As one type of primary liver cancer, intrahepatic cholangiocarcinoma （ICC） is characterized by an insidious onset, a rapid progression and a high level of malignancy. Most patients are already in middle and late stages. Radical surgical resection remains a sole cure for ICC. However, postoperative survival time is short and the prognosis rather poor. In recent years, some advances have been made in the diagnosis and treatment of ICC. A surgical based multidisciplinary approach helps to improve the overall prognosis of patients. Based upon current hot issues in the diagnosis and treatment of ICC, this review summarized the latest research advances in the diagnosis and treatment of early and locally advanced ICC under a multidisciplinary integrated management model and explore future prospects.

As a complex surgical procedure, ex-vivo liver resection and autotransplantation （ELRA） is indicated for complex lesions invading inferior vena cava, portal vein, liver vein and their branches. In recent years, ELRA has evolved rapidly after extensive applications and researches. Major indications are advanced liver malignancies and end-stage hepatic alveolar echinococcosis （HAE）. According to a recent study, patients with liver Child-Pugh score B and ratio of residual liver volume （RLV） to standard liver volume （SLV） of 0.35-0.40 might fulfill the liver requirements of ELRA. In addition, in vivo temporary portal vena cava shunting has also become a primary choice for its lower postoperative mortality than extracorporeal venous bypassing. Intraoperative revascularization focuses upon selecting reconstruction mode of retrohepatic inferior vena cava. Based upon defect severity of posterior hepatic inferior vena cava wall after lesion resection, direct suturing, patching and artificial blood vessel may be adopted. This review summarized the latest surgical researches of ELRA to further explore its development potentials.

Traditional laparoscopic hepatectomy has many disadvantages, such as difficulty in tumor localization, inaccurate marking of liver segments, and lack of intraoperative real-time navigation, which cannot meet the requirements of precise hepatectomy and anatomical hepatectomy. The emergence of fluorescence imaging technology represented by indocyanine green has shown powerful advantages in displaying bile ducts, locating tumors, marking liver segments, displaying micro lesions, and examining resection margins, which has made up for the inherent defects of laparoscopy and gradually become the mainstream of laparoscopy. The innovation and development of fluorescence imaging technology such as excitation light source and probe molecule have further promoted the in-depth application of fluorescence imaging technology in laparoscopic hepatectomy.

Pancreatic cancer （PC） is one of the most malignant tumors in digestive tract. It lacks early screening and diagnostic methods and treatment outcomes are disappointing. Its incidence rate is rising all over the world. This review focused upon the effects of intestinal flora on the occurrence and development of PC and discussed its possible mechanism of action. Other topics included dosing of antibiotics, fecal bacteria transplantation and other measures for regulating the composition of intestinal flora in the comprehensive treatment of PC. It was intended to offer new rationales for an early diagnosis and accurate treatment of PC.

For benign tumors and borderline tumors of pancreas adjacent to main pancreatic duct, surgeons often opt to expand the resection range and perform digestive tract reconstruction for minimizing the risk of compromising main pancreatic duct during surgical enucleation. This expanded surgical approach causes excessive iatrogenic injuries so as to disrupt normal anatomical structure of pancreas and impairs the continuity of digestive tract. It is not conducive to patient outcomes. There are continuous advancements of mini-invasive surgical concepts and medical technology. Drawing upon extensive experiences of robotic pancreatic surgery, the authors proposed the concept of pancreatic duct （repair） surgery with a core of main pancreatic duct bridging repair. The goal was to achieve minimal trauma and obtain optimal outcomes for benign and borderline pancreatic tumors.

Duodenal perforation is an occasional and yet serious complication of endoscopic retrograde cholangiopancreatography （ERCP） and sphincterotomy. Its early clinical symptoms are often difficult to differentiate with those of postoperative pancreatitis and cholangitis. Delayed diagnosis and retroperitoneal infection may lead to sepsis and multiple organ failure with prolonged hospitalization and higher mortality. Loose intraperitoneal tissue easily spreads along retroperitoneal space and poor blood supply causes early abscess formation. An early diagnosis and timely interventions shall greatly improve patient outcomes. This review summarized the domestic and foreign literature on properly managing retroperitoneal infection in duodenal perforation after ERCP.

Severe acute pancreatitis （SAP） is frequently associated with a high mortality. With a quick progression, it is accompanied by one or more complications. This review focused upon the application scopes, advantages and disadvantages of various pancreatic scoring systems to assist clinicians in assessing disease severity and predicting outcomes. It was intended to provide references for properly managing SAP.

Objective To explore the clinicopathological features of colonic neuroendocrine neoplasms （CNENs） and identify prognostic factors. Methods Clinical data were retrospectively reviewed for 28 patients hospitalized with CNENs from January 2012 to December 2022. The differences were examined in clinical characteristics of CNENs between left and right colon. Survival analysis was performed with Kaplan-Meier curve and clinical factors affecting the prognosis of CNENs summarized. Results There were 18 males and 10 females with a median age of 57.0（52.0-64.0） years. Tumor diameter was <2 cm （n=5） and ≥2 cm （n=23）. Tumor was located in right colon （n=28） and left colon （n=9）. Compared with CNENs in left colon, those located in right colon had larger tumor diameters and advanced T stages （P<0.05）. There were endoscopic mucosal resection （n=2）, endoscopic submucosal dissection with additional local resection （n=1）, endoscopic submucosal dissection with additional radical resection （n=1）, radical resection （n=12）, palliative resection （n=7） and non-surgery （n=5）. The clinical stages were T₁ （n=6）, T₃ （n=5） and T₄ （n=17）.Among 20 cases of radical/palliative resection plus lymphadenectomy, 15 were pathologically confirmed as associated lymph node metastasis and 10 had associated distant metastases. During a median period of 34.5（3.0-118.0） month, 11 patients died from disease progression. Seven cases of colonic neuroendocrine tumors （CNETs） without distant metastasis achieved long-term survival after primary tumor resection.Univariate prognostic analysis revealed that tumor diameter, pathological classification, depth of invasion and M stage were associated with cancer-specific survival（CSS）（all P<0.05）. And multivariate analysis indicated that M stage was significantly associated with prognosis [HR=8.958, 95%CI（2.241, 35.811）, P=0.002]. Conclusion CNENs have a high rate of metastasis and an overall poor prognosis.For CNETs without distant metastasis, primary tumor resection is efficacious.

Objective To explore whether or not Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis. Methods A total of 97 patients with hepatitis B cirrhosis and portal hypertension hypersplenism undergoing Hassab operation were selected and divided into two groups of disease （n=40） and control （n=57） according to the diagnostic criteria of splenic artery steal syndrome （SASS）. The inter-group differences in perioperative parameters were compared. Results No significant inter-group differences existed in perioperative parameters （P>0.05） or model for end-stage liver disease （MELD） score at Day 3 post-operation （P>0.05）. At Day 7 post-operation, MELD score of SASS group was significantly better than that of control group [（3.17±2.96） vs.（4.68±2.31）]; At Day 14 post-operation, the values of hepatic artery diameter/velocity were significantly better in SASS group than those in control group [（4.13±0.33） vs.（3.85±0.34） mm; （50.83±3.85） vs.（47.55±3.05） cm/s]（P<0.05）. Conclusion Hassab operation can effectively improve hepatic artery perfusion and liver function in patients with decompensated cirrhosis. Introducing the concept of "Cirrhotic SASS" into clinical practices may benefit more patients with cirrhosis, portal hypertension and hypersplenism.

Objective To explore the application outcomes of naso-pancreatic duct in patients with intraperitoneal infection of severe acute pancreatitis complicated with pancreatic fistula. Methods From June 2019 to January 2021, the relevant clinical data were retrospectively reviewed for 47 patients with intraperitoneal infection of severe acute pancreatitis plus pancreatic fistula. They were assigned into two groups of treatment（n=22） and control（n=25）. Treatment group had an insertion of a naso-pancreatic duct during endoscopic retrograde cholangiopancreatography（ERCP） while control group was not placed. Postoperative efficacy was examined. Results As compared with control group, study group underwent nasal pancreatic duct drainage via ERCP for （12.10±5.89） days. And indwelling time of control group was （17.90±3.95） days. Abdominal drain had markedly reduced indwelling time, And sepsis during treatment occurred at a rate of 4.5%（1/22） in study group and a rate of 32.0%（8/25） in control group. The incidence of active abdominal hemorrhage requiring intervention or surgical intervention was 4.5%（1/22） in study group and 28.0%（7/25） in control group. And pseudocysts occurred at a rate of 13.6%（3/22） in study group and a rate of 40.0%（10/25） in control group. All differences were statistically significant （all P<0.05）, However, no significant difference existed in duration of leucocytosis or length of hospitalization （P>0.05）. Conclusion For patients with severe intraperitoneal infection of acute pancreatitis complicated with pancreatic fistula, naso-pancreatic duct implantation may minimize the amount of pancreatic fistula and control abdominal infection, thereby arresting the progression of the disease to refractory pancreatic fistula and the occurrence of serious complications such as pancreatic pseudocyst and massive bleeding. It can reduce the time of patients with tube, and its application has certain clinical value.

Objective To explore the feasibility of modified Kakita pancreaticojejunostomy （PJ） during pancreaticoduodenectomy （PD）. Methods Between May 2018 and June 2022, 153 patients undergoing open PJ were selected as group A while 110 patients undergoing mini-invasive PJ as group B. In group A, the procedures included open pancreaticoduodenectomy （OPD, n=135）, mini-invasive PD with a conversion into laparotomy （n=13） and mini-invasive PD with a small retrieval incision reconstruction （n=5）. In group B, laparoscopic pancreaticoduodenectomy （LPD, n=87） and robotic pancreaticoduodenectomy （RPD, n=23）. The perioperative clinical data of two groups were retrospectively reviewed. Results A total of 263 cases of PD were successfully performed. In group A, median time of PJ was 9（7-15） min and median volume of blood loss 200（50-1 000） mL. There were postoperative complication （Clavien-Dindo≥3）（n=18, 11.8%）, grade B/C postoperative pancreatic fistula （POPF） （n=14, 9.2%） and biliary fistula （n=8, 5.2%）. There were grade B/C intra-abdominal hemorrhage （n=13, 8.5%） and gastrointestinal hemorrhage （n=1, 0.7%）. Fourteen patients （9.2%） were diagnosed as intra-abdominal infection. 30-day reoperation occurred in 8 patients （5.2%） and 2 patients （1.3%） died because of grade C POPF within 90 days of surgery. In group B, median time of PJ was 17（12-25） min and median volume of blood loss 60（10-250） mL. Among postoperative complication （Clavien-Dindo≥3）（n=7, 6.4%）, there were grade B POPF （n=5, 4.6%）, biliary fistula （n=5, 4.6%）, grade B/C intra-abdominal hemorrhage （n=3, 2.7%） and gastrointestinal hemorrhage （n=1, 0.9%）. Nine patients （8.2%） were diagnosed as intra-abdominal infection. 30-day reoperation occurred （n=3, 2.7%） and 1 patient （0.9%） died within 90 days of surgery. Conclusion With a short learning curve, modified Kakita PJ may be performed under OPD or mini-invasive PD.

Objective To explore the therapeutic efficacy of three-port laparoscopic common bile duct stones combined with gallbladder stones surgery in elderly patients. Methods From September 2020 to July 2022, retrospective analysis was conducted for 65 patients undergoing laparoscopic, choledochoscopic and duodenoscopic three-port combined surgery for common bile duct stones and gallbladder stones. There were 36 males and 29 females with an age range of（20-87） years. They were assigned into two groups of elderly（n=32） and non-elderly（n=33）. The relevant clinical data included operative duration, volume of blood loss, common bile duct diameter, postoperative hospitalization stay, postoperative complications and hospital expenses were collected. Results The total length of hospitalization stay was longer in elderly group than that in non-elderly group [（14.5±3.6） vs.（12.5±4.3） day]. However, the differences were not statistically significant in operative duration, intraoperative volume of blood loss, postoperative hospitalization stay, hospital expenses or postoperative complications [12.5%（4/32） vs. 6.1%（2/33）]. Conclusion No significant difference exists in the efficacy of three-port combined surgery between elderly and non-elderly patients, making it a safe and effective procedure for elders.

Objective To assess the relationship between body composition alteration and complications after radical gastrectomy through analyzing morphometric parameters from preoperative computed tomography （CT） images. Methods The relevant clinical data were retrospectively reviewed for 118 patients undergoing radical gastrectomy from January 2020 to January 2023. Baseline profiles, body composition parameters, surgical findings and postoperative morbidities were recorded. Logistic regression analysis was performed for examining the factors associated with occurrence of postoperative complications. Results There were 76 males and 42 females with an average age of 66.5 year. Visceral obesity, sarcopenia and myosteatosis occurred in 30.5%（36/118）, 35.6%（42/118） and 39.8%（47/118）. There were total gastrectomy （n=29） and subtotal gastrectomy （n=89）. Incidence of delayed gastric emptying, wound infection, pulmonary disease, surgical site infection, anastomotic leakage and postoperative hemorrhage were 13.6%（16/118）, 11.0%（13/118）, 10.2%（12/118）, 9.3%（11/118）, 6.8%（8/118） and 3.4%（4/118） respectively. Complications above Clavien-Dindo Ⅲ accounted for 7.6%（9/118）. Visceral obesity was correlated closely with prolonged operative duration and greater intraoperative hemorrhage. Individuals with sarcopenia were more prone to anastomotic leakage and abdominal infection. In patients of myosteatosis, the incidence of postoperative gastric emptying disorders and pulmonary complications （as well as overall complications） was higher in those without myosteatosis.Multivariate logistic regression analysis indicated that myosteatosis was independent risk factor for postoperative complications after radical gastrectomy[OR=4.256,95% CI （1.192,9.475）,P=0.001]. Conclusion Preoperative CT images may accurately reflect the body composition of patients for further evaluations of nutrition status. And occurrence of complications are correlated closely with the alteration of body composition after radical gastrectomy.