Colorectal cancer is one of the most common malignant tumors of digestive tract. In recent years, with the introduction of the concept of precision treatment and the improvement of precision diagnosis technology, scholars have gradually paid attention to Her-2 positive colorectal cancer, which accounts for about 5%, including Her-2 overexpression, ERBB2 gene amplification and mutation. At present, many studies have confirmed the feasibility of targeting Her-2 in colorectal cancer patients with overexpression or amplification of Her-2 that fail to receive standard treatment, but there is no definite and feasible treatment strategy for Her-2 mutant patients. This article reviews the progress in the diagnosis and treatment of Her-2 positive colorectal cancer in recent years.

Constipation is a common clinical symptom of digestive tract. With the change of diet structure and the improvement of living standard, the incidence rate of constipation is significantly improved. However, for slow-transit constipation(STC), which is ineffective in conservative treatment, surgery is an important treatment. For benign diseases such as constipation, it is particularly important to find a safe and effective minimally invasive surgery. This operation is a case of the fourth generation Da Vinci robotic single-incision plus one port laparoscopic total colectomy with fascia space priority approach in the treatment of slow-transit constipation, and discussed the feasibility, advantages, disadvantages and individualization of this operation.

Colorectal cancer is one of the most common malignant tumors of the digestive system in the world. Due to the unnoticeable or atypical early symptoms, colorectal cancer is often ignored or delayed in diagnosis and treatment. In recent years, non-invasive colorectal cancer screening methods based on stool specimens have been widely used at the grassroots and clinical level due to their simplicity, non-invasiveness and economic factors. Fecal occult blood test is the most important method for non-invasive screening of colorectal cancer. Other fecal screening methods still need to be further studied and validated. The combination of multiple methods of fecal screening showed better sensitivity than single methods, suggesting that multiple non-invasive screening methods can be combined to construct colorectal cancer screening models that are more accurately suited to the target population undergoing colonoscopy. This article reviews the current status and future of fecal screening methods for colorectal cancer.

Colorectal cancer is the second largest cause of cancer-related death in the world, and ranks as the third most common malignant tumor in the world. Approximately 25% of patients present with colorectal liver metastases(CRLM) at first diagnosis, and surgical treatment is often considered necessary for the potential long-term survival of patients with CRLM. The median overall survival (OS) of patients who achieved R0 resection in CRLM was 42 months, and the 5-year survival rate was 35%~40%. The initial resectable rate is less than 20%. Therefore, surgical resection of initial unresectable CRLM after conversion therapy will significantly improve the prognosis of patients with CRLM. In this review, we introduce the latest literature on initial unresectable CRLM conversion therapy,and discuss the advances in diagnosis, treatment methods and therapeutic effects, so as to guide clinical practice.

Perianal necrotizing fasciitis (PNF) is a special type of infection that typically involves mixing infection with a variety of bacteria, including anaerobic and aerobic bacteria. PNF infection can spread along the superficial fascia of the perianal and perineum, up to the abdominal wall and down to the lower extremities. Meanwhile, the infection may also spread deep to the pelvic extraperitoneal space such as the superior levator anal space, the peribladder space, the retrorectal space, and even further spread to the retroperitoneal space. These infections often spread along the fascia, the fascial space, and can also spread along the vascular and nerve crossing foramen. Although the current medical level has been greatly improved and developed, clinicians still face great challenges in the diagnosis and treatment of perianal necrotizing fasciitis. The purpose of this study was to retrospectively analyze the anatomical knowledge of perianal perineum, pelvic cavity, retroperitoneal fascia and space, as well as the infection spread and dissemination route of PNF through gross anatomical data, case data and previous literature, in order to provide reference for the diagnosis and surgical treatment of PNF.

After years of comparative studies, high ligature of the inferior mesenteric artery (IMA) remains one of the routine methods in radical surgery for sigmoid and rectal cancer, offering certain advantages in several aspects. However, the collateral blood flow pathway of descengding and sigmoid colon after high ligature, in the past, has been limited to theoretical concepts such as the marginal artery and the Riolan arch (with scarce visual research reports on the specific morphology of the postoperative Riolan arch). In the past five years, we have dedicated ourselves to researching the computerized tomography angiography (CTA)imaging method of small blood vessels and have discovered the evolutionary process of the "Riolan arch" (indicated by quotation marks to borrow this concept). Furthermore, we have introduced principles of fluid dynamics to provide an explanation. Subsequently, the findings were validated through preoperative and postoperative comparative studies. This paper combines existing literature to elucidate research perspectives in this area, serving as a reference for further studies. It is hoped that more individuals will engage in deeper research and this work will contribute to the understanding attention point of specific operative procedures.

To determine the utility of cell free ferrous protoporphyrin(FH) substance detection and colorectal epithelial cell reactive oxygen species (ROS) for colorectal cancer screening.

At the Gastrointestinal Endoscopy Center of Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, 220 patients underwent colonoscopies between September 2021 and January 2022. Each patient also received colonoscopic histopathological biopsy, ROS, and FH kits. To determine the efficacy of ROS and FH for colorectal cancer screening, the Kappa test was used.

Among the 220 patients with pathological results, twenty samples were from colorectal cancer patients and 200 samples were from non-colorectal cancer patients. In colorectal cancer patients, the sensitivities of ROS and FH assays were 95% and 100%, respectively; the specificities were 99% and 69%, respectively; and the Kappa values were 0.919 and 0.288, respectively (both P＜0.001).

The results of ROS detection are in high agreement with the pathological results of colorectal cancer, and the ROS and FH of colorectal epithelial cells have high sensitivity and specificity.

According to the expert consensus of the radioactive rectal injury (2021 edition), the clinical characteristics of different clinical types of patients with radiation-induced late rectal injury (RLRI) were described, the differences in complications among different clinical types were analyzed, and the clinical treatment methods and therapeutic effects of different types of patients were compared.

The clinical data of 85 patients with RLRI who were hospitalized in the Department of Colorectal and Anal Surgery of the Sixth Affiliated Hospital of Sun Yat-sen University from January 2020 to December 2020 were retrospectively summarized. The differences of clinical data characteristics, treatment methods, treatment effects, complications (including fistula, stenosis, obstruction, perforation, etc.) among different clinical types were analyzed.

Among 85 patients with RLRI, there were 29 cases of telangiectasia, twelve cases of ulceration, four cases of stenosis and 40 cases of mixed. There were statistical differences in age, BMI, RTOG/EORTC score, VRS score and serum albumin in patients with different clinical types of RLRI (P<0.05). The complications of different clinical types were significantly different (Z=-5.066, P< 0.001). There was no significant difference in treatments and therapeutic effect among different clinical types (χ²=3.021, P=0.388; χ²=0.299, P=0.861).

Clinical data such as age, BMI, albumin, RTOG/EORTC score and VRS score were different in patients with RLRI of different types, and patients with clinical classification of telangiectasia had a higher probability of complications, suggesting the importance of early intervention and personalized step-up treatment, which is worthy of reference by clinicians in the diagnosis and treatment process.

To construct a nomogram to predict the 1-,3- and 5-year overall survival (OS) of colorectal cancer liver metastases(CRLM) patients, and to validate the prediction efficiency and clinical benefit of the model.

The clinical data of 113 colorectal liver metastasis patients who underwent resection of liver metastases in the Affiliated Hospital of Qingdao University from January 2008 to January 2022 were retrospectively analyzed. Using R software to implement random sampling, ninty-one patients (4/5) were selected as the training group, and the remaining 22 patients (1/5) were selected as the validation group. In the training group, use the multivariate Cox stepwise regression analysis to select 10 risk factors in the best survival prediction model. A nomogram for predicting 1-,3-and 5-year OS was established based on these risk factors. The nomogram's prediction efficiency was evaluated by concordance index (C-index), receiver operating characteristic curve (ROC) and calibration curve. The clinical benefit and application value of the model were evaluated by clinical decision curve analysis.

The results of multiple COX stepwise regression analysis based on training group showed that: age, BMI, the primary tumor histological grade, preoperative plasma CEA level, preoperative neutrophils-lymphocyte ratio (NLR), surgical margin, measured blood loss, postoperative targeted therapy, CRS score and postoperative recurrence and metastasis were the best risk factors for predicting the prognosis of CRLM patients. A nomogram was established and validated based on the risk factors. The C-index of OS in training and validation groups were 0.742(95%CI: 0.652~0.832) and 0.653(95%CI: 0.423~0.883). The average area under the curve (AUC) of ROC curves of 1-,3- and 5-year OS in the training and validation groups were all more than 0.7. Calibration curves also showed an excellent agreement between actual survival and nomogram predictive survival. The clinical decision curve analysis showed that model can bring higher clinical benefit.

The established nomogram can accurately predict the 1-,3-and 5-year OS of CRLM patients after operation. It may be helpful for clinical oncologists to evaluate the prognosis of CRLM patients and optimize diagnosis and treatment plan.

To investigate the application value of near-infrared fluorescence angiography based on epiplogram in the prevention of anastomotic leakage (AL) after laparoscopic intersphincteric resection (ISR) for ultra-low rectal cancer.

We retrospectively collected a total of 505 patients with ultra-low rectal cancer after ISR surgery, including 90 patients with fluorescence angiography of epiploic appendages (FAEA). Perfusion assessment and transection line of the bowel was analyzed by FAEA in the monochrome fluorescence mode. After matching with 1:2 ratio, the FAEA group (n=73) and control group (n=135) were well balanced. The primary endpoint was the incidence of anastomotic leak within 6 months.

The incidence of anastomotic leakage in FAEA group was lower (2.7% vs. 11.1%, P=0.035) than control group. Logistic regression analysis showed that male (OR=2.650, 95%CI=1.156~6.076, P=0.021), neoadjuvant chemoradiotherapy (OR=6.795, 95%CI=3.141~14.699, P＜0.001) and tumor distance to the anus ≤4 cm (OR=4.754, 95%CI=1.611~12.987, P=0.004) were independent risk factors of AL. LCA retention (OR=0.460, 95%CI=0.227~0.929, P=0.030), ileostomy (OR=0.198, 95%CI=0.083~0.474, P=0.004) and FAEA (OR=0.252, 95%CI=0.071~0.900,P=0.034) were independent protective factors for AL. FAEA significantly shortened postoperative hospital stay [9(6~12) vs. 10 (8~13), P=0.008].

Perfusion assessment by FAEA can be used as an effective way to prevent the complications of anastomotic leakage after laparoscopic intersphincteric resection.