In recent years, the adoption of single-incision laparoscopic surgery (SILS) for colorectal procedures has significantly increased in clinical practice both domestically and internationally, supported by progressively robust evidence. Furthermore, the emergence of novel operative platforms, such as robotic single-incision laparoscopic systems, has brought unprecedented evolution and transformation to the indications and technical procedures of SILS for colorectal surgery. Consequently, the existing consensus urgently requires revision and updating to meet the pressing need for standardized guidance in current clinical practice. To address this need, the Single-incision Laparoscopic Surgery Group of Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, building upon the 2019 expert consensus on SILS for colorectal surgery, has convened a panel of leading domestic experts experienced in this field to update this consensus. This initiative aims to promote the continued standardized, efficient, and beneficial development of single-incision laparoscopic colorectal surgery.

Colonoscopy-assisted natural orifice specimen extraction surgery (CA-NOSES) is a minimally invasive surgical approach in which the resected specimen is completely extracted through the colonic lumen and anus with the assistance of colonoscopy, following laparoscopic or robotic radical resection of colon tumors and intracorporeal digestive tract reconstruction. It represents an important extension of the existing natural orifice specimen extraction surgery (NOSES) system. To standardize the clinical application of this technique, Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, the NOSES Committee of the Chinese Anti-Cancer Association, and the China NOSES Alliance organized experts from relevant fields nationwide. Based on a systematic review of the domestic and international literature and in conjunction with accumulated clinical experience in China, consensus was achieved through extensive discussion, leading to the formulation of this expert consensus. This document systematically addresses key aspects of CA-NOSES, including its definition and technical characteristics, indications and contraindications, preoperative evaluation and bowel preparation, equipment selection and patient positioning, standardized operative procedures, prevention and management of complications, as well as oncological outcomes. Current evidence indicates that, when indications are strictly adhered to and aseptic and oncological principles are rigorously followed, CA-NOSES offers advantages such as reduced surgical trauma, faster postoperative recovery, and improved cosmetic outcomes. Its safety and oncological efficacy are not inferior to those of conventional laparoscopic-assisted colectomy with mini-laparotomy for specimen extraction in colon tumor surgery. This consensus aims to provide practical technical guidance and a theoretical basis for the standardized implementation of CA-NOSES and to lay a foundation for future multicenter clinical studies.

Standardized lymph node dissection and negative surgical margins are fundamental to achieving optimal outcomes in radical resection for colorectal cancer. However, discrepancies exist among international guidelines (e.g., European/American vs. Japanese) regarding the optimal extent of bowel resection, particularly the length of the distal margin in rectal cancer, which directly influences surgical approach and decisions on functional preservation. This article aims to systematically review the theoretical basis for the extent of intestinal resection in colon cancer and rectal cancer at different sites. By analyzing and comparing the Western concept of total mesenteric excision with Japanese data on precise measurements based on lymph node metastasis patterns, this paper focuses on the principles for resection margins: 10 cm for both proximal and distal margins in colon cancer, 3 cm for rectosigmoid and high rectal cancer, 2 cm for low rectal cancer, and special considerations (e.g., post-neoadjuvant therapy, poorly differentiated types). Key research data are summarized to provide evidence-based references for surgeons to develop individualized and precise surgical strategies in clinical practice.

To investigate the expression of cellular Mesenchymal-Epithelial Transition Factor (cMET) in colorectal cancer, its relationship with clinicopathological features and molecular characteristics, and its prognostic value, in order to inform clinical decision-making.

In this retrospective study, 314 colorectal cancer patients who underwent surgery at the National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between April 2017 and December 2023 were included. cMET expression was assessed by immunohistochemistry, and genetic alterations in MET and other common genes (BRAF, KRAS, NRAS, TP53, PIK3CA) were analyzed via next-generation sequencing. Clinical data were collected from electronic medical records, and recurrence and survival outcomes were evaluated using SPSS.

Among the 314 patients, 248 had low cMET expression and 66 had high expression. Most patients(78.34%, 246/314) had stage Ⅲ~Ⅳ disease. The median disease-free survival was 11 months, with 292 cases (92.99%) experiencing recurrence or metastasis. cMET expression was associated only with tumor differentiation, and genetic alterations varied by tumor location. Only one case showed low-level MET amplification. Kaplan-Meier analysis indicated shorter disease-free survival in stage Ⅳ patients with high cMET expression (χ²=6.224, P=0.013). Univariate and multivariate Cox regression analyses confirmed that cMET expression (HR=2.542, P=0.015) and N stage (HR=2.668, P=0.019) were independent risk factors for worse disease-free survival in stage Ⅳ colorectal cancer.

cMET expression can serve as a useful prognostic indicator in stage Ⅳ colorectal cancer, with high cMET expression associated with shorter disease-free survival.

To evaluate the prognostic performance of two lymph node-based staging systems, tumor-ratio-metastasis (TRM) and tumor-log odds-metastasis (TSM), developed from the lymph node ratio (LNR) and log odds of positive lymph nodes (LODDS), and to compare them with the American Joint Committee on Cancer (AJCC) TNM staging system in colorectal cancer.

The training cohort consisted of postoperative colorectal cancer patients with pathologically confirmed lymph node metastasis registered in the Surveillance, Epidemiology, and End Results (SEER) database between 2010 and 2015 (n=13 469). The external validation cohort was a two-center cohort composed of patients treated at Chuzhou First People's Hospital and Shanghai General Hospital between 2018 and 2022 (n=402). X-tile software was used to determine the optimal cut-off values for LNR and LODDS (0.20/0.57 and −0.58/0.17, respectively), on the basis of which the TRM and TSM staging systems were constructed. Prognostic performance was assessed using multivariable Cox regression, Harrell's concordance index, time-dependent receiver operating characteristic curves and the corresponding area under the receiver operating characteristic curve at 36 and 60 months, calibration plots, and decision curve analysis. Model fit and comparative performance were further evaluated using the Akaike information criterion, Bayesian information criterion, and likelihood ratio test.

In the training cohort, both TRM and TSM were independent prognostic factors for overall survival (both P＜0.05). The 3-and 5-year area under the receiver operating characteristic curve values were 0.829 and 0.828 for TRM, 0.827 and 0.823 for TSM, and 0.823 and 0.822 for TNM, respectively. Harrell's C-index was also slightly higher for TRM (0.757) and TSM (0.755) than for TNM (0.751). The Akaike information criterion, Bayesian information criterion, and likelihood ratio test consistently favored TRM. In the external validation cohort, the 3-year area under the receiver operating characteristic curve values were 0.757 for TNM, 0.827 for TRM, and 0.829 for TSM, while the corresponding 5-year values were 0.650, 0.710, and 0.709. TRM showed the highest C-index overall and outperformed TNM and TSM in overall predictive performance. Calibration plots showed acceptable agreement between predicted and observed survival. Decision curve analysis indicated greater net clinical benefit for TRM and TSM than for TNM across most clinically relevant threshold probabilities, with TRM showing the most consistent overall performance.

The TRM and TSM systems, derived from LNR and LODDS, provided better prognostic discrimination and potential clinical utility than the conventional AJCC TNM staging system in colorectal cancer. External validation in a two-center cohort further supported their robustness, and TRM showed the most favorable overall performance. Further large-scale prospective multicenter studies are needed to confirm their generalizability and support clinical implementation.

This study utilized bioinformatics methods to screen out genes related to lysosomes in colorectal cancer and constructed a prognostic model.

The colorectal cancer data sets were downloaded from TCGA and GEO databases, respectively. The R package was used to screen out the differentially expressed LRGs related to CRC survival, and univariate Cox regression and LASSO regression were used to screen the related prognostic genes to construct a prognostic risk model. Univariate Cox regression analysis was used to construct a clinical prognostic model, and independent prognostic and survival analysis was performed. The performance of the model was verified by K-M survival curve and ROC curve analysis. Finally, the relationship between ATP6V1G2, DLG4, LZTS1 gene and protein expression and pathological features and prognosis of colorectal cancer was further verified by in vitro experiments.

Seven related prognostic genes were screened out, including ATP6V1G2, LZTS1, CLU, PDGFRA, CLVS2, DLG4 and RAMP1, and a prognostic model of colorectal cancer was constructed based on these genes. K-M survival curve showed that the prognosis of low-risk group was significantly better than that of high-risk group (χ²=15.14, P=0.0001), which was verified in GEO database. The ROC curve showed that the AUC values of 5-year and overall survival time were greater than 0.65 (0.67, 0.66), indicating that the model had certain predictive ability. GO enrichment analysis showed that LRGs were mainly involved in autophagy, endocytosis, macroautophagy, cell degradation and other processes, thereby affecting the occurrence, development and transformation of colorectal cancer. KEGG enrichment analysis showed that Rap1 signaling pathway, endocytosis and salivary secretion were mainly enriched. The results of in vitro experiments showed that ATP6V1G2 and DLG4 were highly expressed (ATP6V1G2: t=−6.847, P＜0.05; DLG4: t=−6.324, P＜0.05) and LZTS1 was lowly expressed (t=5.568, P＜0.05) in colorectal cancer. The high expression of ATP6V1G2 and DLG4 and low expression of LZTS1 were significantly correlated with the depth of tumor invasion (ATP6V1G2: χ²=5.333, P=0.021; DLG4: χ²=6.522, P=0.011; LZTS1: χ²=6.095, P=0.014), lymph node metastasis (ATP6V1G2: χ²=7.065, P=0.008; DLG4: χ²=5.265, P=0.022; LZTS1: χ²=5.224, P=0.022) and patient age (ATP6V1G2: χ²=4.844, P=0.028; DLG4: χ²=6.332, P=0.012; LZTS1: χ²=4.969, P=0.026). The higher the expression levels of ATP6V1G2 and DLG4, and the lower the expression level of LZTS1, the worse the prognosis of the patients will be. ROC curve showed that ATP6V1G2, DLG4 and LZTS1 alone and in combination had predictive value for the diagnosis and prognosis of colorectal cancer (ATP6V1G2: AUC=0.886, P＜0.001; DLG4: AUC=0.781, P=0.003; LZTS1: AUC: 0.667, P=0.029; Combination of the three: AUC=0.894, P＜0.001).

This study successfully constructed a prognostic model of colorectal cancer based on 7 lysosome-related genes, which can better predict the prognosis of patients. The high expression of ATP6V1G2 and DLG4 and low expression of LZTS1 can be used as potential molecular markers for poor prognosis of colorectal cancer.

To compare the efficacy of sequential neoadjuvant therapy following self-expanding metal stent (SEMS) placement versus laparoscopic surgery alone in obstructive colorectal cancer (OCRC).

A retrospective cohort study with propensity score matching (PSM) was conducted. Clinical data of 157 patients with OCRC who underwent SEMS placement at Tangdu Hospital, Air Force Medical University from February 2018 to October 2024 were collected. Patients were divided into a bridging laparoscopic surgery group (bridging group) and a sequential neoadjuvant therapy plus laparoscopic surgery group (sequential group) according to subsequent treatment strategies. After 1:2 PSM, a total of 60 patients were included, with 20 in the bridging group and 40 in the sequential group. Perioperative outcomes, tumor pathological characteristics, and survival outcomes were compared between the two groups.

The interval from stent placement to surgery was significantly longer in the sequential group (t=8.22, P＜0.05), but the postoperative hospital stay was significantly shorter (t=3.15, P＜0.05). Regarding safety and feasibility, the proportion of patients with moderate surgical risk (ASA class III) was slightly lower in the sequential group (7.5% vs. 20.0%, Z=−1.81, P＞0.05), and the rate of primary stoma creation was also lower (7.5% vs. 20.0%, χ²=0.99, P＞0.05). The two groups were comparable in terms of operative time, R0 resection rate, intraoperative blood transfusion rate, quality of surgical specimens (CME or TSME), time to first postoperative flatus, and overall incidence of postoperative complications. In terms of oncological outcomes, there was a statistically significant difference in postoperative pathological TNM staging between the two groups (Z=−2.10, P＜0.05), with a pathological complete response rate of 12.5% in the sequential group. The tumor diameter was slightly smaller in the sequential group (Z=−1.17, P＞0.05). The sequential group had a higher number of harvested lymph nodes and fewer positive lymph nodes, as well as a lower positive lymph node ratio compared to the bridging group, although these differences were not statistically significant (all P＞0.05). The disease-free survival rate was significantly better in the sequential group (χ²=4.13, P＜0.05). Although the difference in overall survival rate was not statistically significant (χ²=1.31, P＞0.05), a superior trend was observed in the sequential group.

Sequential neoadjuvant therapy following SEMS placement and laparoscopic surgery is safe and feasible for OCRC patients, facilitating postoperative recovery and improving disease-free survival.

To explore the clinical characteristics of patients with non-hereditary colorectal polyp disease and investigate the risk factors associated with polyp recurrence.

A total of 442 patients with non-hereditary colorectal polyp disease who underwent endoscopic resection from January 2021 to December 2023 were selected. Clinical data and colonoscopy monitoring results within one year post-resection were collected to analyze the influencing factors of polyp recurrence.

The mean age of patients at initial colonoscopy was (56.63±10.71) years, with 241 males (54.52%) and a BMI of (23.25±3.35) kg/m². During the 1-year follow-up, a total of 90 patients (20.36%) experienced recurrence. Compared with the non-recurrence group, the recurrence group had older age (t=2.290, P=0.023), higher BMI (t=2.550, P=0.011), higher triglyceride (TG) levels (t=2.558, P=0.011), a higher proportion of males (χ²=10.915, P=0.001), a higher proportion of smokers (χ²=9.919, P=0.002), a higher proportion of dyslipidemia (χ²=11.256, P=0.001), lower high-density lipoprotein(HDL) levels (t=2.285, P=0.023), and a higher TG/HDL (t=6.473, P＜0.001). There were significant differences between the recurrence and non-recurrence groups in the stratification of maximum polyp diameter, polyp number, and pathological type of polyps (χ²=6.345, 19.390, and 14.484; P=0.042, ＜0.001, and 0.002, respectively). The recurrence group had higher proportions of patients with a maximum polyp diameter＞15 mm, polyp number＞10, and tubulovillous adenoma. Stratified analysis showed that among patients with hyperplastic polyps, the recurrence group had higher TG levels (t=3.092, P=0.007) and TG/HDL ratio (t=4.041, P=0.001); among patients with tubulovillous adenomas, the recurrence group had higher TG levels (t=4.254, P＜0.001) and TG/HDL ratio (t=5.102, P＜0.001) and lower HDL levels (t=−2.391, P=0.020). Multivariate logistic regression analysis revealed that male sex (OR=5.426, P=0.010), smoking (OR=6.945, P=0.004), maximum polyp diameter＞15 mm (OR=7.574, P=0.013), polyp number＞10 (OR=9.152, P=0.019), and elevated TG (OR=4.444, P=0.018) were independent risk factors for polyp recurrence.

The 1 year polyp recurrence rate after endoscopic resection in patients with non hereditary colorectal polyposis was 20.36%. Male sex, smoking, a maximum polyp diameter ＞15 mm, a polyp number ＞10, and elevated TG were independent risk factors for polyp recurrence. Clinically, enhanced postoperative colonoscopic surveillance and intervention for metabolic risk factors should be implemented in patients with the above characteristics.

The treatment of colorectal cancer is frequently constrained by tumour microenvironment (TME)-mediated immune suppression and multidrug resistance. Protein degradation-targeting chimeras (PROTACs) demonstrate significant potential in targeting “undruggable” molecules by recruiting E3 ubiquitin ligases to degrade target proteins. This paper provides a systematic review of PROTAC research progress in colorectal cancer therapy, with a particular emphasis on its interaction mechanisms with the TME. It explores in depth how PROTACs inhibit tumour proliferation and overcome resistance by degrading oncogenic proteins, and how they can be combined with novel delivery systems to remodel the immunosuppressive microenvironment and enhance anti-tumour immune responses. Results indicate that PROTAC technology, leveraging its precision degradation and microenvironment remodelling advantages, offers novel avenues for overcoming current therapeutic challenges in colorectal cancer.

Acute appendicitis is one of the common causes of acute abdominal pain. In the past, the main clinical treatment for acute appendicitis was appendectomy. However, with deeper research in the function of appendix and considering issues such as residual surgical scars from surgical procedures, along with the rapid development of endoscopic technology, endoscopic retrograde appendicitis therapy (ERAT) was pioneered in 2012 by Professor Liu Bingrong's team. After more than a decade of development, ERAT technology has become quite mature and can be used to treat various types of acute appendicitis, including peri-appendiceal abscesses and appendiceal fecalith impactions. Moreover, with the advent of currently direct endoscopic retrograde appendicitis therapy（D-ERAT）, the success rate and safety of the procedure have improved, significantly reducing radiation exposure to patients and medical staff, and addressing the difficulty of performing ERAT in special patient populations such as pregnant women. This article briefly reviews the historical development of the ERAT procedure, explores the innovative treatment approach of D-ERAT, and looks forward to the future prospects of D-ERAT.

Rectal anastomotic stenosis is a common complication after rectal cancer surgery. Endoscopic balloon dilation is a commonly used clinical treatment method, which is effective for some patients, but there are still some patients who cannot meet the conditions for ileostomy reversal after multiple endoscopic balloon dilations. Magnetic surgery technology is a new clinical diagnosis and treatment technology. This article reports one case of rectal anastomotic stenosis after rectal cancer surgery treated with magnetic surgery technology, aiming to provide a new treatment method for patients with rectal anastomotic stenosis.

With the continuous advancement of minimally invasive surgical concepts and techniques, natural orifice specimen extraction surgery (NOSES) has demonstrated advantages such as minimal trauma, rapid recovery, and excellent cosmetic outcomes in colorectal cancer surgery. However, the traditional double-stapling technique is associated with a structural defect known as the "dog-ear" deformity, which may increase the risk of anastomotic leakage. This paper reports a case of total laparoscopic double-purse-string anastomosis applied in radical resection of rectal cancer. By manually placing double purse-string sutures and avoiding the use of multiple staplers, this surgical approach not only reduces the risk of anastomotic complications but also decreases the consumption of surgical consumables. The patient had an uneventful postoperative recovery without complications, confirming the feasibility and safety of this technique in laparoscopic colorectal surgery.