The new understanding and rational treatment about high-grade gastric intraepithelial neoplasia        SHI Ying-qiang. Department of Abdominal Surgery, Fudan University Shanghai Cancer Center； Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, China
Abstract    Recently, the high-grade gastric intraepithelial neoplasia, served as a pathological diagnosis, has been applied in the clinical practice more and more universally. Actually, a series of development have experienced prior to the concept and its category has gradually improved. However, major difference about understanding the concept has existed between the eastern and western experts, as well as between clinical and pathological doctors. Furthermore, clinical doctors feel so confused to treat gastric intraepithelial neoplasia. By now, there is no uniform standard about how to choose endoscopic submucosal dissection (ESD), laparoscopic surgery or open surgery. The harmonious communication between clinical and pathological doctors might be the optimal treatment for intraepithelial neoplasia. Moreover, the study of precancerous lesions and surgical treatment might be one of the therapeutic tendencies about surgical oncology.

Sphincter-preserving surgery for low rectal cancer：Selection and evaluation        XU Jian-min, FENG Qing-yang. Department of General Surgery, Zhongshan Hospital，Fudan University, Shanghai200032,China
Corresponding author：XU Jian-min，E-mail：xujmin@aliyun.com
Abstract    The lymphatic drainage of rectal cancer is the basis of sphincter-preserving surgery. The main difficulty of sphincter-preserving surgery for low rectal cancer locates in balancing the distal resection margin and the length of remaining rectum. Different sphincter-preserving surgical approaches have their own advantages. Rectal cancer anterior resection is the most common surgical approach of sphincter-preserving surgery. But for less than 2cm of remaining rectum after tumor resection，the anterior resection is not appropriate. Compared with traditional approaches，the intersphincteric resection (ISR) and anterior perineal plane for ultra-low anterior resection (APPEAR) can achieve sphincter preservation for lower position of tumors. With the development of surgical instruments，minimally invasive techniques have been gradually applied in sphincter-preserving surgery. The advantages of robotic surgery mainly focus on more convenient operation and better protection of pelvic organs，compared with conventional laparoscopy. Surgical techniques of local excision have also made great progress. But the indications should be rigorously evaluated.

Ultrasound diagnosis of thyroid microcarcinoma       ZHAN Wei-wei. Department of Ultrasound Diagnosis and Treatment, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai200025, China
Abstract    Ultrasonography (US) is increasingly being used by endocrinologists and surgeons in the diagnosis and management of patients with thyroid nodules. US may be used to help stratify the risk of malignancy in thyroid nodules and cervical lymph nodes. US plays an important role in the preoperative evaluation of thyroid microcarcinoma and cervical lymph nodes.

Choice of surgical treatments and skillful elements for parastomal hernia        YAO Qi-yuan, HE Kai. Department of General Surgery, Huashan Hospital, Fudan University, Shanghai 200040, China
Corresponding auttor:YAO Qi-yuan, E-mail:wyhernia@yahoo.com.cn
Abstract    Ventral hernia can only be cured through operations. However, it is still a challenge for surgeons to treat the parastomal hernia. Recently, mesh and laparoscopic technique have been widely used in the cure of the parastomal hernia with some progress. But some problems such as recurrence, nonideal stomal function and poor outlooks are still existed. The parastomal hernia repair should not only close the hernia ring, but also rebuild the stomal in situ.

Biological subtype of breast cancer and treatment as well as prognosis        ZHAO Yi, DENG Xin. Department of Pancreatic and Breast Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, China
Corresponding author: ZHAO Yi, E-mail: zhaoy5@sj-hospital.org
Abstract    With the development of early diagnosis and comprehensive treatment for breast cancer, the incidence of breast cancer is rising. Though the mortality of breast cancer declines, it remains one of the deadly diseases for woman. The prognosis of breast cancer with the same pathology type and clinical stage differs greatly even the treatment is same. It suggests highly heterogenicity of the breast cancer. The simply TNM stage based on anatomy and histology grade is not sufficient for the current breast cancer treatment. Especially need for breast cancer biological subtype based on molecular level which can suggest the clinical behavior and guide the treatment is the current research focus. It indicates that the treatment of breast cancer has entered the age of advocating individualized treatment on the basis of the standard multidisciplinary treatment. 

Emphasis on the epidemiological research of colorectal cancer        WANG Jian-ping. Department of Colorectal Surgery, the Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou510650, China
Abstract    In the past 30 years, with the improvement of living conditions and the change of dietary structure, the incidence of colorectal cancer has been increasing straightly. Colorectal cancer has become the third most common cancer in China, and the second most common cancer in some developed regions. Therefore, it is necessary to emphasize more on the epidemiological research of colorectal cancer, and find out an appropriate strategy for the prevention and screening of colorectal cancer in China.

Japanese gastric cancer treatment guidelines-the 4th Edition 2014 update message        HU Xiang. Department of General Surgery，the First Affiliated Hospital，Dalian Medical University，Dalian 116011，China
Abstract    The launch of Japanese gastric cancer treatment guidelines ( the following as guide) -the 3rd Edition in 2010 has produced a great effect on the surgical treatment of gastric cancer. The treatment of gastric cancer is more standardized, rationalized and normalized. In recent years, new research results made "guide" revised and reedited. In the new "guide" of the 4th Edition 2014, seven major problems were revised on the basis of the previous “guide”. New evidence and standards were introduced (the definition of gastric operation was updated; temporary provisions and flow chart were enacted for the lymph node dissection when the size of esogastric junction adenocarcinoma is smaller than 4cm; laparoscopic distal gastrectomy was considered to be the conventional treatment for stage I gastric cancer; the relevant standards under gastroscope therapy; the recommended degree of chemotherapy ; the recommended scheme and flow chart for HER2-negative and HER2-positive gastric carcinoma; the relevant provisions of the operation, chemotherapy and follow-up for gastric cancer of stage M1). The "guide"- the 4th edition  has acquired the latest scientific achievements, which makes the basic principles for the treatment of gastric cancer and the concept more scientific and accurate. It will provide important guidance for the future clinical practice.

Some new understanding about biological materials used for hernia and abdominal wall surgery        MA Song-zhang. Department of Hernia and Abdominal Wall Surgery，Chaoyang Hospital of Capital Medical University，Beijing 100020，China
Abstract    Based on modified classification of surgical meshes for hernia repair which recommended by Europe Hernia Society，biological mesh and fully absorbable synthetic materials are combined to one class: biologicals. The healing process for biologicals material is biological degradation and remodeling process，which is different from synthetic material scar forming process. The current used crosslinked biologic mesh will slow the degradation of the implemented meshes，allow the mature collagen in regenerated tissue to be strong enough to support the tension from the defect repair area. If the control for the crosslink in manufacturing processes is not appropriate，it may result in reduced scaffold porosity and restricted host cell infiltration of the scaffold. The processes may lead to fibrous encapsulation rather than tissue remodeling of the biologic scaffold for an effective soft tissue repair. After non-crosslinked biologic mesh is imbedded，it will vascularize quickly and enter repair area with phagocyte，and demonstrate tolerance of infection mechanism. Once infection occurred，it is not necessary to take out the mesh. Non-crosslinked biologic mesh is the first choice for contamination incisional hernia. Compare to synthetic material，biological mesh is lack the mechanical strength of synthetic materials. That is the reason for new hybrid polypropylene ECM material coming to market.

Attention to the diagnosis and treatment of primary hyperparathyroidism        LIAO Quan, ZHAO Yu-pei. Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medicine Sciences & Peking Union Medical College, Beijing 100730, China
Corresponding author: ZHAO Yu-pei, E-mail: zhao8028@263.net
Abstract    Primary hyperparathyroidism (PHPT) is the most common cause of hypercalcemia, which can cause osteoporosis, kidney stones, gastrointestinal, cardiovascular and neuropsychiatric symptoms. However, the clinical presentation of PHPT has changed and is mild or asymptomatic in up to 80 % of patients in Western countries. The procedure of diagnosis and localization for PHPT includes clinical examination, laboratory test and imaging techniques. Parathyroidectomy is the initial treatment choice for clinically symptomatic PHPT patients. The management of mild and asymptomatic PHPT patients should select surgical or conservative approach according to individualization principle.

Significance of fine needle aspiration cytology in the diagnosis of thyroid cancers        PING Bo. Department of Pathology，Fudan University Shanghai Cancer Center;Department of Oncology，Shanghai Medical College of Fudan University，Shanghai200032，China
Abstract    Fine needle aspiration (FNA) of thyroid gland remains to be the most accurate and cost-effective evaluation method for thyroid nodules, though it is not able to distinguish between follicular carcinoma and follicular adenoma. The application of FNA in thyroid surgical decision making and planning may significantly reduce the amount of surgical procedures during the management of thyroid nodules, and thus may increase the detection rate of malignancy by operation, save medical resources, and finally diminish the unnecessary loss of the patients caused by over practice.

Stereotactic guided mammotome biopsies in diagnosis of suspicious breast microcalcifications LEI Yu-tao*, HOU Kuan-yong, LIU Yi,et al.*General Suregery, Peking University Third Hospital, Beijing 100191，China Corresponding author：LEI Yu-tao，E-mail：leiyt@vip.sina.com Abstract Objective To evaluate the clinical application of stereotactic guided Mammotome biopsy in the diagnosis of breast microcalcifications. Methods During November, 2007 and December, 2008, we diagnosed and treated 21 patients with 29 untouched calcification lesions, aged 28 to 67 with an average of 46.6. Excision or biopsy of the lesions was performed using Mammotome biopsy under stereotactic guidance, and then all cases were followed up in 1-9 months. Results 29 lesions from 21 patients were excised with stereotactic guided Mammotome biopsy. 15 lesions completely removed appeared as clustered calcifications in diameter <1cm. 5 lesions in 4 patients were diagnosed as DCIS, the others were showed to be hyperplasia, in which 7 lesions appeared as fibrocystic hyperplasia, 3 lesions accompany with varying degrees of ductal epithelial hyperplasia, and 1 lesion with papilloma formation. 1 patient after operation appeared hematoma at the puncture site, which absorbed naturally after 2 weeks.. In the follow-up study, 4 patients undergoing mastectomy appeared without recurrence, and others show no signs of malignancy. Conclusion Stereotactic guided Mammotome biopsy is position fixed accurately and minimally invasive to breast surgery, especially suitable for breast microcalcification.

Diagnosis and treatment progress of phyllodes tumor of breast        ZUO Wen-shu, ZHENG Gang. Breast Disease Center, Shandong Cancer Hospital, Shandong Academy of Medical sciences, Jinan 250117, China
Corresponding author: E-mail：cjcpt@public.jn.sd.cn
Abstract    Phyllodes tumors，which are defined as fibroepithelital of breast tumours，are uncommon，and they are difficult to predict biologic behavior based on clinicopathologic features. The diagnosis and classification of phyllodes tumors of the breast rely mainly on histopathological examination. Core needle aspiration biopsy is the best diagnostic method. The different surgical operation should be performed according to the different classification. Breast surgery with clear margin is the current treatment of choice for phyllodes tumors. The rationality of the first operation resection range is the most important prognostic factor. The postoperative adjuvant chemotherapy, radiation therapy and endocrine therapy appear to be increasing in recent years，but their efficacy is debatable.

tumor; efficacy; evaluation

Etiology and characteristics of gastrointestinal bleeding  SUO Jian. Department of General Surgery，the First Hospital of Jilin University, Changchun 130021，China
Abstract    Gastrointestinal bleeding is the loss of blood from the gastrointestinal tract. The common cause of the disease includes inflammation of the digestive tract itself, mechanical injury, vascular lesions, tumors and extra-gastrointestinal tract diseases, etc. Different causes of gastrointestinal bleeding are different significantly. Therefore, the realization of the etiology and characteristics is essential for surgeons to diagnosis and treat the disease. The etiology of gastrointestinal bleeding has been discussed and summarized in the paper.

The analysis of gastric cancer staging AJCC 6th ed. and 7th ed.        SHAN Fei, LI Zi-yu, BU Zhao-de, et al. Key Laboratory of Carcinogenesis and Translational Research（Ministry of Education）, Department of Gastrointestinal Surgery, Peking University School of Oncology， Beijing Cancer Hospital & Institute, Beijing 100142, China
Corresponding author:JI Jia-fu, E-mail: jiafuj@hotmail.com
Abstract    Objective    To evaluate clinical value of the 7thed gastric cancer staging AJCC by comparing with the 6thed.  Methods    It performed a retrospective analysis of 922 gastric cancer patients with complete clinical data. The patients had all been treated in Beijing Cancer Hospital from Sep. 1995 to Dec. 2007. The prognostic differences between the 6th ed. gastric cancer staging AJCC and the 7th ed. were analyzed by the Kaplan-Meier method and compared by the log-rank test. The multivariate analysis used the Cox stepwise logistic regression.  Results    The 7th ed.witnessed considerable adjustments in T staging and N staging which showed better performance in prognosis of gastric cancer patients. In a multivariate Cox model, patients who had earlier M staging , earlier 7th ed. N staging, earlier 6th ed. TNM staging and lymph node dissection were associated with better survival.  Conclusion    T staging and N staging of 7th ed. show better performance, but the 7th TNM staging has not been proven to be superior to the 6th  ed., and the further study should be carried out to verification.

Treatment of lower extremity deep venous thrombosis：Guideline and practice        WANG Shen-ming, WU Ri-dong.
Department of Vascular Surgery, the First Affiliated Hospital of Sun Yat-sen University，Guangzhou510080，China
Corresponding author：WANG Shen-ming, E-mail：wshenm@mail.sysu.edu.cn
Abstract    Deep venous thrombosis (DVT) is a common and serious disease，which is usually secondary to surgery，delivery，tumor and other risk factors. The incidence of DVT is increasing year by year. If not be treated in time，it will casuse a series of complications，which may serisouly affect the quality of life. Pulmonary embolism and post-thrombotic syndrome are relatively serious complications. Therefore，surgeons must pay more attention to the early and standard treatment of DVT. At present，there are some guidelines on the treatment of DVT，which can standardize the clinical treatment. Most commonly used methods are anticoagulation (low molecular weight heparin，Rivaroxaban，etc.)，systemic thrombolysis，catheter-directed thrombolysis，pharmacomechanical catheter-directed thrombolysis and elastic compression stockings and so on. The reasonable choice of the methods will improve the prognosis and raise the quality of life.

Clinicopathologic features and survival of mucinous and signet-ring cell adenocarcinoma of the colon and rectum SONG Wu, HE Yu-long, CAI Shi-rong, et al. Department of Gastrointestinopancreatic Surgery, the First Affiliated Hospital of Sun Yet-San University, Guangzhou 510080,China Corresponding author: HE Yu-long, E-mail: YLH@medical.com Abstract Objective To investigate the clinicopathological characteristics and prognosis of colorectal mucinous (MC) and signet-ring cell(SR) adenocarcinoma. Methords Patients diagnosed as mucinous (n=144, 5.45%), signet-ring cell(n=25, 1.19%) carcinoma of all 2 089 cases of colorectal cancer from 1994 to 2007 in a single institution were evaluated. The clinicopathological parameters and survival of mucinous and signet-ring cell were analyzed retrospectively. Results Compared with MC, the SR were found to be more common in female and younger age group（P<0.01）. The SR was more often located in rectum while mucinous more in colon（P<0.01）. There was no significant difference in tumor size, lymph node metastasis, distant metastasis, serosal infiltration, adjacent organ invasion, radical resectional rate and the ratio of patients of later stage（P>0.05）.In compare of MC patients with SR tumors were worse in long-term overall survival , survival in the group of receiving radical resection. (P<0.05). Conclusion Mc and SR adenocarcinoma have unique mechanism of carcinogenesis and similar biological behavior, and both of them, especially signet-ring cell carcinoma, were independent prognostic factor for patients with colorectal cancer. The results may resulted from the location and special pathologic type.

Comparison of thyroid nodules and differentiated thyroid cancer guidelines from American and Chinese        TIAN Wen,LUO Ji. Department of General Surgery, Chinese PLA General Hospital,Beijing100853,China 
Corresponding author: TIAN Wen,E-mail:  tianwen301@sina.com
Abstract    With the rise in the incidence of thyroid cancer, domestic doctors focus on the treatment of thyroid nodules and differentiated thyroid cancer, and published the latest guideline. Compared to the guidelines of NCCN and ATA, this guideline suits China's national conditions in nodule evaluation, surgical procedures, postoperative 131I therapy and TSH suppression treatment. In particular, the recommendations for treatment of benign thyroid nodules and TSH suppression therapy goals based on double risk assessment are being put forward, and established the foundation for the diagnosis and treatment of thyroid nodules standard.