Background: Minimally invasive surgeries are increasingly central to modern medicine, particularly in liver transplantation. These techniques, which offer reduced trauma, precise operations, minimal bleeding, and swift recovery, are, however, unevenly adopted across China. Only a limited number of centers routinely perform minimally invasive donor hepatectomies, indicating a significant imbalance in the development and application of these advanced procedures. Additionally, there lacks a set of standardized guidelines that are tailored to meet China's unique healthcare challenges and conditions. Methods: In August 2023, the Branch of Organ Transplant of Chinese Medical Association and the Branch of Organ Transplant Physicians of Chinese Medical Doctor Association convened a group of national liver transplantation experts to establish a guideline development committee. This committee conducted a thorough review of relevant literature, evaluated existing guidelines and consensus, and assessed factors such as the evidence base, patient preferences, and the cost-effectiveness of interventions within China. After multiple rounds of discussions, both online and offline, the committee finalized the guidelines. Results: This collaborative effort led to the creation of the "Chinese guidelines for minimally invasive donor hepatectomy in living donor liver transplantation (2024 edition)". These guidelines address crucial aspects such as the safety and advantages of minimally invasive surgery for living donor liver transplantation, donor selection criteria, anesthesia strategies, surgical technical details, and learning curves associated with these procedures, resulting in a comprehensive set of 26 recommendations. Conclusions: The formulation of these guidelines represents a significant advancement towards standardizing minimally invasive liver transplantation surgeries in China. They are designed to enhance outcomes for both donors and recipients by synthesizing expert consensus with contemporary research and clinical practices. Moreover, they serve as a crucial reference for surgeons and medical institutions, promoting the refinement and adoption of minimally invasive surgical techniques in liver transplantation.
Hepatic venous pressure gradient (HVPG) is considered the gold standard for diagnosing clinically significant portal hypertension (CSPH). To further standardize the application of HVPG measurement, the Chinese Portal Hypertension Alliance (CHESS) and the Minimally Invasive Interventional Collaboration Group of the Chinese Society of Gastroenterology have updated the "Consensus on clinical application of hepatic venous pressure gradient in China (2023 edition)". This consensus provides 10 recommendations, with the aim of effectively promoting standardized measurement and the regulated application of HVPG in the field of cirrhotic portal hypertension in China.
Colorectal cancer (CRC) has been a common malignant tumor in China. Through the great effort in cancer prevention and treatment, the 5-year survival rate of patients with CRC in China has been largely improved. However, insufficient early diagnosis and treatment have seriously impeded the prognosis of Chinese CRC patients. The Early Diagnosis and Treatment Group of the Chinese Medical Association, Oncology Branch organized experts in the area of CRC to write the Expert Consensus on the Early Diagnosis and Treatment of Colorectal Cancer in China and issued it publicly (2020 edition). The 2020 edition of expert consensus has been meaningful to the early diagnosis and standardized treatment of CRC. Based on the prior edition, the Early Diagnosis and Treatment Group of the Chinese Medical Association, Oncology Branch revise the consensus focused on the early screening and diagnosis protocols for colorectal cancer, endoscopic/surgical management of early colorectal tumor, as well as adjuvant treatment and remedial measures and follow-up monitoring protocols. The 2023 edition of the consensus not only synthesized the latest evidence from China and combined it with the specific national condition and clinical practice, but also referred to the international guidelines. This 2023 edition consensus, developed for clinicians working on the screening, early diagnosis and treatment for CRC, would further promote the standardization and advances in the diagnosis and treatment of CRC at the early stage in China, and improve the survival and prognosis of CRC.
Objective:To study the relationship between 5-item modified frailty index (5i-mFI) and short-term complications, 30-day mortality and prognosis of pancreaticoduodenectomy (PD).Methods:The data of 269 patients who underwent PD in the First Affiliated Hospital of Bengbu Medical College from March 2017 to October 2022 were retrospectively collected. According to the scores of 5 variables including hypertension, diabetes, chronic obstructive pulmonary disease, congestive heart failure and dependent functional status, 5i-mFI score was performed. The patients were divided into non-frail group (0 or 1 point) and frail group (≥2 points) by 5i-mFI score. The relationship between 5i-mFI score and short-term complications and death within 30 days after PD was discussed. The area under the curve (AUC) was used to determine the ability of 5i-mFI score to identify recent postoperative complications.Results:55 cases (20.4%) were included in the frailty group and 214 cases (79.6%) were included in the non-frailty group. The mild complications, major complications, any complications and mortality within 30 days after operation in the frailty group were significantly higher than those in the non-frailty group, and the probability increased gradually with the increase of 5i-mFI score, the differences were statistically significant (all P<0.01). The incidence of postoperative complications such as grade B/C pancreatic fistula, gastric emptying disorder, chylous leakage, bile leakage, pulmonary complications, cardiac complications, and deep vein thrombosis was higher in the frailty group (P<0.05). The AUC of 5i-mFI score for predicting short-term complications after PD was 0.843 (standard error?=0.03, 95% CI: 0.784-0.903, P<0.01), with good accuracy.Conclusions:Compared with non-frail patients, frail patients with 5i-mFI≥ 2 points have higher probability of postoperative complications and 30-day mortality. The 5i-mFI score has certain predictive value for short-term complications and 30-day mortality after PD, which is helpful for clinical decision-making.
Objective:To compare the diagnostic efficacy of ACR TI-RADS and C-TIRADS for malignant thyroid nodules, the value of recommending fine-needle aspiration biopsy (FNA), and the consistency in the application of the guidelines by physicians.Methods:Using the ACR TI-RADS and C-TIRADS classification methods, ultrasography images of 3 018 thyroid nodules (size≥1 cm) from January 2009 to November 2018 in 5 hospitals were retrospectively analyzed. The receiver operating characteristics (ROC) curves were constructed using pathological findings as the gold standard to compare the diagnostic efficacy of the two guidelines. Area under the ROC curve (AUC), diagnostic sensitivity, specificity, Youden index and accuracy, and consistency of whether recommending FNA were analyzed to test the clinical applicability of the two guidelines.Results:The AUC of ACR TI-RADS and C-TIRADS were 0.892 and 0.884; the accuracy, sensitivity, and specificity of ACR TI-RADS were 0.812, 0.668, and 0.926, and of C-TIRADS were 0.811, 0.735, and 0.870. The unnecessary puncture rates for ACR TI-RADS and C-TIRADS were 40.2% and 31.9%; the concordance of FNA of the recommended nodes for ACR TI-RADS was good, while C-TIRADS was moderate (Fleiss’s Kappa=0.713 and 0.601).Conclusions:ACR TI-RADS has better diagnostic efficacy than C-TIRADS. ACR TI-RADS has higher specificity and AUC, and C-TIRADS has higher sensitivity. C-TIRADS has lower unnecessary puncture rate and ACR TI-RADS has higher consistency in recommending FNA.
