Robot surgery is an important trend in contemporary colorectal cancer surgical treatment. The Robotic Surgery Group, Colorectal Cancer Committee of Chinese Medical Doctor Association organized experts in relevant fields across the country to update and revise the application standards of robotic colorectal cancer surgery based on the Expert consensus on robotic surgery for colorectal cancer (2015 edition) and the revised version in 2020, in accordance with the development of robotic surgery concepts, technologies, and equipment in recent years, in order to promote the application and promotion of robotic surgery.
Colorectal cancer (CRC) is one of the most common malignant tumors in China, ranking second in morbidity and fourth in mortality. Metastasis and recurrence are the leading causes of patient death, and the peritoneum is a frequent site of metastasis in CRC, second only to liver and lung metastases. However, the prognosis of peritoneal metastasis is much worse than hepatic and pulmonary metastasis. CRC peritoneal metastasis is challenging early diagnosis, presents with severe symptoms, and has a poor prognosis. It is crucial to emphasize standardized diagnosis and treatment for CRC peritoneal metastasis to improve patients' outcome and enhance their quality of life. This consensus, based on evidence-based medical evidence, revised the "Chinese Expert Consensus on the Diagnosis and Treatment of Colorectal Cancer Peritoneal Metastasis (2022 edition)" and reached a preliminary consensus on the definition, diagnosis, treatment, and prevention of CRC peritoneal metastasis, with the aim of guiding and standardizing the diagnosis and treatment of CRC peritoneal metastasis, developing reasonable and effective comprehensive treatment plans, prolonging survival time and improving quality of life for CRC peritoneal metastasis patients, thereby raising the overall level of diagnosis and treatment for CRC in China.
Importance:Effective treatment of locally advanced gastric cancer (GC) or gastroesophageal junction (GEJ) cancer remains a challenge. Objective:To compare the efficacy and safety of atezolizumab plus trastuzumab plus capecitabine and oxaliplatin chemotherapy (XELOX) vs trastuzumab plus XELOX in Chinese patients with locally advanced human epidermal growth factor receptor 2 (ERBB2; formerly HER2)-positive GC or adenocarcinoma of the GEJ. Design, Setting, and Participants:This was an open-label phase 2 randomized clinical trial conducted at 8 study sites in China. Patient recruitment started on February 25, 2021, and this study is ongoing as participants are still being actively followed up. Chinese patients eligible for surgery with locally advanced ERBB2-positive GC or adenocarcinoma of the GEJ were included. Data were analyzed from March 2021 to October 2023. Interventions:Eligible patients were enrolled and randomly assigned 1:1 to perioperative treatment with either atezolizumab plus trastuzumab plus XELOX (arm A) or trastuzumab plus XELOX (arm B) for 3 neoadjuvant cycles (3 weeks per cycle) and 5 adjuvant cycles. Main Outcomes and Measures:The primary efficacy end point was the pathological complete response (pCR) rate following completion of neoadjuvant therapy and surgery. Results:In total, 42 patients were screened and randomly assigned to arm A (n = 21) or arm B (n = 21). The median (range) ages were 61 (33-72) years and 65 (49-72) years in arm A and arm B, respectively, and 39 patients (93%) were male. The pCR rate was significantly higher in arm A (8 [38%]) than arm B (3 [14%]; difference, 23.8%; 90% CI, 1.3-44.7). Age younger than 65 years, male sex, and intestinal Lauren classification were significantly associated with a better pCR rate in arm A. Median event-free survival, disease-free survival, and overall survival were not reached. Based on the same way of interpretation, major pathologic response should be statistically significantly different between the 2 arms, while other outcome measures remained not significantly different. The incidence of treatment-emergent adverse events was 100% (21 of 21) and 100% (21 of 21) in arms A and B, respectively; grade 3 or higher TEAEs, 57% (12 of 21) and 67% (14 of 21), respectively; and serious TEAEs, 29% (6 of 21) and 10% (2 of 21), respectively. Conclusions and Relevance:In this randomized clinical trial, add-on atezolizumab to trastuzumab plus XELOX therapy demonstrated promising efficacy in this patient population, and no new safety concerns were raised. Trial Registration:ClinicalTrials.gov Identifier: NCT04661150.
BACKGROUND:Gastric cancer is the fifth most common cancer globally and is associated with significant morbidity and mortality. Despite its alarming prevalence, limited comparative evidence exists on its treatment efficacy and prognosis across diverse China populations. METHODS:To address this, our study used a large-scale dataset from the National Cancer Information Database, including data from 220,304 patients from 53 leading hospitals across 27 provinces in China. RESULTS:From 2017 to 2023, early-stage (Stages I-II) gastric cancer diagnoses increased to 35.63% of all cancer cases. Our study evaluated the neoadjuvant treatment strategies, adjuvant post-operative therapy, first- and second-line management for progressive stages, alongside current gastric cancer treatment guidelines in China. Notably, immunotherapy accounted for 16.17% and 23.28% of first- and second-line treatments for late-stage gastric cancers, and 14.56% and 5.00% for neoadjuvant and adjuvant therapies, respectively. Analysis of survival rates revealed that the 1-, 2-, 3-, 4-, and 5-year survival rates were 74.07%, 54.89%, 44.21%, 37.97%, and 33.53%, respectively. The 5-year survival rates across stages I-IV were 85.07%, 49.34%, 35.56%, and 13.15%, respectively. CONCLUSIONS:These findings offer critical insights into the current state of gastric cancer treatment in China and can inform future initiatives to improve therapeutic outcomes for patients with gastric cancer.
OBJECTIVE:To compare the perioperative safety and specimen characteristics after transanal endoscopic intersphincteric resection (taE-ISR) versus classical intersphincteric resection (cISR) in patients with locally advanced rectal cancer (LARC) treated with neoadjuvant chemoradiotherapy (nCRT). METHODS:Clinicopathological data of 145 patients (75 undergoing taE-ISR and 70 undergoing cISR after nCRT) were retrospectively analyzed. Baseline characteristics, perioperative details, and pathological specimen quality of the two groups were compared. RESULTS:Intraoperative blood loss was lower in the taE-ISR group compared to cISR (50.0 (40.0-100.0) ml vs. 70.0 (50.0-100.0) ml, P = 0.034). Two patients (2.6 %) in the taE-ISR group and eight patients (11.4 %) in the cISR group sustained adjacent organ injury (P = 0.037). There was no statistically significant difference in the prevalence of postoperative complications between the two groups (17.3 % vs. 30.0 %, P = 0.072). However, pelvic abscess (1.3 % vs. 8.6 %, P = 0.042) and rectovaginal fistula (0.0 % vs. 5.7 %, P = 0.036) occurred less often in taE-ISR compared to cISR. The complete resection rate was higher in taE-ISR compared to cISR (98.7 % vs. 91.4 %, P = 0.042). No patients in taE-ISR had positive distal resection margins (DRM), while four patients in cISR had positive DRM (0.0 % vs. 5.7 %, P = 0.036). CONCLUSION:taE-ISR after nCRT was associated with higher-quality specimens, reduced intraoperative blood loss, and fewer perioperative complications, attesting to the feasibility and safety of taE-ISR In low-LARC patients.
With advancements in surgical technology, minimally invasive and function- preserving approaches have become fundamental objectives of both patients and physicians. In recent years, laparoscopic endoscopic cooperative surgery (LECS) has gained increasing attention for its significant role in achieving these goals. However, a notable gap remains in the availability of evidence-based guidelines to standardize the clinical implementation of LECS for gastrointestinal tumors. This guideline is collaboratively developed by the Gastrointestinal Stromal Tumor Committee of the Chinese Anti-Cancer Association, Chinese Gastric Cancer Association, the NOTES Group of the Digestive Endoscopy Branch of the Chinese Medical Association, and the Greater Bay Area Laparoscopic Endoscopic Cooperative Surgery Alliance. Through integrating the current best evidence and experts' opinions, we developed 22 recommendations on 16 clinical questions, including the LECS indications, use of antibiotics, enhanced recovery after surgery, wound suture, and surgical training. This guideline provides comprehensive guidance and recommendations for LECS, aimed at promoting the precise, minimally invasive and function-preserving treatment of gastrointestinal tumors.
In recent years, with the popularization of minimally invasive surgery, laparoscopic transphrenic approach (LTP) surgery for Siewert Type II adenocarcinoma of esophagogastric junction (AEG) has gradually been applied in clinical practice. This technique combines the advantages of transthoracic and transabdominal approaches, achieving a combined operation of the thoracic and abdominal cavities. It can achieve thorough lymph node dissection, safe esophageal resection margin, and reliable digestive tract reconstruction, and has promising application prospects. However, there is no unified standard for LTP surgery at present, which hinders the standardization and further promotion of this technology. Therefore, the Oncology Gastroenterology Committee of China Anti-cancer Association has convened experts from domestic gastrointestinal and thoracic surgery fields, reviewed relevant literature, and combined with clinical practice. After extensive discussions, they formulated the LTP surgical operation standard. This standard encompasses various aspects, including the surgical approach, indications, contraindications, preoperative preparation, operational procedures (encompassing anesthesia, patient positioning, surgeon's stance, abdominal operation port layout, thoracic operation port layout, the Five-Step Maneuver lower mediastinal lymphadenectomy, and digestive tract reconstruction), as well as the prevention and management of specific complications. The aim is to provide a reference for clinical doctors conducting the Siewert Type II AEG radical surgery with LTP.
Natural orifice specimen extraction surgery of precision functional sphincter- preserving surgery for ultra-low rectal cancer (NOSES-PPS) is an innovative surgical technique that builds upon traditional laparoscopic surgery for low rectal cancer. This method utilizes a specially designed transparent screw-thread anal dilator and associated equipment to achieve precise tumor localization and resection through direct visualization via the anus. Digestive tract reconstruction is then accomplished using a combination of a precision circular stapler and manual suturing, thereby preserving sphincter function in patients with ultra-low rectal cancer. NOSES-PPS has been widely adopted across multiple provinces and cities in China, with over 500 cases successfully performed to date. The technique and its outcomes have been published in both national and international peer-reviewed journals, receiving significant recognition from the medical community. However, as a novel approach to rectal cancer surgery, there is currently a lack of authoritative clinical practice guidelines detailing the specific procedural steps of NOSES-PPS. To address this gap, the Colorectal Tumor Committee of the Chinese Medical Association, the Colorectal Cancer Committee of the Chinese Anti-cancer Association, and the China NOSES Collaborative Group have jointly led an effort to establish standardized guidelines for NOSES-PPS. This initiative involved the collaboration of experts in colorectal oncology from numerous large medical centers across China. Through multiple rounds of consultation and discussion, these experts have developed a comprehensive set of guidelines that detail the definition of NOSES-PPS, requirements for instrumentation, indications, key operative techniques, and the management of perioperative and postoperative complications. This guideline aims to promote the standardized implementation of NOSES-PPS in clinical practice.
The incidence of adenocarcinoma of the esophagogastric junction has been gradually increasing in recent years. Due to the smaller resection range, partial preservation of the function of stomach, high safety, better postoperative nutritional status, and lesser negative psychological impact on patients, the application of proximal gastrectomy has increased significantly. Proximal gastrectomy disrupts the normal anatomical structure of the esophagogastric junction, resulting in permanent loss of the anti-reflux function of the cardia. At the same time, the retained pylorus may lead to delayed gastric emptying, making it prone to the complications such as reflux esophagitis and anastomotic stenosis. In recent years, various anti-reflux digestive tract reconstruction methods have emerged, allowing proximal gastrectomy to partially preserve stomach function while avoiding severe postoperative reflux esophagitis. This consensus, based on the "Chinese consensus on digestive tract reconstruction after proximal gastrectomy (Version 2020)", updates the research findings of multiple anti-reflux surgical techniques. It aims to promote the technical points of various proximal gastrectomy digestive tract reconstruction techniques, evaluate their anti-reflux efficacy, and provide guidance for the clinical application of digestive tract reconstruction after proximal gastrectomy.
Colorectal cancer is the second most common malignant tumor in China, with rectal cancer accounting for approximately 50% of all cases. While neoadjuvant therapy is essential for diagnosis and treatment, proctectomy with radical resection remains indispensable. Especially for middle and low rectal cancer, the length of the distal resection margin is critical for prognosis, organ preservation, and postoperative quality of life. However, determining a "safe" margin to ensure the radical resection (R0) while maximizing the function of the anal sphincter poses a significant challenge for surgeons. Aiming at this, we conducted a comprehensive review of authoritative guidelines and literature domestically and internationally. We divided the issues related to resection margin in proctectomy into three chapters: (1) the concept and definition of the resection margin; (2) the evaluation of the resection margin in preoperative, intra-operative, and post-operative stages; and (3) radical resection of rectal cancer after neoadjuvant therapy. With the help of the Delphi method, the expert group voted twice for 14 recommendations and finally established the "Chinese Expert Consensus for Resection Margin in Rectal Cancer Surgery (2024 version)". This consensus serves as a valuable reference for clinicians to carry out proctectomy of rectal cancer, which can improve patient's quality of life without affecting their prognosis.
In the past two decades, with the development and application of laparoscopic technique and the promotion of the concept of complete mesocolic excision, significant changes have occurred in the surgical treatment of right-sided colon cancer. The Chinese Society of Colorectal Surgery and Chinese Colorectal Research Consortium (CCRC) Organized national experts in colorectal surgery to form a consensus on 14 key clinical issues related to right hemicolectomy, taking into account the preferences of Chinese doctors and patients as well as the pros and cons of intervention measures, with a view to standardizing the surgical treatment of right colon cancer. The consensus recommendations were focused on three main aspects: (1) surgical anatomy: the key structures and its definitions related to the mesentery and vascular anatomy were clarified. It is recommended that the left side of the superior mesenteric artery be considered the medial boundary for complete mesocolic excision; (2) surgical technique: laparoscopy is recommended as the preferred surgical approach for right-sided colon cancer; (3) surgical principles: D2 lymph node dissection could be considered as the standard of care for right-sided colon cancer. Standard D2 could be considered as routine procedure unless preoperative imaging or intraoperative exploration revealed suspected regional lymph node metastasis. Dissection of infrapyloric lymph node is not recommended unless it is suspected as metastasis. Additionally, consensus recommendations were made regarding the location of vascular ligation, the extent of bowel resection, and anastomosis techniques.
The publication of Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2018 edition) has widely accelerated the standardization and homogenization on the surgical treatment of adenocarcinoma of esophagogastric junction (AEG). In China, the surgical outcomes of AEG, the universality and practicability of this consensus has also been affirmed after the clinical practice during the past 5 years. Due to the persistent increasing incidence of AEG, the specificity on anatomic site, clinicopathological characteristics, molecular biological characteristics, AEG had been always the hotspot of many clinical trials and more clinical evidences had been published. However, its definition, classification, staging, surgical approach, resection pattern, extent of lymphadenectomy, and the digestive tract reconstruction etc. remain controversial. In light of the above, it is necessary to update the 2018 edition of consensus. The Chinese expert consensus on the surgical treatment for adenocarcinoma of esophagogastric junction (2024 edition) is generated based on the currently available and best clinical evidence, the latest global guidelines or consensuses, and the opinions from the Chinese expert panel. The present consensus focuses on the key points of surgical treatment and issues in dispute, and provides scientific recommendations. The goal of this expert consensus was to improve the homogeneity in understanding and practice between Chinese thoracic and gastrointestinal surgeons, and to further standardize surgical treatment of AEG. Those pending issues in this consensus need high-quality clinical research to further investigate.
In recent years, domestic and foreign data have demonstrated that the watch and wait strategy has good safety and efficacy for patients who achieve clinical complete response (cCR) after neoadjuvant therapy. Watch and wait strategy and local resection in selective patients can achieve organ preservation and improve the quality of life. Since the release of the Expert Consensus on Watch and Wait Strategy Following Neoadjuvant Therapy for Rectal Cancer (2020 version), it has attracted widespread attention from medical professionals and patients in the field of rectal cancer treatment. In recent years, the proportion of cCR after neoadjuvant therapy has further increased, and the relevant data of observation strategy has gradually accumulated. However, there are still different opinions on issues such as outcome parameters, risks and benefits, eligible population, re-evaluation criteria and timing, follow-up and salvage methods, and strategies to improve efficacy. Though it can be explained by the various viewpoints, experiences, and evidences, it objectively hinders the development of watch and wait strategy. Therefore, the Chinese Watch and Wait Database Research Collaboration Group (CWWD), together with Chinese Society of Colorectal Surgery, Chinese Medical Association; Colorectal Cancer Physician Specialty Committee, Chinese Medical Doctor Association; Colorectal Cancer Committee, Chinese Anti-Cancer Association; Colorectal Surgeon Working Group, Medical Doctor Association and relevant experts has updated consensus into the 2024 version. This consensus lists the key issues in the practice of watch and wait for rectal cancer, marks the level of evidence and expert opinions through literature review and expert opinion, and exposes the unresolved problems to provide thoughts and solutions for future work in this area.
Lateral lymph node metastasis (LLNM) is common in mid-low rectal cancer and is also a major cause of postoperative local recurrence. Currently, there is still controversy regarding the diagnosis and treatment of LLNM in rectal cancer. This consensus, based on the "Chinese Consensus on Diagnosis and Treatment of Lateral Lymph Node Metastasis in Rectal Cancer (2019 edition)," incorporates the latest domestic and international research findings and revises aspects related to the diagnosis, treatment strategies, follow-up, and management of recurrence of LLNM in rectal cancer. A total of 42 domestic colorectal cancer experts participated in this consensus. It proposes 18 consensus statements on the diagnosis and treatment of LLNM, using the evaluation criteria of the U.S. Preventive Services Task Force for grading recommendations. The aim is to standardize further the diagnostic criteria and treatment strategies for LLNM in rectal cancer. Unresolved issues in this consensus require further clinical practice and active engagement in high-quality clinical research to explore and address them progressively.
For patients with metastatic colorectal cancer (mCRC) who achieve disease control during first-line standard therapy, post-induction strategies should emphasize on quality of life improvement while maintaining disease control. Chemotherapy combined with anti-epidermal growth factor receptor (EGFR) monoclonal antibody is the standard first-line treatment for RAS wild-type mCRC patients. After anti-EGFR-based first-line induction therapy achieves at least stable disease, anti-EGFR-based maintenance treatment could maintain disease control while keeping a good safety profile. Based on research evidence and clinical practice, the Chinese expert consensus on anti-EGFR-based maintenance strategy for RAS wild-type mCRC aims to futher clarify the treatment timing, regimen options, adverse reaction management and follow-up strategy, providing standardized guidance to maximize the clinical benefit in RAS wild-type mCRC.
Conformal sphincter-preservation operation (CSPO) is considered the effective surgical technique for preserving the sphincter in cases of low rectal cancer. Accurate preoperative diagnosis and staging, reasonable selection of surgical approaches and technique, standardized perioperative management, and postoperative rehabilitation are the keys to ensuring the oncological clearance and functional preservation of CSPO. However, there is currently a lack of standardized surgical procedure for implementing CSPO in China. Therefore, the Colorectal Surgery Group of Surgery Branch of the Chinese Medical Association,along with the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Anorectal Branch of Chinese Medical Doctor Association, gathered experts in colorectal surgery to discuss and establish this standardized surgical procedure of CSPO. This standard, based on the latest evidence from literature, expert experiences, and China national condition, focuses on the definition, classification, pelvic anatomy, surgical techniques, postoperative complications, and perioperative care of CSPO. It aims to guide the standardized clinical practice of CSPO in China.
Peritoneal tumours have a large population and a poor prognosis with limited therapeutic options available, and are common originated from gastric, colorectal, appendix and other cancers. Traditionally, peritoneal tumours have long been considered to be a terminal condition with a median survival of 3-6 months, and the palliative symptomatic treatment is recommended. Recently, the multimodal therapeutic strategy of cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) has resulted in more effective on the prevention and treatment of peritoneal metastasis, which can significantly improve the survival and quality of life. Under the guidance of the China Anti-Cancer Association (CACA), the "CACA Guidelines for Holistic Integrative Management of Cancer-Peritoneal Tumours" was jointly completed by experts in related fields organized by the Chinese Society of Peritoneal Oncology. This guideline is guided by the concept of integrative medicine and focuses on the domestic epidemiology, genetic background and original studies. It emphasizes the multidisciplinary team to holistic integrative medicine (MDT to HIM), and pays attention to the whole-course management of "prevention, screening, diagnosis, treatment, and rehabilitation". This guideline mainly focuses on peritoneal metastasis from gastrointestinal tumours, aiming to standardize the clinical diagnosis and treatment process, and jointly promote the management of peritoneal metastasis in China.
目的 研究基于5A模式的分级干预对低位直肠癌结肠造口患者的作用影响.方法选取首都医科大学附属北京康复医院 2020 年 9 月至 2022 年 9 月收治的 100 例低位直肠癌行结肠造口患者作为研究对象,按照随机数表法分为对照组(n=50)和研究组(n=50).对照组给予常规造口护理干预及随访,研究组在对照组基础上增加基于 5A模式的分级干预,两组均随访至术后 3 个月.比较两组干预前后的造口接受度问卷(stoma acceptance questionnaire,SAQ)、自我护理能力测定量表(exercise of self-care agency scale,ESCA)、乐观主义-悲观主义量表(optimistic tendency-pessimism scale,OPS)和直肠癌特异性生活质量调查表 29(quality of life questionnaire-colorectal 29,QLQ-CR29)评分,并统计两组术后 3 个月内造口并发症的发生情况.结果 干预前,两组SAQ评分、ESCA各维度评分、QLQ-CR29 评分、OPS乐观维度和 OPS悲观维度评分比较,差异均无统计学意义(均 P＞0.05).干预后,两组SAQ评分、ESCA各维度评分、OPS乐观主义评分高于干预前,QLQ-CR29 评分、OPS悲观主义评分低于干预前,且研究组SAQ评分、ESCA各维度评分、OPS乐观主义评分高于对照组,QLQ-CR29 评分、OPS悲观主义评分低于对照组,差异有统计学意义(均P＜0.05).术后 3 个月内,研究组造口并发症总发生率明显低于对照组,差异有统计学意义(P＜0.05).结论 基于 5A模式的分级干预有助于提高低位直肠癌结肠造口患者的造口接受度和自护能力,增强积极乐观心理,改善造口生活质量,降低造口并发症发生率.
目的 系统评价结直肠癌保肛术后低位前切综合征风险预测模型.方法 系统检索中国知网、万方数据知识服务平台、中国期刊服务平台、中国生物医学文献数据库、Embase、PubMed、Web of Science和The Cochrane Library,检索时限为建库至 2023 年 4 月 16 日.由 2 名研究者独立进行文献筛选和提取结直肠癌保肛术后低位前切综合征预测模型相关数据,根据预测模型研究偏倚风险评估工具(predictive model research bias risk assessment tool,PROBAST)对纳入文献的偏倚风险和适用性进行评价.结果 共纳入 13 篇文献,涉及 17 个结直肠癌保肛术后低位前切综合征预测模型,各模型受试者工作特征曲线的曲线下面积均大于 0.7(0.707～0.858),其中 13 个为Logistic回归模型,支持向量机、决策树、随机森林、人工神经网络模型各 1 个.5 篇文献进行了内部验证,4 篇文献进行了外部验证.PROBAST工具评估结果显示,纳入的 13 篇文献均为高偏倚风险;模型适用性方面,2 篇为不清楚,1 篇为高适用性,10 篇为低适用性.模型重复报告的独立预测因子频率高的前 3 个因子为术前新辅助治疗、低位肿瘤和吻合口漏.结论 结直肠癌保肛术后低位前切综合征预测模型具有较好的预测性能,但整体偏倚风险高,建议未来研究对现有模型进行验证和更新,并开发偏倚风险低、临床实用性强的本土化风险预测模型.
术式概要 单切口腹腔镜手术(single-incision laparoscopic surgery, SILS)+1 腹腔镜扩大右半结肠根治性切除术是指通过一个小切口放置单孔操作平台,再加一个穿刺孔,在腹腔镜下完成右半结肠切除,回肠-横结肠吻合,最后通过上述的小切口取出标本. 此手术方式较传统腹腔镜手术操作更复杂、更具有挑战性.
