Pseudomyxoma peritonei (PMP) is a rare and highly heterogeneous clinicopathological syndrome, characterized primarily by the dissemination and implantation of mucin-secreting tumor cells within the abdominal cavity, along with the progressive accumulation of mucinous ascites. It most commonly arises as a complication of appendiceal mucinous tumors. In its early stages, the disease often progresses insidiously, typically presenting with abdominal distension and pain as initial clinical manifestations. Currently, cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) is considered the standard treatment for PMP. However, this therapeutic approach is associated with considerable surgical trauma and a high risk of postoperative complications. In the treatment of PMP, the central challenge lies in attaining effective CRS while simultaneously minimizing the risk of surgical complications.

Ileostomy is widely used in sphincter-preserving surgery for low rectal cancer. It can serve not only as a temporary protective measure for low rectal anastomosis surgery, but also as a permanent treatment. In recent years, advances in laparoscopic technology (Da Vinci robot/3D) and the concept of mesenteric anatomy have significantly increased the sphincter-preserving rate for low and ultra-low rectal cancer; however, the incidence of anastomotic leakage has not decreased. To prevent the occurrence of leakage after low rectal anastomosis and reduce the severity of complications caused by anastomotic leakage, prophylactic ileostomy is clinically performed during the surgical procedure. Despite continuous improvements in surgical techniques and stoma care, short-term and long-term complications associated with ileostomy, as well as the resulting psychosocial barriers, remain common. Therefore, we need to take effective measures during the perioperative period to reduce the risk and severity of stoma-related complications. For complications that have already occurred, we should actively adopt effective treatment measures, strengthen technical guidance and psychological counseling for stoma patients, and ultimately improve the patients’ prognosis and postoperative quality of life.

To analyze the current clinical application status of natural orifice specimen extraction surgery (NOSES) in China, providing important reference for its standardized and scientific promotion.

A WeChat-based questionnaire survey was conducted among physicians specializing in general surgery, oncological surgery, gynecology, and urology across China. The survey covered physician demographics, NOSES implementation status, challenges encountered, and the current state of NOSES technical training and research.

The survey covered 31 provinces, autonomous regions, and municipalities in China, yielding 1 710 valid responses. Among respondents, 1 166 (68.2%) performed NOSES procedures, while 544 (31.8%) did not. A total of 854 hospitals performed NOSES procedures, conducting 120 835 cases. By specialty: colorectal tumors (86 430 cases, 71%); gastric tumors (11 574 cases, 10%); gynecological tumors (5 612 cases, 5%); other benign conditions (17 219 cases, 14%). By specimen retrieval route: 95 553 cases (79.1%) via the anus, 23 383 cases (19.4%) via the vagina, and 1 375 cases (1.1%) via anterior rectal wall incision. By proportion of NOSES procedures among similar surgeries, 478 hospitals performed NOSES procedures accounting for less than 10% of similar surgeries, 317 hospitals performed them between 10% and 20%, and 59 hospitals performed them at over 20%. The survey revealed that most physicians primarily encountered NOSES techniques through large academic conferences (53%). Training methods predominantly involved attending workshops (42%) and watching live surgical demonstrations by experts (38%). 88% of surgeons who have performed NOSES believed that their assistants should receive training in NOSES techniques at experienced centers, while 92% of those who have not performed NOSES agreed that they themselves need to undergo such training. 50.3% of surgeons who have performed NOSES held the view that their assistants can be authorized to independently perform the procedure after completing 10~20 cases of hands-on training, and 55.3% of those who have not performed NOSES believed that they can independently carry out the procedure after such training. 290 individuals conducted NOSES-related research projects, with 212 publishing Chinese papers and 125 publishing English papers. Database data uploads (67 individuals) increased by 42.86%, 26.19%, 50.60%, and 131.03% respectively compared to previous periods. 83.2% and 82.7% of hospitals support their institutions and physicians in performing NOSES procedures, with 99.5% of treated patients expressing high satisfaction with NOSES outcomes.

NOSES surgery has gained widespread attention and experienced rapid growth in China, with over 120 000 procedures performed across disciplines including colorectal, gastric, gynecological, hepatobiliary, and urological surgery. It has generated positive impacts at the hospital, physician, and patient levels. In recent years, young and middle-aged physicians have become the main force performing NOSES procedures; primary-care physicians outside tertiary hospitals have acquired the capability to routinely perform NOSES surgery; major academic conferences have increased awareness of NOSES procedures, with surgical demonstrations and training workshops driving its dissemination. Training at accredited centers remains the most efficient pathway for young physicians to master the technique. Currently, NOSES-related research articles and projects continue to increase, with clinical studies gradually emerging to provide higher-level evidence-based support for the technique.

To compare the short-term clinical efficacy of the three-arm and four-arm Da Vinci robotic surgical systems in radical resection of sigmoid colon cancer and mid-high rectal cancer, so as to provide reference for clinical application.

A retrospective cohort study was conducted. The clinical data of patients who underwent sigmoid colon or mid-high rectal cancer surgery using the three-arm or four-arm Da Vinci robotic surgical system in the Department of Colorectal Oncological Surgery, the Second Affiliated Hospital of Harbin Medical University from January 2019 to February 2025 were collected. The patients were grouped according to the surgical methods. There were 118 cases in the three-arm group and 87 cases in the four-arm group. The preoperative general data, surgery-related indicators, pathological results, postoperative recovery, complications, and treatment costs of the two groups of patients were compared and analyzed. The differences in short-term clinical efficacy were evaluated through statistical methods.

There were no significant differences in the data such as age (t=−1.376, P=0.985), gender composition (χ²=0.624, P=0.430), body mass index (t=1.192, P=0.392), tumor location (χ²=0.673, P=0.412), maximum tumor diameter (t=0.364, P=0.547), and comprehensive TNM staging of the tumor (χ²=0.639, P=0.726) between the two groups of patients. In terms of surgery-related indicators, the operation time of the four-arm group was shorter than that of the three-arm group (t=4.859, P=0.004), the intraoperative blood loss was less (t=3.191, P<0.01), the time to first postoperative exhaust was earlier (t=8.742, P=0.040), and the time to first intake of liquid food after surgery was earlier (t=4.340, P=0.038). In terms of pathological features, there were no statistically significant differences between the two groups in the gross type of the tumor (χ²=0.019, P=0.891), histological type (χ²=0.891, P=0.345), degree of differentiation (χ²=0.993, P=0.609), number of lymph nodes detected (t=1.455, P=0.367), nerve invasion (χ²=2.371, P=0.124), vascular invasion (χ²=0.013, P=0.910), lymphatic vessel invasion (χ²=0.118, P=0.731), circumferential resection margin of tumor (P=1.000), and the upper and lower tumor resection margins (P=1.000). There were no significant differences in the postoperative hospital stay (t=0.182, P=0.534), treatment costs (t=−0.367, P=0.713), and the occurrence of complications (all P>0.05) between the two groups of patients. All patients achieved R0 resection.

Compared with the three-arm Da Vinci system, the four-arm Da Vinci system shows better operation efficiency and advantages in postoperative recovery in colorectal cancer surgery, and does not affect the radical resection of the tumor, which is worthy of clinical promotion.

Comparison of short-term efficacy between domestic robot and laparoscope in patients undergoing radical resection for rectal cancer.

A retrospective analysis was conducted on the clinical data of rectal cancer patients who underwent radical resection of rectal cancer in the Department of Colorectal Oncology, the Second Affiliated Hospital of Harbin Medical University. A total of 476 patients were enrolled in the study, including 50 cases in the domestic robot group (Group K) and 426 cases in the laparoscopic group (Group L). After propensity score matching (PSM), there were 39 cases in Group K and 114 cases in Group L. Group K used the KD-SR-01 surgical robot system, while Group L used the traditional laparoscopic system. The postoperative complications and other postoperative - related outcomes were compared between the two groups.

All patients underwent successful surgery, with no conversion to open surgery or palliative surgery, resulting in a 100% surgical success rate. Compared with Group L, Group K showed a lower incidence of postoperative complications (χ²=3.959, P=0.047), less intraoperative blood loss (Z=−5.155, P<0.001), and a shorter time to first postoperative flatus (Z=−5.692, P<0.001). The NASA-TLX score indicated that Group K was significantly superior to Group L in terms of the surgeon’s subjective physical demand (Z=−3.25, P=0.001). On the first postoperative day, the neutrophil count in Group K was significantly lower than that in Group L (t=−2.07, P=0.04). On the fifth postoperative day, both the white blood cell count and neutrophil count in Group K were significantly lower than those in Group L (white blood cell count: t=−4.57, P<0.001; neutrophil count: t=−5.32, P<0.001). Meanwhile, among obese/overweight patients, Group K had a lower incidence of postoperative complications, less intraoperative blood loss, and a shorter time to first postoperative flatus compared with Group L. In terms of postoperative pathology, the two groups showed similar results in all indicators except that Group K had more lymphovascular invasion (χ²=6.12, P=0.013).

Compared with laparoscopy, the application of domestic surgical robot in the short-term efficacy after radical resection for rectal cancer patients shows lower incidence of complications, less intraoperative blood loss, faster postoperative flatus, lower postoperative inflammatory levels, and less physical consumption for surgeons. For overweight and obese rectal cancer patients, the domestic surgical robot also provides lower incidence of postoperative complications, less blood loss, and faster time to first flatus

To investigate the effect of exosomes secreted by microsatellite stability(MSS) colorectal cancer cells after radiotherapy on the function of CD8⁺T cells and to explore the underlying mechanisms.

CT-26 cells were treated with 0 Gy, 10 Gy, and 20 Gy radiation doses, and cell viability was assessed using the CCK-8 assay, while apoptosis was measured by flow cytometry to determine the optimal radiation dose. Exosomes were isolated by ultracentrifugation and characterized by transmission electron microscopy and Western blot. CD8⁺T cells were cultured alone (control group) or co-cultured with exosomes (experimental group), followed by functional analysis via flow cytometry. Exosomal transcriptomic and metabolomic approaches were employed to investigate the impact of radiotherapy on the composition of CT-26 derived exosomes.

A 10 Gy radiation dose did not significantly affect the proliferation of CT-26 cells. Radiation did not significantly alter the morphology or secretion quantity of exosomes released by CT-26 cells, but it modified the proportions of some non-coding RNAs and the composition of metabolites within the exosomes. Differential metabolite enrichment analysis revealed that the altered metabolites in exosomes from irradiated CT-26 cells were primarily enriched in immune-related metabolic pathways such as neuroactive ligand-receptor interaction, serotonergic synapse, retinoic acid metabolism, and sphingolipid metabolism. Compared to the blank group, CT-26 exosomes (control group) suppressed CD8⁺T cell function (blank group vs. control group: CD44⁺CD8⁺T cells: 60.720±3.529 vs. 42.640±2.378, t=9.501, P<0.001; IFN-γ⁺CD8⁺T cells: 2.362±0.418 vs. 1.632±0.198, t=3.532, P=0.008). However, exosomes from irradiated CT-26 cells reversed this suppression, restoring CD8⁺T cell function to a level close to that of the blank group (radiation group vs. control group: CD44⁺CD8⁺T cells: 61.720±3.891 vs. 42.640±2.378, t=9.357, P<0.001; IFN-γ⁺CD8⁺T cells: 2.512±0.469 vs. 1.632±0.198, t=3.858, P=0.010).

Radiotherapy can reprogram the metabolism of exosomes derived from MSS colorectal cancer cells, thereby activating the anti-tumor immune function of CD8⁺T cells.

To investigate the relationship between the phenotypic characteristics of CD8⁺ exhausted T cells (CD8⁺Tex) in the tumor microenvironment before immune checkpoint blockage (ICB) therapy and pathological complete response in colorectal cancer patients.

Tumor samples from 20 colorectal cancer patients treated with ICB before treatment were analyzed using public single-cell database (GSE236581). The proportion of CD8⁺Tex subgroups, terminal exhaustion scores, tumor-specific scores, and T cell receptor(TCR) diversity were compared between patients with pathological complete response and those without complete response.

The proportion of CD8⁺Tex in the pathological complete response group was significantly higher than in the pathological non-complete response group (χ²=935.45, P<0.05). In addition, the terminal exhaustion score and tumor-specific score were higher in the pathological complete response group than in the non-complete response group (t=7.53, P<0.05; t=10.13, P<0.05), and this phenomenon was independently observed in both dMMR and pMMR subgroups. Lastly, the TCR diversity of CD8⁺Tex cells in the pathological complete response group was significantly higher (t=3.65, P<0.05), and dMMR patients had higher diversity than pMMR patients.

A high proportion, high terminal exhaustion status, and high TCR diversity of CD8⁺Tex cells in tumors before treatment are key markers for predicting ICB efficacy, independent of MSI status. This finding provides new evidence for extending ICB therapy to pMMR patients.

Colorectal cancer is one of the most common malignant tumors worldwide, with surgical resection remaining the cornerstone of curative treatment. Although laparoscopic surgery has significantly advanced the development of minimally invasive treatments, the traditional abdominal wall-assisted incision still carries risks of postoperative pain, incisional hernia, and infection. Against this backdrop, natural orifice specimen extraction surgery (NOSES), which eliminates the need for abdominal wall incisions, has emerged as a research focal focus in colorectal cancer surgery. Through systematic exploration and technological innovation led by Chinese scholars such as professor Wang Xishan, NOSES in China has transitioned from its nascent phase to a relatively mature stage, significantly improving postoperative quality of life for patients. However, this surgical approach still faces two critical challenges: aseptic and tumor-free safety. This review aims to systematically summarize the research progress on aseptic and tumor-free issues in NOSES for colorectal cancer, integrates global technical practice variations and innovations in intelligent assistive devices, and proposes strategies for technical standardization and clinical translation.

The pathogenesis of colorectal cancer is closely linked to immune regulation within the tumor microenvironment (TME). In this complex setting, neutrophils, as key components of the innate immune system, exhibit remarkable heterogeneity and functional plasticity. Recent studies have demonstrated that tumor-associated neutrophils (TANs) play a dual role in inflammation-driven tumorigenesis, angiogenesis, immune suppression, and the formation of a metastatic microenvironment in colorectal cancer, primarily through the release of cytokines, proteases, and reactive oxygen species (ROS), as well as the formation of neutrophil extracellular traps (NETs). Their specific functions are not a simple "either-or" dichotomy but rather represent a functional continuum dynamically shaped by intricate signaling networks within the TME. This article provides a systematic review of the molecular regulatory networks, clinical relevance, and therapeutic potential of TANs in the initiation and progression of colorectal cancer. Furthermore, we conclude that future research should focus on elucidating the characteristics of different TAN subsets, the mechanisms underlying their functional polarization, and how targeted interventions can improve the prognosis of colorectal cancer patients, thereby offering novel strategies and references for the clinical prevention and treatment of this disease.

To investigate the application value of transanal assistance in laparoscopic transabdominal intersphincteric resection (ISR) sphincter-preserving surgery for low rectal cancer.

A retrospective analysis of clinical data from 37 patients with cT1~T2 low rectal cancer who underwent transanal assistance in laparoscopic transabdominal ISR at He’nan Provincial People’s Hospital between February 2023 and February 2025. During surgery, the assistant used the self-made anal lifter and anal pusher to assist the primary surgeon in dissecting the distal rectum to achieve subtotal or total ISR, reconstructing the digestive tract, or reinforcing the anastomosis. Baseline characteristics, postoperative pathology, postoperative complications, and tumor recurrence or metastasis during follow-up were collected and analyzed.

All 37 patients successfully underwent ISR sphincter-preserving surgery without prophylactic stoma creation, conversion to open surgery, or change in surgical approach. The mean operative time was (198.38±30.48) min, with a median intraoperative blood loss of 100 (50~250) mL. All patients achieved R0 resection, with a mean number of lymph nodes removed of (19.51±3.62). The mean postoperative hospital stay was (10.32±2.31) days. No tumor cells were detected in the cytological examination of the peritoneal lavage fluid. No anastomotic leaks or perioperative deaths occurred. All patients underwent postoperative follow-up with a median duration of 10 (6~18) months. No tumor recurrence or metastasis was observed during follow-up.

The application of transanal assistance in laparoscopic transabdominal ISR sphincter-preserving surgery for low rectal cancer is safe and feasible.

To explore the surgical methods and experiences and lessons in perioperative management of radiation-induced enteropathy.

A retrospective review of data from 12 patients with chronic radiation-induced intestinal injury who underwent surgical treatment at the First Hospital of Shanxi Medical University from January 2024 to April 2025. Four patients underwent simple ileostom. Eight patients had resection of the responsible lesion, including 4 modified Bacon procedures, one Parks procedure, one Dixon procedure, and 2 total pelvic reconstructions due to concurrent bladder fistula.

Among the 8 patients who underwent resection, one died due to empty pelvis syndrome; one had intestinal retraction leading to a stoma that could not be reduced; three had their stomas reduced, with anal function pending observation; two stomas awaited reduction; additionally, four patients currently had ileostomies with the lesion pending resection.

Resection of the responsible lesion can cure radiation-induced rectal injury, significantly alleviating clinical symptoms and improving the quality of life for patients. However, perioperative management is challenging and complications are numerous, making the compilation of clinical experiences and lessons regarding this condition necessary.

Natural orifice specimen extraction surgery(NOSES) for colorectal cancer has now been widely recognized and applied by colorectal surgeons. One key technique in digestive tract reconstruction during this procedure is the methods that place and fix the anvil of the circular stapler into the proximal colon segment. This article reports and analyzes two cases report of NOSES for colorectal tumors in which anvils were placed with magnetic traction, and discusses the feasibility, advantages and precautions of this method based on the author’s experience, with the aim of providing a new method for the placement of anvil in NOSES for colorectal tumors and promoting its application.

With social and economic development, the demand for sphincter-preserving procedures among patients with low rectal tumors has been increasingly growing. As a type of sphincter-preserving reconstruction for low rectal tumors, the modified Bacon procedure has gained increasing attention from clinicians due to its advantages: after transanal transection, the proximal rectum and specimen are exteriorized through the anus, with the externalized bowel segment resected in the second stage; no prophylactic stoma is required; no additional abdominal auxiliary incision is needed; and the technique is simple and safe. With the rising number of patients opting for sphincter preservation, more institutions have adopted this procedure in recent years. This article presents a video case of a modified Bacon procedure for low rectal cancer using electrosurgical instruments, and discusses the insights into the application of such devices, the indications for this technique, key procedural points, and postoperative considerations.