Segmental gastrectomy is a common function preserving operation, and its combination with sentinel lymph node navigation technology shows a broad prospect in the treatment of early gastric cancer. Commonly anastomosis methods include the follows: (1) Hand-sewn anastomosis: this method is relatively simple, reduces the use of stapler, and can effectively reduce surgical cost. However, laparotomy or small-incision assisted laparoscopic surgery is required to accomplish anastomosis, so the surgical wound is relatively large. (2) Delta anastomosis: this anastomosis is entirely endoscopic, requiring no small incision with less surgical trauma. However, due to the presence of residual cavities in the small curvature of the side-to-side anastomosis, and the possibility of excessive incision of the posterior wall of the stomach, which may shorten the pyloric sleeve, there is an increased risk of gastric stasis after the operation. (3) Hybrid technique: this anastomosis method is safe and effective. However, it requires total endoscopic gastric anterior wall suture, which represents higher requirements for surgeons. Therefore, surgeons experienced in minimally invasive surgeries are recommended to perform this anastomosis. (4) Puncture technique: this anastomotic method is end-to-end anastomosis with low risk of gastric stasis, and is applicable for entirely endoscopic anastomosis. However, the stapler is not typically used for gastrointestinal surgery, which brings certain limitations to clinical promotion. These anastomoses have their own advantages and disadvantages, and their effects on gastric function are also controversial. In conclusion, the development of segmental gastrectomy is still in its infancy, and prospective multicenter randomized controlled trials are awaited to confirm the safety of oncology and standardize the techniques.

Objective: For gastric cancer patients undergoing total gastrectomy, the esophagojejunal anastomosis is the main site of postoperative anastomotic leakage. How to improve the safety of the esophagojejunal anastomosis is a hot topic. This study evaluated the safety of double and a half layered esophagojejunal anastomosis in total gastrectomy for gastric cancer. Methods: A retrospective cohort study was conducted. Clinical data of 764 gastric cancer patients, who were diagnosed as gastric adenocarcinoma by preoperative gastroscopicbiopsy and were judged to be able to complete R0 resection by imaging examination, in the Affiliated Tumor Hospital of Zhengzhou University (Henan Cancer Hospital) from May 2015 to May 2019 were retrospectively collected and analyzed. two and a half layered esophagojejunal anastomosis was used in the treatment group (295 cases), and the routine anastomosis was used in the control group (469 cases). Postoperative complicating including anastomosis-assisted complications were compared between the two groups. Results: The baseline data of two groups were not significantly different (all P>0.05). All the patients successfully completed the operation. In observation group and control group, the total operative time [(140.7±27.0) minutes vs. (139.6±22.8) minutes], intraoperative blood loss [(200.6±111.0) ml vs. (214.4±114.1) ml], anastomosis time [(20.4±4.3) minutes vs. (19.9±4.6) minutes], time to first flatus [(4.1±1.1) days vs. (4.2±1.1) days], time to fluid diet [(5.4±1.0) days vs. (5.5±0.9) days], time to postoperative nasointestinal tube removal [(9.8±3.2) days vs. (10.0±2.3) days], and postoperative hospital stay [(15.4±6.5) days vs. (15.9±5.6) days] were not significantly different (all P>0.05). Compared to the control group, the treatment group had lower rates of anastomosis-associated complications [1.7% (5/295) vs. 4.7% (22/469), χ(2)=4.768, P=0.029] and anastomotic leakage [1.0% (3/295) vs.3.4% (16/469), χ(2)=4.282, P=0.039]. The differences in the incidence of anastomotic stenosis and anastomotic bleeding were not statistically significant between the two groups (both P>0.05). In the treatment group and control group, rates of total postoperative complication [34.2% (101/295) vs. 32.2% (151/469), χ(2)=0.838, P=0.360] and severe complication [Clavinen-Dindo grade III and above; 4.7% (14/295) vs. 7.2% (34/469), Z=-1.465, P=0.143] were not significantly different as well. Conclusion: Two and a half layered esophagojejunal anastomosis is safe and feasible in total gastrectomy for gastric cancer and can reduce anastomosis-associated complications.

Objective: To investigate the clinical application of carbon nanoparticles mapping lymph nodes in curative resection for colorectal carcinoma. Methods: Patients diagnosed with colorectal cancer before operation and undergoing radical surgery with intact postoperative pathological data in the Sixth Affiliated Hospital, Sun Yat-sen University from March 2016 to March 2018 were included in this retrospective case-control study. Those who were diagnosed with ileus, recurrent carcinoma or underwent emergency operation were excluded. A total of 1421 cases were included, with 156 cases in the carbon nanoparticles mapping group and 1265 cases in the control group. Using 1∶3 case control matching based on gender, weight, TNM staging and neoadjuvant chemotherapy, 145 and 435 cases were finally recruited in the carbon nanoparticles mapping group and control group, respectively. Patients in the carbon nanoparticles mapping group underwent preoperative colonoscopy with carbon nanoparticles submucosal injection 2.4 (1.0 - 14.0) days before operation. Carbon nanoparticles of 0.25 ml was injected at 4 points (3, 6, 9 and 12 o'clock each) 0.5-1.0 cm around the tumor. The number of eliminated lymph node, number of positive lymph node and positive rate between the two groups were compared, and the number of eliminated lymph node in different subgroups of T stage, N stage, TNM stage and neoadjuvant chemotherapy was analyzed and compared. Results: After case control matching, total number of eliminated lymph nodes in the carbon nanoparticles mapping group was significantly higher than that in the control group (22.2±11.2 vs. 19.0±9.5, t=3.025, P=0.003). However, no statistically significant differences were found in the number of positive lymph node and lymph node positive rate between two groups (all P>0.05). Subgroup analysis showed that as compared to the control group, total number of eliminated lymph nodes in the carbon nanoparticles mapping group was significantly higher in T3 stage subgroup (median: 22 vs. 18, Z=2.435, P=0.015), N0 stage subgroup (median: 20.5 vs. 17.5, Z=2.772, P=0.006), TNM II stage subgroup (median: 23.5 vs. 19.0, Z=2.654, P=0.008) and neoadjuvant chemotherapy (median: 22.5 vs. 13.0, Z=3.287, P=0.001), while compared to the control group, the number of positive lymph node (median: 4.0 vs. 6.5, Z=-2.530, P=0.011) and the lymph node metastasis degree (median: 16% vs. 31%, Z=-2.862, P=0.004) were lower in the carbon nanoparticles mapping group in N2 subgroup. Conclusion: Carbon nanoparticles mapping lymph nodes can effectively enhance the number of eliminated lymph nodes in curative resection for colorectal cancer.

Gastrointestinal stromal tumor (GIST) is the most common soft tissue sarcoma of the gastrointestinal tract. With the development of diagnosis and treatment of GIST, the overall survival is significantly prolonged, and GIST may be classified as a "chronic disease". How to effectively manage the patients with whole-course information is an important problem faced by colleagues who are responsible for GIST patients. We believe that every GIST patient has a need for whole-course management, which is also an important factor related to efficacy. The concept of information-based management, the management system in line with the characteristics of GIST disease and full-time managers of GIST disease are the guarantees for the realization of whole-course management, and also the prerequisites for homogeneals diagnosis and treatment of GIST.

Objective: To understand the treatment status and effects on colorectal cancer (CRC) patients in China during the COVID-19 pandemic, and provide evidence for decision-making for health-care workers. Methods: The method of cross-sectional study was applied. A questionnaire survey of CRC patients in China was carried out. Their basic and treatment information during the COVID-19 were collected and associated effects on treatment, nursing, state of psychology and needs of social support were analyzed. Results: Of the 1147 participants in the study, 635 (55.4%) were male and 512 (44.6%) were female with mean age of (52.8±12.8) years. The treatment or follow up of 896 (78.1%) CRC patients were affected during the COVID-19 outbreak. A total of 253 patients (22.1%) had their treatment regiments changed, of whom 141 (12.3%) had their chemotherapy regiments postponed or changed, and 83 patients (7.2%) had their surgical treatment affected. Among the above 83 patients, 39 patients (3.4%) underwent emergency surgery. A total of 277 patients (24.1%) had their out-of-hospital care needs affected, mainly due to maintenance of PICC (49.5%, 137/277). CRC patients had poorer sleep quality and increased levels of insomnia than before (P<0.001), and were more distressed, anxious, depressed, and angry than they were before. They presented the more requirements of help (P<0.001). In addition, 376 patients (32.8%) had received telemedicine services, but only 36.4% (137/376) of them were satisfied. Conclusions: The COVID-19 epidemic has effect on the integrated treatment of CRC patients include diagnosis, treatment, examination and prognosis. While protecting CRC patients from being infected with SARS-CoV-2, health-care workers should also actively help them to receive timely and correct treatment and pay attention to their nursing, nutritional, psychological and social support needs in the COVID-19 epidemic.

Objective: To verify clinical applicability of the non-special perioperative administration for enhanced recovery after surgery (ERAS) proposed by Japanese scholars in Chinese gastric cancer patients. Methods: The main measures of the non-special perioperative administration for ERAS are as follows: (1) discussion of multiple disciplinary team before surgery; (2) rehabilitation education for patients; (3) no routine bowel preparation before surgery; (4) placement of nasogastric tube for decompression routinely before operation and removal as early as 24 hours after surgery; (5) appropriate rehydration; (6) antibiotic prophylaxis before surgery; (7) place abdominal drainage tubes when necessary; (8) epidural patient-controlled analgesia and oral medication for postoperative pain management; (9) start low-molecular-weight heparin injection 48h after surgery and ambulation every day to prevent deep vein thrombosis; (10) postoperative dietary management and supplement with parenteral nutrition intermittently; (11) remove Foley catheter about 24 hours after surgery. A retrospective cohort study was performed, including 203 patients undergoing radical gastrectomy at Department of Gastroenterology, Tianjin Medical University Cancer Institute and Hospital from January 2017 to December 2018. Inclusion criteria were patients who were ≤75 years old without distant metastasis by preoperative examination, were diagnosed as gastric adenocarcinoma by postoperative histopathology and had complete clinicopathological and follow-up data. Patients with history of other malignancies and gastrectomy, extensive implantation of the abdominal cavity or malignant ascites by intraoperative exploration, death within 1 month after surgery, and residual gastric cancer were excluded. The perioperative management methods were chosen by patients. There were 123 patients who followed non-special perioperative administration for ERAS (non-special preparation group) and 80 patients who underwent traditional perioperative management (traditional method group). The primary outcomes (postoperative hospital stay, time to the first flatus, time to the first fluid diet, time to the first ambulatory activity, morbidity of postoperative complication, mortality, and readmission rate) and secondary outcomes (operative time, intraoperative blood loss and postoperative pain score) were compared between the two groups. Results: Compared to the traditional method group, the non-special preparation group had shorter time to the first flatus [(3.6±1.1) days vs. (4.8±1.4) days, t=3.134, P=0.003], shorter time to the first liquid diet [(2.6±0.9) days vs. (5.5±1.6) days, t=15.105, P<0.001], shorter time to the first ambulatory activity [(1.9±0.5) days vs. (4.1±1.1) days, t=8.543, P<0.001] and shorter postoperative hospital stay [(9.6±2.3) days vs. (12.9±2.3) days, t=5.020, P<0.001]. Besides, incidences of pancreatic leakage [6.5% (8/123) vs. 16.3% (13/80), χ(2)=4.964, P=0.026], lymphatic leakage [1.6% (2/123) vs. 13.8% (11/80), χ(2)=11.887, P=0.001], peritoneal effusion [2.4% (3/123) vs. 10.0% (8/80), χ(2)=4.032, P=0.045], and gastroparesis [0.8% (1/123) vs. 7.5% (6/80), χ(2)=4.657, P=0.031] in the non-special preparation group were significantly lower. The overall morbidity of postoperative complications and incidences of pulmonary infection and intestinal adhesion were not significantly different between the two groups (all P>0.05). As for the secondary outcomes, compared to the traditional method group, the non-special preparation group had less intraoperative blood loss [(80.4±24.4) ml vs. (100.5±19.4) ml, t=3.134, P=0.003] and lower postoperative pain score [postoperative day 1: (4.4±0.3) vs. (5.3±0.8), t=2.504, P=0.037],while the difference in operative time was not significant (P>0.05). Conclusion: The non-special perioperative administration for ERAS proposed by Japanese scholars is effective and safe, which has certain clinical applicability and value for Chinese patients with gastric cancer.

Radiation intestinal injury (RII) refers to the intestinal complication resulting from radiation therapy of pelvic, abdominal or retroperitoneal tumor, which involves the small intestine, colon and rectum. Although the advances in radiotherapy technology have decreased the injury of adjacent tissues, 90% of the patients receiving radiotherapy have acute symptoms, the quality of life is affected due to gastrointestinal symptoms in 50% of patients, and 20%-40% of patients have moderate to severe symptoms. Based on the pathological stage, characteristics and clinical manifestations, RII can be divided into acute and chronic types, generally 3 to 6 months as the cutoff in clinical history. The main preventions of RII include reducing the radiation doses and narrowing the exposure fields. Acute RII is characterized by mucosal inflammation and self-limitation, and its treatment includes symptomatic and nutritional management. As the chronic ischemia and fibrosis in chronic RII are irreversible, bowel resection is the ideal treatment. The surgical indications for chronic RII are grade 3 and 4 intestinal injuries, including obstruction, bleeding, intestinal necrosis, perforation, and fistula. The current surgical procedure is definitive intestinal resection with stage I or II gastrointestinal reconstruction. The optimal time for definitive surgery is still controversial. Based on our experiences, 1 year after the end of radiation therapy is optimal. Under the circumstances of emergency surgery, severe malnutrition, abdominal infection, extensive intestinal injury, and abdominal adhesions that cannot be mobilized, ostomy and abdominal drainage are recommended, and definitive surgery can be considered after the return to enteral nutrition and extinction of intestinal inflammation. Preoperative setting of ureteral catheter, imaging assessment of colorectal position and iliac vascular injury, and preoperative nutritional support can reduce the risk of systemic complications effectively.

目的： 评估改良的横结肠保护性造口+皮下腹腔外造口关闭在腹腔镜中低位直肠癌前切除术应用价值。 方法： 回顾性分析2016年1月至2019年2月间浙江大学金华医院结直肠肛门外科收治64例行腹腔镜中低位直肠癌切除切除术+改良的横结肠保护性造口+皮下腹腔外造口关闭患者的手术相关资料。 结果： 全组均顺利完成一期手术，无死亡病例。全组患者一期保护性造口的手术时间（26.3±10.4）min，造口相关出血量（5.2±4.2）ml，住院时间为（11.2±1.7）d、住院费用为（4.0±1.6）万元。一期手术相关并发症：吻合口漏12例（18.8%），患者均无广泛的腹膜刺激症状及严重全身毒性反应，无再次手术；吻合口狭窄4例（6.2%），2例经扩肛治疗痊愈，另2例出现直肠吻合口及上方肠管的严重肠管挛缩及狭窄并导致永久性横结肠造口；造口旁感染2例（3.1%），造口局部肠壁皮肤分离1例，造口皮疹3例（4.7%），无造口回缩及造口狭窄病例。全组64患者中除2例永久性造口外，另62例于术后1~6（3.4±2.6）个月二期局部麻醉下行皮下腹腔外造口关闭。二期手术时间（19.3±12.4）min，术中出血（2.6±3.9）ml，住院时间（5.6±2.1）d，住院费用（0.4±0.2）万元。二期手术并发症：结肠瘘口修补处漏2例（3.2%），切口感染2例（3.2%）。 结论： 改良的横结肠保护性造口及后续的皮下腹腔外造口关闭安全可行，对于伴随直肠吻合口漏高危因素的患者是一种可供选择的治疗措施。.

Fecal microbiota transplantation (FMT) has gradually shown application prospects in the treatment of intestinal and extraintestinal diseases. In order to standardized FMT operation, based on the clinical experience of the Tenth People's Hospital Affiliated to Tongji University, combined with domestic and foreign literature, Parenteral and Enteral Nutrition Branch of Chinese Medical Association, Enhanced Recovery after Surgery Branch of China International Health Care Promotion Exchange Association, China Microecological Treatment Innovation Alliance, and Microecology Committee of Shanghai Preventive Medicine Association to formulated the" Chinese experts consensus on clinical practice of the selection and establishment of fecal microbiota transplantation delivery routes". It includes four parts: the selection of delivery route, the methodology of transplantation path establishment, the clinical application, and the monitoring of adverse events.

In hospitals and medical schools as densely populated sites with high risk of coronavirus disease 2019 (COVID-19), it is vital to adjust the teaching and training strategy for medical students to ensure curriculum completion with safety. This article aims to introduce the experience of teaching and training for medical students under the epidemic situation at Department of Surgery, Shanghai Medical College, Fudan University and Zhongshan Hospital. The content includes exploring diversified online teaching models for undergraduate surgery courses and clinical practice, carrying out online graduate education and dissertation plans, and strengthening comprehensive education of medical humanity combined with knowledge of COVID-19 prevention. Through implementation of the above teaching strategies, scheduled learning plans of medical students can be well completed in an orderly, safe and quality-ensured manner. Our experience provides practical solution of medical teaching and could be advisable for other medical colleges and teaching hospitals.