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??Updates and interpretations of the NCCN Clinical Practice Guidelines (2016 second version) on gastrointestinal stromal tumor WANG Ming, CAO Hui. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Corresponding author: CAO Hui, E-mail: caohuishcn@hotmail.com
Abstract The diagnosis and treatment of gastrointestinal stromal tumor (GIST) is getting more and more standardized. In the last decade, due to the revelation of the molecular mechanism of its tumorigenesis, as well as the effectiveness of tyrosine kinase inhibitors, GIST has become well known as one of the most classical model of target therapy on solid tumor in the precision medicine era. The National Comprehensive Cancer Network (NCCN) issued the latest version of clinical practice guideline on GIST in Feb. 2016. The updated guideline emphasized the importance of the management of wild-type GIST, also updated the surveillance strategy of very small gastric GIST (<2cm), and the predictor of GIST biological behavior. This paper provides interpretations of these updates, aiming to improve the clinical practice of GIST.     

NCCN������֯�����ٴ�ʵ��ָ�ϣ�2017���2�棩��θ�����������ݽ�������½��

??Updates and interpretations of the NCCN Clinical Practice Guidelines (2017 second version) on gastrointestinal stromal tumor WANG Ming, CAO Hui. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Corresponding author: CAO Hui, E-mail: caohuishcn@hotmail.com
Abstract The diagnosis and treatment of gastrointestinal stromal tumor ??GIST?? is getting more and more standardized. In the last decade??due to the revelation of the molecular mechanism of its tumorigenesis??as well as the effectiveness of tyrosine kinase inhibitors??GIST has become well known as one of the most classical models of targeted therapy on solid tumor in the precision medicine era. The National Comprehensive Cancer Network ??NCCN?? issued the latest version of clinical practice guideline on GIST in Feb. 2017. The updated guideline standardized the principle of imaging and updated the predictor of GIST biological behavior. Given the newly emerged evidence from clinical trials??in the discussion chapter??the updated guideline also highlighted the prognostic value of mutational characteristics and the role of laparoscopic surgery in the treatment of GIST. The paper provides interpretations of the updates??aiming to improve the clinical practice of GIST.     

NCCN������֯����——θ���������ٴ�ʵ��ָ�ϣ�2015���1�棩�����½�������

??Updates and interpretations of the NCCN Clinical Practice Guidelines 2015 on gastrointestinal stromal tumor CAO Hui, WANG Ming. Department of Gastrointestinal Surgery, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Corresponding author: CAO Hui, E-mail: caohuishcn@hotmail.com
Abstract Gastrointestinal stromal tumor (GIST) is the most common mesenchymal tumor of the gastrointestinal tract. In the last decade, the diagnosis and treatment of GIST has become more and more standardized and rational. The National Comprehensive Cancer Network (NCCN) issued the latest version of clinical practice guideline on Soft Tissue Sarcoma—GIST in Feb. 2015. The updated guideline emphasized the importance of genotyping in GIST, also updated the predictor of GIST biological behavior.     

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??The Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) gastric cancer TNM staging system (8th edition) explanation and elaboration SHAN Fei , LI Zi-yu, ZHANG Lian-hai, et al. Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing 100142, China
Corresponding author: JI Jia-fu, E-mail: jijiafu@hsc.pku.edu.cn
Abstract The Union for International Cancer Control (UICC) and the American Joint Committee on Cancer (AJCC) have issued the Eighth Edition of TNM staging system manual in October 2016. The updated version made evidence-based, prominent revisions in cancer stage classification system. Specifically, the old TNM staging system based on post-operative pathological examination was replaced by a more sophisticated staging system including clinical staging (cTNM), pathological staging (pTNM), and neo-adjuvant post-treatment staging (ypTNM). These revisions help oncologists and other clinicians better determine the stage of gastric cancer patients according to their conditions and treatments. Consequentially, appropriate individualized anti-cancer treatment could be made possible for each patient. Also, the Eighth Edition revised the guidance in staging gastroesophageal junction cancer and cardia cancer. Another update is N3a and N3b, separated from N3, work as two independent groups in staging system. Comparing to the Seventh Edition, some adjustment was made in sub-classifying patients of stage III. The usefulness and appropriateness of the new updates need clinical validation around the world. Although a risk prediction model incorporating the recent advancement of molecular biology has not been developed as expected, the Eighth Edition provides a useful tool for clinicians in the transition to precision treatment for gastric cancer.     

2016��NCCN���ٰ��ٴ�ʵ��ָ�ϣ���1�棩��������

??Updates and interpretations of the National Comprehensive Cancer Network guidelines for breast cancer (Version 1, 2016) ZHOU Bin??LIU Shi-wei,GAO Guo-xuan,et al.Department of Breast Disease Center, Peking University First Hospital,Beijing 100034,China
Correspongding author: LIU Yin-hua, E-mail??liuyinhua@
medmail.com.cn
Abstract Updates of the National Comprehensive Cancer Network (NCCN) Guidelines for breast cancer involved workup, surgical treatment, preoperative systemic therapy, systemic adjuvant treatment, radiotherapy, targeted therapy, endocrine therapy, treatment of recurrence/stage IV disease and follow-up. Since the NCCN Guidelines were introduced into China ten years ago, diagnosis and treatment of breast cancer have achieved prominent progress from group-based therapy based on TNM stage to classification treatment based on pathology and immunohistochemistry, symbolizing specialization and standardization of the diagnosis and treatment of breast cancer in China. The next-generation sequencing technology and other non-anatomical information will be used to build an individual prognostic system, which is the highlight of the 8th edition TNM cancer staging system. Seven kinds of tumor including breast cancer have been selected. A deeper understanding of the nature of breast cancer will build a bridge to the Personalized Medicine.     

2016��NCCN���ٰ��ٴ�ʵ��ָ�ϣ�V1�棩�������ݽ��

??Interpretation of NCCN clinical practice guidelines in oncology: Pancreatic adenocarcinoma (version 1, 2016) BAI Xue-li, MA Tao, LIANG Ting-bo. Department of Hepatobiliary and Pancreatic Surgery, the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China
Corresponding author:LIANG Ting-bo??E-mail: liangtingbo@
zju.edu.cn
Abstract The incidence of pancreatic cancer grows dramatically in the recent years, and the prognosis remains very poor. A multidisciplinary approach based on evidence may be the best choice to prolong patients’ survival. The National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology: Pancreatic Adenocarcinoma has become one of the most important tools in guiding the clinical diagnosis and treatment of pancreatic cancer. The version 1, 2016 of NCCN guideline for pancreatic cancer has updated several aspects including the management of borderline resectable pancreatic cancer, radiological evaluation, and surveillance.     

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??In regard to japanese gastric cancer treatment guidelines-the 3rd Edition HU Xiang. Department of General Surgery??the first Affiliated Hospital??Dalian Medical University??Dalian 116011??China Abstract The Japanese Gastric Cancer Association will issue a revised edition of gastric cancer treatment guidelines in Jan, 1st, 2010. Distinctive features of this revision are lymph node grading based on the removal effect, lymphadenectomy according to the D1/D2 dissection. Based on a high level evidence-based medicine, the Para-aortic lymph node dissection in D3 dissection was excluded in this edition. According to JCOG9912 and SPIRITS trials, neoadjuvant chemotherapy with CDDP and TS-1 has become a standard option in unresectable or recurrent gastric cancer. So the revised edition of gastric cancer treatment guidelines provided more advanced and scientific treatment programs.     

2015��V1�桶NCCNθ���ٴ�ʵ��ָ�ϡ����½��

??Updates of NCCN clinical practice guidelines for gastric cancer XU Ze-kuan.Department of General Surgery, the First Affiliated Hospital of Nanjing Medical University, Nanjing210029, China
Abstract In recent years, with the rapid development of diagnosis and treatment of gastric cancer, NCCN gastric cancer clinical practice guidelines also continue to release new versions to follow up the progress of the new frontier. In the new NCCN guideline (Version1.2015), new evidence and standard were introduced, and four major aspects were revised,including: ??1??The criteria of unresectability for cure was updated, ??2??the principles of genetic risk assessment for gastric cancer, the new risk assessment and genetic consultation were modified, ??3??the systemic therapy for locally advanced, locally recurrent or metastatic gastric cancer were modified, ??4??the partial contents of radiation therapy were revised. The new guideline has included the latest research achievements, which makes the concept of the treatment of gastric cancer more scientific and standardized. It will provide important guidance for the future clinical practice.     

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??The usage of Overlap method in Billroth I reconstruction of totally laparoscopic distal gastrectomy??A report of 1 case MIAO Ru-lin , LI Zi-yu , SHAN Fei, et al. Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Gastrointestinal Cancer Center, Peking University Cancer Hospital & Institute, Beijing100142, China
Corresponding author: LI Zi-yu, E-mail: ligregory@outlook.com
Abstract Objective To introduce the usage of Overlap method in Billroth I reconstruction of totally laparoscopic distal gastrectomy. Methods This study retrospectively analyzed 1 case of overlap Billroth ?? reconstruction for totally laparoscopic distal gastrectomy in Peking University Cancer Hospital and described the technique details of the method. Results In overlap Billroth ?? reconstruction, the duodenum bulb is transected in the caudal-to-cranial direction and then the cranial part of the transection line is opened. After transection of the stomach, the point of greater curvature 60mm from the transection line is opened. Then a 60mm linear stapler is used for the side-to-side anastomosis of gastric greater curvature and upper-lateral wall of duodenum. Finally, the conjuncture incision is closed with another linear stapler. Conclusion The overlap Billroth ?? reconstruction method for totally laparoscopic distal gastrectomy is simple to operate and the digestive tract is not twisted which may contribute to faster recovery of bowel function.     

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目的 探讨和总结临床活估肝移植的手术经验。方法 对12例活体肝移植（13次手术，包括第一次减体积再次肝移植手术）的手术情况进行回顾性分析。结果 13次活体肝移植手术均获成功；所有供体手术后顺利康复，未出现任何严重并发症，并全部纳入术后长期随访中。1例晚期肝癌病人移植后死于胆瘘及继发多器官功能不全；9例Wilson病受体获得长期存活，术后神经系统症状显著改善，复查肝功能、铜氧化酶水平全部在正常范围；1例Wilson瘤，受体于术后72天死于不可递转的排异反应；1例乙型肝炎肝硬化伴亚急性戊型肝炎、肝功能衰竭、Ⅳ期肝性脑病的病人，行急诊成人右叶供肝活体肝移植，术后恢复顺利，现为术后第11周，未出现严重并发症，已恢复正常生活。结论 精湛细致的手术技术是活体肝移植成功的关键，活体肝移植适合我国国情，是解决当前全球性供肝来源匮乏问题的有效途径。     

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??Part of the interpretation of the diagnosis and treatment of pancreatic neuroendocrine neoplasms CSCO expert consensus surgery LOU Wen-hui. Department of General Surgery, Zhongshan Hospital, Fudan University,Shanghai200032??China
Abstract The incidence of pancreatic neuroendocrine neoplasm is steadily increasing in recent years. It is important to standardize the treatment of pancreatic neuroendocrine neoplasm. Localized or down-staged tumor after new adjuvant therapy should be resected. Debulking could not prolong the survival of local advanced or metastatic tumor patients, but could improve the quality of life in patients of functional tumor. Aggressive treatment of liver metastasis such as combination of surgery, RFA or TACE may achieve long term survival in metastatic patients. Liver transplantation should be accomplished with caution.     

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??Development and trends in Japanese gastric surgery: experiences from Japanese Gastric Cancer Treatment Guidelines (ver. 5) HAN Fang-hai, YANG Bin. Department of Gastrointestinal Surgery??Sun Yat-sen Memorial Hospital??Sun Yat-sen University??Guangzhou 510120??China
Corresponding author: HAN Fang-hai, E-mail: FH_han@163.com
Abstact The Japanese Gastric Cancer Treatment guidelines has been revised for 5 times since it was first issued on March 2001. The original versions were mainly based on retrospectively studies and expert consensus. The New guideline and classification are established based on the best recent clinical evidence??and it addresses several important clinical issues including non-curative surgery for advanced gastric cancer with non-curable factors??bursectomy??splenectomy for advanced proximal gastric cancer??gastric cancers invading distal esophagus??etc. New edition also releases the clinical questions of neoadjuvant chemotherapy, D2+paraaortic lymph node dissection, diagnostic criteria of peritoneal dissemination by staging laparoscopy??the definition and extent of the lymph node dissection for EGJ cancer and remnant gastric cancer.