Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensivel...Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensively investigated.Therefore,this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.Methods:Patients with RPC who underwent radical pancreatectomy and IORT were enrolled.The primary endpoint was time to treatment failure(TTF)survival,whereas the secondary endpoints were safety and overall survival(OS).Results:By November 2023,35 patients with RPC were treated according to the study protocol.The median TTF was 11.67 months,whereas the median OS for the cohort was 22.2 months.The local recurrence rate was 20%.The most common postoperative complication was pancreatic fistula.The incidence of delayed gastric emptying was 20%.Within 30 days after surgery,one patient experienced abdominal pain,another experienced vomiting,and one died because of abdominal infection and a grade C pancreatic fistula.Carcinoembryonic antigen(CEA)and D-dimer levels significantly correlated with TTF and OS in multivariate analyses.The carbohydrate antigen 19-9(CA19-9)level was another prognostic factor significantly associated with OS.Patients with low D-dimer and normal CA19-9 levels showed prolonged OS with an IORT dose≤15 Gy.Conclusions:This study supports use of IORT with a 50 kV X-ray source in treating RPC.IORT using a low-energy X-ray source was well-tolerated and feasible.Additionally,D-dimer,CEA,and CA19-9 levels may help identify patient profiles potentially benefitting from IORT.展开更多
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings oft...BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention.Herein,we report a case of RS who underwent complete resection through endoscopic full-thickness resection(EFTR)and discuss the clinical,imaging,and pathological features for differential diagnosis.CASE SUMMARY A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy.A neurogenic tumor with extraluminal growth was considered based on the imaging findings.Resection was required,and an EFTR was performed.On endoscopic exploration,a smooth surface extruding mass was identified at the rectum.The patient was discharged 48 hours after the operation without infection or bleeding.Based on the pathological and immunohistochemical findings of the resected mass,a rectal benign schwannoma was diagnosed.The patient did not undergo any adjuvant therapy.Nearly one year later,a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed,and no tumor recurrence or metastasis was noted.CONCLUSION EFTR is safe and effective for resecting gastrointestinal stromal tumors,especially those with extraluminal growth and no lymph node involvement.展开更多
In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic ...In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers.We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques,particularly endoscopic submucosal dissection.This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy,as well as a summary of key studies on the learning curve for these techniques.Additionally,we explore the impact of an endo-scopist’s specialty on endoscopy outcomes,drawing from current evidence in the literature to shape our perspective in this evolving field.展开更多
BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in...BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in the prognostic evaluation of CRC.Laparoscopic radical resection is a common surgical approach for treating CRC.However,research on the link between preoperative imaging and short-term prognosis in this context is limited.We hypothesized that specific preope-rative imaging features can predict the short-term prognosis in patients under-going laparoscopic CRC resection.AIM To investigate the imaging features of CRC and analyze their correlation with the short-term prognosis of laparoscopic radical resection.METHODS This retrospective study conducted at the Affiliated Cancer Hospital of Shandong First Medical University included 122 patients diagnosed with CRC who under-went laparoscopic radical resection between January 2021 and February 2024.All patients underwent magnetic resonance imaging(MRI)and were diagnosed with CRC through pathological examination.MRI data and prognostic indicators were collected 30 days post-surgery.Logistic regression analysis identified imaging fea-tures linked to short-term prognosis,and a receiver operating characteristic(ROC)curve was used to evaluate the predictive value.RESULTS Among 122 patients,22 had irregular,low-intensity tumors with adjacent high signals.In 55,tumors were surrounded by alternating signals in the muscle layer.In 32,tumors extended through the muscular layer and blurred boundaries with perienteric adipose tissue.Tumor signals appeared in the adjacent tissues in 13 patients with blurred gaps.Logistic regression revealed differences in longitudinal tumor length,axial tumor length,volume transfer constant,plasma volume fraction,and apparent diffusion coefficient among patients with varying prognostic results.ROC analysis indicated that the areas under the curve for these parameters were 0.648,0.927,0.821,0.809,and 0.831,respectively.Sensitivity values were 0.643,0.893,0.607,0.714,and 0.714,and specificity 0.702,0.904,0.883,0.968,and 0.894(P<0.05).CONCLUSION The imaging features of CRC correlate with the short-term prognosis following laparoscopic radical resection.These findings provide valuable insights for clinical decision-making.展开更多
Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains...Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.展开更多
BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient sel...BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.展开更多
BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a la...BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a large proportion of SMT.Due to the deep lesion location of gastric SMT,endoscopic submucosal dissection related techniques are difficult to operate,while endoscopic full-thickness rese-ction(EFTR)has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach.Ho-wever,complete closure of the gastrectomy site after EFTR is critical.If the closure is incomplete,it may cause peritonitis,late perforation and other conditions,and even require further surgical intervention.Although there are currently a number of suture devices and techniques that can be used to promote closure,they have the problem of requiring additional equipment or being inconvenient to use.Although metal clips are widely used,their effectiveness depends on the size and tension of the defect.Therefore,an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment.AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR.METHODS In this study,the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed.The patients were divided into a preclosure group(54 patients)and a non-preclosure group(40 patients)on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR.Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection,whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection.The lesion size,wound closure time,number of titanium clips used,incidence of postoperative complications,and postoperative hospitalization time were compared between the two groups.RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group(6.69±2.109 minutes vs 11.65±3.786 minutes,P<0.001).The number of titanium clips used was significantly lower in the preclosure group(8.93±2.231)than in the non-preclosure group(12.05±4.495)(P<0.001).There was no sig-nificant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay(6.41±1.31 vs 6.13±1.06 days).For all patients in the preclosure group and the non-preclosure group,resection was completed successfully without bleeding,abdominal pain,abdominal distension,or other postoperative complications.CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR,reliably preventing the tumor from falling into the peritoneal cavity.展开更多
BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparosco...BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.展开更多
Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria....Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.展开更多
BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,d...BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.展开更多
BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria fo...BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria for their application.AIM To provide a reference for the development of standardized treatment strategies for gGISTs.METHODS Clinical baseline characteristics,histopathological results,and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed.Propensity score matching(PSM)was employed to achieve balance in baseline characteristics of the two groups.RESULTS Among 206 patients,135 were in the ER group and 71 in the LR group.The ER group had significantly smaller tumors[3.5 cm(3.0-4.0 cm)vs 4.2 cm(3.3-5.0 cm),P<0.001]and different tumor locations(P=0.048).After PSM,59 pairs of patients were balanced.After matching,the baseline characteristics of the ER and LR groups did not differ significantly from each other.Compared with LR,ER had faster recovery of diet(P=0.046)and fewer postoperative symptoms(P=0.040).LR achieved a higher complete resection rate(P<0.001)and shorter operation time(P<0.001).No significant differences were observed in postoperative hospital stay(P=0.478),hospital costs(P=0.469),complication rates(P>0.999),pathological features(mitosis,P=0.262;National Institutes of Health risk classification,P=0.145),recurrence rates(P=0.476),or mortality rates(P=0.611).CONCLUSION Both ER and LR are safe and effective treatments for gGISTs.ER has less postoperative pain and faster recovery,while LR has a higher rate of complete resection.展开更多
AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlyi...Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not clear.This study was to find out whether systemic inflammation plays an important role.Methods:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex assay.The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR.Results:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels.Compared to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly lower.Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation.The levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital stay.Importantly,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection.Conclusions:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.展开更多
Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to inv...Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.展开更多
In the study by Wu et al,patients with unresectable hepatocellular carcinoma were subjected to transarterial chemoembolization(TACE)as a conversion therapy in order to render their tumors suitable for resection.A nomo...In the study by Wu et al,patients with unresectable hepatocellular carcinoma were subjected to transarterial chemoembolization(TACE)as a conversion therapy in order to render their tumors suitable for resection.A nomogram was devised and shown to be effective in predicting the survival of these patients.Generalization of the results,however,is questionable since the study subjects consisted of patients who had resection after TACE while excluding patients with the same disease but not suitable for TACE.Immunotherapy can be considered to be an option for conversion therapy.However,markers for determining responses to a conversion therapy and for guiding the decision between TACE and sequential immunotherapy have been lacking.The question of whether effective conversion therapy can truly enhance overall survival remains unanswered.展开更多
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
基金supported by the Tianjin Science and Technology Commission key project(Grant No.21JCZDJC00980)Tianjin Science and Technology Commission project(Grant No.22ZXJBSY00030)Tianjin Health Research project(Grant No.TJWJ2022MS007)。
文摘Objective:The role of intraoperative radiation therapy(IORT)in the management of resectable pancreatic cancer(RPC)remains unclear.To date,the application of IORT using a low-energy X-ray source has not been extensively investigated.Therefore,this study was conducted to evaluate the safety and efficacy of IORT using a 50 kV X-ray source in treating RPC.Methods:Patients with RPC who underwent radical pancreatectomy and IORT were enrolled.The primary endpoint was time to treatment failure(TTF)survival,whereas the secondary endpoints were safety and overall survival(OS).Results:By November 2023,35 patients with RPC were treated according to the study protocol.The median TTF was 11.67 months,whereas the median OS for the cohort was 22.2 months.The local recurrence rate was 20%.The most common postoperative complication was pancreatic fistula.The incidence of delayed gastric emptying was 20%.Within 30 days after surgery,one patient experienced abdominal pain,another experienced vomiting,and one died because of abdominal infection and a grade C pancreatic fistula.Carcinoembryonic antigen(CEA)and D-dimer levels significantly correlated with TTF and OS in multivariate analyses.The carbohydrate antigen 19-9(CA19-9)level was another prognostic factor significantly associated with OS.Patients with low D-dimer and normal CA19-9 levels showed prolonged OS with an IORT dose≤15 Gy.Conclusions:This study supports use of IORT with a 50 kV X-ray source in treating RPC.IORT using a low-energy X-ray source was well-tolerated and feasible.Additionally,D-dimer,CEA,and CA19-9 levels may help identify patient profiles potentially benefitting from IORT.
文摘For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
基金Supported by Chengdu Key Technology Innovation R&D Projects(In the Field of Population Health)in the 2023,No.2022-YF05-02120-SN.
文摘BACKGROUND Rectal schwannoma(RS)is a rare subtype of schwannoma that presents diagnostic challenges owing to its clinical rarity.The absence of typical symptoms,specific signs,and distinctive radiographic findings often hinders clinicians from reaching a definitive diagnosis before surgical intervention.Herein,we report a case of RS who underwent complete resection through endoscopic full-thickness resection(EFTR)and discuss the clinical,imaging,and pathological features for differential diagnosis.CASE SUMMARY A 71-year-old Chinese woman presented to our outpatient clinic with a 4-year history of a rectal mucosal mass for a follow-up surveillance colonoscopy.A neurogenic tumor with extraluminal growth was considered based on the imaging findings.Resection was required,and an EFTR was performed.On endoscopic exploration,a smooth surface extruding mass was identified at the rectum.The patient was discharged 48 hours after the operation without infection or bleeding.Based on the pathological and immunohistochemical findings of the resected mass,a rectal benign schwannoma was diagnosed.The patient did not undergo any adjuvant therapy.Nearly one year later,a follow-up surveillance colonoscopy and an abdominal and pelvic plain plus enhancement scan were performed,and no tumor recurrence or metastasis was noted.CONCLUSION EFTR is safe and effective for resecting gastrointestinal stromal tumors,especially those with extraluminal growth and no lymph node involvement.
文摘In this editorial,we provide commentary on a recently published study by Zhao et al in the World Journal of Gastrointestinal Oncology.The study discusses the clinical characteristics of patients undergoing endoscopic resection for gastric cancers.We feel it is important to engage our endoscopy community in a discussion on the current evidence in the literature on the necessary number of cases for training in endoluminal surgery techniques,particularly endoscopic submucosal dissection.This includes the latest recommendations from the European Society of Gastrointestinal Endoscopy,as well as a summary of key studies on the learning curve for these techniques.Additionally,we explore the impact of an endo-scopist’s specialty on endoscopy outcomes,drawing from current evidence in the literature to shape our perspective in this evolving field.
文摘BACKGROUND Colorectal cancer(CRC)is a malignant tumor with high morbidity and mortality rates worldwide.With the development of medical imaging technology,imaging features are playing an increasingly important role in the prognostic evaluation of CRC.Laparoscopic radical resection is a common surgical approach for treating CRC.However,research on the link between preoperative imaging and short-term prognosis in this context is limited.We hypothesized that specific preope-rative imaging features can predict the short-term prognosis in patients under-going laparoscopic CRC resection.AIM To investigate the imaging features of CRC and analyze their correlation with the short-term prognosis of laparoscopic radical resection.METHODS This retrospective study conducted at the Affiliated Cancer Hospital of Shandong First Medical University included 122 patients diagnosed with CRC who under-went laparoscopic radical resection between January 2021 and February 2024.All patients underwent magnetic resonance imaging(MRI)and were diagnosed with CRC through pathological examination.MRI data and prognostic indicators were collected 30 days post-surgery.Logistic regression analysis identified imaging fea-tures linked to short-term prognosis,and a receiver operating characteristic(ROC)curve was used to evaluate the predictive value.RESULTS Among 122 patients,22 had irregular,low-intensity tumors with adjacent high signals.In 55,tumors were surrounded by alternating signals in the muscle layer.In 32,tumors extended through the muscular layer and blurred boundaries with perienteric adipose tissue.Tumor signals appeared in the adjacent tissues in 13 patients with blurred gaps.Logistic regression revealed differences in longitudinal tumor length,axial tumor length,volume transfer constant,plasma volume fraction,and apparent diffusion coefficient among patients with varying prognostic results.ROC analysis indicated that the areas under the curve for these parameters were 0.648,0.927,0.821,0.809,and 0.831,respectively.Sensitivity values were 0.643,0.893,0.607,0.714,and 0.714,and specificity 0.702,0.904,0.883,0.968,and 0.894(P<0.05).CONCLUSION The imaging features of CRC correlate with the short-term prognosis following laparoscopic radical resection.These findings provide valuable insights for clinical decision-making.
基金supported by the National Natural Science Foundation of China(grants 82373365 and 82173317)the Tianjin Key Medical Discipline Construction Project(TJYXZDXK-009A).
文摘Intrahepatic cholangiocarcinoma(ICC)poses a significant threat to human health owing to its high malignancy rate and poor prognosis.Sur-gery is the most effective treatment option for ICC.However,the prognosis remains unfavorable even after surgical resection.Therefore,neo-adjuvant therapy has emerged as a potential treatment option for patients with ICC.Neoadjuvant therapy can improve patient prognosis by reducing the tumor size and eliminating tiny lesions that are not visible to the naked eye.Nevertheless,specific treatment options for neoad-juvant therapy are unavailable.This review summarizes the studies on neoadjuvant therapy for ICC in the last decade,including chemotherapy,radiotherapy,interventional therapy,targeted therapy,and immunotherapy,with the aim of providing suggestions for the selection of clinical treatment options for patients with ICC.Current reports suggest that chemotherapy is the most effective neoadjuvant treatment option.How-ever,radiotherapy and interventional therapies require further investigation to obtain conclusive recommendations.Although targeted thera-pies and immunotherapies have been studied less extensively,several ongoing clinical trials are investigating these promising approaches.
基金Supported by Beijing Natural Science Foundation,No.L222054 and No.4232058.
文摘BACKGROUND Diverting stoma(DS)is routinely proposed in intersphincteric resection for ultra-low rectal cancer,but it is associated with increased stoma-related complications and economic burden.Appropriate patient selection and operative strategies to avoid stoma formation need further elucidation.METHODS This study enrolled 505 consecutive patients,including 84 who underwent stoma-free(SF)intersphincteric resection.After matching,patients were divided into SF(n=78)and DS(n=78)groups.The primary endpoint was the anastomotic leakage(AL)rate within 6 months and its protective factors for both the total and SF cohorts.The secondary endpoints included overall survival and disease-free survival.RESULTS The AL rate was greater in the SF group than in the DS group(12.8%vs 2.6%,P=0.035).Male sex[(odds ratio(OR)=2.644,P=0.021],neoadjuvant chemoradiotherapy(nCRT)(OR=6.024,P<0.001),and tumor height from the anal verge≤4 cm(OR=4.160,P=0.007)were identified as independent risk factors.Preservation of the left colic artery(LCA)was protective in both the total cohort(OR=0.417,P=0.013)and the SF cohort(OR=0.312,P=0.027).The female patients who did not undergo nCRT and had preservation of the LCA experienced a significantly lower incidence of AL(2/97,2.1%).The 3-year overall survival or disease-free survival did not significantly differ be-tween the groups.CONCLUSION Female patients who do not receive nCRT may avoid the need for DS by preserving the LCA without increasing the risk of AL or compromising oncological outcomes.
文摘BACKGROUND Gastrointestinal submucosal tumors(SMTs)mostly grew in the lumen,but also some of the lesions were extraluminal,in which the stomach was the most co-mmon site.Gastrointestinal stromal tumor account for a large proportion of SMT.Due to the deep lesion location of gastric SMT,endoscopic submucosal dissection related techniques are difficult to operate,while endoscopic full-thickness rese-ction(EFTR)has been widely used in clinical practice because it is less invasive and can preserve the physiological structure and function of the stomach.Ho-wever,complete closure of the gastrectomy site after EFTR is critical.If the closure is incomplete,it may cause peritonitis,late perforation and other conditions,and even require further surgical intervention.Although there are currently a number of suture devices and techniques that can be used to promote closure,they have the problem of requiring additional equipment or being inconvenient to use.Although metal clips are widely used,their effectiveness depends on the size and tension of the defect.Therefore,an effective and convenient endoscopic closure technique is urgently needed to solve the closure problem of gastric SMTs after treatment.AIM To investigate the effect of combined application of the preclosure technique and dental floss traction in gastric wound closure following EFTR.METHODS In this study,the data of 94 patients treated for gastric SMTs at the Gastrointestinal Endoscopy Center of the Affiliated Union Hospital of Fujian Medical University from April 2022 to May 2023 were retrospectively analyzed.The patients were divided into a preclosure group(54 patients)and a non-preclosure group(40 patients)on the basis of the timing of wound closure with titanium clips after dental floss traction-assisted EFTR.Each patient in the preclosure group had their wounds preclosed with titanium clips after subtotal lesion resection,whereas each patient in the non-preclosure group had their wounds closed with titanium clips after total lesion resection.The lesion size,wound closure time,number of titanium clips used,incidence of postoperative complications,and postoperative hospitalization time were compared between the two groups.RESULTS The wound closure time was significantly shorter in the preclosure group than in the non-preclosure group(6.69±2.109 minutes vs 11.65±3.786 minutes,P<0.001).The number of titanium clips used was significantly lower in the preclosure group(8.93±2.231)than in the non-preclosure group(12.05±4.495)(P<0.001).There was no sig-nificant difference between the two groups in terms of the need for an indwelling gastric tube or the length of postoperative hospital stay(6.41±1.31 vs 6.13±1.06 days).For all patients in the preclosure group and the non-preclosure group,resection was completed successfully without bleeding,abdominal pain,abdominal distension,or other postoperative complications.CONCLUSION Application of the preclosure technique combined with dental floss traction can be used intraoperatively to effectively close the surgical wound in patients undergoing EFTR,reliably preventing the tumor from falling into the peritoneal cavity.
基金Supported by National Natural Science Foundation of China,No.82273442.
文摘BACKGROUND Non-alcoholic fatty liver disease(NAFLD)is characterized by the accumulation of fat in the liver in individuals who do not consume alcohol.Several risk factors influencing the onset of NAFLD after laparoscopic pancreaticoduodenectomy(LPD)have been identified.This study investigated the risk factors associated with the development of fatty liver after laparoscopic duodenum-preserving pancreatic total head resection(LDPPHRt)and LPD.AIM To compare the effects of LDPPHRt and LPD on the development of postoperative NAFLD.METHODS This retrospective cohort study included 59 patients who were histologically diagnosed with benign or low-grade malignant pancreatic tumors and who underwent laparoscopic pancreatic surgery(LDPPHRt or LPD)between May 2020 and April 2023.Patient data on perioperative and postoperative variables were analyzed and compared.Multivariate logistic regression was used to identify pre-,peri-,and postoperative risk factors for NAFLD,with statistical significance set at P<0.05.RESULTS Of the 59 patients included in the study,17(28.8%)developed NAFLD within 6-12 months post-surgery.The incidence of NAFLD was significantly higher in the LPD group compared to the LDPPHRt group(40.0%vs 12.5%,P=0.022).Multivariable analysis identified the LDPPHRt surgical approach(compared to LPD)as an independent protective factor against the development of postoperative NAFLD,with an odds ratio of 0.208(95%confidence interval:0.046-0.931;P=0.040).CONCLUSION Our findings indicate that LDPPHRt is more effective than LPD in reducing the incidence of postoperative NAFLD,which may inform surgical decision-making and optimize patient outcomes after laparoscopic pancreatic surgery.
文摘Background:Hepatocellular carcinoma (HCC) is a leading cause of cancer-related mortality. While liver transplantation (LT) provides the best long-term survival, it is constrained by organ scarcity and strict criteria. Liver resection (LR) is often the initial treatment for patients with solitary tumors and preserved liver function. The high recurrence rates associated with LR has prompted the exploration of sequential living donor liver transplantation (seq LDLT) after LR as a strategy for HCC patients with high-risk of recurrence.Methods:We analyzed data from 27 adult patients who underwent seq LDLT after LR for HCC at Kaohsiung Chang Gung Memorial Hospital (KCGMH) between June 1994 and December 2023. Patients were selected based on high-risk histopathological features post-LR or as part of downstaging strategy. Outcomes measured included overall survival (OS) and disease-free survival (DFS).Results:Among 765 HCC patients who underwent LDLT, 204 received LR before LDLT, and 27 underwent seqL DLT. Five patients (19%) underwent living donor liver transplantation (LDLT) following LR as a downstaging strategy while the rest received seqL DLT as a preemptive strategy. The median age was 53.5 years with 85%males. Chronic hepatitis B was the predominant underlying disease (74%). The 1-, 3-, and 5-year OS and DFS rates were 100%, 96.0%, 96.0%and 100%, 96.2%, 96.2%, respectively, with two patients experiencing HCC recurrence. One patient died from HCC recurrence. High-risk histopathological features included microvascular invasion (52%), satellite nodules (15%), multiple tumors (26%), tumors> 5 cm(19%), and a total tumor diameter> 10 cm (7%).Conclusions:Seq LDLT offers a promising, tailored approach for managing HCC with adverse histopathologic features. Combining seq LDLT, downstaging strategies, and multidisciplinary treatments can achieve satisfactory OS and DFS in carefully selected patients, highlighting the need for refined criteria to identify the best candidates.
基金Supported by Guangdong Provincial Science and Technology Plan Project,No.2022A0505050065Guangdong Natural Science Foundation,No.2022A1515011632.
文摘BACKGROUND Laparoscopic hepatectomy is a proven safe and technically feasible approach for liver tumor resection,but laparoscopic anatomical SVIII resection(LASVIIIR)remains rarely reported due to poor accessibility,difficult exposure,and the deep-lying Glissonean pedicle.This study examined the safety,feasibility,and perio-perative outcomes of LASVIIIR via a middle hepatic fissure approach at our in-stitution.AIM To investigate the safety,feasibility,and perioperative outcomes of LASVIIIR via a middle hepatic fissure approach at our institution.METHODS From November 2017 to December 2022,all patients with a liver tumor who underwent LASVIIIR were enrolled.The perioperative outcomes and postope-rative complications were evaluated.RESULTS Thirty-four patients underwent LASVIIIR via a middle hepatic fissure approach from the side or cranio side and were included.The mean operation time was 164±54 minutes,and the intra-operative blood loss was 100 mL(range:20-1000 mL).The mean operative times were,respectively,152±50 minutes and 222±29 minutes(P=0.001)for the caudal side and cranial side approaches.In addition,the median blood loss volumes were 100 mL(range:20-300 mL)and 250 mL(range:20-1000 mL),respectively,for the caudal and cranial sides(P=0.064).Three patients treated using the cranial side approach experienced bile leakage,while 1 patient treated using the caudal side approach had subphrenic collection and underwent percutaneous drainage to successfully recover.There were no differences regarding postoperative hospital stays for the caudal and cranial side approaches[9(7-26)days vs 8(8-19)days](P=0.226).CONCLUSION LASVIIIR resection remains a challenging operation,but the middle hepatic fissure approach is a reasonable and easy-to-implement technique.
基金Supported by The Medical Science and Technology Project of Zhejiang Province,China,No.2024KY1792The Health Science and Technology Program of Zhejiang Province,China,No.22PY101+2 种基金The Program of Taizhou Science and Technology Grant,China,No.22ywb08 and No.22ywb09The Scientific Research Fund Program of Enze Medical Center,China,No.22EZB12 and No.22EZC17The Open Fund of Key Laboratory of Key Laboratory of Minimally Invasive Techniques and Rapid Rehabilitation of Digestive System Tumor of Zhejiang Province,China,No.21SZDSYS15.
文摘BACKGROUND Endoscopic resection(ER)and laparoscopic resection(LR)have been widely used for the treatment of non-metastatic gastric gastrointestinal stromal tumors(gGISTs)(2-5 cm),but there are no selection criteria for their application.AIM To provide a reference for the development of standardized treatment strategies for gGISTs.METHODS Clinical baseline characteristics,histopathological results,and short-term and long-term outcomes of patients who treated with ER or LR for gGISTs of 2-5 cm in Taizhou Hospital of Zhejiang Province from January 2014 to August 2022 were retrospectively reviewed.Propensity score matching(PSM)was employed to achieve balance in baseline characteristics of the two groups.RESULTS Among 206 patients,135 were in the ER group and 71 in the LR group.The ER group had significantly smaller tumors[3.5 cm(3.0-4.0 cm)vs 4.2 cm(3.3-5.0 cm),P<0.001]and different tumor locations(P=0.048).After PSM,59 pairs of patients were balanced.After matching,the baseline characteristics of the ER and LR groups did not differ significantly from each other.Compared with LR,ER had faster recovery of diet(P=0.046)and fewer postoperative symptoms(P=0.040).LR achieved a higher complete resection rate(P<0.001)and shorter operation time(P<0.001).No significant differences were observed in postoperative hospital stay(P=0.478),hospital costs(P=0.469),complication rates(P>0.999),pathological features(mitosis,P=0.262;National Institutes of Health risk classification,P=0.145),recurrence rates(P=0.476),or mortality rates(P=0.611).CONCLUSION Both ER and LR are safe and effective treatments for gGISTs.ER has less postoperative pain and faster recovery,while LR has a higher rate of complete resection.
文摘AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
基金This study was supported by Shenzhen Fundamental Research Program-General Program(No.JCYJ20210324114403010).
文摘Background:Our clinical practice of laparoscopic liver resection(LLR)had achieved better short-term and long-term benefits for patients with hepatocellular carcinoma(HCC)over open liver resection(OLR),but the underlying mechanisms are not clear.This study was to find out whether systemic inflammation plays an important role.Methods:A total of 103 patients with early-stage HCC under liver resection were enrolled(LLR group,n=53;OLR group,n=50).The expression of 9 inflammatory cytokines in patients at preoperation,postoperative day 1(POD1)and POD7 was quantified by Luminex Multiplex assay.The relationships of the cytokines and the postoperative outcomes were compared between LLR and OLR.Results:Seven of the circulating cytokines were found to be significantly upregulated on POD1 after LLR or OLR compared to their preoperative levels.Compared to OLR,the POD1 levels of granulocytemacrophage colony-stimulating factor(GM-CSF),interleukin-6(IL-6),IL-8,and monocyte chemoattractant protein-1(MCP-1)in the LLR group were significantly lower.Higher POD1 levels of these cytokines were significantly correlated with longer operative time and higher volume of blood loss during operation.The levels of these cytokines were positively associated with postoperative liver injury,and the length of hospital stay.Importantly,a high level of IL-6 at POD1 was a risk factor for HCC recurrence and poor disease-free survival after liver resection.Conclusions:Significantly lower level of GM-CSF,IL-6,IL-8,and MCP-1 after liver resection represented a milder systemic inflammation which might be an important mechanism to offer better short-term and long-term outcomes in LLR over OLR.
文摘Objective:Transurethral resection of bladder tumor is one of the most common everyday urological procedures.This kind of surgery demands a set of skills that need training and experience.In this review,we aimed to investigate the current literature to find out if simulators,phantoms,and other training models could be used as a tool for teaching urologists.Methods:A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement and the recommendations of the European Association of Urology guidelines for conducting systematic reviews.Fifteen out of 932 studies met our inclusion criteria and are presented in the current review.Results:The UroTrainer(Karl Storz GmbH,Tuttlingen,Germany),a virtual reality training simulator,achieved positive feedback and an excellent face and construct validity by the participants.The inspection of bladder mucosa,blood loss,tumor resection,and procedural time was improved after the training,especially for inexperienced urologists and medical students.The construct validity of UroSim®(VirtaMed,Zurich,Switzerland)was established.SIMBLA simulator(Samed GmbH,Dresden,Germany)was found to be a realistic and useful tool by experts and urologists with intermediate experience.The test objective competency model based on SIMBLA simulator could be used for evaluating urologists.The porcine model of the Asian Urological Surgery Training and Education Group also received positive feedback by the participants that tried it.The Simulation and Technology Enhanced Learning Initiative Project had an extraordinary face and content validity,and 60%of participants would like to use the simulators in the future.The 5-day multimodal training curriculum“Boot Camp”in the United Kingdom achieved an increase of the level of confidence of the participants that lasted months after the project.Conclusion:Simulators and courses or curricula based on a simulator training could be a valuable learning tool for any surgeon,and there is no doubt that they should be a part of every urologist's technical education.
文摘In the study by Wu et al,patients with unresectable hepatocellular carcinoma were subjected to transarterial chemoembolization(TACE)as a conversion therapy in order to render their tumors suitable for resection.A nomogram was devised and shown to be effective in predicting the survival of these patients.Generalization of the results,however,is questionable since the study subjects consisted of patients who had resection after TACE while excluding patients with the same disease but not suitable for TACE.Immunotherapy can be considered to be an option for conversion therapy.However,markers for determining responses to a conversion therapy and for guiding the decision between TACE and sequential immunotherapy have been lacking.The question of whether effective conversion therapy can truly enhance overall survival remains unanswered.
