BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,...BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.展开更多
BACKGROUND Preoperative serum tumor markers not only play a role in the auxiliary diagnosis and postoperative monitoring in colorectal cancer(CRC),but also have been found to have potential prognostic value.AIM To ana...BACKGROUND Preoperative serum tumor markers not only play a role in the auxiliary diagnosis and postoperative monitoring in colorectal cancer(CRC),but also have been found to have potential prognostic value.AIM To analyze whether preoperative serum tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),affect the prognosis of CRC.METHODS This was a retrospective study conducted in a single center.Patients with nonmetastatic CRC who underwent initial surgery between January 2011 and January 2020 were enrolled and divided into development site and validation site groups at a ratio of 7:3.The independent prognostic factors were screened by Cox regression analysis,and finally,a prognostic nomogram model was established.The newly developed model was tested by internal validation.RESULTS Eventually,3526 postoperative patients with nonmetastatic CRC were included in the study.There were 2473 patients at the development site and 1056 patients at the validation site.Age(P<0.01,HR=1.042,95%CI=1.033-1.051),tumor node metastasis(TNM)classification(P<0.01,HR=1.938,95%CI=1.665-2.255),preoperative CEA(P=0.001,HR=1.393,95%CI=1.137-1.707)and CA19-9(P<0.01,HR=1.948,95%CI=1.614-2.438)levels were considered independent prognostic factors for patients with nonmetastatic CRC and were used as variables in the nomogram model.The areas under the curve of the development and validation sites were 0.655 and 0.658,respectively.The calibration plot also showed the significant performance of the newly established nomogram.CONCLUSION We successfully constructed a nomogram model based on age,TNM stage,preoperative CEA,and CA19-9 levels to evaluate the overall survival of patients with nonmetastatic CRC.展开更多
BACKGROUND The albumin-bilirubin(ALBI)score is a serum biochemical indicator of liver function and has been proven to have prognostic value in a variety of cancers.In colorectal cancer(CRC),a high ALBI score tends to ...BACKGROUND The albumin-bilirubin(ALBI)score is a serum biochemical indicator of liver function and has been proven to have prognostic value in a variety of cancers.In colorectal cancer(CRC),a high ALBI score tends to be associated with poorer survival.AIM To investigate the correlation between the preoperative ALBI score and outcomes in CRC patients who underwent radical surgery.METHODS Patients who underwent radical CRC surgery between January 2011 and January 2020 at a single clinical center were included.The ALBI score was calculated by the formula(log10 bilirubin×0.66)+(albumin×-0.085),and the cutoff value for grouping patients was-2.8.The short-term outcomes,overall survival(OS),and disease-free survival(DFS)were calculated.RESULTS A total of 4025 CRC patients who underwent radical surgery were enrolled in this study,and there were 1908 patients in the low ALBI group and 2117 patients in the high ALBI group.Cox regression analysis revealed that age,tumor size,tumor stage,ALBI score,and overall complications were independent risk factors for OS;age,tumor stage,ALBI score,and overall complications were identified as independent risk factors for DFS.CONCLUSION A high preoperative ALBI score is correlated with adverse short-term outcomes,and the ALBI score is an independent risk factor for OS and DFS in patients with CRC undergoing radical surgery.展开更多
BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer(RC),but there were significant differences in the reported risk factors for complications after s...BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer(RC),but there were significant differences in the reported risk factors for complications after stoma reversal.No studies have analyzed the risk factors for stoma-related complications and overall postoperative com-plications separately.AIM To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.METHODS This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022.Continuous variables are expressed as the mean±SD and were analyzed with independent-sample t tests,while frequency variables are expressed as n(%),and theχ2 test or Fisher’s exact test was used.Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.RESULTS The overall complication rate after ileostomy reversal was 11.4%.Patients with lower preoperative albumin concentration(P<0.01),greater blood loss(P=0.017),and longer operative times(P<0.01)were more likely to experience postoperative complications.The incidence of stoma-related complications was 6.4%.Analysis of the study showed that a higher body mass index(BMI)(P<0.01),preoperative comorbid hypertension(P=0.049),time from primary surgery to ileostomy reversal(P<0.01)and longer operation time(P=0.010)were more likely to result in stomarelated complications postoperatively.Multivariate logistic regression analysis revealed that a lower preoperative albumin level(P<0.01,OR=0.888,95%CI:0.828-0.958)was an independent risk factor for overall complications.Moreover,multivariate analysis revealed that BMI(P<0.01,OR=1.176,95%CI:1.041-1.330)and time from primary surgery to ileostomy reversal(P<0.01,OR=1.140,95%CI:1.038-1.252)were independent risk factors for stoma-related complications after stoma reversal.CONCLUSION The preoperative albumin level was a predictor of overall complications.Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.展开更多
BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obst...BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.展开更多
基金Supported by Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.
基金CQMU Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND Preoperative serum tumor markers not only play a role in the auxiliary diagnosis and postoperative monitoring in colorectal cancer(CRC),but also have been found to have potential prognostic value.AIM To analyze whether preoperative serum tumor markers,including carcinoembryonic antigen(CEA)and carbohydrate antigen 19-9(CA19-9),affect the prognosis of CRC.METHODS This was a retrospective study conducted in a single center.Patients with nonmetastatic CRC who underwent initial surgery between January 2011 and January 2020 were enrolled and divided into development site and validation site groups at a ratio of 7:3.The independent prognostic factors were screened by Cox regression analysis,and finally,a prognostic nomogram model was established.The newly developed model was tested by internal validation.RESULTS Eventually,3526 postoperative patients with nonmetastatic CRC were included in the study.There were 2473 patients at the development site and 1056 patients at the validation site.Age(P<0.01,HR=1.042,95%CI=1.033-1.051),tumor node metastasis(TNM)classification(P<0.01,HR=1.938,95%CI=1.665-2.255),preoperative CEA(P=0.001,HR=1.393,95%CI=1.137-1.707)and CA19-9(P<0.01,HR=1.948,95%CI=1.614-2.438)levels were considered independent prognostic factors for patients with nonmetastatic CRC and were used as variables in the nomogram model.The areas under the curve of the development and validation sites were 0.655 and 0.658,respectively.The calibration plot also showed the significant performance of the newly established nomogram.CONCLUSION We successfully constructed a nomogram model based on age,TNM stage,preoperative CEA,and CA19-9 levels to evaluate the overall survival of patients with nonmetastatic CRC.
文摘BACKGROUND The albumin-bilirubin(ALBI)score is a serum biochemical indicator of liver function and has been proven to have prognostic value in a variety of cancers.In colorectal cancer(CRC),a high ALBI score tends to be associated with poorer survival.AIM To investigate the correlation between the preoperative ALBI score and outcomes in CRC patients who underwent radical surgery.METHODS Patients who underwent radical CRC surgery between January 2011 and January 2020 at a single clinical center were included.The ALBI score was calculated by the formula(log10 bilirubin×0.66)+(albumin×-0.085),and the cutoff value for grouping patients was-2.8.The short-term outcomes,overall survival(OS),and disease-free survival(DFS)were calculated.RESULTS A total of 4025 CRC patients who underwent radical surgery were enrolled in this study,and there were 1908 patients in the low ALBI group and 2117 patients in the high ALBI group.Cox regression analysis revealed that age,tumor size,tumor stage,ALBI score,and overall complications were independent risk factors for OS;age,tumor stage,ALBI score,and overall complications were identified as independent risk factors for DFS.CONCLUSION A high preoperative ALBI score is correlated with adverse short-term outcomes,and the ALBI score is an independent risk factor for OS and DFS in patients with CRC undergoing radical surgery.
基金Science and Technology Planning Project of Yuzhong District of Chongqing City,No.20210115.
文摘BACKGROUND Previous studies have analyzed the risk factors for complications after ileostomy reversal for rectal cancer(RC),but there were significant differences in the reported risk factors for complications after stoma reversal.No studies have analyzed the risk factors for stoma-related complications and overall postoperative com-plications separately.AIM To analyze the risk factors for overall complications and stoma-related complications after ileostomy reversal for patients with RC.METHODS This was a retrospective study of 439 patients who underwent ileostomy reversal at a clinical center and were followed up between September 2012 and September 2022.Continuous variables are expressed as the mean±SD and were analyzed with independent-sample t tests,while frequency variables are expressed as n(%),and theχ2 test or Fisher’s exact test was used.Univariate and multivariate logistic regression analyses were used to identify predictors of overall complications and stoma-related complications.RESULTS The overall complication rate after ileostomy reversal was 11.4%.Patients with lower preoperative albumin concentration(P<0.01),greater blood loss(P=0.017),and longer operative times(P<0.01)were more likely to experience postoperative complications.The incidence of stoma-related complications was 6.4%.Analysis of the study showed that a higher body mass index(BMI)(P<0.01),preoperative comorbid hypertension(P=0.049),time from primary surgery to ileostomy reversal(P<0.01)and longer operation time(P=0.010)were more likely to result in stomarelated complications postoperatively.Multivariate logistic regression analysis revealed that a lower preoperative albumin level(P<0.01,OR=0.888,95%CI:0.828-0.958)was an independent risk factor for overall complications.Moreover,multivariate analysis revealed that BMI(P<0.01,OR=1.176,95%CI:1.041-1.330)and time from primary surgery to ileostomy reversal(P<0.01,OR=1.140,95%CI:1.038-1.252)were independent risk factors for stoma-related complications after stoma reversal.CONCLUSION The preoperative albumin level was a predictor of overall complications.Preoperative BMI and the time from primary surgery to ileostomy reversal were predictors of stoma-related complications.
基金The ethics committee of the First Affiliated Hospital of Chongqing Medical University approved this study,No.K2024-008-01.
文摘BACKGROUND Ostomy is a common surgery usually performed to protect patients from clinical symptoms caused by distal anastomotic leakage after colorectal cancer(CRC)surgery and perforation or to relieve intestinal obstruction.AIM To analyze the complications after transverse colostomy closure.METHODS Patients who underwent transverse colostomy closure from Jan 2015 to Jan 2022 were retrospectively enrolled in a single clinical center.The differences between the complication group and the no complication group were compared.Logistic regression analyses were conducted to find independent factors for overall complications or incision infection.RESULTS A total of 102 patients who underwent transverse colostomy closure were enrolled in the current study.Seventy(68.6%)patients underwent transverse colostomy because of CRC related causes.Postoperative complications occurred in 30(29.4%)patients and the most frequent complication occurring after transverse colostomy closure was incision infection(46.7%).The complication group had longer hospital stays(P<0.01).However,no potential risk factors were identified for overall complications and incision infection.CONCLUSION The most frequent complication occurring after transverse colostomy closure surgery in our center was incision infection.The operation time,interval from transverse colostomy to reversal,and method of anastomosis might have no impact on the postoperative complications.Surgeons should pay more attention to aseptic techniques.
