Purpose:Stomach adenocarcinoma (STAD) is characterized by significant heterogeneity, within which myeloid cells play crucial yet incompletely understood roles. The relationship between the functional states of myeloid cells, patient prognosis, and therapeutic response requires further elucidation. Methods:We integrated single-cell RNA-seq profiles and 443 bulk RNA-seq profiles from the TCGA-STAD cohort. By integrating myeloid cell differentiation trajectories inferred from Monocle2 pseudotime analysis with survival analysis, we identified myeloid state-related prognostic genes (MSRPGs) and constructed a molecular classification (STAD-MSC). We also explored its prognostic significance and multi-omics features. Additionally, we utilized correlation analysis to establish regulatory networks and predict candidate inhibitors. The 5-gene risk model was evaluated in a public 355-patient validation cohort, and the STAD-MSC framework was further assessed at the protein level in a 70-patient retrospective cohort using immunohistochemistry for NNMT, AXL, and COL1A1. Results:We identified 32 MSRPGs across five distinct myeloid states. Consensus clustering stratified the patients into three subtypes, including low immune infiltration STAD (LI-STAD), moderate immune infiltration STAD (MI-STAD), and high immune infiltration STAD (HI-STAD). The HI-STAD subtype, characterized by high immune infiltration accompanied by an immunosuppressive and dysfunctional microenvironment, exhibited the poorest overall survival (global log-rank p = 0.018). The multi-omics analysis revealed subtype-specific genomic and immune landscapes. A 5-gene prognostic signature was constructed and evaluated as a risk-associated prognostic model. In silico analysis identified subtype-associated differences in predicted drug response. Exploratory pharmacogenomic analysis revealed nominal associations for dabrafenib (p = 0.0051) and ruxolitinib (p = 0.041), suggesting potential subtype-specific therapeutic vulnerabilities. Importantly, the three-protein classifier (NNMT/AXL/COL1A1) stratified a retrospective 70-patient cohort into three subgroups with significantly different OS and PFS. Conclusion:Using public-cohort and protein-level clinical validation, we established STAD-MSC, a myeloid state-centric molecular taxonomy that stratifies STAD patients into subgroups with distinct prognoses and immunosuppressive microenvironmental features, providing a framework for immune-informed patient stratification.

Despite treatment advances, intestinal surgery remains common in Crohn’s disease (CD), with over half of patients experiencing postoperative recurrence. Intestinal fibrosis represents a key pathological feature underlying this clinical course. This study aimed to investigate the relationship between fibrosis severity and the risk of postoperative recurrence. A multi-center retrospective cohort study included CD patients undergoing intestinal resection. Histopathological slides from lesion sites and resection margins were analyzed using Masson’s trichrome staining to quantify the proportion of collagen fiber area, representing fibrosis extent. Postoperative endoscopic and clinical recurrence data were collected via electronic medical records and patient follow-up interviews. Multivariable Cox regression models estimated hazard ratios (HRs) with 95

Background Accurate risk stratification and early detection of colorectal cancer (CRC) are critical for improving patient outcomes and optimizing the use of colonoscopy; however, the diagnostic performance of existing biomarkers remains suboptimal. This study aimed to develop and evaluate machine learning (ML)-based models to facilitate individualized risk assessment and clinical decision-making for colorectal lesions. Methods A total of 1,714 participants who underwent colonoscopy at Department of Gastrointestinal Surgery, Ruijin Hospital, Shanghai Jiaotong University School of Medicine were included. Participants were categorized into normal colonoscopy controls (n = 677) and high-risk colorectal diseases group (n = 1,037), with the latter further subdivided into adenomas (n = 376) and CRC (n = 661) subsets. Demographic characteristics and relevant laboratory data were collected. Variables significantly associated with high-risk colorectal conditions or CRC were identified using univariable and multivariable logistic regression analyses and incorporated into two independent nomogram-based ML models. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC), calibration curve, and decision curve analysis (DCA). SHapley Additive exPlanations (SHAP) analysis was performed to determine each feature’s contribution. Results Gender, age, hemoglobin (Hb), C-reactive protein (CRP), carcinoembryonic antigen (CEA), and Septin9 methylation were independent predictors of high-risk colorectal diseases, with the latter five also specific for CRC (p < 0.001). Two ML models were developed: one predicting the probability of high-risk colorectal diseases and the other distinguishing CRC from adenoma. Both models demonstrated strong discriminative ability with high AUCs and favorable net clinical benefit on DCA. Calibration curves showed close concordance between predicted risk and the observed outcomes. SHAP analysis highlighted Septin9 methylation as the most influential variable in the predicting model. Threshold values of 37.3 and 67.1 points were identified as optimal cutoffs for high-risk diseases and CRC discrimination, respectively. Conclusions We developed and validated two ML-based models integrating Septin9 methylation with routine serum biomarkers for early detection and differentiation of CRC. These models show potential as non-invasive clinical decision-support tools to facilitate individualized risk assessment and support clinical management in patients undergoing evaluation for colorectal neoplasia.

BackgroundMitoxyperilysis is a recently described lytic cell death pathway linked to innate immune activation and metabolic disruption. Its clinical and biological relevance in colorectal cancer (CRC) remains unclear. This study aimed to develop a mitoxyperilysis-related signature (MRS) for prognostic stratification and to characterize its associated tumor microenvironmental features.MethodsBulk transcriptomic and clinical data from TCGA, GSE17536, and GSE29621 were used to construct and validate the MRS through an integrated machine-learning framework. Survival analysis, nomogram construction, pathway enrichment, immune deconvolution, ESTIMATE analysis, immunophenoscore-related assessment, and drug-response prediction were performed. Single-cell RNA sequencing and cell-cell communication analyses were used to define the cellular context of the MRS-associated phenotype. ANO1 was further evaluated by pan-cancer and CRC-specific analyses and validated by in vitro and in vivo experiments.ResultsThe MRS consistently stratified overall survival across the training and validation cohorts and improved individualized risk prediction when incorporated into a nomogram. The MRS-high subtype was associated with extracellular matrix remodeling, invasion-related pathways, stromal enrichment, immune infiltration, and increased expression of inhibitory immune checkpoints. Single-cell analysis linked the adverse phenotype to epithelial cells with higher proliferative, metastatic, stress-adaptive, and immune-interactive features. These cells showed enhanced communication with stromal and immune compartments, particularly through FN1-, MK-, CXCL-, and CCL-related signaling. ANO1 was identified as a candidate downstream effector associated with the MRS-high state. Functionally, ANO1 knockdown suppressed CRC cell proliferation, migration, invasion, and xenograft tumor growth.ConclusionMitoxyperilysis-related transcriptional programs are associated with a clinically aggressive and immune-remodeled ecosystem state in colorectal cancer. The MRS serves as a reliable tool for prognostic stratification and provides a transcriptional framework for characterizing CRC states linked to epithelial aggressiveness, microenvironmental remodeling, intercellular communication, and adverse clinical outcome. ANO1 may function as an important downstream effector associated with this MRS-high ecosystem state.

Colorectal cancer (CRC) metastasis requires coordination between tumor-intrinsic programs and the surrounding microenvironment, yet how proteasomal regulation intersects with the epitranscriptome in this process remains unclear. Here, analyses of TCGA, GEO, and an institutional cohort of 146 CRC patients identified PSMC5 upregulation as associated with metastatic progression and poor prognosis. Mechanistically, PSMC5 promoted SMURF1-dependent K11-linked ubiquitination of METTL14 at K263, leading to METTL14 destabilization, global m⁶A remodeling, and activation of EMT-associated malignant phenotypes. Rescue experiments further supported METTL14 as a functional downstream effector of PSMC5. Integrative single-cell, spatial transcriptomic, and multiplex immunofluorescence analyses showed that PSMC5-high epithelial states were associated with spatially organized "regulatory islands," defined here as PSMC5-high epithelial nests with peripheral Treg and M2 enrichment together with relative CD8⁺ T-cell exclusion. In vivo, SMURF1 silencing restored METTL14 expression and attenuated PSMC5-driven tumor growth and lung metastasis. Collectively, these findings define a PSMC5/SMURF1/METTL14 axis that links proteasomal regulation to epitranscriptomic remodeling and metastatic progression in CRC, and identify this pathway as a candidate therapeutically actionable axis.

BACKGROUND:An increasing number of medical professionals are choosing to use totally laparoscopic total gastrectomy (TLTG) as a treatment option for gastric cancer. However, the optimal reconstruction method is still under debate. The objective of this study is to evaluate the immediate results of 2 intracorporeal esophagojejunostomy techniques: overlap (isoperistaltic side-to-side) (O) and pi-shaped (π) (anisoperistaltic side-to-side) anastomosis. METHODS:Hospital records of 110 patients who underwent esophagojejunostomy (group O, n=65 or group π, n=45) after TLTG from January 2016 to December 2019 were retrospectively reviewed. The demographic and clinicopathologic characteristics, along with the surgical and pathologic results, were recorded, compared, and evaluated for immediate impacts. RESULTS:The demographic characteristics of the 2 groups exhibited no significant disparities. Moreover, there were no statistically notable differences in tumor size, lymph node count, or TNM stage between the 2 groups. All surgeries were successfully completed without any complications or need for conversion to laparotomy, and there were no occurrences of postoperative mortality. In addition, there were no statistically significant variances between the 2 groups in terms of total operation time, estimated blood loss, time to first flatus, or length of postoperative hospital stay. Time for esophagojejunostomy, however, was statistically significantly shorter in group π than in group O (27.4±5.2 vs. 36.7±5.0 min) ( P <0.001). No statistically significant difference was found between the 2 groups with regard to postoperative complications: 5 grade I, 6 grade II, and 1 grade IIIa in group O (n=12) versus 5 grade I, 3 grade II, 2 grade IIIa, and 1 grade IIIb in group π (n=11). At 6-month endoscopy and oral water-soluble contrast medium follow-up, no anastomotic complication was noted. CONCLUSIONS:The π anastomosis is feasible, safe, with the need for fewer cartridges and is eventually a time-saving procedure for esophagojejunostomy with no hand-sewing involved. In this study, both methods have shown favorable short-term results in the treatment of gastric cancer.

Gastric and esophageal cancers are the primary forms of upper gastrointestinal (GI) malignancies, with early diagnosis being critical for improving patient survival rates. Raman spectroscopy has emerged as a promising non-invasive tool for in situ tumor diagnosis, offering detailed biochemical molecular insights. However, its clinical application is hindered by challenges such as Raman probe navigation and stable positioning within the narrow confines of the GI tract. To address these limitations, we developed an endoscopic Raman robot system that integrates a Raman fiber-optic probe with surgical endoscopic continuum robotic technology, enhancing the accuracy and efficiency of in situ optical biopsies for upper GI tumors. The system enables precise navigation, stable positioning, and teleoperation. In the repeated locating and measuring tests on tumor tissue, it achieves the Raman spectral similarity of over 96%, ensuring reliable tumor analysis. The system is also integrated with an online tumor diagnosis platform, that is a diagnostic accuracy of over 85%, to facilitate real-time spectral analysis and diagnosis during gastroscopic tumor inspection. Finally, we conducted validation tests on a gastrointestinal phantom, the ex vivo porcine gastric tissue, and the animal models of a live swine, all of which demonstrated the system's capability for effective navigation, target localization, spectral acquisition, and tumor diagnosis with a 10-s acquisition time. This system represents a significant advancement in early cancer detection, offering improved diagnostic reliability and efficiency, with the potential to enhance patient outcomes through timely intervention.

Background:Crohn's disease (CD) involves chronic intestinal inflammation, frequently requiring surgical intervention. CD patients undergoing surgery often undergo increased psychological stress. One of the outcomes of persistent stress is post-traumatic stress (PTS), a mental health concern associated with immune dysregulation and disease progression. However, research on PTS in CD patients following surgery is limited. Objectives:This study aims to explore the incidence and associated factors of PTS in CD patients after surgery. Design:A retrospective cross-sectional study. Methods:This retrospective cross-sectional study investigated 124 patients with CD who underwent surgery between September 2015 and July 2023. Online questionnaires, including the PTSD checklist, 5th edition (PCL-5), Crohn's and Colitis Knowledge Score, and Short Generic Patient Experience Questionnaire, were employed. The potential risk factors for PTS were evaluated through univariate and multivariate analyses. Results:Among sampled individuals, 44 patients (35.5%) were classified into the PTS group. The patients in the PTS group had a significant lower monthly income (27.3% vs 8.8%, p = 0.006), higher Harvey-Bradshaw Index score (3.82 ± 3.25 vs 2.31 ± 2.50, p = 0.009), more occurrence of perianal lesions (36.4% vs 20%, p = 0.047), higher ostomy (36.4% vs 20%, p = 0.047), and laparotomy rates (31.8% vs 15%, p = 0.028). Through logistic regression analysis, we identified postoperative complications and a history of multiple surgeries as independent risk factors for PTS (p = 0.002 and p = 0.019, respectively). Conclusion:PTS is common in CD patients requiring bowel resection and multiple surgeries, as well as other postoperative related factors, can invoke psychological and mental stress. These findings provide insights for formulating medical service strategies that prioritize patient mental health.

PURPOSE Complete mesocolic excision (CME) is being increasingly used for the treatment of right-sided colon cancer, although there is still no strong evidence that CME provides better long-term oncological outcomes than D2 dissection. The controversy is mainly regarding the survival benefit from extended lymph node dissection emphasized by CME. METHODS This multicenter, open-label, randomized controlled trial (ClinicalTrials.gov identifier: NCT02619942 ) was performed across 17 hospitals in China. Patients diagnosed with stage T2-T4aNanyM0 or TanyN + M0 right-sided colon cancer were randomly assigned (1:1) to undergo either CME or D2 dissection during laparoscopic right colectomy. The primary outcome was the 3-year disease-free survival (DFS), and the main secondary outcome was the 3-year overall survival (OS). RESULTS Between January 11, 2016, and December 26, 2019, 1,072 patients were randomly assigned (536 patients to CME and 536 patients to D2 dissection). In total, 995 patients (median age 61 years, 59% male) were included in the primary analysis (CME [n = 495] v D2 dissection [n = 500]). No significant differences were found between the groups in 3-year DFS (hazard ratio [HR], 0.74 [95% CI, 0.54 to 1.02]; P = .06; 86.1% in the CME group v 81.9% in the D2 group) or in 3-year OS (HR, 0.70 [95% CI, 0.43 to 1.16]; P = .17; 94.7% in the CME group v 92.6% in the D2 group). CONCLUSION This trial failed to find evidence of superior DFS outcome for CME compared with standard D2 lymph node dissection in primary surgical excision of right-sided colon cancer. Standard D2 dissection should be the routine procedure for these patients. CME should only be considered in patients with obvious mesocolic lymph node involvement.

Gastric and esophageal cancers, the predominant forms of upper gastrointestinal malignancies, contribute significantly to global cancer mortality. Routine detection methods, including medical imaging, endoscopic examination, and pathological biopsy, often suffer from drawbacks such as low sensitivity and laborious and complex procedures. Raman spectroscopy is a non-invasive and label-free optical technique that provides highly sensitive biomolecular information to facilitate effective tumor identification. In this work, we report the use of fiber-optic Raman spectroscopy for the accurate and rapid diagnosis of gastric and esophageal cancers. Using a database of 14,000 spectra from 140 ex vivo tissue pieces of both tumor and normal tissue samples, we compare the random forest (RF) and our established Euclidean distance Raman spectroscopy (EDRS) model. The RF analysis achieves a sensitivity of 85.23

Intestinal fibrosis, a severe complication of Crohn's disease (CD), is characterized by excessive extracellular matrix (ECM) deposition and induces intestinal strictures, but there are no effective antifibrosis drugs available for clinical application. We performed single-cell RNA sequencing (scRNA-Seq) of fibrotic and nonfibrotic ileal tissues from patients with CD with intestinal obstruction. Analysis revealed mesenchymal stromal cells (MSCs) as the major producers of ECM and the increased infiltration of its subset FAP(+) fibroblasts in fibrotic sites, which was confirmed by immunofluorescence and flow cytometry. Single-cell transcriptomic profiling of chronic dextran sulfate sodium salt murine colitis model revealed that CD81(+)Pi16(-) fibroblasts exhibited transcriptomic and functional similarities to human FAP(+) fibroblasts. Consistently, FAP(+) fibroblasts were identified as the key subtype with the highest level of ECM production in fibrotic intestines. Furthermore, specific knockout or pharmacological inhibition of TWIST1, which was highly expressed by FAP(+) fibroblasts, could significantly ameliorate fibrosis in mice. In addition, TWIST1 expression was induced by CXCL9(+) macrophages enriched in fibrotic tissues via IL-1 beta and TGF-beta signal. These findings suggest the inhibition of TWIST1 as a promising strategy for CD fibrosis treatment.

Intestinal fibrosis, a severe complication of Crohn's disease (CD), is characterized by excessive extracellular matrix (ECM) deposition and induces intestinal strictures, but there are no effective antifibrosis drugs available for clinical application. We performed single-cell RNA sequencing (scRNA-Seq) of fibrotic and nonfibrotic ileal tissues from patients with CD with intestinal obstruction. Analysis revealed mesenchymal stromal cells (MSCs) as the major producers of ECM and the increased infiltration of its subset FAP+ fibroblasts in fibrotic sites, which was confirmed by immunofluorescence and flow cytometry. Single-cell transcriptomic profiling of chronic dextran sulfate sodium salt murine colitis model revealed that CD81+Pi16- fibroblasts exhibited transcriptomic and functional similarities to human FAP+ fibroblasts. Consistently, FAP+ fibroblasts were identified as the key subtype with the highest level of ECM production in fibrotic intestines. Furthermore, specific knockout or pharmacological inhibition of TWIST1, which was highly expressed by FAP+ fibroblasts, could significantly ameliorate fibrosis in mice. In addition, TWIST1 expression was induced by CXCL9+ macrophages enriched in fibrotic tissues via IL-1β and TGF-β signal. These findings suggest the inhibition of TWIST1 as a promising strategy for CD fibrosis treatment.

Despite surgical improvements and pharmacological advances,management of late-stage gastric cancer patients,especially those with hepatic metastasis remains challenging[1-3].

Emerging studies have shown that pyroptosis plays a non-negligible role in the development and treatment of tumors. However, the mechanism of pyroptosis in colorectal cancer (CRC) remains still unclear. Therefore, this study investigated the role of pyroptosis in CRC. A pyroptosis-related risk model was developed using univariate Cox regression and LASSO Cox regression analyses. Based on this model, pyroptosis-related risk scores (PRS) of CRC samples with OS time > 0 from Gene Expression Omnibus (GEO) database and The Cancer Genome Atlas (TCGA) database were calculated. The abundance of immune cells in CRC tumor microenvironment (TME) was predicted by single-sample gene-set enrichment analysis (ssGSEA). Then, the responses to chemotherapy and immunotherapy were predicted by pRRophetic algorithm, the tumor immune dysfunction and exclusion (TIDE) and SubMap algorithms, respectively. Moreover, the Cancer Therapeutics Response Portal (CTRP) and PRISM Repurposing dataset (PRISM) were used to explore novel drug treatment strategies of CRC. Finally, we investigated pyroptosis-related genes in the level of single-cell and validated the expression levels of these genes between normal and CRC cell lines by RT-qPCR. Survival analysis showed that CRC samples with low PRS had better overall survival (OS) and progression-free survival (PFS). CRC samples with low PRS had higher immune-related gene expression and immune cell infiltration than those with high PRS. Besides, CRC samples with low PRS were more likely to benefit from 5-fluorouracil based chemotherapy and anti-PD-1 immunotherapy. In novel drug prediction, some compounds such as C6-ceramide and noretynodrel, were inferred as potential drugs for CRC with different PRS. Single-cell analysis revealed pyroptosis-related genes were highly expressed in tumor cells. RT-qPCR also demonstrated different expression levels of these genes between normal and CRC cell lines. Taken together, this study provides a comprehensive investigation of the role of pyroptosis in CRC at the bulk RNA sequencing (RNA-seq) and single-cell RNA sequencing (scRNA-seq) levels, advances our understanding of CRC characteristics, and guides more effective treatment regimens.

BackgroundPerioperative immune-nutritional status is correlated with post-operative outcomes. This study aimed to evaluate whether pre-operative nutritional status could predict post-operative complications in patients with Crohn’s disease (CD) and whether pre-operative enteral nutrition (EN) can prevent post-operative complications.MethodsThis retrospective cohort study analyzed the electronic health records of 173 patients diagnosed with CD in Ruijin Hospital, Shanghai, China, between August 2015 and May 2021: 122 patients had pre-operative nutritional support while 51 patients underwent surgery without pre-operative nutritional support. The pre-operative nutritional status, disease activity index, disease-related data, frequency of multiple surgery, operative data, and post-operative characters in each group were compared to determine whether the nutritional support and status could significantly affect post-operative outcome. One-to-one propensity score matching (PSM) was performed to limit demographic inequalities between the two groups.ResultsAfter PSM, no statistically significant differences were found in pre-operative patient basic characteristics between the two groups of 47 patients (98 patients in all) included in this study. Overall, 21 patients developed 26 post-operative complications. In terms of pre-operative nutritional status, the level of serum albumin (ALB), pre-albumin (pre-ALB), and hemoglobin (Hb) in the nutrition group were statistically higher than that in the control group. We also observed a statistically significant decrease in post-operative complications, need for emergency surgery, and staged operations, while the rate of laparoscopic surgery was higher in the nutrition group compared to the non-nutritional group. Post-operative complications were related to pre-operative nutritional condition, which indicated that EN may improve the nutritional status and reduced the rate of post-operative complications.ConclusionPre-operative nutritional status is correlated with post-operative outcomes while EN plays a positive role in preventing the post-operative complications. EN is useful for improving the pre-operative nutritional status and reducing the post-operative adverse events for CD patients undergoing surgery.

Conventional laparoscopic-assisted right hemicolectomy requires a small abdominal incision to extract the specimen, which becomes an important source of postoperative complications and impairs perioperative experience. Transvaginal natural orifice specimen extraction surgery (NOSES VIIIA) avoids this small incision by extracting the specimen through the vagina. Here we describe the design of a multicenter, open-label, parallel, noninferior, phase III randomized controlled trial (NCT 05495048). The aim of this study is to confirm that the NOSES VIIIA procedure is not inferior to small-incision assisted right hemicolectomy in long-term oncological efficacy. A total of 352 female patients with right colon adenocarcinoma/high-grade intraepithelial neoplasia will be randomly assigned to the NOSES VIIIA arm and the small-incision arm in a 1:1 ratio. The primary end point of this trial is 3 year disease-free survival. Clinical Trial Registration: NCT05495048 (ClinicalTrials.gov)

Achieving carbon emission peak by 2030 and carbon neutrality by 2060 is China’s long-term climate change strategy for the 21st century in accordance with the provisions of the Paris Agreement. Achieving carbon emission peak and carbon neutrality have caused a profound change in the society, which not only requires energy conservation and carbon emission reduction of all walks of life, but also profoundly affects people’s lifestyles. In the current carbon emission reduction research, low-carbon lifestyles tends to focus on the relationship between human behavior and energy conservation. This paper starts from a new perspective, low-carbon lifestyle and health, focuses on the community fitness activity environment in the construction of complete residential communities, seizes the Combination of Physical-Medical Therapy national policy, improves people’s health on the basis of advocating fitness activities and reducing medical travel, closely links low-carbon, health and community construction, and endows the low-carbon community with a health function. Studies have shown that regular exercise can effectively prevent and manage many urban chronic diseases. By carefully selecting the prevalent chronic diseases and population disability adjustment years, this paper presents the characteristics of chronic diseases in major China provinces. Taking into account popular fitness activities, this paper innovatively puts forward the ‘urban chronic disease community physical activity management model’. At the same time, it proposes the community fitness and activity infrastructure design and build strategies to manage urban chronic diseases. At the end of the article, it gives an actual project case of fitness and activity environment and puts forward the suggestion of establishing ‘Living Laboratory for Community Fitness and Activity’ as the test bed to collect big data for follow-up study.

BACKGROUND:Recent interest in laparoscopic right colectomy with D3 lymphadenectomy for right colon cancer, has raised renewed attention to the anatomic variations of the gastrocolic trunk of Henlé (GTH). Understanding the vascular structure of the GTH region for individual patients should improve surgical outcomes. The goal of this nationwide multicenter study (Anatomical Classification of Henlé's Trunk in Laparoscopic Right Hemi-colectomy (HeLaRC) trial) was to study the anatomic patterns of the GTH region, to clarify the implications of GTH in laparoscopic right colectomy with D3 lymphadenectomy (D3-RC) and analyze their clinical significance. METHODS:We enrolled 583 patients from 26 centers across China who underwent D3-RC. The number of tributaries, length and types of GTH constitutions and their influence on intra-operative data were investigated. A nomogram score (based on the length of GTH, body mass index (BMI), tumor location, T stage and type of GTH (type I vs. non-type I) was established to assess the potential hazard of bleeding. RESULTS:The GTH was found in 567 patients (97.3%). The distribution of GTH types was 0 (14.1%, n = 80), I (53.3%, n = 302), II (27.0%, n = 153), III (5.6%, n = 32). Of note, the type I GTH, T1 stage and tumor location at ileocecal or ascending colon were correlated with shorter exposure time of the GTH region (P < 0.0001). Short length of GTH (P = 0.002) and tumor location (transverse colon vs. non transverse colon) (P = 0.003) were correlated with the amount of GTH bleeding during the surgery. Nomogram discrimination was good (C-index: 0.72 (95% CI: 0.64, 0.80)). The dissection plane was better in patients with type I GTH than with other types (P = 0.023). CONCLUSION:GTH pattern variations may affect surgical outcomes in patients undergoing D3-RC. Better recognition of GTH anatomy might lead to a safer operation with better oncologic quality.

Objectives Chemotherapy without radiation therapy for locally advanced rectal cancer (LARC) has attracted increasing attention, but the optimal schema remains controversial. In this study, we aimed to assess the efficacy and toxicity of neoadjuvant chemotherapy (nCT) of two regimens for patients with mid‐low baseline resectable LARC. Methods A retrospective study was performed in 131 patients with baseline resectable LARC in a single center between April 2016 and August 2020. All patients received four cycles of neoadjuvant CapeOX or mFOLFOX6 before surgery. Clinical characteristics, pathological response, and survival status were then assessed. Results After a 1:1 propensity score matching, 96 patients were enrolled, including 48 receiving CapeOX and 48 receiving mFOLFOX6. The objective regression rates were 50.00% and 58.33%, and the pathological complete response rates were 6.25% and 8.33%, respectively, in the CapeOX and mFOLFOX6 groups. Patients who received mFOLFOX6 had a better tumor regression grade (TRG) than those who received CapeOX ( P = 0.005). Patients in both groups had similar survival outcomes. Conclusions The nCT has shown promising tumor response and survival outcomes, which can be a treatment option for baseline resectable LARC. For the two regimens, mFOLFOX6 provided better TRG than CapeOX, although no differences were observed in disease‐free survival and OS.