspectives for improving patient prognosis.