To evaluate the relationship between the use of proton pump inhibitors (PPI) and the risk of gastric cancer and colorectal cancer by using meta-analysis. Computer search PUBMED, EMBASE, Cochrane Library, CNKI and Wanfang database to obtain relevant literature on the use of PPI and the risk of gastric cancer and colorectal cancer, extract relevant data, and use Stata14.0 for Meta-analysis. A total of 24 articles were included, including 12 articles for gastric cancer and 12 articles for colorectal cancer. A total of 5 313 749 persons were included in the study and analysis. Meta-analysis results showed that the risk of gastric cancer in PPI users was significantly increased [risk ratio (RR) = 2.04, 95% confidence interval (CI) (1.33–2.75)], and the regional subgroup analysis results showed that in Europe [RR = 2.01, 95% CI (0.92, 3.09), P < 0.05] and Asia [RR = 2.15, 95% CI (1.16, 3.14), P < 0.05] This risk is higher, and Asia is higher than Europe. The risk of colorectal cancer is slightly increased [RR = 1. 22, 95% CI (1.03, 1.40, P < 0.05], and the regional subgroup analysis results show that in Europe [RR = 1.05 95% CI (0.98, 1.12), P < 0.05] and Asia [RR = 1.18, 95% CI (1.10, 1.27), P < 0.05]. This risk is low, but Asia is higher than Europe. The use of PPI significantly increases gastric cancer However, the risk of colorectal cancer is not significantly increased. The risk of gastric cancer and colorectal cancer in the population using PPI in Asia is higher than that in Europe.

Background: Long-course neoadjuvant chemoradiotherapy (Lc-NCRT) is the conventional treatment for locally advanced rectal cancer (LARC). It improves R0 resection rate and reduces local recurrence rate, but it cannot improve long-term oncological outcomes. It also causes several radiotherapy-related side effects. In recent years, some studies have shown that neoadjuvant chemotherapy (NCT) may be noninferior to Lc-NCRT. Therefore, we systematically evaluated the efficacy and safety of NCT and Lc-NCRT for LARC.Methods: Cochrane Library, Embase, PubMed, WanFang Data, and CNKI were systematically searched as the relevant literature. The literature was screened independently by two groups, and data were extracted and evaluated for bias. A meta-analysis was performed using Revman5.4 software. The primary outcomes were tumor response to neoadjuvant therapy and long-term oncological outcomes.Results: A total of 17 studies with 5,168 cases (1,957 cases in NCT and 3,211 cases in Lc-NCRT) were included in our meta-analysis. Compared with the Lc-NCRT group, although the NCT group had a lower pCR rate [RR = 0.65, 95% CI (0.56–0.75), P < 0.0001], less downstaging [RR = 1.11, 95%CI(1.03–1.19), P = 0.06] and more adverse events of neoadjuvant therapy [RR = 1.11, 95% CI (1.03–1.19); P = 0.06], it had no difference in long-term survival outcome [3-year overall survival: HR = 1.13, 95% CI (0.70–1.83), P = 0.62; 3-year disease-free survival: HR = 1.16, 95% CI (0.96–1.39), P = 0.12; 3-year local recurrence-free survival: HR = 1.36, 95% CI (0.9–2.08), P = 0.15] and serious adverse events [RR = 0.84, 95% CI (0.45–1.57), P = 0.58] from the Lc-NCRT group. Moreover, the incidence of anastomotic leakage [RR = 0.48, 95% CI (0.34–0.45)] and permanent stoma rate [RR = 0.7, 95% CI (0.58–0.84), P < 0.0001] after operation was lower in the NCT group.Conclusion: NCT is a potential option for the treatment of LARC as it is beneficial for improving the sphincter preservation rate and reducing anastomotic leakage, the long-term oncological outcome is considerable, and the safety is controllable. Larger randomized controlled trials (RCT) with longer follow-up data are needed to clarify the specific regimens of NCT and the risk stratification of rectal cancer.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/home identifier, CRD42024579586.

Background: The effectiveness of the anastomosis method for laparoscopic left colectomy (LLC) remains inconclusive. Thus, a systematic review and meta-analysis were conducted to compare the outcomes between intraperitoneal anastomosis (IPA) and extraperitoneal anastomosis(EPA)in LLC.Methods: PubMed, Embase, the Cochrane Library, CNKI, and WanFangData were systematically searched for relevant literature. The literature was screened independently by two groups, and data were extracted and evaluated for bias. Meta-analysis was performed using Revman5.4 software.Results: Twelve studies with a total of 1,278 patients were included in our meta-analysis. Compared with the EPA group, the IPA group had less blood loss [odds ratio (OR)=–20.32, 95% confidence interval (CI) (−27.98–12.65), p<0.00001], a lower overall complication rate [OR=0.45, 95% CI (0.33–0.63), p<0.00001], fewer non-severe complications [OR=0.44, 95% CI (0.30–0.64), p<0.0001], and fewer surgical site infections [OR=0.39, 95% CI (0.21–0.71), p=0.002]. Additionally, a longer operation time appeared in the multicenter and propensity score matching (PSM) subgroups of the IPA group. Furthermore, patients in the IPA group had an earlier exhaust time and shorter hospital stays. There were no significant differences between the two groups regarding severe complications, anastomose-related complications, postoperative blood transfusion, ileus, reoperation rate, time to stool, pathologic sample length, and lymph node dissection number.Conclusion: IPA seems more advantageous than EPA for patients receiving LCC in terms of complications and postoperative recovery and has similar oncological outcomes. However, it may take longer and be more difficult to perform.Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails PROSPERO, identifier (CRD4202454391).

Backgroud: Intersphincteric resection (ISR) is an important and challenging sphincter-preserving procedure for patients with low rectal cancer. Preserving anal function is more important than preserving its appearance. Owing to its unique advantages, the robotic platform makes ISR safer and less invasive. Whether this advantage is reflected in functional aspects is worth further exploration. Methods: PubMed, Cochrane Library and Embase were systematic researched for articles published relevant literature. The literature was screened independently by two groups, and data on functional, perioperative, and oncology outcomes were extracted and evaluated for bias. Meta-analysis was performed using Revman5.4 software. Results: Ten studies with a total of 1279 patients were included in our meta-analysis, and Funnel plots suggested no major publication bias. The robotic ISR group had lower Wexner scores [MD = –1.46, 95%CI (–2.03 ∼–0.88), p < 0.001] than the laparoscopic ISR group, but with no significant difference compared to other functional outcomes. The robotic ISR group performed better in preserving the integrity of the rectal mesentery [OR = 3.08, 95%CI (1.72, 5.53), p = 0.0002], had less intraoperative bleeding [MD = –11.47, 95%CI (–17.25, –5.68), p = 0.0001], and had fewer postoperative complications [OR = 0.71, 95%CI (0.53, 0.94), p = 0.02], although the operation took longer [MD = 0.76, 95%CI (0.62∼0.91), p < 0.001]. No significant differences were observed in the long-term oncological outcomes between the two groups. Conclusion: Robotic ISR has potential advantages in preserving the anal function, with fewer complications and similar oncological outcomes compared with Laparoscopic ISR. Due to limitations in sample size and study design, the results of this study still require validation through randomized controlled trials. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO , identifier CRD420251012991.

Background: Para-aortic lymph node metastasis (PALNM) in colorectal cancer (CRC) is a rare but prognostically significant condition, occurring in approximately 1–2% of patients. Current guidelines classify PALNM as stage IV disease but provide no clear consensus on optimal management. Treatment strategies vary widely, and the role of para-aortic lymph node dissection (PALND) remains controversial due to limited evidence from small, retrospective studies and the absence of randomized controlled trials. This study aimed to perform a comprehensive meta-analysis of survival outcomes in CRC patients with PALNM undergoing PALND compared with non-surgical management. Methods: A systematic literature search of PubMed, Embase, and Cochrane Library was conducted up to 23 March 2026. Eight retrospective cohort studies comprising 929 patients met the inclusion criteria. Individual patient data for overall survival (OS) were reconstructed from published Kaplan–Meier curves using validated methodology. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using random-effects models. Sensitivity, subgroup, and time-to-event analyses were performed, and risk of bias was assessed using the ROBINS-I V2 tool. Results: Pooled analysis demonstrated that PALND was associated with significantly improved OS compared with non-surgical management (HR = 0.49, 95% CI: 0.39–0.63, P < 0.001), representing a 51% reduction in mortality risk. Median OS was 36.8 months in the surgery group versus 12.9 months in the non-surgery group. The 3-year and 5-year OS rates were 50.5% and 38.8% in the surgery group, compared with 27.5% and 11.0% in the non-surgery group, respectively. Restricted mean survival time analysis demonstrated a 12.1-month gain (95% CI: 8.7–15.6, P < 0.001) at 60 months. Sensitivity analyses confirmed the robustness of findings, with HRs ranging from 0.33 to 0.52 across multiple scenarios. Subgroup analyses revealed more pronounced benefit in metachronous metastases (HR = 0.34, 95% CI: 0.22–0.51) versus synchronous disease (HR = 0.63, 95% CI: 0.45–0.88). Moderate heterogeneity (I² = 43.1%) was observed overall but reduced to near-zero levels across all subgroup analyses. Conclusion: This IPD-based meta-analysis provides the most comprehensive evidence to date that PALND is associated with a significant survival benefit in selected CRC patients with PALNM. Despite the inherent limitations of retrospective data, these findings support consideration of surgical resection as a viable treatment option in appropriately selected patients.

Background: Prognostic assessment for colorectal cancer (CRC) displays substantial heterogeneity, as reliance solely on traditional TNM staging falls short of achieving precise individualized predictions. The integration of diverse biological information sources holds the potential to enhance prognostic accuracy.Objective: To establish a comprehensive multi-tiered precision prognostic evaluation system for CRC by amalgamating gene expression profiles, clinical characteristics, and tumor microsatellite instability (MSI) status in CRC patients.Methods: We integrated genomic data, clinical information, and survival follow-up data from 483 CRC patients obtained from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. MSI-related gene modules were identified using differential expression analysis and Weighted Gene Co-expression Network Analysis (WGCNA). Three prognostic models were constructed: MSI-Related Gene Prognostic Model (Model I), Clinical Prognostic Model (Model II), and Integrated Multi-Layered Prognostic Model (Model III) by combining clinical features. Model performance was assessed and compared using Receiver Operating Characteristic (ROC) curves, Kaplan-Meier analysis, and other methods.Results: Six MSI-related genes were selected for constructing Model I (AUC = 0.724); Model II used two clinical features (AUC = 0.684). Compared to individual models, the integrated Model III exhibited superior performance (AUC = 0.825) and demonstrated good stability in an independent dataset (AUC = 0.767).Conclusion: This study successfully developed and validated a comprehensive multi-tiered precision prognostic assessment model for CRC, providing an effective tool for personalized medical management of CRC.