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??Further discussion on the clinical problems of "breast hyperplasia" WANG Fei??YU Zhi-gang. Department of Breast Surgery, the Second Hospital of Shandong University, Jinan 250033,China
Corresponding author: YU Zhi-gang, E-mail:yzg@medmail.com.cn
Abstract Breast hyperplasia is one of the most common female benign breast diseases in clinical practice, and it has a wide range of clinical manifestation and pathological changes. Currently, there are a lot of controversies as to the definition, classification, diagnosis and treatment of breast hyperplasia. Because of the complicated pathological changes and inconsistent prognosis, breast hyperplasia should be more often considered as a group of diseases rather than a single disease. However, considering the absolute and objective risk of concomitant or subsequent breast cancer, comprehensive assessment of clinical history, physical examination, imaging tests and possible biopsy should be recommended, and subsequent treatment should be classified. Based on multidisciplinary cooperation including breast clinicians, radiologists and pathologists, surgeons should pay more attention to the screening of patients who need clinical intervention especially surgical intervention.     

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??Reports of plenary session from the 89th Annual Meeting of the Japanese Gastric Cancer Association LIANG Han. Department of Gastrointestinal Oncological Surgery, Tianjin Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laborary of Cancer Prevention and Therapy, Tianjin 300060, China
Abstract According to the Japanese gastric cancer treatment guidelines, the 5th edition, splenectomy is not recommended to the standard D2 procedure for proximal gastric cancer that does not invade the greater curvature. Bursectormy is not recommended as a standard treatment for cT3/4 gastric cancer. “Surgery first followed by chemotherapy” strategy is not recommended but chemotherapy first can be a choice for patients with stage IV gastric cancer. Absolute indication for standard EMR/ESD is expanded for early gastric cancer. Oxaliplatin and Ramucirumab are approved for chemotherapy and target therapy for gastric cancer. The indication of Capecitabine and oxaliplatin to perioperative chemotherapy is expanded. 30-40 clinical questions were selected and best possible answers after discuss are be done. Based on IGCA TNM Project, the 15th Japanese and 8th UICC/AJCC Classification are integrated and for the first time, it has international view. According to the 15th Japanese Classification of Gastric Carcinoma, No.6 lymph nodes are redefined as No.6a, No.6v and No.6i. Revision of macroscopic peritoneal metastasis (P1) has been made. According to the metastasis extent, P1 is divided into P1a, P1b and P1c. In case with duodenal invasion of gastric cancer, if No.13 lymph nodes metastasis is present, such metastasis is considered to be regional but not M1. R concept is not suitable in endoscopic resection. The definition of EGJ cancer is depended on the endoscopic findings, upper gastrointestinal series and pathological study. The criteria of pathological response rate is modified and the 10% of residual tumors cutoff is defined.     

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??The focus of The 88th Annual Meeting of Japanese Gastric Cancer Association LIANG Han. Department of Gastric Cancer, National Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Prevention and Treatment, Cancer Hospital, Tianjin Medical University, Tianjin 300060, China
Abstract The revised parts of The Fifteenth Edition of Japanese Gastric Cancer Treatment Guidelines are focus on No.6 Node, peritoneal metastasis (P1) and principle of duodenal invasion. No.6 nodes are divided into three subgroup and named No.6a, No.6v and No.6i. P1 is divided into P1a, P1b, P1c and P1x. Thirteen studies about laparoscopic surgery, neoadjuvant chemotherapy, adjuvant chemotherapy, perioperative radiochemotherapy, HIPC and anti-angiogenesis among the global important clinical trials of gastric cancer are from China. The UICC/AJCC TNM project have been collected 25411 cases with follow-up data from 17 counties worldwide. The result suggests that stage ?? should be proper revised in the 8th Edition. The conversion therapy for local advanced disease has obtained outstanding results. The follow-up data of PHOENIX study will be published in soon after and it will be evidence for new guidelines for the treatment of peritoneal metastasis.     

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??Reports from the 90th Annual Meeting of the Japanese Gastric Cancer Association LIANG Han. Department of Gastrointestinal Oncological Surgery, Tianjin Cancer Hospital, Tianjin Medical University, National Clinical Research Center for Cancer, Key Laborary of Cancer Prevention and Therapy, Tianjin 300060, China
Abstract According to the 15th Japanese Classification of Gastric Carcinoma??No.6 lymph nodes are redefined as No.6a??No.6v and No.6i. Revision of macroscopic peritoneal metastasis ??P1?? has been made according to the metastasis extent??P1 is divided into P1a??P1b and P1c. In case with duodenal invasion of gastric cancer??if No.13 lymph nodes metastasis is present??such metastasis is considered to be regional but not M1. No.14v re-defined as regional node??but it is not recommended including to the D2 dissection. EGJ was re-defined and the definition of EGJ cancer is depended on the endoscopic findings??upper gastrointestinal series and pathological study. In the Japanese gastric cancer treatment guidelines??the 5th edition??26 clinical questions were collected the final recommendations were made by the Guideline Committee. Palliative gastrectomy plus chemotherapy is not recommended as a treatment for advanced gastric cancer. Splenectomy is not recommended to the standard D2 procedure for proximal gastric cancer that does not invade the greater curvature. Bursectormy is not recommended as a standard treatment for cT3/4 gastric cancer. The indication for laparoscopy-assisted gastrectomy is extended. Neu-adjuvant chemotherapy plus extended lymphadenectomy or co-resection are recommended for the selected patients.     

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??The clinical application of “embeddedness-like” pancreaticojunostomy on the pancreaticoduodenectomy??An analysis of 150 cases LÜ Yang, ZHANG Lei, LI Jian-ang, et al. Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China
Corresponding author: XU Xue-feng,E-mail:xuefengxu87@aliyun.com
Abstract Objective To investigate the effect of “embeddedness-like” pancreaticojunostomy on the incidence of major complications (pancreatic fistula, biliary fistula and delayed gastric emptying) after pancreatoduodenectomy (PD). Methods The data of 150 cases of PD admitted from August 2013 to December 2015 in Zhongshan Hospital, Fudan University were analyzed. All surgeries were performed "embeddedness-like" pancreaticojunostomy. The general information, disease status, and the occurrence rate of postoperative complications (including postoperative pancreatic fistula, biliary leakage, delayed gastric emptying, bleeding and death) within 30 days after the surgery were observed. Results Among 150 cases, there were 30 cases had postoperative pancreatic fistula (POPF) (20%), the proportion of Grade A, B and C was 14.7% (n=22), 5.3% (n=8) and 0, respectively. A total of 2% (n=3) of the cases had the biliary fistula and 3.3% (n=5) appeared delayed gastric emptying (DGE). Furthermore, no postoperative bleeding and operative deaths occurred. Conclusion The application of the “embeddedness-like” pancreaticojunostomy is safe and effective in pancreaticoduodenectomy, and could validly reduce the incidence of POPF and bleeding.     

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近年来,胃癌的治疗策略发生了很大的变化,多学科的参与使胃癌的疗效得到很大的提高。其中,内镜治疗、腹腔镜手术、术前新辅助化疗及姑息性手术等新的治疗手段,既延长病人生命,也改善了病人的生存质量。作者通过对"2014年韩国国际胃癌周"最新动态的介绍及评述,介绍当前胃癌治疗的热点问题,以期为我国的胃癌治疗与研究提出新的参考与思路。     

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为了达到既治疗十二指肠球部巨大溃疡，又克服传统B-Ⅱ胃大部切除术远期并发症发生率高的目的，我们在开展改良B-I“幽门再造”式胃大部切除术(BIG)实验研究成功的基础上[1]，于1990年8月应用于临床，至1999年12月共为39例十二指肠球部巨大溃疡病人实施了该术式，临床经过及随访结果表明，效果满意。     

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??Explanation of the 7 clinical questions in Japanese gastric cancer treatment guidelines——the 4th edition 2014 CHEN Jun-qing. Department of Surgical Oncology, the First Affiliated Hospital of China Medical University, Shenyang 110001, China
Abstract Japanese gastric cancer treatment guide lines -the 4th Edition has proposed a solution for 3 kinds of patients with resectable M1 disease and without any other non-curative factors. They are scheduled to receive combined treatment -operation and chemotherapy. For example, patients who are scheduled to receive gastrectomy with extended lymphadenectomy (No.16a2??b1). Patients with CY1 disease, who are proposed to receive radical resection as routines, have achieved better results, combined with paraoperational chemotherapy. Patients with a small number of liver metastases are recommended with surgical therapy combined with systemic treatment. The guide provided effective treatments, which deserve attention, considered for patients with four kinds of advanced gastric cancer that are not applicable to standard chemotherapy.     

“保胆”理念正误

胆囊切除术是公认的胆囊良性疾病的治愈手段，国内外学术界对于手术适应证和手术时机已有明确共识。近年来，“保胆手术”治疗胆囊良性疾病颇受热议，一些医生将“保护胆囊”的学术观点等同于“保留胆囊”的手术技术，这种误解可能导致病人出现差异性的预后。因此，临床医师应明晰“保护胆囊”理念与“保胆手术”的差别，对胆囊良性疾病的诊疗原则有正确的理解和应用。     

“胰腺影像检查”基本知识

影像学检查已成为诊断胰腺疾病的主要手段,本文着重探讨胰腺影像检查的基本知识：①检查选择：每种检查都有其自身特点,根据病情,适时选择合适的成像技术是准确诊断胰腺疾病的前提;②读片要点：从直接征象、间接征象、胰外病变和演变规律四方面入手,全面认识胰腺疾病的大体形态和生物学特性;③检查原则：循序渐进、逐渐深入、仔细分析、逐步确诊;④常见失误：一锤定音,仓促诊治。     

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??The new era of precision medicine: what should surgeons do? GU Jin. Beijing Cancer Hospital, Beijing100142, China
Abstract Imperceptibly, we have entered an era of precision medicine. First of all, surgeons should know what is precision medicine? Surgeons hope to distinguish precision medicine and individualized therapy. Secondly??surgeons should learn how to use precision medical to guide clinical practice. Furthermore, surgeons must realize the limitations of precision medicine. Finally, surgeons should keep pace with the times understanding in every change around, continuing to found the clinical questions carefully, and combine it with basic research.