With immune checkpoint inhibitors in gastrointestinal tumors gradually expanding from late-stage first-line treatment to the perioperative setting, immunotherapy has moved progressively earlier in the treatment course. Perioperative immunotherapy has now become one of the key research directions in gastrointestinal oncologic surgery. At the same time, its implementation is bound to exert a substantial impact on many aspects of traditional gastrointestinal tumor surgery. A growing body of clinical evidence has shown that combining immunotherapy with conventional chemotherapy and radiotherapy can significantly improve pathological complete response rates in gastrointestinal tumors, and this benefit has been translated from pathological response to survival outcomes. This article systematically examines the multidimensional impact of perioperative immunotherapy on surgical treatment for gastrointestinal tumors, with a particular focus on four major shifts： the transition from pathological response to long-term survival benefit, clinical practice in organ preservation, the bidirectional regulation of surgical timing and difficulty, and the individualized reconstruction of lymph node dissection strategies.

Immunotherapy is reshaping the treatment landscape for resectable gastric cancer. Perioperative chemotherapy has become one of the standard treatment options, yet the rate of pathological complete response remains low. The MATTERHORN trial demonstrated significant improvements in pathological response and event-free survival （EFS）. This article summarizes the current status of perioperative immune checkpoint inhibitors （ICIs） therapy and highlights its future direction toward biomarker-driven, individualized multimodal treatment for gastric cancer.

Gastric cancer is a highly prevalent and highly lethal malignancy worldwide. Radical surgical resection remains the cornerstone for achieving long-term survival in patients with locally advanced gastric cancer. In recent years, immunotherapy, represented by immune checkpoint inhibitors （ICIs）, has achieved breakthrough progress in advanced gastric cancer and is profoundly reshaping the perioperative treatment landscape. Multiple phase Ⅲ randomized controlled trials, including KEYNOTE-585, MATTERHORN, and DRAGON-Ⅳ, as well as the phase Ⅱ study NEOSUMMIT- 01, have demonstrated that perioperative immunotherapy combined with chemotherapy can significantly improve the pathological complete response rate and event-free survival, bringing a transformative change to the treatment of locally advanced gastric cancer. However, perioperative immunotherapy for gastric cancer is still in development, and a complete and unified framework for evaluation and treatment has yet to be established. Many issues closely related to clinical practice remain to be further explored. This article systematically reviews the target population, efficacy assessment, and current treatment status of perioperative immunotherapy, and provides an in-depth discussion of several key issues in current perioperative immunotherapy.

Objective To evaluate the efficacy of postoperative adjuvant chemotherapy combined with immunotherapy in patients with N₃ gastric cancer. MethodsA total of 82 patients with N₃ gastric cancer who underwent D₂ radical gastrectomy and received postoperative adjuvant chemotherapy with or without immunotherapy in the Department of Gastrointestinal Surgery, The First Affiliated Hospital of Zhengzhou University, from January 2022 to December 2024 were enrolled. According to the postoperative adjuvant treatment regimen, patients were assigned to a combined treatment group and a monotherapy group. The combined treatment group included 23 patients who received postoperative adjuvant chemotherapy plus immunotherapy, whereas the monotherapy group included 59 patients who received postoperative adjuvant chemotherapy alone. Clinical and pathological characteristics, as well as postoperative follow-up data, were collected for both groups. Survival analysis, subgroup analysis, feature-variable screening, and comparison of toxicity incidence were performed. ResultsThe combined treatment group showed significantly longer disease-free survival （DFS） and overall survival （OS） than the monotherapy group （both P<0.05）. Subgroup analysis showed that patients aged≥60 years, male patients, patients with nerve invasion, and patients without cancer nodules derived significant benefit from adjuvant chemotherapy combined with immunotherapy in terms of DFS （all HRs with upper limits of the 95% CIs <1）. Male patients, patients with tumors located in the gastric antrum/pylorus, maximum tumor diameter≥5 cm, distal gastrectomy, non-diffuse type, poorly differentiated carcinoma, postoperative pathological stage IIIB, vascular invasion, nerve invasion, no cancer nodules, <8 treatment cycles, and CPS score ≥5 derived significant benefit from the combined regimen in terms of OS （all HRs with upper limits of the 95% CIs <1）. The Boruta algorithm identified postoperative adjuvant treatment modality, CPS score, and number of treatment cycles （8 cycles） as key feature variables influencing both DFS and OS. There was no significant difference in overall drug-related toxicity incidence between the two groups. ConclusionCompared with adjuvant chemotherapy alone, postoperative adjuvant chemotherapy combined with immunotherapy yields longer DFS and OS in patients with N₃ gastric cancer.

Objective To investigate the impact of neoadjuvant immunochemotherapy （nICT） versus neoadjuvant chemotherapy （nCT） alone on surgical safety and perioperative complications in patients with locally advanced Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction （AEG）. Methods A retrospective analysis was conducted on clinical data from patients with locally advanced Siewert type Ⅱ/Ⅲ AEG who received neoadjuvant therapy followed by D₂ radical resection at the Gastrointestinal Surgery Department of Weifang People's Hospital between January 2022 and December 2024. Patients were divided into two groups based on treatment regimen： the neoadjuvant immunochemotherapy group （nICT group） and the neoadjuvant chemotherapy alone group （nCT group）. Baseline characteristics, surgical parameters, postoperative complications （Clavien-Dindo classification）, and pathological response （tumor regression grade, TRG） were compared between the two groups. Results A total of 65 patients were enrolled, including 39 in the nICT group and 26 in the nCT group. Baseline characteristics were comparable between the two groups, except that the nICT group had significantly higher proportions of ypN0 patients （56.4% vs. 19.2%, P=0.013） and patients without vascular invasion （38.5% vs. 11.5%, P=0.024） compared to the nCT group. Regarding surgical parameters, the nICT group showed higher rates of laparoscopic surgery （74.4% vs. 53.8%） and proximal gastrectomy （20.5% vs. 3.8%） than the nCT group, though the differences were not statistically significant （P>0.05）. No significant differences were observed between the two groups in operative time, radicality, intraoperative blood loss, number of lymph nodes dissected, postoperative hospital stay, or total hospitalization costs （P>0.05）. For postoperative complications, there were no significant differences in the incidence of Clavien-Dindo grade Ⅱ （38.5% vs. 30.8%） or grade Ⅲ （10.3% vs. 7.7%） complications between the groups （P>0.05）. One patient in the nCT group developed a grade Ⅳ complication （duodenal stump fistula）, while no grade Ⅳ complications occurred in the nICT group. Pathological evaluation revealed that the proportion of patients with TRG1 was significantly higher in the nICT group than in the nCT group （28.2% vs. 7.7%, P=0.043）, and both patients achieving pathological complete response （TRG0） were in the nICT group. There was no statistically significant difference in preoperative and postoperative nutritional indicators between the two groups. Conclusion Neoadjuvant chemotherapy combined with immunotherapy is safe and feasible for patients with locally advanced Siewert type Ⅱ/Ⅲ adenocarcinoma of the esophagogastric junction. Compared to chemotherapy alone, this combination does not significantly increase surgical risk or perioperative complications. The combined regimen achieves higher rates of lymph node downstaging, pathological response, and negative vascular invasion, with a trend toward reduced extent of gastric resection.

Objective To develop a novel pancreatic pseudocyst （PPC） classification based on pancreatic duct anatomy and to assess its utility for guiding precision,stepwise treatment. Methods We retrospectively reviewed 48 patients with PPC treated at our center between January 2018 and March 2024. Patients were classified by the anatomical relationship between the pancreatic duct and the cyst into three types：Type A — encapsulated collection;Type B — cyst communicating with the main pancreatic duct;and Type C — cyst communicating with branch pancreatic ducts. Each type was managed with a corresponding stepwise treatment protocol. Treatment outcomes and prognosis were evaluated. Results Six-month cure rates were 94.1%（16/17） for Type A,100.0%（18/18） for Type B,and 92.3%（12/13） for Type C. Median hospital stay was 11 days for Type A,18 days for Type B,and 12 days for Type C. Recurrence rates were 5.9%（1/17）,11.1%（2/18）,and 7.7%（1/13） for Types A,B,and C,respectively. The overall complication rate among the 48 patients was 10.4% （5/48）,and no Clavien-Dindo grade Ⅲ or higher complications occurred. Compared with conventional management,the proposed protocol lowered the rate of surgical intervention to 14.6%. Conclusion A stepwise treatment strategy guided by pancreatic duct anatomical classification allows for tailored, precision care of PPC patients. This approach maintains high cure rates while substantially reducing surgical intervention rates,offering a practical new strategy for PPC treatment.

Objective To develop a risk prediction model for diarrhea after laparoscopic appendectomy （DALA） based on preoperative indicators and clinical characteristics, thereby providing a reference for early postoperative diarrhea identification. Methods This retrospective study was conducted using medical records from Beijing Chao-yang Hospital and Beijing Anzhen Hospital. A total of 3,326 patients with acute appendicitis were included and randomly divided into a training set and a test set at a 7：3 ratio. Least absolute shrinkage and selection operator （LASSO） regression was used to identify key preoperative predictors. Subsequently, six machine learning algorithms were applied to construct and validate DALA risk identification models. Model performance was evaluated using the area under the receiver operating characteristic curve （AUROC）, accuracy, sensitivity, specificity, and Brier score to determine the optimal model. Results LASSO regression identified 8 key predictor variables. Among the six machine learning models, the random forest model performed best, with an AUROC of 0.888 （95%CI： 0.887-0.889） in the training set and 0.797 （95%CI： 0.794-0.800） in the test set. The accuracies in the training and test sets were 0.864 （95%CI： 0.862-0.867） and 0.811 （95%CI： 0.806-0.816）, respectively. Conclusion This study integrated preoperative laboratory indicators and clinical characteristics and successfully constructed a DALA risk prediction model using machine learning algorithms. After validation, the model demonstrated excellent predictive performance and may provide an important reference for early screening of DALA, optimization of clinical management, and decision-making, with substantial potential for clinical translation.

Objective To evaluate the clinical application and significance of a probe-guided sinus tract scraping technique—using a self-made scraping probe—in the surgical management of simple low anal fistula. Methods In this prospective study,84 consecutive inpatients who underwent surgery for simple low anal fistula at Xuzhou Tongshan District People's Hospital between January 2022 and December 2023 were enrolled and randomized （random-number table） into two equal groups （n=42 each）. In the probe-scraping group,a self-made sinus tract scraping probe was introduced through the external opening and withdrawn at the internal opening to remove chronic granulation tissue and necrotic debris within the tract. In the traditional surgery group,the fistula tract was fully incised along its course from the external to the internal opening and necrotic tissue was excised in the conventional manner. Outcomes included fistula healing time,postoperative pain intensity, postoperative bleeding rate,pain with defecation,and fistula recurrence at 3- and 6-month follow-up. Results The probe-scraping group experienced significantly faster healing：（8.0±1.5） d versus （15.7±3.0） d in the traditional group （P<0.05）. Postoperative pain and anorectal defecation discomfort were both significantly lower in the probe-scraping group compared with the traditional group （both P<0.05）. There was no significant difference in postoperative bleeding between groups （P>0.05）. At 3 months,recurrence rates were 7.1% in the probe-scraping group and 2.4% in the traditional group （P>0.05）. At 6 months,total recurrence rates were 9.5% and 7.1%,respectively （P>0.05）. Conclusion Probe-guided sinus tract scraping using a self-made scraping probe offers comparable curative effectiveness to conventional full-tract incision for simple low anal fistula, while avoiding full incision of the tract and providing advantages of reduced trauma,faster recovery,and milder postoperative pain.

Objective To evaluate the effect of leukocyte-filtered blood transfusion on perioperative immune function in trauma patients and to identify independent factors associated with postoperative wound infection. Methods We retrospectively reviewed 173 trauma patients admitted to the Emergency Department of the First Affiliated Hospital of Air Force Medical University from June 2022 to September 2024. Patients were grouped as follows： observation group （n=57） — received leukocyte-filtered blood component transfusion; control group （n=58） — received whole blood transfusion; blank group （n=58） — did not require transfusion. Perioperative clinical indicators were recorded, and T-cell subsets （CD3⁺, CD4⁺, CD8⁺, and CD4⁺/CD8⁺） were measured preoperatively and on postoperative days 1, 3, and 7 （POD1,3,7）. Among transfused patients, those with and without postoperative wound infection were compared; logistic regression identified independent risk and protective factors for wound infection, and receiver operating characteristic （ROC） analysis assessed the predictive performance of selected variables. Results Operative time and duration of drain placement did not differ significantly among the three groups （P>0.05）. Transfusion volume was comparable between the observation and control groups （P>0.05）. All three groups exhibited significant reductions in CD3⁺, CD4⁺, and CD8⁺on POD1, POD3, and POD7 compared with preoperative levels （P<0.05）. However, on POD3 and POD7 the decreases in CD3⁺ and CD8⁺were significantly smaller in the observation group than in the control and blank groups （P<0.05）. The reductions in CD4⁺on POD3 and POD7 were significantly smaller in the observation and blank groups compared with the control group （P<0.05）. CD4⁺/CD8⁺ratios increased on POD3 and POD7 in both the observation and blank groups （P<0.05）. Among 115 transfused patients, 24 （20.87%） developed postoperative wound infection. Multivariate logistic regression identified surgical type, mean red blood cell storage time, duration of drain placement, Acute Physiology and Chronic Health Evaluation Ⅱ （APACHE Ⅱ） score, and Injury Severity Score （ISS） score as independent risk factors for postoperative wound infection （all P<0.05）, while perioperative antibiotic use was an independent protective factor （P<0.05）. ROC analysis showed that mean red blood cell storage time, APACHE Ⅱ score, ISS score, and their combined prediction significantly discriminated patients who developed wound infection （P<0.05）; the combined model yielded an AUC of 0.991 （95% CI： 0.980-1.000）, sensitivity 1.000, and specificity 0.956. Conclusion Leukocyte-filtered blood transfusion attenuates transfusion-related impairment of immune function in trauma patients and may facilitate recovery. Surgical type, mean red blood cell storage time, duration of drain placement, APACHE Ⅱ, and ISS are independent risk factors for postoperative wound infection after transfusion, whereas perioperative antibiotic administration is protective. Enhanced monitoring and targeted preventive interventions are recommended to reduce postoperative wound infection risk.

Objective To evaluate whether radiofrequency ablation （RFA） performed with artificial hydrothorax and ascites assistance improves lesion ablation rates,mitigates liver function injury,and affects complications and recurrence in patients with liver cancer. Methods Using 1∶1 nearest-neighbor propensity score matching,prospectively enrolled patients with liver cancer were allocated to a study group receiving RFA assisted by artificial hydrothorax and ascites （n=55） or to a control group undergoing conventional RFA （n=55）. Outcomes compared between groups included complete lesion ablation rate,postoperative liver function tests,postoperative complications,and recurrence within one year. Results The study group achieved a higher complete lesion ablation rate than the control group （90.91% vs 76.36%,P<0.05）. On postoperative day 3,the study group showed significantly lower serum alanine aminotransferase [（82.48 ± 16.03） U/L vs （124.31 ± 26.71） U/L],aspartate aminotransferase [（73.06 ± 11.24） U/L vs （94.21 ± 23.81） U/L],and total bilirubin [（20.32 ± 5.13） mmol/L vs （23.54 ± 6.04） mmol/L] compared with the control group （P<0.05）. There were no significant differences in complication rates or in 1-year recurrence rates between groups （5.45% vs 9.09%,P>0.05）. Conclusion Artificial hydrothorax/ascites-assisted RFA for liver cancer demonstrates improved lesion ablation efficacy and attenuates immediate postoperative liver function impairment,with a favorable safety profile.

Objective To compare the efficacy and safety of synchronous endoscopic retrograde cholangio pancreatography （ERCP） combined with laparoscopic cholecystectomy （LC） versus staged ERCP followed by LC in patients with gallbladder stones and concomitant common bile duct stones. Methods We retrospectively reviewed 255 patients treated for gallbladder stones with common bile duct stones in the Department of General Surgery at Qianjiang Central Hospital between January 2020 and December 2023. Patients were grouped by surgical approach：observation group （n=168） underwent synchronous ERCP + LC;control group （n=87） underwent staged ERCP and LC. We compared pre- and postoperative laboratory indices （total bilirubin,direct bilirubin, aspartate aminotransferase（AST）,alanine aminotransferase （ALT）,albumin,serum amylase）,length of hospital stay, and postoperative complication rates. Results There were no significant differences in preoperative total bilirubin, direct bilirubin,ALT,AST,albumin,or serum amylase between groups （P>0.05）. Median hospital stay was significantly shorter in the observation group （10.50 days） than in the control group （12.00 days） （P<0.05）. Postoperatively, the observation group showed decreases in total bilirubin,direct bilirubin,and albumin that were significantly greater than those in the control group （all P<0.05）. Postoperative ALT,AST,and serum amylase did not differ significantly between groups （P>0.05）. The observation group experienced 2 cases of acute pancreatitis （1.20%） and 7 cases of hyperamylasemia （4.20%）,for a total complication rate of 5.36%. The control group had 4 cases of acute pancreatitis （4.60%）,2 cases of hyperamylasemia （2.30%）,1 case of gastrointestinal bleeding （1.15%）,and 1 case of hepatic hematoma （1.15%）,for a total complication rate of 9.20%. Conclusion Synchronous ERCP combined with LC is a viable option for patients with gallbladder stones and common bile duct stones. Compared with staged ERCP and LC,the synchronous approach reduces length of hospital stay and is associated with a lower incidence of postoperative acute pancreatitis and a lower overall complication rate.

Objective To evaluate the clinical utility of perioperative serum iron and serum amylase （AMS） changes for the early detection of postoperative pancreatic fistula （POPF） following resection for pancreatic cancer. Methods We retrospectively reviewed 105 patients who underwent pancreatic cancer surgery at the First Affiliated Hospital of Huzhou University between January 2016 and December 2024 （57 men, 48 women）. Patients were grouped by postoperative outcome into a POPF group （n=47） and a non-POPF group （n=58）. Serum iron and AMS levels were recorded preoperatively and on postoperative day （POD） 1,POD 2-3, and POD 4-7. Diagnostic performance was evaluated using receiver operating characteristic （ROC） curve analysis. Results Serum iron levels were significantly lower in the POPF group than in the non-POPF group on POD 1,POD 2-3,and POD 4-7 （[4.489 ± 1.623] μmol/L vs [5.703 ± 3.863] μmol/L;[4.506 ± 1.572] μmol/L vs [5.972 ± 1.794] μmol/L;[5.215 ± 2.378] μmol/L vs [6.866 ± 3.077] μmol/L）,with t=2.17, 4.398,and 3.018,respectively （all P<0.05）. AMS was significantly higher in the POPF group on POD 1 and POD 4-7 （[269.306 ± 198.852] U/L vs [125.86 ± 131.513] U/L;[46.779 ± 29.103] U/L vs [34.753 ± 25.608] U/L）,with t=-4.249 and -2.251,respectively （both P<0.05）. AMS on POD 2-3 did not differ significantly between groups （P>0.05）. ROC analysis demonstrated that POD 2-3 serum iron predicted POPF with an AUC of 0.748 （95%CI： 0.652-0.844）. The optimal cutoff was 4.850 μmol/L （sensitivity 66.0%, specificity 75.4%）. POD 1 AMS predicted POPF with an AUC of 0.780 （95%CI：0.691-0.869）;the optimal cutoff was 143.300 U/L （sensitivity 72.3%,specificity 77.2%）. Combining POD 2-3 serum iron <4.850 μmol/L with POD 1 AMS >143.300 U/L improved discrimination （AUC 0.850,95%CI：0.771-0.929）,significantly outperforming each marker alone （both P<0.05） and yielding a negative predictive value of 97.8%. Conclusion Perioperative monitoring of serum iron and AMS provides valuable adjunctive information for early diagnosis and management of POPF after pancreatic cancer surgery. A drop in serum iron （<4.850 μmol/L） together with an elevated AMS （>143.300 U/L） may serve as an early warning sign of POPF and can inform timely clinical interventions to improve patient outcomes.

Hepatobiliary surgery demands excellent operative exposure,reliable identification of vascular and biliary anatomical variants,and precise tumor localization. Thanks to interdisciplinary progress in surgical methods,optical imaging, and molecular imaging,fluorescence imaging-guided surgery is becoming increasingly valuable in hepatobiliary care. Near‑infrared fluorescence imaging—most commonly using indocyanine green—provides real‑time visualization of hepatic and biliary anatomy and tumor margins,markedly enhancing procedural safety and accuracy. This review provides a systematic overview of the principles,current applications,limitations,challenges,and future directions of fluorescence guidance in hepatobiliary surgery,focusing on its roles in liver resection,biliary procedures,and liver transplantation. With continued improvements in hardware,the integration of artificial intelligence,and the development of new molecular probes,fluorescence imaging-guided surgery is poised to advance hepatobiliary surgery toward greater precision and individualized treatment.