Gastric cancer is one of the most common malignancies worldwide, and standardized surgical treatment plays a crucial role in improving its survival and prognosis. Clinical research provides scientific evidence for establishing standardized surgical treatment systems, while clinical practice continuously validates and refines research outcomes during their practical application. This article explored the core value of clinical research in driving the evolution of surgical approaches in gastric surgery, and highlighting the core value of clinical research in clinical practice. Moreover, we discussed implementation strategies for high-quality clinical research in surgery, and identified challenges and future directions in clinical research. Furthermore, this article elucidated the significant role clinical research plays in developing standardized treatment systems, aiming to provide theoretical support and practical references for designing and conducting future high-quality clinical research.

In recent years, the surgical management of gastrointestinal tumors has undergone progressive standardization and refinement, with increasing consensus on operative strategies and resection margins. The advent of advanced laparoscopic techniques and the Da Vinci robotic-assisted surgical system has revolutionized the surgical treatment paradigm, bringing new breakthroughs in the treatment of gastrointestinal tumors. Beyond technical advancements, the integration of perioperative chemotherapy, radiotherapy, targeted therapy, and multidisciplinary team strategies has contributed to the prognosis improvement of gastrointestinal tumors. Moreover, advancements in molecular biology have further driven the evolution of gastrointestinal oncologic surgery toward precision medicine.

Intersphincteric resection （ISR） has emerged as a pivotal sphincter-preserving procedure for low-level rectal cancer, demonstrating significant improvements in anal preservation rates while maintaining optimal oncological outcomes. This technique necessitates concomitant rectal resection with partial or complete internal anal sphincter excision, followed by ultra-low anastomotic reconstruction. This substantially elevates the risk of postoperative low anterior resection syndrome （LARS）. Characterized by increased stool frequency, urgency, and bowel dysfunction, LARS has garnered escalating clinical attention in recent years. However, perioperative interventions for preventing and managing LARS remain inadequately standardized. This article systematically reviewed current evidence to elucidate critical technical elements for perioperative anal function preservation following ISR.

Objective To analyze the prognostic factors and recurrence patterns of locally advanced gastric cancer （LAGC） patients who underwent D2 radical gastrectomy after receiving neoadjuvant chemotherapy combined with immunotherapy. Methods A total of 76 LAGC patients who received neoadjuvant chemotherapy combined with immunotherapy followed by D2 radical gastrectomy at the Department of Gastrointestinal Surgery, Union Hospital, Huazhong University of Science and Technology, from January 2020 to October 2023, were enrolled. According to postoperative recurrence, patients were divided into the recurrence group （22 cases） and non-recurrence group （54 cases）. Clinical and follow-up data were collected. Results There were 14 patients with a single recurrence mode （63.6%）, and the proportion of patients with local recurrence, regional recurrence, abdominal metastasis and distant metastasis was 4.5%, 4.5%, 4.5%, and 50.1%, respectively. Statistically significant differences were found between the recurrence and non-recurrence groups in terms of nerve invasion, vascular invasion, posttreatment pathological tumor （ypT） staging and posttreatment pathological lymph node （ypN） status（all P<0.05）. Univariate analysis revealed that signet-ring cell carcinoma, nerve invasion, vascular invasion, ypT stage, and ypN status were significantly related with disease-free survival （DFS） after D2 radical gastrectomy in LAGC patients receiving neoadjuvant chemotherapy and immunotherapy （all P<0.05）. Multivariate analysis showed that signet-ring cell carcinoma （P=0.048） and ypN status （P=0.035） were independent factors affecting DFS after D2 radical gastrectomy. Additionally, there was a significant difference in the incidence of double recurrence between the ypN0 group and the ypN₊ group patients. Conclusion Signet-ring cell carcinoma and ypN status are independent prognostic factors for LAGC after neoadjuvant chemotherapy combined with immunotherapy and surgery. Preventing distant recurrence after neoadjuvant chemotherapy combined with immunotherapy and surgery is an important approach to further improve the long-term prognosis of LAGC.

Objective Peritoneal metastasis is the most common site of distant metastasis in gastric cancer and associated with poor prognosis. Occult peritoneal metastasis （OPM）, characterized by the absence of imaging signs, is challenging to diagnose preoperatively, posing difficulties for clinical decision-making. This study aims to develop a prediction tool for OPM in gastric cancer based on clinical features using a decision tree model. Methods This was a retrospective study involving gastric cancer patients who underwent contrast-enhanced CT and laparoscopic exploration at the Gastrointestinal Oncology Center of Peking University Cancer Hospital from 2015 to 2019. Univariate and multivariate analyses were conducted to identify clinicopathological features associated with OPM. A decision tree model was constructed and its diagnostic performance was evaluated in both the training and validation sets. Results A total of 414 patients were included, of whom 63 （15.22%） had peritoneal metastasis. Multivariate logistic regression analysis identified that tumor long diameter （OR=1.023,95%CI：1.003-1.044;P=0.026）, cN3 staging （OR=6.587,95%CI： 1.362-31.846;P=0.019）, Borrmann type Ⅳ （OR=47.012,95%CI：4.903-1521.541;P=0.005）, and CA125 level （OR=1.014,95%CI：1.002-1.027;P=0.021） were independent risk factors for OPM in gastric cancer. The decision tree model incorporated six classification variables, including the tumor long diameter, cN stage, Borrmann classification, CA125 level, CA19-9 level, and Lauren classification. In the validation set, the model achieved a diagnostic accuracy of 87.2%, sensitivity of 68.3%, specificity of 90.6%, an area under the curve （AUC） of 0.807 （95% CI：0.766-0.847;P<0.001）, and a negative predictive value of 0.941. Conclusion This study developed a decision tree model based on clinical features, demonstrating good diagnostic performance for OPM in gastric cancer with negative CT findings.

Objective To investigate the short-term effect of preoperative neoadjuvant chemoradiotherapy combined with programmed cell death 1 （PD-1） inhibitors on the treatment of ulcerative colitis related colorectal cancer （UCRCC）. Methods Clinical data of UCRCC patients who received PD-1 inhibitors combined with neoadjuvant therapy and surgically operated in the Second Hospital of Nanjing from March 2021 to December 2023 were retrospectively collected. Patients were divided into the control group （n=46） and combination group （n=34） based on preoperative treatment regimens. Patients in the control group received two cycles of capecitabine + oxaliplatin chemotherapy preoperatively, followed by two cycles of radiotherapy after a 2-week rest. Those in the combination group received PD-1 inhibitors every 3 weeks for two cycles, plus clinical management as the same as in the control group. All patients underwent surgery （total colorectal resection with ileostomy or radical intestinal tumor resection） 4-6 weeks after neoadjuvant chemoradiotherapy. The effect of neoadjuvant therapy, tumor markers, drug toxicity, side effects, perioperative indicators and postoperative pathology were compared between the two groups. Results Disease control rate in the combination group was significantly higher than that of the control group （P<0.05）. The levels of carbohydrate antigen 242, carbohydrate antigen 72-4, carcinoembryonic antigen and carbohydrate antigen 199 in the combination group were significantly lower than those of the control group （P<0.05）, and the percentage of tumor regression grades 0 and 1 was significantly higher compared to the control group. There were no significant differences in the incidence of toxic and side effects and perioperative indexes between the two groups （P>0.05）. Conclusion Preoperative neoadjuvant chemoradiotherapy combined with PD-1 inhibitors demonstrates favorable efficacy in controlling UCRCC, reducing tumor marker levels, improving postoperative pathological outcomes, and exhibiting an acceptable safety profile.

Objective To investigate the postoperative complications of endoscopic retrograde cholangiopancreatography （ERCP） in older patients and risk factors. Methods A total of 400 patients who underwent ERCP or those who were successfully treated in the Fourth Affiliated Hospital of Xinjiang Medical University from October 2017 to December 2023 were retrospectively involved, including 228 males and 172 females. Patients were divided into two groups according to whether they had postoperative complications： control group and complication group. The general conditions, preoperative diagnosis, comorbidities, laboratory examinations of the two groups were recorded. Univariate regression analysis was used to analyze the risk factors for serious complications after surgery. Results A total of 32 patients had postoperative complications, and the incidence of postoperative complications was 8.0%. Compared with the control group, the patients in the complication group were significantly older （P=0.003）, and had significantly lower body mass index （BMI） （P=0.013）, higher proportions of poorly controlled hypertension and diabetes mellitus, pulmonary dysfunction, history of ERCP, difficult intubation, Sphincter of Oddi dysfunction （SOD）, proportion of common bile duct stenosis （P<0.05）. Univariate regression analysis showed that age （OR=1.25, 95% CI：1.05-1.22, P=0.001）, BMI （OR=0.88, 95% CI：0.78-0.98,P=0.02）, poorly controlled blood pressure （OR=2.0, 95% CI：1.5-4.0,P=0.000 1）, poorly controlled blood glucose （OR=1.5, 95% CI：1.00-2.01,P=0.02）, pulmonary dysfunction （OR=0.88, 95% CI：0.78-0.98,P=0.02）, history of ERCP （OR=2.2, 95% CI：1.45-3.01,P=0.001）, SOD （OR=3.82, 95% CI：2.15-5.88, P=0.001）, and common bile duct stenosis （OR=1.48, 95% CI：0.49-4.51,P=0.002） were associated with postoperative complications of ERCP. Conclusion In older patients, factors such as age, BMI, poorly controlled hypertension and diabetes, pulmonary dysfunction, prior ERCP history, sphincter of Oddi dysfunction, and CBD stenosis are all significantly associated with post-ERCP complications. The incidence of postoperative complications following ERCP in elderly patients is relatively low, with no severe complications observed, indicating that ERCP is a safe and effective diagnostic and therapeutic procedure for this population.

Objective To analyze the risk factors for postoperative mortality in patients with perforated peptic ulcer （PPU）, and to develop a nomogram to predict the postoperative mortality in PPU patients and to evaluate its performance. Methods A case-control study was conducted. Clinical data of PPU patients who underwent surgical treatment in the Department of General Surgery at Anqing Municipal Hospital from January 2019 to December 2023 were retrospectively analyzed. A total of 21 indicators, including general information and biochemical tests on admission, were collected. A univariate analysis was first performed to assess whether postoperative outcomes resulted in the mortality, followed by a multivariate logistic regression analysis of statistically significant indicators from the univariate analysis. Based on the results of the multivariate analysis, a nomogram to predict the mortality in postoperative PPU patients was constructed. Internal validation was performed using the Bootstrap resampling method. The performance of the nomogram was evaluated using the receiver operating characteristic （ROC） curve, calibration curve, and decision curve analysis （DCA）. Results A total of 283 patients were enrolled in the study and divided into the postoperative death group （n=27） and survival group （n=256） based on postoperative outcomes, with a mortality rate of 9.5%. Statistically significant differences were observed between the postoperative death group and the survival group in terms of gender, age, presence of shock before surgery, time from onset to surgery being greater than 24 hours, history of hypertension, cerebrovascular sequelae, history of heart disease, history of chronic obstructive pulmonary disease （COPD）, use of immunosuppressants, white blood cell count, hemoglobin, albumin, creatinine, and C-reactive protein （P<0.05）. The multivariate logistic regression analysis showed that older age （OR=1.080, 95%CI： 1.006-1.160）, time from onset to surgery being greater than 24 hours （OR=7.122, 95%CI： 1.361-37.280）, history of COPD （OR=27.017, 95%CI： 2.172-336.106）, and elevated creatinine levels （OR=1.016, 95%CI： 1.008-1.020） were risk factors for postoperative mortality in PPU patients. Elevated white blood cell count （OR=0.859, 95%CI： 0.761-0.969） was identified as a protective factor. The nomogram based on the multivariate analysis showed an area under the curve of 0.963 （95% CI： 0.934-0.986） during internal validation. The calibration curve closely matched the ideal curve, and the DCA indicated a significant positive net benefit from the nomogram. Conclusion The nomogram to predict postoperative mortality in PPU patients, based on five indicators—age, time from onset to surgery being greater than 24 hours, history of COPD, white blood cell count, and creatinine levels—demonstrates strong predictive ability. It can be used for early identification of high-risk PPU surgical patients, which may help improve patient outcomes and reduce mortality rates.

Objective To investigate the risk of gastroparesis and prognosis of late-phase gastroparesis in severe acute pancreatitis （SAP）, and to constructa nomogram to early predict its risk, thus reducing the incidence of gastroparesis. Methods A retrospective analysis was conducted on the clinical data of 240 SAP patients who were admitted to the Department of Pancreatic Surgery, Renmin Hospital of Wuhan University, from October 2019 to December 2023. Based on the occurrence of gastroparesis at 2 weeks of SAP, they were divided into the gastroparesis group and non-gastroparesis group, and clinical data were compared between groups. A total of 240 SAP patients were randomly divided into the training set （192 cases） and validation set （48 cases） at a ratio of 8∶2. Correlation analysis was conducted on the variables in the training set, and Lasso regression and multivariate logistic regression was used to identify risk predictors for gastroparesis. A nomogram was constructed, validated, and analyzed. Results The incidence of gastroparesis in the late phase of SAP was 29.6% （71/240）. Compared with the non-gastroparesis group, patients with gastroparesis demonstrated significantly increased hospitalization costs, prolonged hospital stays, higher rates of extended ICU admission, elevated 60-day all-cause mortality, and greater frequencies of both overall surgical interventions and laparotomy procedures. Through analysis of the training cohort, seven independent predictive factors were identified： Nutritional Risk Screening 2002 （NRS2002） score, time interval from SAP onset to enteral nutrition initiation, mean 72-hour blood glucose （Glu） levels, C-reactive protein concentration, leukocyte count, as well as the extent and anatomical distribution of pancreatic/peripancreatic necrosis or inflammatory exudation. These parameters were incorporated into a nomogram, which exhibited excellent discriminative ability, calibration, and clinical utility in both training and validation datasets. Conclusion The validated nomogram provides clinicians with a practical tool for early identification of high-risk patients and targeted intervention to improve the prognosis of SAP.

Severe acute pancreatitis develops rapidly and extremely dangerous, with a high incidence of complications, and poor prognosis. Infected pancreatic necrosis （IPN） is one of the complications of severe pancreatitis. Approximately 20% of severe acute pancreatitis patients develop pancreatic or peripancreatic necrosis, with a mortality rate ranging from 8% to 39%. Early diagnosis of IPN remains challenging due to limited diagnostic methods, and controversies persist regarding optimal treatment strategies and timing. So far, a "step-up" strategy is the main strategy for treating IPN. This paper reported the diagnosis and treatment of an adult male IPN patient with repeated courses and long hospital stay. Based on our clinical experience and literature review at home and abroad, we introduced and summarized the etiology, pathogenesis, early diagnosis, and treatment of IPN, in order to enhance clinicians' understanding and provide practical guidance for clinical practice.

Objective To explore the impacts of laparoscopic sleeve gastrectomy （LSG） combined with jejunal-jejunal bypass （JJB） on metabolic indicators in obese patients. Methods The medical records of 36 obese patients in Xiaolan People's Hospital of Zhongshan from July 2020 to July 2023 were retrospectively analyzed. According to the different surgical methods, patients were divided into the observation group （n=18, LSG+JJB） and control group （n=18, LSG）. The weight loss-related indicators, lipid metabolism, glucose metabolism, quality of life and complications were compared between groups before surgery and 12 months after surgery. Results At 1 year postoperatively, the body mass index （BMI）, waist circumference, abdominal circumference, and hip circumference in both groups were significantly reduced compared to preoperative levels, which were significantly lower in the observation group than the control group （all P<0.05）. Postoperative lipid metabolism indicators, glucose metabolism indicators, and quality of life in both groups were significantly improved compared to preoperative levels, which were more pronounced in the observation group than the control group （all P<0.05）. Severe postoperative complications were not reported in both groups, and there was no significant difference in the incidence of complications between the two groups （P>0.05）. Conclusion For patients with obesity, LSG+JJB treatment can enhance the effect of weight loss, improve the function of glucolipid metabolism, and increase the quality of life, without increasing the risk of postoperative complications. It has a high safety profile and can be used as a good choice for weight loss surgery.

Abdominal hernia is a common surgical condition that is divided into primary and secondary abdominal wall hernias. The former includes umbilical hernia, white line hernia, semimeniscus hernia, and lumbar hernia, and the latter refers to incisional hernia. It is generally believed that immediate surgery should be performed even in the absence of any clinical manifestations, and surgery is the only effective treatment for abdominal wall hernias. Commonly used surgical modalities include open sublay, laparoscopic intraperitoneal onlay mesh （IPOM）, mini/less open sublay MILOS/endoscopic mini/less open sublay technique （eMILOS）, transabdominal preperitoneal （TAPP）, laparoscopic totally extra-peritoneal hernia repair （TEP）, enhanced-view totally extraperitoneal （eTEP）, and transabdominal partial extraperitoneal tape. In recent years, endoscopic sublay repair （ESR） has become widely used. It is divided into transabdominal sublay （TAS） and totally extraperitoneal sublay （TES）, which are evolved from TAPP and TEP, respectively. Its practicality and effectiveness require a large number of clinical data to verify. This article reviewed the relevant literatures on ESR in the treatment of abdominal wall hernia, discussed the application and research progress of ESR in the treatment of abdominal wall hernia, and analyzed the feasibility and superiority of ESR.

The clinical application of immune checkpoint inhibitors （ICIs） has significantly improved cancer treatment outcomes, yet ICI-induced hyperprogressive disease （HPD） has become a critical issue affecting the prognosis. This review systematically summarized research advances in HPD, focusing on controversies in its definition, underlying mechanisms, and clinical management strategies. Currently, the absence of unified diagnostic criteria for HPD leads to substantial heterogeneity in evaluation systems based on tumor growth kinetics and imaging characteristics, resulting in incidence variations ranging from 4.8% to 37.3% across studies. Mechanistic investigations revealed that HPD development is closely associated with multifactorial interactions involving oncogenic pathway abnormalities, immune microenvironment remodeling, and cytokine dysregulation. We proposed establishing multidimensional predictive models that integrate clinical features, genomic biomarkers, and radiomics, and exploring targeted intervention strategies to optimize immunotherapy decision-making.