Precision medicine for gastrointestinal cancer:Recent progress and future perspective

Gastrointestinal(GI)cancer has a high tumor incidence and mortality rate worldwide.Despite significant improvements in radiotherapy,chemotherapy,and targeted therapy for GI cancer over the last decade,GI cancer is characterized by high recurrence rates and a dismal prognosis.There is an urgent need for new diagnostic and therapeutic approaches.Recent technological advances and the accumulation of clinical data are moving toward the use of precision medicine in GI cancer.Here we review the application and status of precision medicine in GI cancer.Analyses of liquid biopsy specimens provide comprehensive real-time data of the tumor-associated changes in an individual GI cancer patient with malignancy.With the introduction of gene panels including next-generation sequencing,it has become possible to identify a variety of mutations and genetic biomarkers in GI cancer.Although the genomic aberration of GI cancer is apparently less actionable compared to other solid tumors,novel informative analyses derived from comprehensive gene profiling may lead to the discovery of precise molecular targeted drugs.These progressions will make it feasible to incorporate clinical,genome-based,and phenotype-based diagnostic and therapeutic approaches and apply them to individual GI cancer patients for precision medicine.

Precision Surgery for Placenta Previa Complicated with Placenta Percreta

Objectives:To investigate whether a precise circular resection of the uterine tissue at the placental attachment part is effective in cases with placenta previa complicated with placenta percreta (PPWPP).Methods:Patients diagnosed with PPWPP were assessed for pregnancy termination at 34-36 weeks of gestation.During the operation,we performed circular resection of the uterine tissue at the placental attachment part.Then the characteristics of the operation and the follow-ups were recorded.Results:During the operation,the vital signs were stable.The mean intraoperative blood loss,packed red blood cells units transfusion,fresh frozen plasma transfusion,and operation time were 2140 mL,6 U,440 mL,and 179.8 minutes,respectively.There was no bowel,ureter,or bladder injury.And there was no patient transferred to the ICU after operation.The mean postoperative blood loss was 458.6mL.There was no fever,infection,intestinal obstruction,or other complications after operation during the hospitalization.The shape and the blood flow of the uterus were normal.After the patients were discharged,one had developed cesarean scar diverticulum.The mean lochia duration was 30 days.The menstrual cycle and volume were as before.The shape and the blood flow of the uterus and the ovarian were normal.Conclusions:The circular resection following end-to-end anastomosis is an effective precision surgical approach for PPWPP.It can achieve the purpose of hemostasis while maximizing the protection of organ function and reducing surgical trauma.