Natural orifice specimen extraction surgery (NOSES) has become an important part of minimally invasive surgery. Compared with other types of cancers, NOSES has the earliest initiation, fastest development, most detailed theory, and most sophisticated techniques in the application of colorectal neoplasms. To ensure the standardized development and promotion of NOSES surgery in clinical practice, the Colorectal Cancer Professional Committee of the Chinese Medical Doctor Association, the Colorectal Cancer Professional Committee of the China Anti-Cancer Association, and the China NOSES Alliance elaborated comprehensively on several aspects such as the definition, classification, nomenclature of surgical procedures, surgical principles, indications and contraindications, surgical technique practice, prevention and management of complications, clinical research, and technical standardization training based on the "Expert Consensus on NOSES Surgery for Colorectal Cancer (2019 version)."

In recent years, with the application of new targeted drugs, it has become a first-line scheme for individualized and comprehensive treatment of colorectal cancer. Colorectal Cancer Committee of Chinese Medical Doctor Association, Colorectal Cancer Professional Committee of Chinese Anti-Cancer Association, Expert Committee on Quality Control of Colorectal Cancer of Center National Cancer/National Cancer Quality Control Center organized many experts nationwide to discuss the standardized application of colorectal cancer targeted drugs.

Colorectal cancer (CRC) has the second highest incidence and the fourth highest mortality rate among malignant tumors in China. Being common metastatic site, peritoneum metastases have high incidence, are difficult to diagnose early, and have a poor prognosis. Since the diagnosis and treatment of peritoneal metastases from colorectal cancer has not formed a standardized pattern, in 2017, the Colorectal Cancer Committee of the Chinese Medical Doctor Association organized relevant authoritative experts to formulate the Chinese expert opinion on the diagnosis and treatment of colorectal cancer peritoneal metastases(2017), which played a positive role within the profession.In the past few years, more and more attention has been paid to peritoneal metastases of colorectal cancer, and a series of clinical trials have been carried out and some experiences have been accumulated.Therefore, the committee has revised the 2017 edition of the Chinese expert opinion on the diagnosis and treatment of colorectal cancer peritoneal metastases and formulated the 2022 edition of the Chinese expert consensus on the diagnosis and treatment of colorectal cancer peritoneal metastases.In order to guide and standardize the diagnosis and treatment of colorectal cancer peritoneal metastases, develop a rational and effective comprehensive treatment option, prolong the survival time and improve the quality of life of patients, and improve the overall diagnosis and treatment level of colorectal cancer in China.

Recently, natural orifice specimen extraction surgery (NOSES) have been developed rapidly in China. ″Chinese consensus of NOSES in colorectal neoplasm (2017)″ and ″International consensus of NOSES in colorectal neoplasm (2017)″ were published, which played important roles in regulating clinical practice of NOSES in China and even all over the world. However, with the improvment of NOSES, the colorectal NOSES has experienced an great progress. In this context, based on the consensus of 2017, the new verson of ″Chinese consensus of NOSES in colorectal neoplasm (2019)″ is revised and published, the theoretical and technical system of NOSES for colorectal cancer is improved in this new consensus in order to better guide clinical practice.

To explore the safety and advantages of using our new self-made transparent screw-thread anal dilator in the treatment of ultra-low rectal cancer through natural orifice specimen extraction surgery (NOSES).

Retrospective analysis of 5 cases in which patients underwent the laparoscopy combined with transanal manual anastomosis precision functional sphincter-preserving NOSES surgery (PPS) for Ultra-Low Rectal Cancer using the new screw-thread anal dilator between May 2018 to June 2018 at Gastrointestinal Surgery Department, Shanghai Tenth People's Hospital. A summary was made of the patients' operation time, intraoperative bleeding volume, length of hospital stay, complications and anal function.

The PPS for Ultra-Low Rectal Cancer was successfully completed in all 5 patients. The average operation time was (217.01±37.75) min, the average intraoperative bleeding volume was (108.32±53.15) mL, the average length of hospital stay after operation was (6.34±1.72) days, average Wexner and Vaizey scores for anal function after operation were 3 points, and no significant complications occurred after operation.

Using the new screw-thread anal dilator in the treatment of ultra-low rectal cancer through PPS has proven to be safe and effective. Incision of abdomen to extract specimen was avoided, and the surgical trauma was significantly reduced. At the same time, the lesion can be precisely resected under direct vision, with post-operative anal function being preserved and improved to a great extent, thus improving quality of life after operation. Moreover, the device is operable, economical and practical; indeed, it is worth promoting and applying in clinic. However, the above conclusions still need to be further validated by clinical studies with large sample sizes.

Nowadays, as the result of there is few evidence available for the diagnosis and treatment of appendiceal neoplasm, clinicians have not reached a consensus on it. In this case, Colorectal Cancer Committee of Chinese Medical Doctor Association organized multidisciplinary experts to develop Chinese experts consensus on multidisciplinary treatment of appendiceal neoplasms (2021 version) focusing on the issues and dispute of clinical characteristics, diagnosis, treatment and follow-up monitoring by synthesizing domestic and foreign research and clinical practice. The purpose of this consensus is to provide more detailed multidisciplinary treatment strategies for clinicians to treat appendiceal neoplasm.

Robotic minimally invasive surgery and natural orifice specimen extraction surgery (NOSES) have been important trends in the surgical modalities of colorectal tumor. NOSES performed on robotic platform, incorporating the merits of both, has drawn extensive concern from colorectal surgeons. Robotic NOSES is in the early stages of implementation. There is no consensus on standards in clinic. Consequently, an expert consensus is urgently needed for scientific and standardized guidance for robotic NOSES in colorectal tumor, which is of significant importance for the development of robotic NOSES.

Pelvic exenteration is often required for primary rectal cancer beyond totalmesorectal excision (PRC-bTME) and locally recurrent rectal cancer (LRRC). Some patients with radical resection can achieve long-term survival, but they need to face risks, such as huge surgical trauma, serious perioperative complications, permanent loss of organ function and decline in quality of life. The preoperative evaluation of PRC-bTME and LRRC should emphasize multidisciplinary collaboration, and develop individualized diagnosis and treatment strategies. The principles of function preservation in oncology surgery and risk-benefit balance should be followed, and R0 resection should be emphasized. Perioperative complications, surgical trauma and organ function loss should be minimized to achieve the best quality control and balance point. This consensus was formulated by the Colorectal Cancer Committee of the Chinese Medical Doctor Association and the Gastrointestinal Surgery Committee of China International Exchange and Promotive Association for Medical and Health Care. The draft was formed based on the summary of domestic and foreign research progress and expert experience. After discussion, review and modification by experts, a secret ballot was conducted for each major opinion, and in-depth demonstration was carried out according to the principles of evidence-based medicine. Finally, the Chinese expert consensus on the pelvic exenteration with primary rectal cancer beyond total mesorectal excision planes and locally recurrent rectal cancer (2023 edition) was formed. This consensus mainly summarizes the indications and contraindications of PE for PRC-bTME and LRRC, preoperative diagnosis and evaluation, perioperative treatment, as well as the resection scope, surgical methods, reconstruction of related organs, safety and complications of PE, postoperative follow-up and other issues, in order to provide guidance for PRC-bTME and LRRC to perform PE.

Colorectal cancer (CRC) is one of the most commonly diagnosed cancers in China and worldwide. CRC accompany with other system diseases or insufficiency, such as kidney insufficiency, liver insufficiency, hepatitis, cardiovascular disease, agedness or weakness is not uncommon. Complications may affect the treatment choices of CRC, while CRC therapies also have an effect the complications. We overviewed the effect of complications on pharmacokinetics and pharmacodynamics of drug therapy, and discussed the optimal medication for these patients.

The morbidity and mortality of colorectal cancer increaserecently in China. Peritoneal, as a common site of metastasis, is one of the typical causes of treatment failure. Although there are many kinds of peritoneal prophylactic and therapeutic drugs for peritoneal metastasis of colorectal cancer, the dose and time of action have not yet formed a standardized treatment model. In order to standardize intraoperative prophylactic and therapeutic intraperitoneal intervention methods, the experts from Professional Committee of peritoneal metastasis and Colorectal Cancer Committee of Chinese Medical Doctor Association developed "Chinese expert consensus for prophylactic and therapeutic intraperitoneal medication for peritoneal metastases from colorectal cancer". It aims at improving the overall diagnosis and treatment of colorectal cancer, extend the survival time of patients and improve the quality of life.

Intersphincteric resection (ISR) is an ultra-low sphincter- preserving operation. The completely abdominal approach to ISR has rarely been reported. This surgical procedure was successfully performed in our hospital, aiming to discuss the operation criterion.

Left hemi-colon has special bidirectional arterial blood supply, and its lymphatic drainage can drain to the superior mesenteric vessels and inferior mesenteric vessels at the same time. The blood supply of left hemi-colon depends on branch vessels of inferior mesenteric artery(IMA) and middle colic artery(MCA), and high vascular variation brings uncertainty about the dominant vessels and the direction of the main lymphatic drainage. Recently, in addition to the middle colic and left colic artery(LCA),the accessory middle colic artery (AMCA) has been recognized as a feeding artery for the left hemi-colon. Surgery for located in the left hemi-colon cancer is difficult to perform because of the complex anatomy of high vascular variation. In the radical resection of left colon cancer, adequate mobilization of the colon is particularly important to meet the sufficient resection margin and the root ligation of both sides of the blood supply vessels. The anatomical understanding of left hemi-colon vessels provides a theoretical basis for vascular management and lymph node dissection in radical resection of left hemi-colon cancer.

The liver is the most common anatomical site for hematogenous metastases of colorectal cancer, and colorectal liver metastasis is one of the most difficult and challenging situations in the treatment of colorectal cancer. In order to improve the diagnosis and comprehensive treatment in China, the Guidelines have been edited and revised for several times since 2008, including the overall evaluation, personalized treatment goals and comprehensive treatments,to prevent the occurrence of liver metastases, improve the resection rate of liver metastases and survival. The revised Guideline version 2020 includes the diagnosis and follow-up, prevention,multidisciplinary team (MDT), surgery and local ablative treatment, neoadjuvant and adjuvant therapy, and comprehensive treatment, with state-of-the-art experience and findings, detailed content, and strong operability.

To investigate the diagnostic performance of blue laser imaging (BLI) combined with JNET classification for analyzing invasive depth of colorectal lesions.

A collection of 694 cases of colorectal lesions under BLI in our hospital from August 2016 to July 2018 was performed. The imagings of lesions were analyzed to assess their pathological properties and invasive depth according to JNET classification. The pathological diagnosis of biopsy tissue was the gold standard. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy were observed.

In all lesions, there were 500 polypoid lesions and 194 superficial lesions. In all lesions, polypoid lesions and superficial lesions, the diagnostic accuracy of Type 1 was 99.1%, 99.2% and 99.0% respectively; the diagnostic accuracy of Type 2A was 80.7%, 81.4% and 78.9% respectively; the diagnostic accuracy of Type 2B was 78.0%, 78.8%, and 75.8% respectively. The diagnostic accuracy of Type 3 was 96.4%, 96.6%, and 95.9% respectively, which was similar to the diagnosis accuracy of NBI. There was no significant difference in the diagnostic accuracy between polypoid lesions and superficial lesions.

Blue laser imaging combined with JNET classification is an effective tool for judging the depth of invasion of colorectal lesions. Morphological differences in colorectal lesions are not factors that influence the application of JNET classification in colorectal lesions.