ObjectiveOur objective was to estimate the effect of flexible sigmoidoscopy (FS)-based screening on colorectal cancer (CRC) incidence and mortality by conducting an updated meta-analysis of randomized controlled trials (RCTs).MethodsPubMed, Web of Science, Embase, and Cochrane Library searched for RCTs from database inception to December 2022. The methodological quality of the RCTs was assessed using the Cochrane Collaboration Risk of Bias Tool. RevMan 5.4 was used for this meta-analysis.ResultsFour RCTs involving 457, 871 patients were included. This meta-analysis revealed that FS-based screening was associated with a 20% relative risk reduction in CRC incidence [RR = 0.80; 95% CI (0.75, 0.86); P < 0.00001], and a 24% reduction in CRC mortality [RR = 0.76; 95% CI (0.70, 0.82); P < 0.00001]. In addition, this meta-analysis revealed that FS-based screening reduced the incidence[RR = 0.68; 95% CI (0.60, 0.77); P < 0.00001] and mortality[RR = 0.64; 95% CI (0.49, 0.83); P = 0.0007] of distal CRC, but had no significant effect on proximal colon cancer.ConclusionFS-based screening appeared to be effective in reducing distal CRC incidence and mortality in patients at average risk compared to no intervention, but had no significant effect on proximal colon cancer.

Right hemicolectomy is currently the most important and effective method for the treatment of right hemicolectomy. With the development of surgical technology, right hemicolectomy has also ushered in many new surgical methods and challenges. From open surgery to laparoscopic surgery, minimally invasive surgery has attracted the attention of surgeons. At present, more and more patients benefit from minimally invasive surgery, which also motivates colorectal surgeons to take on new challenges with minimally invasive techniques for right hemicolectomy. The exploration from conventional five-hole laparoscopy to three-hole laparoscopy and the innovation of single-hole laparoscopy have also aroused more attention and controversy. However, the application of robot represents another great progress in surgical technology. Robotic surgery is better than laparoscopic surgery for early postoperative recovery and the number of lymph nodes obtained. However, whether robotic surgery can bring long-term benefits to patients is the main research goal of surgeons. In addition, the current unified idea for right hemicolectomy is total mesocolectomy and whether D3 lymph node dissection is a hot topic of discussion. Ileocolon anastomosis after right hemicolectomy has also become a problem of current concern. No consensus has been reached between in vivo anastomosis and in vitro anastomosis, and the main concern is the occurrence of abdominal infection. This paper will review the hot topics and controversies in the study of right hemicolectomy.

ObjectiveGlucocorticoids have been used in patients undergoing perioperative hepatectomy, however their safety and efficacy remain controversial. This meta-analysis was conducted to investigate this issue and further provide reference for clinical practice.MethodsPubMed/MEDLINE, Embase, and Cochrane Library were searched for randomized controlled trials (RCTs) from database inception to December 2022. Literature screening and data extraction were performed independently by two reviewers. The methodological quality of the RCTs was assessed using the Jadad scale. RevMan 5.4 was used for the meta-analysis.ResultsA total of 11 RCTs involving 905 patients were included. Compared with the control group, we found perioperative glucocorticoid administration significantly lowered overall complication rate [RR = 0.67; 95% CI (0.55, 0.83); P = 0.0003], infectious complication rate [RR = 0.41; 95% CI (0.21, 0.82); P = 0.01] and postoperative liver failure [RR = 0.63; 95% CI (0.41, 0.97); P = 0.03]. In addition, glucocorticoids appear to improve liver function (TBil) [MD = -0.36, 95% CI (-0.59, -0.14), P = 0.001] and reduce the release of certain inflammatory cytokines (IL-6) [MD = -48.52, 95% CI (-56.88, -40.16), P ConclusionBased on the available evidence, glucocorticoids appear to be safe and effective in patients undergoing hepatectomy, but further research is needed.

In recent years, with the continuous development of medical technology and the continuous maturity of precision anastomosis instruments, the willingness of some patients to preserve anus has been realized, but at the same time, it has also increased the incidence of anastomotic leakage. Postoperative anastomotic leakage of rectal cancer is a life-threatening complication with an incidence of 2.4% to 15.9% and a mortality rate of about 16%. The main risk factors include smoking, alcohol consumption, obesity, diabetes and malnutrition. Anastomotic leakage not only affects the prognosis of patients, but also brings great psychological burden to patients. Therefore, to explore the risk factors of anastomotic leakage after rectal cancer surgery and to prevent the occurrence of anastomotic leakage has become the focus of clinicians. This article reviews the Influencing factors and predictive biomarkers of postoperative anastomotic leakage in rectal cancer, in order to provide help for clinicians.

近年来，抗程序性死亡受体1（PD-1）/程序性死亡受体-配体1（PD-L1）的免疫治疗给中晚期结直肠癌患者带来了新的曙光，但研究者却发现并非所有的结直肠癌患者都能从抗PD-1/PD-L1的免疫治疗中获益。因此，精准筛选出结直肠癌患者抗PD-1/PD-L1治疗的获益人群成为当前重大难题。随着精准诊疗理念的迅速发展以及循证医学证据的不断积累，为筛选结直肠癌免疫治疗的获益人群提供了有力帮助。通过人体生物标志物的差异来预测结直肠癌患者免疫治疗的疗效成为当下热点。生物标志物是免疫治疗的重大突破，不仅可以筛选出结直肠癌免疫治疗的获益人群，还能够避免无效治疗以及不良反应。本文通过回顾近期文献，阐述结直肠癌患者抗PD-1/PD-L1治疗下生物标志物的研究现状及未来发展。

Objective:To evaluate the efficacy of primary tumor resection（PTR）plus chemotherapy versus chemotherapy alone in patients with unresectable asymptomatic colorectal cancer with metastases.Methods:To search relevant studies published in PubMed，Embase，Web of science，Cochrane Library，CNKI，Wanfang and VIP databases from the establishment of the database to October 2022. Meta analysis of survival data was performed by Review Manager 5.4 and Stata 16.0. HR and its 95% CI were used to evaluate the survival risk of patients，Q test and I2 test were used to evaluate the heterogeneity between studies，sensitivity analysis was used to evaluate the reliability of the results，subgroup analysis was used to find the source of heterogeneity，and Egger's test and funnel plot were used to evaluate publication bias between studies.Results:A total of 10 studies were included，including 5 randomized controlled trials（RCTS）and 5 retrospective cohort studies（RCS）. Meta-analysis showed no significant differences in overall survival（OS）and progression-free survival（PFS）between the two treatments. The results of subgroup analysis also suggested no additional survival benefit from PTR. The results of funnel plot and Egger's test（t=-0.360，P=0.730）showed that there was no significant publication bias in the studies reporting patients' OS.Conclusions:Compared with chemotherapy alone，PTR plus chemotherapy can not bring more survival benefits to patients. However，due to the limitations of this study，follow-up large-sample randomized controlled trials are still needed for verification.

目的:通过Meta分析对比机器人辅助下经自然腔道标本取出手术(Natural Orifice Specimen Extraction Surgery,NOSES)与常规机器人辅助手术治疗结直肠癌的临床疗效.方法:检索截至2021年12月公开发表的机器人辅助经自然腔道取出标本的结直肠癌根治术对比常规机器人辅助手术治疗结直肠癌的研究.根据原始文献的纳入标准、排除标准对检索文献进行相关筛选,对纳入文献进行质量评价,获得最终纳入分析的文献.提取纳入文献的相关数据,采用RevMan5.3统计学软件进行分析.结果:最终纳入8篇文献,其中1篇随机对照研究,7篇回顾性研究,共涉及701例患者,其中行机器人辅助下经自然腔道标本取出手术(NOSES组)338例,行常规机器人辅助手术(常规机器人组)363例.Meta分析结果显示,NOSES组手术时间比常规机器人组更长(WMD=7.69,95％CI=1.89～13.50,P=0.009),差异有统计学意义.两组术中出血量相比,NOSES组术中出血量高于常规机器人组(WMD=-4.93,95％CI=-9.32～-0.53,P=0.03);两组切除的肿瘤大小比较,差异无统计学意义(WMD=-0.09,95％CI=-0.26～0.08,P=0.30);两组淋巴结清扫数目比较,差异无统计学意义(WMD=-0.32,95％CI=-0.85～0.21,P=0.24);两组术后腹腔冲洗液细菌学检测结果比较,差异无统计学意义(OR=1.42,95％CI=0.56～3.62,P=0.46).与常规机器人组相比,NOSES组术后VAS评分更低(WMD=-1.14,95％CI=-1.55～-0.74,P<0.001),术后附加镇痛更少(OR=0.22,95％CI=0.13～0.38,P<0.001),术后血常规WBC水平更低(WMD=-0.99,95％CI=-1.44～-0.54,P<0.001),术后首次排气时间更早(WMD=-11.36,95％CI=-14.70～-8.02,P<0.001),术后首次进食时间更早(WMD=-9.13,95％CI=-11.49～-6.78,P<0.001),术后总并发症更少(OR=0.57,95％CI=0.35～0.92,P=0.02),切口感染率更低(OR=0.20,95％CI=0.06～0.83,P=0.006),差异有统计学意义.两组吻合口瘘发生率(OR=1.35,95％CI=0.58～3.14,P=0.49)、腹腔内感染发生率(OR=1.26,95％CI=0.36～4.42,P=0.72)和肠梗阻发生率(OR=0.68,95％CI=0.19～2.43,P=0.56)比较,差异无统计学意义.NOSES组术后住院时间比常规机器人组更短(WMD=-1.21,95％CI=-2.08～-0.34,P=0.006),差异有统计学意义.结论:与传统机器人辅助手术相比,机器人辅助下经自然腔道标本取出手术可以减轻术后疼痛,减小附加镇痛比例,降低机体应激反应,降低术后总并发症发生率,更快恢复胃肠道功能.

OBJECTIVE:It remains controversial which targeted monoclonal antibodies combined with chemotherapy can provide better efficacy in wild-type KRAS/RAS metastatic colorectal cancer (mCRC) patients. Therefore, we used this meta-analysis to assess the latest evidence of clinical outcomes. MATERIALS AND METHODS:We systematically searched PubMed, Web of Science, Cochrane Library and Embase databases for eligible studies published from database inception to May 2022. RevMan 5.4 was used to conduct the meta-analysis. RESULTS:11 RCTs involving a total of 3575 patients were included. Meta-analysis showed that EGFR inhibitors significantly prolonged the overall survival (OS) [HR = 0.83, 95%CI (0.73, 0.94), P = 0.003] and overall response rate (ORR) [RR = 1.11, 95%CI (1.05, 1.18), P = 0.0003] compared to VEGF inhibitors in wild-type KRAS/RAS mCRC patients, but no significant difference in progression-free survival (PFS) [HR = 0.96, 95%CI (0.87, 1.07), P = 0.50]. In subgroup analysis, the survival benefit of EGFR inhibitors was limited to first-line treatment. CONCLUSION:Our study showed that EGFR inhibitors were superior to VEGF inhibitors in wild-type KRAS/RAS mCRC patients, especially in patients with first-line treatment. However, subsequent large sample, multi-center RCTs are needed to further verify our conclusions.

近年来,抗PD-1/PD-L1免疫治疗的出现为晚期肝细胞癌(HCC)患者带来了新的希望.然而,临床实践发现大约只有10％～30％的HCC患者才能从抗PD-1/PD-L1的治疗中获益.因此,精确筛选出抗PD-1/PD-L1治疗的获益人群成为目前的一大难题.循证医学证据的不断积累以及精准诊疗生物标志物的迅速发展,为HCC患者抗PD-1/PD-L1的精准治疗提供了有力帮助.生物标志物是免疫治疗的重大突破,不仅可以筛选出免疫治疗的获益人群,还能够避免毒副反应.本文中,笔者主要阐述HCC患者抗PD-1/PD-L1治疗相关生物标志物的研究现状和未来发展.

Background. Robotic systems can overcome some limitations of laparoscopic total mesorectal excision (L-TME), thus improving the quality of the surgery. So far, many studies have reported the technical feasibility and short-term oncological results of robotic total mesorectal excision (R-TME) in treating rectal cancer (RC); however, only a few evaluated the survival and long-term oncological outcomes. The following study compared the medium-term oncological data, 3-year overall survival (OS), and disease-free survival (DFS) of L-TME and R-TME in patients with rectal cancer. Methods. In this retrospective study, records of patients (patients with stage I-III rectal cancer) who underwent surgery (127 cases of L-TME and 148 cases of R-TME) at the Gansu Provincial Hospital between June 2016 and March 2018 were included in the analysis. Kaplan-Meier analysis evaluated the 3-year OS and DFS for all patients treated with curative intent. Results. The conversion rate was significantly higher, and the postoperative hospital stay was significantly longer in the L-TME group than in the R-TME group (all P<.05). Major complications were significantly lower in the robotic group (P<.05). The 3-year DFS rate (for all stages) was 74.8% for L-TME and 85.8% for R-TME ( P = .021). For disease stage III, the 3-year DFS and OS were significantly higher in the R-TME group ( P<.05). Conclusion. R-TME can achieve better oncological outcomes and is more beneficial for RC patients compared with L-TME, especially for those with stage III rectal cancers. Nevertheless, further randomized controlled trials and a longer follow-up period are needed to confirm these findings.

患者男，76岁，因“间断便血2年余”入院。患者主诉5个月前因便血加重，就诊于当地医院行电子结肠镜检查示：（1）结肠息肉；（2）直肠炎。未予特殊处理。2个月前再次就诊于当地医院行腹部增强CT检查示：膀胱右侧旁可见椭圆形团块影，内侧缘紧邻直肠壁，考虑良性病灶。1周前患者症状再次加重，遂就诊于本院行全腹增强MRI检查示：直肠右侧旁占位性病变，考虑良性病变（图1）。行腹腔镜下腹腔探查术+盆腔肿瘤切除术，术中探查见肿瘤位于直肠和膀胱之间的腹膜内，大小约5 cm×6 cm，活动度可，与周围组织无明显粘连，超声刀可完整剥离肿瘤（图2）。术后肿瘤剖面观如图3所示。病理检查提示：（盆腔、腹壁）纤维坏死结节，伴广泛玻璃样变性及钙盐沉积（图4）。诊断为钙化性纤维性肿瘤（calcifying fibrous tumor，CFT）。

ObjectiveIt remains controversial whether primary tumor resection (PTR) improves survival in patients with asymptomatic, unresectable metastatic colorectal cancer (mCRC). Therefore, we conducted a meta-analysis to assess the latest evidence on clinical outcomes.Materials and MethodsWe systematically searched PubMed, Web of Science, Cochrane Library, and Embase databases for eligible studies published between database inception and May 2022. RevMan 5.4 and Stata 16.0 were used for the meta-analysis.ResultsA total of nine studies were included, including four randomized controlled trials (RCTs) and five retrospective cohort studies. Meta-analysis showed that overall survival (OS) [HR = 0.89, 95%CI (0.74, 1.06), P = 0.19] and progression-free survival (PFS) [HR = 0.87, 95%CI (0.71, 1.06), P = 0.17] were not significantly different between the PTR and non-PTR groups. In the subgroup analysis, all subgroups showed no significant difference in OS between the two groups.ConclusionPTR may not provide additional survival benefits over chemotherapy in asymptomatic, unresectable mCRC patients. However, in view of the limitations of this study, more well-designed RCTs are needed to validate our conclusions.