Treatment Of Gastrointestinal Tumors Research Articles

Safety assessment and determination of a maximally tolerated dose of an RAS-GTPase inhibitor (iRAS) in the treatment of gastrointestinal tumors: preliminary results of the phase I trial

Background: Ras oncogene mutations leading to hyperactivation of the MAPK/ERK signaling pathway occur in 25% of all human tumors, and for gastrointestinal tumors, the frequency of Ras mutations amounts to 60%. The introduction of a Ras-GTPase inhibitor into clinical practice would increase the effectiveness of the treatment of socially significant diseases such as stomach and intestinal cancer.
 Aim: To select the optimal dose with a subsequent assessment of the safety of iRAS when administered to patients with gastrointestinal tract tumors, including those with peritoneal carcinomatosis.
 Materials and methods: This was a prospective open-label non-randomized phase I study for the assessment of safety and tolerability, with an adaptive design and determination of the maximally tolerated dose of the iRAS. Three dose levels were used (0.45 mg/kg, 0.9 mg/kg, 1.8 mg/kg) according to the "3 + 3" scheme. The study included 11 patients after surgery for stomach or colorectal cancer. The patients were administered PIPAC therapy with iRAS twice with a 7-days interval. The study duration was 28 ± 1 days. During the study, the patient monitoring included physical examination, assessment of vital signs, electrocardiography and echocardiography, laboratory parameters (hematology, clinical chemistry, coagulation tests, and urine analysis).
 Results: The anti-tumor iRAS agent demonstrated satisfactory tolerability of all doses studied, including the maximal 1.8 mg/kg dose. Vital sign and laboratory abnormalities were clinically non-significant and did not require additional therapeutic interventions. Statistically significant abnormalities were registered for total protein (p = 0.00028), white blood cell counts (p = 0.007), lymphocyte counts (p = 0.0008), and a number of other blood parameters; however, most of these abnormalities were within the physiological normal ranges. Vital signs such as electrocardiography and echocardiography parameters remained stable throughout the entire follow-up period (28 days after administration of the drug). There were short-term rises in body temperature, minor pains in the postoperative scar area.
 Conclusion: This trial of safety and tolerability of iRAS showed that no cases of dose-limiting toxicity in the studied dose range. The 1.8 mg/kg dose can be recommended for further clinical studies.

Scrape cytology – Diagnostic tool in large intestinal tumors

: Gastrointestinal tumors, mainly esophagogastric and colorectal carcinomas constitute one of the major causes of morbidity and mortality worldwide. The early detection and treatment of gastrointestinal tumors has been shown to improve patient's survival significantly. The current study is carried out to know the efficiency of scrape cytology in diagnosis of large intestinal tumors by comparing with histopathological diagnosisThirty surgically removed large intestinal tumor specimens were studied. Scrapings were taken from representative areas of each specimen, spread on slides, stained with H/E and reported. The specimens were fixed in 10% formalin, grossed and routine histopathological processing was carried out, followed by staining with H/E, examined and reported. The diagnosis obtained by scrape cytology and histopathology was correlated and analyzedTotal 30 specimens were received and majority of them were of rectal tumors(20%) and sigmund colon tumors(20%), followed by rectosigmoid region tumors (17%). Over all the scrape cytology diagnosis showed concordance for 28 cases with histopathology diagnosis having diagnostic accuracy of 93.3%.:Scrape cytology is simple, rapid and economically feasible technique and can be useful as an adjunct for frozen section in intraoperative consultation.

Chinese expert consensus on the application of circulating tumor cell detection in the diagnosis and treatment of gastrointestinal neoplasms (2023 edition)

Circulating tumor cell (CTC), as a novel tumor marker, has the characteristics of non-invasive, dynamic monitoring and high accuracy, and provides precise molecular characteristics of tumors and helps understand the changes in tumor development. Therefore, CTC has important clinical value in the dynamic monitoring of tumor progression. In order to standardize and guide the application of CTC detection in the diagnosis and treatment of gastrointestinal neoplasms, Gastric Cancer Group of Oncology Branch of Chinese Medical Association, Colorectal Cancer Professional Committee of Chinese Medical Doctor Association, Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Gastric Cancer Professional Committee of Chinese Anti-Cancer Association, Digestive Tract Polyp and Precancerous Lesion Professional Committee of Chinese Anti-Cancer Association, jointly convened some domestic experts to discuss and formulate the Chinese expert consensus on the application of circulating tumor cell detection in the diagnosis and treatment of gastrointestinal neoplasms (2023 edition). The consensus provides opinions on the detection technology and clinical application of CTC detection in the diagnosis and treatment of gastrointestinal neoplasms, including the prediction of tumor prognosis, the monitoring of tumor recurrence and metastasis, the evaluation of treatment response, and the additional diagnostic value, providing guidance for clinical application.

Research progress of ginger in the treatment of gastrointestinal tumors

Cancer seriously endangers human health. Gastrointestinal cancer is the most common and major malignant tumor, and its morbidity and mortality are gradually increasing. Although there are effective treatments such as radiotherapy and chemotherapy for gastrointestinal tumors, they are often accompanied by serious side effects. According to the traditional Chinese medicine and food homology theory, many materials are both food and medicine. Moreover, food is just as capable of preventing and treating diseases as medicine. Medicine and food homologous herbs not only have excellent pharmacological effects and activities but also have few side effects. As a typical medicinal herb with both medicinal and edible uses, some components of ginger have been shown to have good efficacy and safety against cancer. A mass of evidence has also shown that ginger has anti-tumor effects on digestive tract cancers (such as gastric cancer, colorectal cancer, liver cancer, laryngeal cancer, and pancreatic cancer) through a variety of pathways. The aim of this study is to investigate the mechanisms of action of the main components of ginger and their potential clinical applications in treating gastrointestinal tumors.

Research progress on drug delivery systems for curcumin in the treatment of gastrointestinal tumors.

Curcumin is a natural compound with a diketone structure, which can control the growth, metastasis, recurrence, neovascularization, invasion, and drug resistance of gastrointestinal tumors by inhibiting nuclear factor κB, overexpression of tumor cells, vascular endothelial growth factor, etc. However, due to the low bioavailability of curcumin formulation, it did not fully exert its pharmacological effects, and its application and development in the treatment of various malignant tumors are still limited. This review summarizes the research on drug delivery systems of curcumin combating digestive tract tumors in order to further reduce the toxic side effects of curcumin-containing drugs and fully exert their pharmacological activities, and improve their bioavailability and clinical value.

Advances in the Mechanism of Action of Neutrophil Extracellular Traps in Gastrointestinal Tumors: A Review.

Neutrophils are important immune cells in the body, extremely abundant, phagocytic and bactericidal, and usually involved in the defense against infectious diseases as immune become. However, a new reticulum structure has been discovered: neutrophil extracellular traps (NETs), which consists of various components such as DNA and proteins, etc. Current studies have found that NETs are closely associated with various diseases such as immune diseases, inflammation and tumors, and the study of the development and metastasis of gastrointestinal tumors has become a recent research hotspot. The clinical significance of NETs has been gradually highlighted, especially in the area of immunosuppression. We reviewed a large amount of relevant literature, summarized the latest detection methods of NETs, explored the mechanism of NETs in gastrointestinal tumors and summarized the latest hotspot directions. NETs are involved in the development of gastrointestinal tumors, and are closely related to the proliferation and metastasis of gastrointestinal tumors. Higher levels of NETs are associated with poor prognosis of gastrointestinal tumors, promote local growth of tumors through various pathways, participate in tumor-related systemic injury, and promote tumor growth and metastasis by enhancing the mitochondrial function of tumor cells and awakening dormant tumor cells. NETs are highly expressed in tumors, and tumors and their microenvironment can promote the production of NETs, providing new ideas for the clinical diagnosis and treatment of gastrointestinal tumors. In this paper, we describe the basic information about NETs, explore the research mechanisms related to NETs in gastrointestinal tumors, and prospectively explore the clinical potential of hotspots and inhibitors related to NETs for gastrointestinal tumors, in order to provide new ideas and targets for the diagnosis and treatment of gastrointestinal tumors.

Super‐stable homogeneous embolic agents advance the treatment of hepatocellular carcinoma

Super‐stable homogeneous embolic agents advance the treatment of hepatocellular carcinoma

Clinical outcomes of endoscopic resection for gastrointestinal stromal tumor originating from the muscularis propria: A single-center experience.

407 Background: With the remarkable advance of endoscopic techniques, endoscopic submucosal dissection (ESD) has become an effective and safe treatment modality for various gastrointestinal tumors (GISTs). However, there is still a lack of evidence on endoscopic treatment of GISTs in the stomach. We aimed to investigate the efficacy and safety of ESD for gastric GISTs and to assess possible predictive factors for incomplete resection. Methods: Between October 2008 and July 2022, a total of 35 patients with gastric GIST underwent ESD at our hospital. Clinicopathologic characteristics of patients and GISTs, therapeutic outcomes, adverse events and follow-up outcomes were evaluated. Results: The overall rates of en bloc resection and complete resection were 77.1% (27/35), 68.6% (24/35), respectively. The median procedure time was 47.3 minutes (range, 15–131 minutes). The procedure-related bleeding and perforation rates were 2.9 % and 17.1%, respectively. In univariate analyses, EUS growth pattern (intraluminal growth, p = 0.027) was independently associated with complete resection. During the median follow-up period of 15.4 months (range, 5.7 – 129 months) in 35 patients except two patients who underwent surgery and one patient who failed to follow up, recurrence occurred in one patient with macroscopically incomplete resection. Conclusions: ESD is an effective, safe, and feasible treatment for gastric GISTs. The frequency of complete resection is increased in EUS with an intraluminal growth pattern. [Table: see text]

Bacteria derived extracellular vesicles in the pathogenesis and treatment of gastrointestinal tumours.

Extracellular vesicles are fundamentally significant in the communication between cells. Outer Membrane Vesicles(OMVs) are a special kind of EVs produced by Gram-negative bacteria, which are minute exosome-like particles budding from the outer membrane, which have been found to play essential roles in diverse bacterial life events, including regulation of microbial interactions, pathogenesis promotion, stress responses and biofilm formation. Recently, and more researches have explored the substantial potentials of EVs as natural functional nanoparticles in the bioengineering applications in infectious diseases, cardiovascular diseases, autoimmune diseases and neurological diseases, such as antibacterial therapy, cancer drugs and immunoadjuvants, with several candidates in clinical trials showing promising efficacy. However, due to the poor understanding of sources, membrane structures and biogenesis mechanisms of EVs, progress in clinical applications still remains timid. In this review, we summarize the latest findings of EVs, especially in gastrointestinal tract tumours, to provide a comprehensive introduction of EVs in tumorigenesis and therapeutics.

NET-Triggered NLRP3 Activation and IL18 Release Drive Oxaliplatin-Induced Peripheral Neuropathy.

Oxaliplatin is an antineoplastic agent frequently used in the treatment of gastrointestinal tumors. However, it causes dose-limiting sensorimotor neuropathy, referred to as oxaliplatin-induced peripheral neuropathy (OIPN), for which there is no effective treatment. Here, we report that the elevation of neutrophil extracellular traps (NET) is a pathologic change common to both cancer patients treated with oxaliplatin and a murine model of OIPN. Mechanistically, we found that NETs trigger NLR family pyrin domain containing 3 (NLRP3) inflammasome activation and the subsequent release of IL18 by macrophages, resulting in mechanical hyperalgesia. In NLRP3-deficient mice, the mechanical hyperalgesia characteristic of OIPN in our model was reduced. In addition, in the murine model, treatment with the IL18 decoy receptor IL18BP prevented the development of OIPN. We further showed that eicosapentaenoic acid (EPA) reduced NET formation by suppressing the LPS-TLR4-JNK pathway and thereby abolished NLRP3 inflammasome activation and the subsequent secretion of IL18, which markedly prevented oxaliplatin-induced mechanical hyperalgesia in mice. These results identify a role for NET-triggered NLRP3 activation and IL18 release in the development of OIPN and suggest that utilizing IL18BP and EPA could be effective treatments for OIPN.

Yiqi Jianpi Huayu Jiedu Decoction Inhibits Metastasis of Colon Adenocarcinoma by Reversing Hsa-miR-374a-3p/Wnt3/β-Catenin-Mediated Epithelial-Mesenchymal Transition and Cellular Plasticity.

Colon adenocarcinoma (COAD) accounts for 95% of colon cancer cases, with the 5-year survival rate significantly affected by local or distant metastases. Yiqi Jianpi Huayu Jiedu decoction (YJHJD), based on the theory of “nourish qi, invigorate the spleen, remove blood stasis, and detoxify”, has long been applied and shown to be remarkable in the prevention and treatment of gastrointestinal tumors. However, the underlying therapeutic mechanisms of YJHJD have not been fully elucidated. Herein, we first confirmed hsa-miR-374a-3p as a tumor suppressor based on its lower expression in the plasma of patients with COAD with liver metastasis and association with more advanced local progression. We also verified WNT3 as a potential target of hsa-miR-374a-3p and observed its increased expression in COAD tissues. Furthermore, we showed that the hsa-miR-374a-3p/Wnt3/β-catenin axis was responsible for epithelial–mesenchymal transition (EMT) and cellular plasticity in COAD, as well as poorer patient prognosis. Our results showed that YJHJD inhibited motility and colony potential in vitro, as well as liver metastasis of COAD in vivo. Moreover, YJHJD induced a reversal of EMT and cellular plasticity-related molecular expression, increased hsa-miR-374a-3p, and decreased Wnt3 and β-catenin levels. In addition, silencing of hsa-miR-374a-3p weakened YJHJD inhibition, whereas the β-catenin inhibitor XAV939 partially repaired it. Taken together, these results demonstrated that YJHJD suppressed the EMT and cellular plasticity of COAD by regulating hsa-miR-374a-3p/Wnt3/β-catenin signaling.

Circular RNAs Involve in Immunity of Digestive Cancers From Bench to Bedside: A Review.

The immune system plays a complex role in tumor formation and development. On the one hand, immune surveillance can inhibit the growth of tumors; on the other hand, immune evasion of tumors can create conditions conducive for tumor development and growth. CircRNAs are endogenous non-coding RNAs with a covalently closed loop structure that are abundantly expressed in eukaryotic organisms. They are characterized by stable structure, rich diversity, and high evolutionary conservation. In particular, circRNAs play a vital role in the occurrence, development, and treatment of tumors through their unique functions. Recently, the incidence and mortality of digestive cancers, especially those of gastric cancer, colorectal cancer, and liver cancer, have remained high. However, the functions of circRNAs in digestive cancers immunity are less known. The relationship between circRNAs and digestive tumor immunity is systematically discussed in our paper for the first time. CircRNA can influence the immune microenvironment of gastrointestinal tumors to promote their occurrence and development by acting as a miRNA molecular sponge, interacting with proteins, and regulating selective splicing. The circRNA vaccine even provides a new idea for tumor immunotherapy. Future studies should be focused on the location, transportation, and degradation mechanisms of circRNA in living cells and the relationship between circRNA and tumor immunity. This paper provides a new idea for the diagnosis and treatment of gastrointestinal tumors.

Laparoscopic proximal gastrectomy and lymph node resection in adenocarcinoma of the esophagogastric junction

The proportion of adenocarcinoma of the esophagogastric junction (AEG) in gastric cancer is gradually increasing. Due to the unique anatomical structure and biological characteristics of the tumor at this site, AEG has a certain degree of complexity in many aspects of diagnosis and treatment, which brings difficulties to the operation method, the selection of the resection range, the lymph node dissection and the treatment decision-making. Therefore, AEG has always been the focus of academic debate. With the development of minimally invasive surgery in recent years, laparoscopic technology has been increasingly mature and widely used in the treatment of gastrointestinal tumors. Compared with distal gastric cancer, the minimally invasive treatment of AEG is in a lagging state, and there are also a series of problems that have not yet reached a consensus. This article reviews and summarizes the recent research progress in two aspects: proximal gastrectomy for AEG and lymph node dissection. Laparoscopic-assisted proximal gastrectomy is safe for early proximal gastric cancer and has a long-term survival outcome not inferior to total gastrectomy, but the surgical indications must be strictly selected. Abdominal lymph node metastasis of AEG is mainly in group 1, 2, 3, and 7, and mediastinal lymph node metastasis is closely related to the length of the infiltrated esophagus. The abdominal transhiatal (TH) approach can obtain a sufficient number of harvested lymph node, and has good safety and efficacy, which is the first-choice of surgical approach for early AEG. The results of the CLASS-10 clinical trial can provide a higher level of evidence for laparoscopic mediastinal lymph node dissection. Laparoscopic surgery for AEG should be carried out in experienced medical center based on clinical research.

Management of acute kidney injury in gastrointestinal tumor: An overview.

Gastrointestinal tumors remain a global health problem. Acute kidney injury (AKI) is a common complication during the treatment of gastrointestinal tumors. AKI can cause a decrease in the remission rate and an increase in mortality. In this review, we analyzed the causes and risk factors for AKI in gastrointestinal tumor patients. The possible mechanisms of AKI were divided into three groups: pretreatment, intrafraction and post-treatment causes. Treatment and prevention measures were proposed according to various factors to provide guidance to clinicians and oncologists that can reduce the incidence of AKI and improve the quality of life and survival rate of gastrointestinal tumor patients.

Quantitative characterization of human oncogene promoter G-quadruplex DNA-ligand interactions using a combination of mass spectrometry and capillary electrophoresis.

Human c-KIT oncogene is known to regulate cell growth and proliferation, and thus, acts as a probable target in the treatment of gastrointestinal tumors (GIST). To identify small molecule ligands which can specifically bind with the G-quadruplex (G4) in the c-KIT promoter region as potential antitumor agents, we propose the combination of electrospray ionization-mass spectrometry (ESI-MS), capillary electrophoresis frontal analysis (CE-FA), and Taylor dispersion analysis (TDA) to accurately investigate the G4/ligands binding properties. First, ESI-MS was used for initial screening of natural products (NPs). CE-FA was then used to calculate specific binding constants and the stoichiometry of the native state binding pair in solution. Next, TDA, a micro-capillary flow technique was used to examine the effect of the ligand binding on the diffusivity and particle size of the c-KIT G4. Two of the screened NPs, scopolamine butylbromide (L1) and isorhamnetin-3-O-neohesperidoside (L3), were found to specifically bind to the c-KIT G4 with binding constants of around 104 M-1 and 1:1 stoichiometry in a free solution. TDA data showed that ligand binding (both L1 and L3) induced the c-KIT strands to fold into a tightly structured G4 with a decreased hydrodynamic radius. These ligands have the potential to be drug candidates for the regulation of c-KIT gene transcription by stabilizing the G4 structure. This methodology not only increased the speed of analysis but also improved its accuracy and specificity compared with the conventional binding approaches.

Research progress of circular RNA in digestive tract tumors: a narrative review.

Circular RNA (circRNA) is a newly discovered non-coding RNA with a closed loop structure. The 3' end and the 5' end of circRNA are covalently bonded and not easily degraded by nucleases. Besides, circRNA can exist in eukaryotes widely and conservatively, and it is stably expressed in human liver, brain, lung and other organs. CircRNA can also regulate gene expression by acting on miRNA just like “miRNA sponge”. With the deepening of research, growing literature has evidence shows that circRNA is related to tumors closely. For tumors, a large part of malignant ones are gastrointestinal tumors (GIST). In recent years, there are some researches which show that circRNA plays an important role in the occurrence and development, detection and treatment, and prognostic evaluation of malignant tumors of the digestive system. This article summarizes the literature reports on circRNA and GIST since March 2019. From 326 records screened, 79 full text articles were assessed for eligibility and 29 studies met the inclusion criteria. We reviewed the relationship between circRNA and GIST, and its role in the development of tumors. These studies show that in the future, circRNA has the potential to be used as a molecular marker for the detection and treatment of GIST.

Abstract 5386: In situ detection of CLDN18.2 RNA in circulating tumor cells in gastrointestinal cancer

Abstract Objective: Recent clinical trials considered Claudin18 splice variants 2 (CLDN18.2) as the promising potential target for gastrointestinal(GI) cancer treatment. CLDN18.2 specifically express in normal stomach and gastric cancer, while ectopic activation can also be found among esophageal, pancreatic and bile duct cancers. However, high-consistency of CLDN18.1 and CLDN18.2 sequences makes it challenging to explore CLDN18.2-specific antibody. Therefore, detecting CLDN18.2 RNA expression may be another choice. Circulating tumor cells (CTCs) are regarded as biomarkers guiding treatment and tools investigated drug-resistant mechanisms. We aim to establish a CLDN18.2 RNA detection method in CTCs(CLDN18.2+ CTCs)for further application in monitoring anti-CLDN18.2 treatment of GI tumor. Methods: We established a CLDN18.2 RNA detection method based on designing a CLDN18.2-specific RNA molecular beacon (MB). 12 late stage GI cancer patients(pts)were enrolled. Paired blood (6ml) and tumor tissue specimens were respectively collected from 2 pancreatic and 10 gastric cancer pts. We evaluated CLDN18.2 expression on tissue by immunohistochemical (IHC) results. Then we analyzed CLDN18.2 expression on CTCs and tumor tissue. Results: Molecular and cell-line validation indicated that CLDN18.2 MB could specifically hybridized with CLDN18.2 RNA. In our study, Every pt had an evaluable CLDN18.2 IHC result. CTCs were identified in all of the pts (CTCs numbers ranging from 2 to 25). 9 of 12 pts had detectable CLDN18.2+CTCs, among which the CLDN18.2+CTCs ratio (CLDN18.2+CTCs/ Total number of CTCs) fluctuated from 14% to 100%. 96 CTCs fluorescence intensity were calculated statistically and classified by Agglomerative Clustering arithmetic. Consequently, we classified 3 clusters with significant differences (p<0.01). The cutoff points were 450rfu and 900rfu respectively. Hence, we subdivided CLDN18.2+CTCs into CLDN18.22+CTC and CLDN18.21+ CTC. Spearman Rank Correlation analysis showed that CLDN18.2+ CTCs ratio was concordant with IHC results. (P=0.007, Spearman=0.75). Conclusions: CLDN18.2 RNA positive CTCs ratio was consistent with CLDN18.2 expression level in GI cancer pts. It is warranted to further exploring the phenotypes and distinct mechanisms of CLDN18.2 RNA positive CTCs dynamic changes during anti-CLDN18.2 therapy. CLDN18.2 Expression in 12 GI cancer ptsPtsCancerCLDN18.2 Expression on Tissue(IHC)CLDN18.2 Expression in CTCs(CLDN18.2 MB)CLDN18.2-CLDN18.21+CLDN18.22+CTCs SumCLDN18.2+CTC ratio1GC020020%2GC0010010100%3GC040040%4GC030030%5GC2+07714100%6GC2+0257100%7PC2+410520%8PC2+0628100%9GC2+710814%10GC3+023225100%11GC3+221560%12GC3+0145100%*GC: Gastric cancer ; PC: Pancreatic cancer Citation Format: Xiaoyi Chong, Linyang Fan, Changsong Qi, Jifang Gong, Zhi Peng, Dan Liu, Yang Chen, Chenhui Xu, Yanyan Li, Congcong Ji, Qin Li, Zhiyuan Hu, Xiaotian Zhang, Lin Shen. In situ detection of CLDN18.2 RNA in circulating tumor cells in gastrointestinal cancer [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 5386.

Случай оперативного лечения гастроинтестинальной опухоли желудка

Случай оперативного лечения гастроинтестинальной опухоли желудка

Clinical Efficacy of Metoprolol Succinic Acid Sustained Release Tablets Combined with Trimetazidine in the Treatment of Gastrointestinal Tumors with Angina Pectoris

Objective: To investigate the clinical efficacy of metoprolol succinate sustained-release tablets combined with trimetazidine in the treatment of gastrointestinal tumors with angina pectoris. Methods: We enrolled the 58 patients with digestive tract tumor merger angina in November 2017 - October 2019 and analysis the hospital clinical data by retrospective method. We included patients with routine treatment in control group (n = 31 cases) and the subjects treated with increased dose of succinic acid metoprololzyban joint with trimetazidineinobservation group (n = 27 cases) according to the different treatment group. Results: The effective rate of angina pectoris treatment in the observation group was higher than that in the control group. Furthermore, the incidence of adverse reactions was lower than that in the control group and the difference was statistically significant (P < 0.05). Conclusion: Metoprolol succinic acid sustained release tablets combined with trimetazidine in the treatment of gastrointestinal tumors with angina pectoris can improve the efficacy of angina pectoris. The drug use is safe and worthy of clinical use.

Treatment strategy for gastrointestinal tumor under the outbreak of novel coronavirus pneumonia in China

The outbreak of the novel coronavirus pneumonia (NCP) has become a public health emergency in China. Chinese authorities and health agencies had devoted great efforts to control this disease. As surgeons specialized in the treatment of gastrointestinal tumors, we should always be aware of the prevention for NCP and incorporate this awareness into every detail of clinical practice. For the patients with gastrointestinal tumors, pre-admission screening should be done in order to rule out NCP. Real-time RT-PCR panel and chest CT scan should be conducted for patients with fever (>37.3℃), travel history to Hubei Province within 14 days, or contact history with residents from Wuhan district within 14 days. Prevention measures for both medical staffs and the screen-negative admitted patients should also be enhanced because false negative is possible. Medical instruments should be properly discarded or disinfected according to standardized procedures established by the local center for disease control and prevention (CDC). Surgical operation should be reduced at a minimal level to prevent cross infection in this special period.Surgical intervention for benign tumor should be postponed. For malignant tumor, multidisciplinary therapy (MDT) is recommended and non-surgical anti-tumor therapy should be selected with higher priority. Neoadjuvant therapy is highly recommended for gastrointestinal cancer at advanced stages that meet the indications of NCCN guideline (gastric cancer T stage ≥ 2/rectal cancer T stage ≥ 3/unresectable colon cancer). Gastric or esophagogastricjunction (EGJ) malignant tumor with obstruction can be managed with gastric tube decompression or stent placement to relieve the symptoms. Transnasal enteral feeding tube intubation/percutaneous endoscopic gastrostomy could be adopted to ensure enteral nutrition supply. For colorectal malignancy with simple intestinal obstruction, stent placement can achieve a high success rate, which not only helps avoid emergency surgery, but also creates a better condition for subsequent surgery. Transcatheter arterial embolization for hemostasis is an alternative choice for gastrointestinal tumor with bleeding. However, emergency operation still must be performed for patients with acute uncontrolled bleeding, obstruction or after other alternative treatment measures fail. All cases with suspicious or confirmed with NCP must be reported to the local CDC department. All invasive intervention must be performed in a designated isolation area. Tertiary prevention measure must be adopted for all anesthetists with additional face mask or medical goggle protection to prevent respiratory droplet transmission. Preventive enterostomy is preferable in lower digestive tract surgery. Thoroughly disinfecting the operating room after surgery is necessary. Fever after surgery must be carefully differentiated whether it's caused by post-surgery abdominal infection/inflammation or NCP. Single-room isolation and related examinations should be performed according to the standard procedures. We believe that with the unprecedentedly joint efforts of doctors and patients, we will eventually win this war against NCP.