101
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Zheng XL, Li WL, Lin YP, Huang TL. Computerized tomography-guided therapeutic percutaneous puncture catheter drainage-combined with somatostatin for severe acute pancreatitis: An analysis of efficacy and safety. World J Gastrointest Surg 2024; 16:59-66. [PMID: 38328327 PMCID: PMC10845273 DOI: 10.4240/wjgs.v16.i1.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Severe acute pancreatitis (SAP), a condition with rapid onset, critical condition and unsatisfactory prognosis, poses a certain threat to human health, warranting optimization of relevant treatment plans to improve treatment efficacy. AIM To evaluate the efficacy and safety of computerized tomography-guided therapeutic percutaneous puncture catheter drainage (CT-TPPCD) combined with somatostatin (SS) in the treatment of SAP. METHODS Forty-two SAP patients admitted to The Second Affiliated Hospital of Fujian Medical University from June 2020 to June 2023 were selected. On the basis of routine treatment, 20 patients received SS therapy (control group) and 22 patients were given CT-TPPCD plus SS intervention (research group). The efficacy, safety (pancreatic fistula, intra-abdominal hemorrhage, sepsis, and organ dysfunction syndrome), abdominal bloating and pain relief time, bowel recovery time, hospital stay, inflammatory indicators (C-reactive protein, interleukin-6, and procalcitonin), and Acute Physiology and Chronic Health Evaluation (APACHE) II score of both groups were evaluated for comparison. RESULTS Compared with the control group, the research group had a markedly higher total effective rate, faster abdominal bloating and pain relief and bowel recovery, shorter hospital length of stay, fewer complications, and lower posttreatment inflammatory indices and APACHE-II scores. CONCLUSION CT-TPPCD in combination with SS is effective for SAP patients, which can reduce complications, accelerate symptom resolution, inhibit inflammation, and improve patient condition, with promising prospects for clinical promotion.
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Affiliation(s)
- Xue-Lan Zheng
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Wan-Ling Li
- CT Room, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yan-Ping Lin
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Ting-Long Huang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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102
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Gu FW, Wu SZ. Added value of ratio of cross diameters of the appendix in ultrasound diagnosis of acute appendicitis. World J Gastrointest Surg 2024; 16:21-28. [PMID: 38328334 PMCID: PMC10845267 DOI: 10.4240/wjgs.v16.i1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Revised: 12/13/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND The maximum outer diameter (MOD) of the appendix is an essential parameter for diagnosing acute appendicitis, but there is space for improvement in ultrasound (US) diagnostic performance. AIM To investigate whether combining the ratio of the cross diameters (RATIO) of the appendix with MOD of the appendix can enhance the diagnostic performance of acute appendicitis. METHODS A retrospective study was conducted, and medical records of 233 patients with acute appendicitis and 112 patients with a normal appendix were reviewed. The MOD and RATIO of the appendix were calculated and tested for their diagnostic performance of acute appendicitis, both individually and in combination. RESULTS The RATIO for a normal appendix was 1.32 ± 0.16, while for acute appendicitis it was 1.09 ± 0.07. The cut-off value for RATIO was determined to be ≤ 1.18. The area under the receiver operating characteristic curve (AUC) for diagnosing acute appendicitis using RATIO ≤ 1.18 and MOD > 6 mm was 0.870 and 0.652, respectively. There was a significant difference in AUC between RATIO ≤ 1.18 and MOD > 6 mm (P < 0.0001). When comparing the combination of RATIO ≤ 1.18 and MOD > 6 mm with MOD > 6 mm alone, the combination showed increased specificity, positive predictive value (PPV), and AUC. However, the sensitivity and negative predictive value decreased. CONCLUSION Combining RATIO of the appendix ≤ 1.18 and MOD > 6 mm can significantly improve the specificity, PPV, and AUC in the US diagnosis of acute appendicitis.
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Affiliation(s)
- Feng-Wa Gu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
| | - Si-Ze Wu
- Department of Ultrasound, The First Affiliated Hospital of Hainan Medical University, Haikou 570102, Hainan Province, China
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103
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Kuang TZ, Xiao M, Liu YF. Predictive value of NLR, Fib4, and APRI in the occurrence of liver failure after hepatectomy in patients with hepatocellular carcinoma. World J Gastrointest Surg 2024; 16:155-165. [PMID: 38328329 PMCID: PMC10845278 DOI: 10.4240/wjgs.v16.i1.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/21/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Neutrophil-lymphocyte ratio (NLR), fibrosis index based on four factors (Fib4), aspartate aminotransferase-to-platelet ratio index (APRI) can be used for prognostic evaluation of hepatocellular carcinoma. However, no study has established an individualized prediction model for the prognosis of hepatocellular carcinoma based on these factors. AIM To screen the factors that affect the prognosis of hepatocellular carcinoma and establish a nomogram model that predicts postoperative liver failure after hepatic resection in patients with hepatocellular carcinoma. METHODS In total, 220 patients with hepatocellular carcinoma treated in our hospital from January 2022 to January 2023 were selected. They were divided into 154 participants in the modeling cohort, and 66 in the validation cohort. Comparative analysis of the changes in NLR, Fib4, and APRI levels in 154 patients with hepatocellular carcinoma before liver resection and at 3 mo, 6 mo, and 12 mo postoperatively was conducted. Binary logistic regression to analyze the influencing factors on the occurrence of liver failure in hepatocellular carcinoma patients, roadmap prediction modeling, and validation, patient work characteristic curves (ROCs) to evaluate the predictive efficacy of the model, calibration curves to assess the consistency, and decision curve analysis (DCA) to evaluate the model's validity were also conducted. RESULTS Binary logistic regression showed that Child-Pugh grading, Surgical site, NLR, Fib4, and APRI were all risk factors for liver failure after hepatic resection in patients with hepatocellular carcinoma. The modeling cohort built a column-line graph model, and the area under the ROC curve was 0.986 [95% confidence interval (CI): 0.963-1.000]. The patients in the validation cohort utilized the column-line graph to predict the probability of survival in the validation cohort and plotted the ROC curve with an area under the curve of the model of 0.692 (95%CI: 0.548-0.837). The deviation of the actual outcome curves from the calibration curves of the column-line plots generated by the modeling and validation cohorts was small, and the DCA confirmed the validity. CONCLUSION NLR, Fib4, and APRI independently influence posthepatectomy liver failure in patients with hepatocellular carcinoma. The column-line graph prediction model exhibited strong prognostic capability, with substantial concordance between predicted and actual events.
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Affiliation(s)
- Tian-Zuo Kuang
- Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, Ji’an 343000, Jiangxi Province, China
| | - Meng Xiao
- Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, Ji’an 343000, Jiangxi Province, China
| | - Yong-Fan Liu
- Department of Hepatobiliary Surgery, Ji’an Central People’s Hospital, Ji’an 343000, Jiangxi Province, China
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104
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Zeng HJ, Liu JJ, Yang YC. Clinical observation of gastrointestinal function recovery in patients after hepatobiliary surgery. World J Gastrointest Surg 2024; 16:76-84. [PMID: 38328324 PMCID: PMC10845271 DOI: 10.4240/wjgs.v16.i1.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/21/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND The liver is an important metabolic and digestive organ in the human body, capable of producing bile, clotting factors, and vitamins. AIM To investigate the recovery of gastrointestinal function in patients after hepatobiliary surgery and identify effective rehabilitation measures. METHODS A total of 200 patients who underwent hepatobiliary surgery in our hospital in 2022 were selected as the study subjects. They were divided into a control group and a study group based on the extent of the surgery, with 100 patients in each group. The control group received routine treatment, while the study group received targeted interventions, including early enteral nutrition support, drinking water before gas discharge, and large bowel enema, to promote postoperative gastrointestinal function recovery. The recovery of gastrointestinal function was compared between the two groups. RESULTS Compared with the control group, patients in the study group had better recovery of bowel sounds and less accumulation of fluids in the liver bed and gallbladder fossa (P < 0.05). They also had shorter time to gas discharge and first meal (P < 0.05), higher overall effective rate of gastrointestinal function recovery (P < 0.05), and lower incidence of postoperative complications (P < 0.05). CONCLUSION Targeted nursing interventions (early nutritional support, drinking water before gas discharge, and enema) can effectively promote gastrointestinal function recovery in patients undergoing hepatobiliary surgery and reduce the incidence of complications, which is worthy of promotion.
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Affiliation(s)
- Hua-Jun Zeng
- Department of General Practice, Nanyang First People's Hospital, Nanyang 473000, Henan Province, China
| | - Jing-Jing Liu
- Department of Anesthesiology, Chinese People’s Armed Police Force Hospital of Beijing, Beijing 100027, China
| | - Ying-Chun Yang
- Department of Anesthesiology, Beijing Fengtai Hospital, Beijing 100071, China
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105
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Rong XJ, Ning Z. Practical effect of different teaching modes in teaching gastrointestinal surgery nursing. World J Gastrointest Surg 2024; 16:166-172. [PMID: 38328328 PMCID: PMC10845283 DOI: 10.4240/wjgs.v16.i1.166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 12/11/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND With the continuous development and progress of medical technology, the position of surgical nursing in the field of clinical medicine is becoming increasingly prominent. As an important branch of the surgical field, the nursing requirements and difficulty of gastrointestinal surgery are also increasing. In order to improve the teaching quality of nursing care in gastrointestinal surgery, many educators and researchers are actively exploring new teaching methods. Among them, the teaching method case-based learning (CBL), scene-simulated learning (SSL), task-based learning (TBL), combining self-evaluation and training mode is considered as an effective method. This method aims to help students to better master knowledge and skills and improve their comprehensive quality by cultivating their self-evaluation ability. AIM To explore the practical effect of CBL-SSL-TBL combined with training mode and student self-assessment in nursing teaching of gastrointestinal surgery. METHODS Seventy-one nursing interns in our hospital from December 2020 to December 2021 were selected. According to different teaching modes, they were divided into observation group CBL-SSL-TBL combined with training mode combined with student self-assessment and control group (conventional teaching mode), of which 36 were in observation group and 35 were in control group. The results of operational skills, theoretical knowledge, nursing students' satisfaction, learning effectiveness questionnaire and teaching effect were compared between the two groups. RESULTS Compared between the two groups, the operational skills and theoretical knowledge scores of the observation group were higher than those of the control group, and the difference was statistically significant (P < 0.05). Compared between the two groups, the total satisfaction ratio of the observation group was higher than that of the control group, the difference was statistically significant (P < 0.05). Compared between the two groups, the observation group was lower than the control group in the questionnaire results of learning efficacy, and the difference was statistically significant (P < 0.05). Compared between the two groups, the proportion of thinking ability, subjective initiative and understanding of theoretical knowledge in the observation group was higher than that in the control group, the difference was statistically significant (P < 0.05). CONCLUSION The use of CBL-SSL-TBL combined with training mode and student self-assessment in gastrointestinal surgery nursing teaching can improve the operational skills of nursing interns, theoretical knowledge and satisfaction scores of nursing students, improve the results of learning efficiency questionnaire and teaching effect, which can be popularized in clinical teaching.
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Affiliation(s)
- Xiao-Juan Rong
- Department of Nursing, Medical College in Jiangxi University of Technology, Nanchang 330098, Jiangxi Province, China
| | - Zhen Ning
- Department of Nursing, Medical College in Jiangxi University of Technology, Nanchang 330098, Jiangxi Province, China
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106
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Chen R, Chen HQ, Li RD, Lu HM. Different timing for abdominal paracentesis catheter placement and drainage in severe acute pancreatitis complicated by intra-abdominal fluid accumulation. World J Gastrointest Surg 2024; 16:134-142. [PMID: 38328315 PMCID: PMC10845288 DOI: 10.4240/wjgs.v16.i1.134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 11/28/2023] [Accepted: 12/15/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Non-surgical methods such as percutaneous drainage are crucial for the treatment of patients with severe acute pancreatitis (SAP). However, there is still an ongoing debate regarding the optimal timing for abdominal paracentesis catheter placement and drainage. AIM To explore the influence of different timing for abdominal paracentesis catheter placement and drainage in SAP complicated by intra-abdominal fluid accumulation. METHODS Using a retrospective approach, 184 cases of SAP complicated by intra-abdominal fluid accumulation were enrolled and categorized into three groups based on the timing of catheter placement: group A (catheter placement within 2 d of symptom onset, n = 89), group B (catheter placement between days 3 and 5 after symptom onset, n = 55), and group C (catheter placement between days 6 and 7 after symptom onset, n = 40). The differences in progression rate, mortality rate, and the number of cases with organ dysfunction were compared among the three groups. RESULTS The progression rate of group A was significantly lower than those in groups B and groups C (2.25% vs 21.82% and 32.50%, P < 0.05). Further, the proportion of patients with at least one organ dysfunction in group A was significantly lower than those in groups B and groups C (41.57% vs 70.91% and 75.00%, P < 0.05). The mortality rates in group A, group B, and group C were similar (P > 0.05). At postoperative day 3, the levels of C-reactive protein (55.41 ± 19.32 mg/L vs 82.25 ± 20.41 mg/L and 88.65 ± 19.14 mg/L, P < 0.05), procalcitonin (1.36 ± 0.51 ng/mL vs 3.20 ± 0.97 ng/mL and 3.41 ± 0.98 ng/mL, P < 0.05), tumor necrosis factor-alpha (15.12 ± 6.63 pg/L vs 22.26 ± 9.96 pg/L and 23.39 ± 9.12 pg/L, P < 0.05), interleukin-6 (332.14 ± 90.16 ng/L vs 412.20 ± 88.50 ng/L and 420.08 ± 87.65ng/L, P < 0.05), interleukin-8 (415.54 ± 68.43 ng/L vs 505.80 ± 66.90 ng/L and 510.43 ± 68.23ng/L, P < 0.05) and serum amyloid A (270.06 ± 78.49 mg/L vs 344.41 ± 81.96 mg/L and 350.60 ± 80.42 mg/L, P < 0.05) were significantly lower in group A compared to those in groups B and group C. The length of hospital stay in group A was significantly lower than those in groups B and group C (24.50 ± 4.16 d vs 35.54 ± 6.62 d and 38.89 ± 7.10 d, P < 0.05). The hospitalization expenses in group A were also significantly lower than those in groups B and groups C [2.70 (1.20, 3.55) ten-thousand-yuan vs 5.50 (2.98, 7.12) ten-thousand-yuan and 6.00 (3.10, 8.05) ten-thousand-yuan, P < 0.05). The incidence of complications in group A was markedly lower than that in group C (5.62% vs 25.00%, P < 0.05), and similar to group B (P > 0.05). CONCLUSION Percutaneous catheter drainage for the treatment of SAP complicated by intra-abdominal fluid accumulation is most effective when performed within 2 d of onset.
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Affiliation(s)
- Rui Chen
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Hua-Qiang Chen
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Rui-Die Li
- Department of General Surgery, Chengdu Sixth People’s Hospital, Chengdu 610058, Sichuan Province, China
| | - Hui-Min Lu
- West China Center of Exellence for Pancreatitis, Institute of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University; Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
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107
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Fang JH, Li WM, He CH, Wu JL, Guo Y, Lai ZC, Li GD. Endoscopic treatment of extreme esophageal stenosis complicated with esophagotracheal fistula: A case report. World J Gastrointest Surg 2024; 16:239-247. [PMID: 38328322 PMCID: PMC10845269 DOI: 10.4240/wjgs.v16.i1.239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND At present, there is no unified and effective treatment for extreme corrosive esophageal stenosis (CES) with esophagotracheal fistula (ETF). This case had extreme and severe esophageal stenosis (ES) and ETF after ingesting an enzyme-based chemical detergent, resulting in a serious pulmonary infection and severe malnutrition. Upper gastrointestinal imaging showed that he had an ETF, and endoscopy showed that he had extreme and severe esophageal stricture. This case was complex and difficult to treat. According to the domestic and foreign literature, there is no universal treatment that is low-risk. CASE SUMMARY A patient came to our hospital with extreme ES, an ETF, and severe malnutrition complicated with pulmonary tuberculosis 1 mo after the consumption of an enzyme-based detergent. The ES was serious, and the endoscope was unable to pass through the esophagus. We treated him by endoscopic incision method (EIM), esophageal stent placement (ESP), and endoscopic balloon dilation (EBD) by using the bronchoscope and gastroscope. This treatment not only closed the ETF, but also expanded the esophagus, with minimal trauma, greatly reducing the pain of the patient. According to the literature, there are no similar reported cases. CONCLUSION We report, for the first time, a patient with extreme CES complicated with ETF, where the endoscope could not be passed through his esophagus but he could be examined by bronchoscopy and treated by EIM, ESP, and EBD.
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Affiliation(s)
- Jia-Heng Fang
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Wei-Min Li
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Cheng-Hai He
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Jian-Liang Wu
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Yun Guo
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Zhi-Chao Lai
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
| | - Guo-Dong Li
- Department of Gastroenterology, Hangzhou Normal University Affiliated Hospital, Hangzhou 310000, Zhejiang Province, China
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108
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Wu G, Li WY, Gong YX, Lin F, Sun C. Impact of open hepatectomy on postoperative bile leakage in patients with biliary tract cancer. World J Gastrointest Surg 2024; 16:67-75. [PMID: 38328317 PMCID: PMC10845266 DOI: 10.4240/wjgs.v16.i1.67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/09/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Bile leakage is a common and serious complication of open hepatectomy for the treatment of biliary tract cancer. AIM To evaluate the incidence, risk factors, and management of bile leakage after open hepatectomy in patients with biliary tract cancer. METHODS We retrospectively analyzed 120 patients who underwent open hepatectomy for biliary tract cancer from February 2018 to February 2023. Bile leak was defined as bile drainage from the surgical site or drain or the presence of a biloma on imaging. The incidence, severity, timing, location, and treatment of the bile leaks were recorded. The risk factors for bile leakage were analyzed using univariate and multivariate logistic regression analyses. RESULTS The incidence of bile leak was 16.7% (20/120), and most cases were grade A (75%, 15/20) according to the International Study Group of Liver Surgery classification. The median time of onset was 5 d (range, 1-14 d), and the median duration was 7 d (range, 2-28 d). The most common location of bile leakage was the cut surface of the liver (70%, 14/20), followed by the anastomosis site (25%, 5/20) and the cystic duct stump (5%, 1/20). Most bile leaks were treated conservatively with drainage, antibiotics, and nutritional support (85%, 17/20), whereas some required endoscopic retrograde cholangiopancreatography with stenting (10%, 2/20) or percutaneous transhepatic cholangiography with drainage (5%, 1/20). Risk factors for bile leakage include male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion. CONCLUSION Bile leakage is a frequent complication of open hepatectomy for biliary tract cancer. However, most cases are mild and can be conservatively managed. Male sex, hepatocellular carcinoma, major hepatectomy, blood loss, and blood transfusion were associated with an increased risk of bile leak.
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Affiliation(s)
- Gang Wu
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Wen-Ying Li
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Yu-Xing Gong
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Feng Lin
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
| | - Chen Sun
- General Surgery Department, The Second Affiliated Hospital of Harbin Medical University, Harbin 150000, Heilongjiang Province, China
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109
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Huang G, Wu KK, Li XN, Kuai JH, Zhang AJ. Intestinal tuberculosis with small bowel stricture and hemorrhage as the predominant manifestation: Three case reports. World J Gastrointest Surg 2024; 16:248-256. [PMID: 38328313 PMCID: PMC10845280 DOI: 10.4240/wjgs.v16.i1.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 12/24/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Intestinal tuberculosis is a chronic disease caused by Mycobacterium tuberculosis that mainly affects the ileum and cecum. Small bowel tuberculosis, characterized by predominant involvement of the small intestine, is an extremely rare condition with highly atypical clinical presentations, making diagnosis even more challenging. CASE SUMMARY We report three cases of small intestinal tuberculosis, two of the patients presented primarily with abdominal pain, and one presented with gastrointestinal bleeding. All patients underwent blood tests and imaging examinations. Small bowel endoscopy (SBE) revealed that the main lesions in these patients were intestinal stenosis or gastrointestinal bleeding caused by small intestinal ulcers. One patient ultimately underwent surgical treatment. Following a complex diagnostic process and comprehensive analysis, all patients were confirmed to have small intestinal tuberculosis and received standard antituberculosis treatment, leading to an improvement in their condition. CONCLUSION Patients with SBTs present with nonspecific symptoms such as abdominal pain, weight loss, and occasional gastrointestinal bleeding. Accurate diagnosis requires a thorough evaluation of clinical symptoms and various tests to avoid misdiagnosis and complications.
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Affiliation(s)
- Gang Huang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Kang-Kang Wu
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Xiao-Na Li
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Jing-Hua Kuai
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
| | - Ai-Jun Zhang
- Department of Gastroenterology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao 266000, Shandong Province, China
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Yang GY, He ZW, Tang YC, Yuan F, Cao MB, Ren YP, Li YX, Su XR, Yao ZC, Deng MH. Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy. World J Gastrointest Surg 2024; 16:205-214. [PMID: 38328333 PMCID: PMC10845281 DOI: 10.4240/wjgs.v16.i1.205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 12/09/2023] [Accepted: 01/09/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis. Postoperative adjuvant external radiation therapy (RT) has been shown to effectively prevent recurrence after liver cancer resection. However, there are multiple RT techniques available, and the differential effects of these techniques in preventing postoperative liver cancer recurrence require further investigation. AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival (OS) and disease-free survival (DFS) and to determine the optimal strategy. METHODS This study involved network meta-analyses and followed the PRISMA guidelines. The data of qualified studies published before July 10, 2023, were collected from PubMed, Embase, the Web of Science, and the Cochrane Library. We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints. The magnitudes of the effects were determined using risk ratios with 95% confidential intervals. The results were analyzed using R software and STATA software. RESULTS A total of 12 studies, including 1265 patients with hepatocellular carcinoma (HCC) after liver resection, were included in this study. There was no significant heterogeneity in the direct paired comparisons, and there were no significant differences in the inclusion or exclusion criteria, intervention measures, or outcome indicators, meeting the assumptions of heterogeneity and transitivity. OS analysis revealed that patients who underwent stereotactic body radiotherapy (SBRT) after resection had longer OS than those who underwent intensity modulated radiotherapy (IMRT) or 3-dimensional conformal RT (3D-CRT). DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS. Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT. CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT. IMRT, a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT, may be a preferred option.
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Affiliation(s)
- Gao-Yuan Yang
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Zhi-Wei He
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yong-Chang Tang
- Department of General Surgery, Qilu Hospital, Shandong University, Jinan 250012, Shandong Province, China
| | - Feng Yuan
- Department of General Surgery, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou 511436, Guangdong Province, China
| | - Ming-Bo Cao
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yu-Peng Ren
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yu-Xuan Li
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Xiao-Rui Su
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Zhi-Cheng Yao
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Mei-Hai Deng
- Department of Hepatobiliary Surgery, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
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Liu Y, Wang XX, Li YL, He WT, Li H, Chen H. Clinical effect of laparoscopic radical resection of colorectal cancer based on propensity score matching. World J Gastrointest Surg 2024; 16:124-133. [PMID: 38328309 PMCID: PMC10845282 DOI: 10.4240/wjgs.v16.i1.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/16/2023] [Accepted: 12/28/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND The incidence of colorectal cancer (CRC) is increasing annually. Laparoscopic radical resection of CRC is a minimally invasive procedure preferred in clinical practice. AIM To investigate the clinical effect of laparoscopic radical resection of CRC on the basis of propensity score matching (PSM). METHODS The clinical data of 100 patients who received inpatient treatment for CRC at Changde Hospital, Xiangya School of Medicine, Central South University (The First People's Hospital of Changde City) were analyzed retrospectively. The control group included patients who underwent open surgery (n = 43), and those who underwent laparoscopic surgery formed the observation group (n = 57). The baseline information of both groups was equipoised using 1 × 1 PSM. Differences in the perioperative parameters, inflammatory response, immune function, degree of pain, and physical status between the groups were analyzed. RESULTS Thirty patients from both groups were successfully matched. After PSM, baseline data showed no statistically significant differences between the groups: (1) Perioperative parameters: The observation group had a longer surgery time, less intraoperative blood loss, earlier first ambulation and first anal exhaust times, and shorter gastric tube indwelling time than the control group; (2) Inflammatory response: 24 h after surgery, the levels of interleukin-6 (IL-6), C-reactive protein (CRP), and tumor necrosis factor-α (TNF-α) between groups were higher than preoperatively. IL-6, CRP, and TNF-α levels in the observation group were lower than in the control group; (3) Immune function: At 24 h after surgery, counts of CD4-positive T-lymphocytes (CD4+) and CD4+/CD8-positive T-lymphocytes (CD8+) in both groups were lower than those before surgery, whereas CD8+ was higher than that before surgery. At 24 h after surgery, both CD4+ counts and CD4+/CD8+ in the observation group were higher than those in the control group, whereas CD8+ counts were lower; (4) Degree of pain: The visual analog scale scores in the observation group were lower than those in the control group at 24 and 72 h after surgery; and (5) Physical status: One month after surgery, the Karnofsky performance score in the observation group was higher than that in the control group. CONCLUSION Laparoscopic radical resection of CRC has significant benefits, such as reducing postoperative pain and postoperative inflammatory response, avoiding excessive immune inhibition, and contributing to postoperative recovery.
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Affiliation(s)
- Yang Liu
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Xian-Xue Wang
- Department of Anesthesiology, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Yu-Lin Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Wen-Tao He
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hong Li
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
| | - Hua Chen
- Department of General Surgery, Changde Hospital, Xiangya School of Medicine, Central South University (The First People’s Hospital of Changde City), Changde 415000, Hunan Province, China
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Yang Y, Fu KZ, Pan G. Role of Oncostatin M in the prognosis of inflammatory bowel disease: A meta-analysis. World J Gastrointest Surg 2024; 16:228-238. [PMID: 38328320 PMCID: PMC10845284 DOI: 10.4240/wjgs.v16.i1.228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/19/2023] [Accepted: 12/29/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Oncostatin M (OSM) is a pleiotropic cytokine which is implicated in the pathogenesis of inflammatory bowel disease (IBD). AIM To evaluate the prognostic role of OSM in IBD patients. METHODS Literature search was conducted in electronic databases (Google Scholar, Embase, PubMed, Science Direct, Springer, and Wiley). Studies were selected if they reported prognostic information about OSM in IBD patients. Outcome data were synthesized, and meta-analyses were performed to estimate standardized mean differences (SMDs) in OSM levels between treatment responders and non-responders and to seek overall correlations of OSM with other inflammatory biomarkers. RESULTS Sixteen studies (818 Crohn's disease and 686 ulcerative colitis patients treated with anti-tumor necrosis factor-based therapies) were included. OSM levels were associated with IBD severity. A meta-analysis found significantly higher OSM levels in non-responders than in responders to therapy [SMD 0.80 (0.33, 1.27); P = 0.001], in non-remitters than in remitters [SMD 0.75 (95%CI: 0.35 to 1.16); P < 0.0001] and in patients with no mucosal healing than in those with mucosal healing [SMD 0.63 (0.30, 0.95); P < 0.0001]. Area under receiver operator curve values showed considerable variability between studies but in general higher OSM levels were associated with poor prognosis. OSM had significant correlations with Simple Endoscopic Score of Crohn's disease [r = 0.47 (95%CI: 0.25 to 0.64); P < 0.0001], Mayo Endoscopic Score [r = 0.35 (95%CI: 0.28 to 0.41); P < 0.0001], fecal calprotectin [r = 0.19 (95%CI: 0.08 to 0.3); P = 0.001], C-reactive protein [r = 0.25 (95%CI: 0.11 to 0.39); P < 0.0001], and platelet count [r = 0.28 (95%CI: 0.17 to 0.39); P < 0.0001]. CONCLUSION OSM is a potential candidate for determining the severity of disease and predicting the outcomes of anti-tumor necrosis factor-based therapies in IBD patients.
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Affiliation(s)
- Yue Yang
- Department of Gastroenterology III, Heilongjiang Provincial Hospital, Harbin 150036, Heilongjiang Province, China
| | - Kan-Zuo Fu
- Department of Nursing, The Second Hospital of Harbin, Harbin 150056, Heilongjiang Province, China
| | - Gu Pan
- Department of Gastroenterology III, Heilongjiang Provincial Hospital, Harbin 150036, Heilongjiang Province, China
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Wu CY, Lin JA, Ye K. Clinical efficacy of modified Kamikawa anastomosis in patients with laparoscopic proximal gastrectomy. World J Gastrointest Surg 2024; 16:113-123. [PMID: 38328314 PMCID: PMC10845268 DOI: 10.4240/wjgs.v16.i1.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/20/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND With the increasing incidence of proximal gastric cancer, laparoscopic proximal gastrectomy has been applied. However, reflux esophagitis often occurs after traditional esophagogastric anastomosis. In order to solve this problem, several methods of digestive tract reconstruction have emerged, but the most satisfying method remains to be discussed. Therefore, we modified traditional Kamikawa anastomosis to investigate the appropriate digestive tract reconstruction in laparoscopic proximal gastrectomy. AIM To discuss the clinical efficacy of modified Kamikawa anastomosis in laparoscopic proximal gastrectomy. METHODS A retrospective case series was adopted. Clinicopathological data were collected from 26 patients who underwent laparoscopic proximal gastrectomy and modified Kamikawa anastomosis at our hospital from January 2020 to September 2022. The operation conditions, postoperative recovery, postoperative complications, and follow-up data were collected and analyzed. RESULTS All the patients were successfully operated on without conversion to laparotomy. The duration of operation and digestive tract reconstruction were 203.500 (150-224) min and 87.500 (73-111) min, respectively. The intraoperative amount of bleeding was 20.500 mL ± 0.696 mL. The time of postoperative first flatus, the first postoperative fluid intake, and the postoperative length of stay were 2 (1-3) d, 4 (3-5) d, and 9 (8-10) d, respectively. All the patients were followed up for 12-23 months. The body mass index at 6 and 12 months after surgery were 22.577 kg/m2 ± 3.098 kg/m2 and 22.594 kg/m2 ± 3.207 kg/m2, respectively. The nutrition risk screening 2002 score, the patient-generated subjective global assessment score, and the gastroesophageal reflux disease scale score were good at 6 and 12 months after surgery. Reflux esophagitis and anastomotic stenosis were not observed in any of the patients during their 12-month postoperative gastroscopy or upper gastrointestinal tract visits. All the patients exhibited no tumor recurrence or metastasis. CONCLUSION The modified Kamikawa anastomosis is safe and feasible for laparoscopic proximal gastrectomy and has good antireflux effects and nutritional status.
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Affiliation(s)
- Chu-Ying Wu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-An Lin
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Zhao NB, Chen Y, Xia R, Tang JB, Zhao D. Prognostic value of ultrasound in early arterial complications post liver transplant. World J Gastrointest Surg 2024; 16:13-20. [PMID: 38328331 PMCID: PMC10845292 DOI: 10.4240/wjgs.v16.i1.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/21/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
Liver transplantation is the primary therapeutic intervention for end-stage liver disease. However, vascular complications, particularly those involving the hepatic artery, pose significant risks to patients. The clinical manifestations associated with early arterial complications following liver transplantation are often nonspecific. Without timely intervention, these complications can result in graft failure or patient mortality. Therefore, early diagnosis and the formulation of an optimal treatment plan are imperative. Ultrasound examination remains the predominant imaging modality for detecting complications post liver transplantation. This article comprehensively reviews common causes and clinical presentations of early hepatic artery complications in the post-transplantation period and delineates abnormal sonographic findings for accurate diagnosis of these conditions. Overall, ultrasound offers the advantages of convenience, safety, effectiveness, and non-invasiveness. It enables real-time, dynamic, and precise evaluation, making it the preferred diagnostic method for post-liver transplantation assessments.
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Affiliation(s)
- Ning-Bo Zhao
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518112, Guangdong Province, China
| | - Yi Chen
- Department of Ultrasound, National Clinical Research Centre for Infectious Disease, Shenzhen Third People's Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518112, Guangdong Province, China
| | - Rui Xia
- Department of Thyroid and Hernia Surgery, The Second Affiliated Hospital, Guangzhou Medical University, Guangzhou 510000, Guangdong Province, China
| | - Jian-Bo Tang
- Department of Biomedical Engineering, Southern University of Science and Technology, Shenzhen 51800, Guangdong Province, China
| | - Dong Zhao
- Department of Liver Surgery and Organ Transplantation Center, Shenzhen Third People's Hospital, The Second Affiliated Hospital of Southern University of Science and Technology, National Clinical Research Center for Infectious Disease, Shenzhen 518112, Guangdong Province, China
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Qian ST, Xie FF, Zhao HY, Liu QS, Cai DL. Prospects in the application of ultrasensitive chromosomal aneuploidy detection in precancerous lesions of gastric cancer. World J Gastrointest Surg 2024; 16:6-12. [PMID: 38328310 PMCID: PMC10845279 DOI: 10.4240/wjgs.v16.i1.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/11/2023] [Accepted: 12/26/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
Gastric cancer (GC) is a prevalent malignant tumor within the digestive system, with over 40% of new cases and deaths related to GC globally occurring in China. Despite advancements in treatment modalities, such as surgery supplemented by adjuvant radiotherapy or chemotherapeutic agents, the prognosis for GC remains poor. New targeted therapies and immunotherapies are currently under investigation, but no significant breakthroughs have been achieved. Studies have indicated that GC is a heterogeneous disease, encompassing multiple subtypes with distinct biological characteristics and roles. Consequently, personalized treatment based on clinical features, pathologic typing, and molecular typing is crucial for the diagnosis and management of precancerous lesions of gastric cancer (PLGC). Current research has categorized GC into four subtypes: Epstein-Barr virus-positive, microsatellite instability, genome stability, and chromosome instability (CIN). Technologies such as multi-omics analysis and gene sequencing are being employed to identify more suitable novel testing methods in these areas. Among these, ultrasensitive chromosomal aneuploidy detection (UCAD) can detect CIN at a genome-wide level in subjects using low-depth whole genome sequencing technology, in conjunction with bioinformatics analysis, to achieve qualitative and quantitative detection of chromosomal stability. This editorial reviews recent research advancements in UCAD technology for the diagnosis and management of PLGC.
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Affiliation(s)
- Su-Ting Qian
- Department of Digestive, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China
| | - Fei-Fei Xie
- Department of Digestive, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China
| | - Hao-Yu Zhao
- Department of Digestive, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China
| | - Qing-Sheng Liu
- Science and Education Section, Hangzhou Hospital of Traditional Chinese Medicine, Hangzhou 310007, Zhejiang Province, China
| | - Dan-Li Cai
- Intensive Care Unit, The First Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou 311122, Zhejiang Province, China
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Li C, Chen HX, Lai YH. Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation. World J Gastrointest Surg 2024; 16:143-154. [PMID: 38328316 PMCID: PMC10845289 DOI: 10.4240/wjgs.v16.i1.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/17/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND The nutritional status is closely related to the prognosis of liver transplant recipients, but few studies have reported the role of preoperative objective nutritional indices in predicting liver transplant outcomes. AIM To compare the predictive value of various preoperative objective nutritional indicators for determining 30-d mortality and complications following liver transplantation (LT). METHODS A retrospective analysis was conducted on 162 recipients who underwent LT at our institution from December 2019 to June 2022. RESULTS This study identified several independent risk factors associated with 30-d mortality, including blood loss, the prognostic nutritional index (PNI), the nutritional risk index (NRI), and the control nutritional status. The 30-d mortality rate was 8.6%. Blood loss, the NRI, and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications. The NRI achieved the highest prediction values for 30-d mortality [area under the curve (AUC) = 0.861, P < 0.001] and severe complications (AUC = 0.643, P = 0.011). Compared to those in the high NRI group, the low patients in the NRI group had lower preoperative body mass index and prealbumin and albumin levels, as well as higher alanine aminotransferase and total bilirubin levels, Model for End-stage Liver Disease scores and prothrombin time (P < 0.05). Furthermore, the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding, primary graft nonfunction, and mortality. CONCLUSION The NRI has good predictive value for 30-d mortality and severe complications following LT. The NRI could be an effective tool for transplant surgeons to evaluate perioperative nutritional risk and develop relevant nutritional therapy.
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Affiliation(s)
- Chuan Li
- Department of Transplantation, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Hong-Xia Chen
- Department of Clinical Pharmacy, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Yan-Hua Lai
- Department of Transplantation, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Zhang ZS. Predictive factors and model validation of post-colon polyp surgery Helicobacter pylori infection. World J Gastrointest Surg 2024; 16:173-185. [PMID: 38328335 PMCID: PMC10845274 DOI: 10.4240/wjgs.v16.i1.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/03/2023] [Accepted: 12/20/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Recently, research has linked Helicobacter pylori (H. pylori) stomach infection to colonic inflammation, mediated by toxin production, potentially impacting colorectal cancer occurrence. AIM To investigate the risk factors for post-colon polyp surgery, H. pylori infection, and its correlation with pathologic type. METHODS Eighty patients who underwent colon polypectomy in our hospital between January 2019 and January 2023 were retrospectively chosen. They were then randomly split into modeling (n = 56) and model validation (n = 24) sets using R. The modeling cohort was divided into an H. pylori-infected group (n = 37) and an H. pylori-uninfected group (n = 19). Binary logistic regression analysis was used to analyze the factors influencing the occurrence of H. pylori infection after colon polyp surgery. A roadmap prediction model was established and validated. Finally, the correlation between the different pathological types of colon polyps and the occurrence of H. pylori infection was analyzed after colon polyp surgery. RESULTS Univariate results showed that age, body mass index (BMI), literacy, alcohol consumption, polyp pathology type, high-risk adenomas, and heavy diet were all influential factors in the development of H. pylori infection after intestinal polypectomy. Binary multifactorial logistic regression analysis showed that age, BMI, and type of polyp pathology were independent predictors of the occurrence of H. pylori infection after intestinal polypectomy. The area under the receiver operating characteristic curve was 0.969 [95% confidence interval (95%CI): 0.928-1.000] and 0.898 (95%CI: 0.773-1.000) in the modeling and validation sets, respectively. The slope of the calibration curve of the graph was close to 1, and the goodness-of-fit test was P > 0.05 in the two sets. The decision analysis curve showed a high rate of return in both sets. The results of the correlation analysis between different pathological types and the occurrence of H. pylori infection after colon polyp surgery showed that hyperplastic polyps, inflammatory polyps, and the occurrence of H. pylori infection were not significantly correlated. In contrast, adenomatous polyps showed a significant positive correlation with the occurrence of H. pylori infection. CONCLUSION Age, BMI, and polyps of the adenomatous type were independent predictors of H. pylori infection after intestinal polypectomy. Moreover, the further constructed column-line graph prediction model of H. pylori infection after intestinal polypectomy showed good predictive ability.
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Affiliation(s)
- Zheng-Sen Zhang
- Health Management Center, Affiliated Hospital of Shaoxing University (Shaoxing Municipal Hospital), Shaoxing 312000, Zhejiang Province, China
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Bencini L. Novel prognostic factors after radical resection of hepatocellular carcinoma: Updating an old issue. World J Gastrointest Surg 2024; 16:1-5. [PMID: 38328325 PMCID: PMC10845265 DOI: 10.4240/wjgs.v16.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/12/2023] [Accepted: 01/08/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
In this editorial, I comment on the article by Li et al published in the recent issue of the World Journal of Gastrointestinal Surgery in 2023, investigating the role of some novel prognostic factors for early survival after radical resection of liver cancer. Liver cancer is an important burden among Asian and Western populations, despite recent advances in both medicine (from virus eradication to systemic target therapies) and surgery. However, survival after proven radical surgery remains poor, with recurrences being the rule. Many prognostic scores have been developed and validated to select those patients who will best benefit from radical liver surgery, although the final general and oncological outcomes continue to be highly jeopardized. Unfortunately, no single biomarker can resolve all these issues for hepatocellular carcinoma, and it remains to be proven whether some of them maintain predictive power in the long-term follow-up. In the ongoing era of "precision" medicine, the novel prognostic markers, including immune inflammatory and nutritional indexes could be of great help in better stratify surgical candidates.
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Affiliation(s)
- Lapo Bencini
- Department of Oncology and Robotic Surgery, Careggi Main Florence University and Regional Hospital, Florence 50134, Italy
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119
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Xu DY, Bai BJ, Shan L, Wei HY, Lin DF, Wang Y, Wang D. Micro-power negative pressure wound technique reduces risk of incision infection following loop ileostomy closure. World J Gastrointest Surg 2024; 16:186-195. [PMID: 38328332 PMCID: PMC10845270 DOI: 10.4240/wjgs.v16.i1.186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/30/2023] [Accepted: 12/13/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Prophylactic loop ileostomy is an effective way to reduce the clinical severity of anastomotic leakage following radical resection of rectal cancer. Incisional surgical site infection (SSI) is a common complication after ileostomy closure. AIM To evaluate the efficacy and safety of the micro-power negative pressure wound technique (MPNPWT) in preventing incisional SSI. METHODS This was a prospective, randomized controlled clinical trial conducted at a single center. A total of 101 consecutive patients who underwent ileostomy closure after rectal cancer surgery with a prophylactic ileostomy were enrolled from January 2019 to December 2021. Patients were randomly allocated into an MPNPWT group and a control group. The MPNPWT group underwent intermittent suturing of the surgical incision with 2-0 Prolene and was covered with a micro-power negative pressure dressing. The surgical outcomes were compared between the MPNPWT (n = 50) and control (n = 51) groups. Risk factors for incisional SSI were identified using logistic regression. RESULTS There were no differences in baseline characteristics between the MPNPWT (n = 50) and control groups (n = 51). The incisional SSI rate was significantly higher in the control group than in the MPNPWT group (15.7% vs 2.0%, P = 0.031). However, MPNPWT did not affect other surgical outcomes, including intra-abdominal complications, operative time, and blood loss. Postoperative hospital stay length and hospitalization costs did not differ significantly between the two groups (P = 0.069 and 0.843, respectively). None of the patients experienced adverse effects of MPNPWT, including skin allergy, dermatitis, and pain. MPNPWT also helped heal the infected incision. Our study indicated that MPNPWT was an independent protective factor [odds ratio (OR) = 0.005, P = 0.025)] and diabetes was a risk factor (OR = 26.575, P= 0.029) for incisional SSI. CONCLUSION MPNPWT is an effective and safe way to prevent incisional SSI after loop ileostomy closure.
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Affiliation(s)
- Deng-Yong Xu
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Bing-Jun Bai
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Lina Shan
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Hui-Yan Wei
- Department of Wound & Ostomy Care Clinic, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Deng-Feng Lin
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
| | - Ya Wang
- Department of Hospital Infection Control, Zhejiang Cancer Hospital, Hangzhou 310005, Zhejiang Province, China
| | - Da Wang
- Department of Colorectal Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, Zhejiang Province, China
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Xiong YF, Wei BZ, Wang YF, Li XF, Liu C. Paravertebral block's effect on analgesia and inflammation in advanced gastric cancer patients undergoing transarterial chemoembolization and microwave ablation. World J Gastrointest Surg 2024; 16:196-204. [PMID: 38328336 PMCID: PMC10845272 DOI: 10.4240/wjgs.v16.i1.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Transarterial chemoembolization (TACE) combined with microwave ablation (MWA) is an effective treatment strategy for patients with advanced gastric cancer and liver metastasis. However, it may cause severe postoperative pain and inflammatory responses. The paravertebral block (PVB) is a regional anesthetic technique that provides analgesia to the thoracic and abdominal regions. AIM To evaluate the effect of PVB on postoperative analgesia and inflammatory response in patients undergoing TACE combined with MWA for advanced gastric cancer and liver metastasis. METHODS Sixty patients were randomly divided into PVB and control groups. The PVB group received ultrasound-guided PVB with 0.375% ropivacaine preoperatively, whereas the control group received intravenous analgesia with sufentanil. The primary outcome was the visual analog scale (VAS) score for pain at 6 h, 12 h, 24 h, and 48 h after the procedure. Secondary outcomes were the dose of sufentanil used, incidence of adverse events, and levels of inflammatory markers (white blood cell count, neutrophil percentage, C-reactive protein, and procalcitonin) before and after the procedure. RESULTS The PVB group had significantly lower VAS scores at 6 h, 12 h, 24 h, and 48 h after the procedure compared with the control group (P < 0.05). The PVB group also had a significantly lower consumption of sufentanil and a lower incidence of nausea, vomiting, and respiratory depression than did the control group (P < 0.05). Compared with the control group, the PVB group had significantly lower levels of inflammatory markers 24 h and 48 h after the procedure (P < 0.05). CONCLUSION PVB can effectively reduce postoperative pain and inflammatory responses and improve postoperative comfort and recovery in patients with advanced gastric cancer and liver metastasis treated with TACE combined with MWA.
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Affiliation(s)
- Ying-Fen Xiong
- Department of Anesthesiology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, Jiangxi Province, China
| | - Ben-Zhong Wei
- Department of Anesthesiology, Nanjing Gulou Hospital Group Yizheng Hospital, Yangzhou 211400, Jiangsu Province, China
| | - Yu-Feng Wang
- Nuclear Medicine Department, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Xiao-Feng Li
- Department of Radiology, Xuzhou Cancer Hospital, Xuzhou 221000, Jiangsu Province, China
| | - Cong Liu
- Department of Minimally Invasive Oncology, Xuzhou New Health Hospital (Xuzhou Hospital Affiliated to Jiangsu University), Xuzhou 221000, Jiangsu Province, China
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Yuan WH, Zhang Z, Pan Q, Mao BN, Yuan T. Risk factors for recurrence of common bile duct stones after surgical treatment and effect of ursodeoxycholic acid intervention. World J Gastrointest Surg 2024; 16:103-112. [PMID: 38328330 PMCID: PMC10845285 DOI: 10.4240/wjgs.v16.i1.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/29/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Endoscopic retrograde cholangiopancreatography (ERCP) is an accurate diagnostic method for choledocholithiasis and treatment option for stone removal. Additionally, ursodeoxycholic acid (UDCA) can dissolve cholesterol stones and prevent their development and reappearance by lowering the cholesterol concentration in bile. Despite these treatment options, there are still patients who experience stone recurrence. AIM To analyze the risk factors for choledocholithiasis recurrence after ERCP retrograde cholangiopancreatography and the effect of UDCA intervention. METHODS The clinical data of 100 patients with choledochal stones who were hospitalized at the Yixing People's Hospital and underwent ERCP for successful stone extraction between June 2020 and December 2022 were retrospectively collected. According to the post-ERCP treatment plan, 100 patients were classified into UDCA (n = 47) and control (n = 53) groups. We aimed to assess the clinical efficacy and rate of relapse in the two patient populations. We then collected information (basic demographic data, clinical characteristics, and serum biochemical indicators) and determined the factors contributing to relapse using logistic regression analysis. Our secondary goal was to determine the effects of UDCA on liver function after ERCP. RESULTS Compared to the control group, the UDCA group demonstrated a higher clinical effectiveness rate of 92.45% vs 78.72% (P < 0.05). No significant differences were observed in liver function indices, including total bilirubin, direct bilirubin, gamma-glutamyl transpeptidase, alanine aminotransferase, alkaline phosphatase, and aspartate aminotransferase, between the two groups before treatment. After treatment, all liver function indices were significantly reduced. Comparing the control vs UDCA groups, the UDCA group exhibited significantly lower levels of all indices (55.39 ± 6.53 vs 77.31 ± 8.52, 32.10 ± 4.62 vs 45.39 ± 5.69, 142.32 ± 14.21 vs 189.63 ± 16.87, 112.52 ± 14.25 vs 149.36 ± 15.36, 122.61 ± 16.00 vs 171.33 ± 22.09, 96.98 ± 10.44 vs 121.35 ± 11.57, respectively, all P < 0.05). The stone recurrence rate was lower in the UDCA group (13.21%) in contrast with the control group (44.68%). Periampullary diverticula (OR: 6.00, 95%CI: 1.69-21.30), maximum stone diameter (OR: 1.69, 95%CI: 1.01-2.85), stone quantity >3 (OR: 4.23, 95%CI: 1.17-15.26), and positive bile culture (OR: 7.61, 95%CI: 2.07-27.91) were independent factors that influenced the relapse of common bile duct stones after ERCP (P < 0.05). Furthermore, postoperative UDCA was identified as a preventive factor (OR: 0.07; 95%CI: 0.08-0.09). CONCLUSION The intervention effect of UDCA after ERCP for common bile duct stones is adequate, providing new research directions and references for the prevention and treatment of stone recurrence.
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Affiliation(s)
- Wei-Hong Yuan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Zheng Zhang
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Qi Pan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Bo-Neng Mao
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
| | - Tao Yuan
- Department of Gastroenterology, Yixing People’s Hospital, Yixing 214200, Jiangsu Province, China
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Zhu XJ, Jiao JY, Xue HM, Chen P, Qin CF, Wang P. Single-incision laparoscopic transabdominal preperitoneal repair in the treatment of adult female patients with inguinal hernia. World J Gastrointest Surg 2024; 16:49-58. [PMID: 38328323 PMCID: PMC10845276 DOI: 10.4240/wjgs.v16.i1.49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 12/09/2023] [Accepted: 01/04/2024] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
BACKGROUND Women have a 3% lifetime chance of developing an inguinal hernia, which is not as common in men. Due to its cosmetic benefits, single-incision laparoscopic transabdominal preperitoneal (SIL-TAPP) inguinal hernia repair is becoming increasingly popular in the management of inguinal hernia in women. However, there are no studies comparing the safety and applicability of SIL-TAPP repair with conventional laparoscopic transabdominal preperitoneal (CL-TAPP) inguinal hernia repair for the treatment of inguinal hernia in women. AIM To compare the outcomes of SIL-TAPP and CL-TAPP repair in adult female patients with inguinal hernia and to estimate the safety and applicability of SIL-TAPP repair in adult female inguinal hernia patients. METHODS We retrospectively compared the clinical information and follow-up data of female inguinal hernia patients who underwent SIL-TAPP inguinal hernia repair and those who underwent CL-TAPP inguinal hernia repair at the Affiliated Hospital of Nantong University from February 2018 to December 2020 and assessed the long-term and short-term outcomes of both cohorts. RESULTS This study included 123 patients, with 71 undergoing SIL-TAPP repair and 52 undergoing CL-TAPP repair. The two cohorts of patients and inguinal hernia characteristics were similar, with no statistically meaningful difference. The rate of intraoperative inferior epigastric vessel injury was lower in patients in the SIL-TAPP cohort (0, 0%) than in patients in the CL-TAPP cohort (4, 7.7%) and was significantly different (P < 0.05). In addition, the median [interquartile range (IQR)] total hospitalization costs were significantly lower in patients in the SIL-TAPP cohort [$3287 (3218-3325)] than in patients in the CL-TAPP cohort [$3511 (3491-3599)]. Postoperatively, the occurrence rate of trocar site hernia was lower in the SIL-TAPP cohort (0, 0%) than in the CL-TAPP cohort (4, 7.7%), and the median (IQR) cosmetic score was significantly higher in the SIL-TAPP cohort [10 (10-10)] than in the CL-TAPP cohort [9 (9-10)]. CONCLUSION SIL-TAPP repair did not increase the incidence of intraoperative and postoperative complications in female inguinal hernia patients. Moreover, female inguinal hernia patients who underwent SIL-TAPP repair had a lower probability of trocar site hernia and inferior epigastric vessel injury than female inguinal hernia patients who underwent CL-TAPP repair. In addition, female inguinal hernia patients who underwent SIL-TAPP repair reported a more aesthetically pleasing postoperative abdominal incision. Therefore, SIL-TAPP repair is a better option for the treatment of inguinal hernias in women.
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Affiliation(s)
- Xiao-Jun Zhu
- Department of General Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Jing-Yi Jiao
- Department of General Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
- Medical School, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Hui-Min Xue
- Department of General Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
| | - Peng Chen
- Department of General Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
- Medical School, Nantong University, Nantong 226001, Jiangsu Province, China
| | - Chang-Fu Qin
- Department of Hernia and Abdominal Wall Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Peng Wang
- Department of General Surgery, The Affiliated Hospital of Nantong University, Nantong 226001, Jiangsu Province, China
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Li XJ, He K. Sarcopenia in cirrhotic patients: Does frailty matter while waiting for a liver transplant? World J Gastrointest Surg 2024; 16:257-259. [PMID: 38328318 PMCID: PMC10845277 DOI: 10.4240/wjgs.v16.i1.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/07/2023] [Accepted: 12/12/2023] [Indexed: 01/25/2024] [Imported: 01/25/2024] Open
Abstract
Sarcopenia reflects patient frailty and should be routinely assessed due to its high prevalence in cirrhotic patients awaiting liver transplants. Pre-transplant nutritional optimization should be tailored for patients with a definitive diagnosis of sarcopenia, therefore improving functional status at transplant and reducing post-transplant mortality. Hepatologists and transplant surgeons should have raised awareness regarding sarcopenia and the reflected frailty that hinder posttransplant outcomes. The policymakers should also take into account when modifying the organ allocation model that sarcopenia or frailty might become a decisive factor in allocating organs for cirrhotic patients, in order to ensure post-transplant survival and quality of life.
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Affiliation(s)
- Xing-Jie Li
- Division of Transplant Surgery, Mayo Clinic Arizona, Phoenix, AZ 85054, United States
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
| | - Kang He
- Department of Liver Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
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Emara MH, Ahmed MH, Radwan MI, Emara EH, Basheer M, Ali A, Elfert AA. Post-cholecystectomy iatrogenic bile duct injuries: Emerging role for endoscopic management. World J Gastrointest Surg 2023; 15:2709-2718. [PMID: 38222007 PMCID: PMC10784825 DOI: 10.4240/wjgs.v15.i12.2709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/26/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
Post-cholecystectomy iatrogenic bile duct injuries (IBDIs), are not uncommon and although the frequency of IBDIs vary across the literature, the rates following the procedure of laparoscopic cholecystectomy are much higher than open cholecystectomy. These injuries caries a great burden on the patients, physicians and the health care systems and sometime are life-threatening. IBDIs are associated with different manifestations that are not limited to abdominal pain, bile leaks from the surgical drains, peritonitis with fever and sometimes jaundice. Such injuries if not witnessed during the surgery, can be diagnosed by combining clinical manifestations, biochemical tests and imaging techniques. Among such techniques abdominal US is usually the first choice while Magnetic Resonance Cholangio-Pancreatography seems the most appropriate. Surgical approach was the ideal approach for such cases, however the introduction of Endoscopic Retrograde Cholangio-Pancreatography (ERCP) was a paradigm shift in the management of such injuries due to accepted success rates, lower cost and lower rates of associated morbidity and mortality. However, the literature lacks consensus for the optimal timing of ERCP intervention in the management of IBDIs. ERCP management of IBDIs can be tailored according to the nature of the underlying injury. For the subgroup of patients with complete bile duct ligation and lost ductal continuity, transfer to surgery is indicated without delay. Those patients will not benefit from endoscopy and hence should not do unnecessary ERCP. For low-flow leaks e.g. gallbladder bed leaks, conservative management for 1-2 wk prior to ERCP is advised, in contrary to high-flow leaks e.g. cystic duct leaks and stricture lesions in whom early ERCP is encouraged. Sphincterotomy plus stenting is the ideal management line for cases of IBDIs. Interventional radiologic techniques are promising options especially for cases of failed endoscopic repair and also for cases with altered anatomy. Future studies will solve many unsolved issues in the management of IBDIs.
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Affiliation(s)
- Mohamed H Emara
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohammed Hussien Ahmed
- Department of Hepatology, Gastroenterology and Infectious Diseases, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Mohamed I Radwan
- Department of Tropical Medicine, Zagazig University, Zagazig 44519, Egypt
| | - Emad Hassan Emara
- Department of Diagnostic and Interventional Radiology, Kafrelsheikh University, Kafr-Elshikh 33516, Egypt
| | - Magdy Basheer
- Department of Surgery, Mansoura University, Mansours 44176, Egypt
| | - Ahmed Ali
- Department of Emergency, Hargeisa Group Hospital, Hargeisa 1235, Somalia
| | - Asem Ahmed Elfert
- Department of Tropical Medicine, Tanta University, Tanta 33120, Egypt
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Liu HL, Peng H, Huang CH, Zhou HY, Ge J. Mutational separation and clinical outcomes of TP53 and CDH1 in gastric cancer. World J Gastrointest Surg 2023; 15:2855-2865. [PMID: 38222005 PMCID: PMC10784822 DOI: 10.4240/wjgs.v15.i12.2855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 10/18/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Gastric cancer (GC) is a deadly tumor with the fifth highest occurrence and highest global mortality rates. Owing to its heterogeneity, the underlying mechanism of GC remains unclear, and chemotherapy offers little benefit to individuals. AIM To investigate the clinical outcomes of TP53 and CDH1 mutations in GC. METHODS In this study, 202 gastric adenocarcinoma tumor tissues and their corresponding normal tissues were collected. A total of 490 genes were identified using target capture. Through t-test and Wilcoxon rank-sum test, somatic mutations, microsatellite instability, and clinical statistics, including overall survival, were detected, compared, and calculated. RESULTS The mutation rates of 32 genes, including TP53, SPEN, FAT1, and CDH1 exceeded 10%. TP53 mutations had a slightly lower overall occurrence rate (33%). The TP53 mutation rate was significantly higher in advanced stages (stage III/IV) than that in early stages (stage I/II) (P < 0.05). In contrast, CDH1 mutations were significantly associated with diffuse GC. TP53 is related to poor prognosis of advanced-stage tumors; nevertheless, CDH1 corresponds to a diffuse type of cancer. TP53 is exclusively mutated in CDH1 and is primarily affected by two distinct GC mechanisms. CONCLUSION Different somatic mutation patterns in TP53 and CDH1 indicate two major mechanisms of GC.
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Affiliation(s)
- He-Li Liu
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Huan Peng
- Clinical Nursing Teaching and Research Section, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Chang-Hao Huang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Hai-Yan Zhou
- Department of Pathology, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
| | - Jie Ge
- Department of Gastrointestinal Surgery, Xiangya Hospital, Central South University, Changsha 410008, Hunan Province, China
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Tang F, Huang CW, Tang ZH, Lu SL, Bai T, Huang Q, Li XZ, Zhang B, Wu FX. Prognostic role of serum carcinoembryonic antigen in patients receiving liver resection for colorectal cancer liver metastasis: A meta-analysis. World J Gastrointest Surg 2023; 15:2890-2906. [PMID: 38222018 PMCID: PMC10784827 DOI: 10.4240/wjgs.v15.i12.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 11/03/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Carcinoembryonic antigen (CEA) is a broad-spectrum tumor marker for differential diagnosis, monitoring, and response assessment of a variety of malignancies. AIM To evaluate whether serum CEA could predict the prognosis in patients with colorectal cancer liver metastasis (CRCLM) before and after liver resection (LR). METHODS PubMed, Embase, Cochrane, and Web of Science were systematically searched to retrieve literature, with a search cut-off date of February 27, 2023. Articles were strictly screened for inclusion according to pre-specified inclusion and exclusion criteria. Data were pooled and analyzed using Stata 16.0. RESULTS This meta-analysis included 36 studies involving a total of 11143 CRCLM patients. The results showed that a high pre-LR serum CEA level was correlated with poor overall survival (OS) [hazard ratio (HR) = 1.61, 95% confidence interval (CI): 1.49-1.75, P < 0.001] and recurrence-free survival (HR = 1.27, 95%CI: 1.11-1.45, P < 0.001) in CRCLM patients. A high post-LR serum CEA level predicted poor OS (HR = 2.66, 95%CI: 2.10-3.38, P < 0.001). A comparison by treatment modality, analysis modality, patient source, and cutoff-value showed that overall, high preoperative and postoperative serum CEA levels remained correlated with a poor prognosis. CONCLUSION This study concluded that high pre-LR and post-LR serum CEA levels were significantly correlated with a poor prognosis in CRCLM patients.
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Affiliation(s)
- Fan Tang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Cheng-Wen Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhi-Hong Tang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Shao-Long Lu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Tao Bai
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Qing Huang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Xing-Zhi Li
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Bin Zhang
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
| | - Fei-Xiang Wu
- Department of Hepatobiliary Surgery, Guangxi Medical University Cancer Hospital, Nanning 530021, Guangxi Zhuang Autonomous Region, China
- Key Laboratory of High-Incidence-Tumor Prevention & Treatment, Ministry of Education, Nanning 530021, Guangxi Zhuang Autonomous Region, China
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Hu YD, Zhang H, Tan W, Li ZK. Impact of hepatectomy and postoperative adjuvant transarterial chemoembolization on serum tumor markers and prognosis in intermediate-stage hepatocellular carcinoma. World J Gastrointest Surg 2023; 15:2820-2830. [PMID: 38222017 PMCID: PMC10784839 DOI: 10.4240/wjgs.v15.i12.2820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/22/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Primary hepatocellular carcinoma (HCC) is a common malignant tumour, and its early symptoms are often not obvious, resulting in many patients experiencing middle- to late-stage disease at the time of diagnosis. The optimal time for surgery is often missed for these patients, and those who do undergo surgery have unsatisfactory long-term outcomes and a high recurrence rate within five years. Therefore, postoperative follow-up treatments, such as transhepatic arterial chemoembolization (TACE), have become critical to improving survival and reducing recurrence rates. AIM To validate the prophylactic role of TACE after hepatic resection and to assess its impact on patient prognosis. METHODS This study investigated the efficacy of TACE in patients with intermediate-stage HCC after hepatectomy. When the post-treatment results of the observation group and the control group were compared, it was found that the inclusion of TACE significantly improved the clinical efficacy, reduced the levels of tumour markers and did not aggravate the damage to liver function. Thus, this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC that helps to improve their quality of life and survival time. RESULTS When the baseline data were analysed, no statistical differences were found between the two groups in terms of gender, age, hepatitis B virus, cirrhosis, Child-Pugh grading, number of tumours, maximum tumour diameter and degree of tumour differentiation. The assessment of clinical efficacy showed that the post-treatment overall remission rate of the observation group was significantly higher than that of the control group. In terms of changes in tumour markers, the alpha-fetoprotein and carcinoembryonic antigen levels in the patients in the observation group decreased more significantly after treatment compared with those in the control group. When post-treatment changes in liver function indicators were analysed, no statistical differences were found in the total bilirubin, alanine aminotransferase and aspartate aminotransferase levels between the two groups. CONCLUSION In patients with intermediate-stage HCC, post-hepatectomy TACE significantly improved clinical outcomes, reduced tumour-marker levels and may have improved the prognosis by removing residual lesions. Thus, this may be an effective and comprehensive treatment strategy for patients with intermediate-stage HCC.
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Affiliation(s)
- Yi-Di Hu
- Department of Surgery, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Hui Zhang
- Department of Surgery, Wenzhou TCM Hospital of Zhejiang Chinese Medical University, Wenzhou 325000, Zhejiang Province, China
| | - Wei Tan
- Department of Hepatobiliary and Pancreatic Surgery, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
| | - Zhuo-Kai Li
- Department of Hepatobiliary and Pancreatic Surgery, Lishui Municipal Central Hospital, Lishui 323000, Zhejiang Province, China
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Zhang Y, Cheng HH, Fan WJ. Duodenojejunostomy treatment of groove pancreatitis-induced stenosis and obstruction of the horizontal duodenum: A case report. World J Gastrointest Surg 2023; 15:2945-2953. [PMID: 38222014 PMCID: PMC10784829 DOI: 10.4240/wjgs.v15.i12.2945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/10/2023] [Accepted: 12/02/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Groove pancreatitis (GP) is a rare condition affecting the pancreatic groove region within the dorsal-cranial part of the pancreatic head, duodenum, and common bile duct. As a rare form of chronic pancreatitis, GP poses a diagnostic and therapeutic challenge for clinicians. GP is frequently misdiagnosed or not considered; thus, the diagnosis is often delayed by weeks or months. The treatment of GP is complicated and often requires surgical intervention, especially pancreatoduodenectomy. CASE SUMMARY A 66-year-old man with a history of long-term drinking was admitted to the gastroenterology department of our hospital, complaining of vomiting and acid reflux. Upper gastrointestinal endoscopy showed luminal stenosis in the descending part of the duodenum. Abdominal computed tomography showed slight exudation in the descending and horizontal parts of the duodenum with broadening of the groove region, indicating local pancreatitis. The symptoms of intestinal obstruction were not relieved with conservative therapy, and insertion of an enteral feeding tube was not successful. Exploratory laparoscopy was performed and revealed a hard mass with scarring in the horizontal part of the duodenum and stenosis. Intraoperative frozen section analysis showed no evidence of malignancy, and side-to-side duodenojejunostomy was performed. Routine pathologic examination showed massive proliferation of fibrous tissue, hyaline change, and the proliferation of spindle cells. Based on the radiologic and pathologic characteristics, a diagnosis of GP was made. The patient presented with anastomotic obstruction postoperatively and took a long time to recover, requiring supportive therapy. CONCLUSION GP often involves the descending and horizontal parts of the duodenum and causes duodenal stenosis, impaired duodenal motility, and gastric emptying due to fibrosis.
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Affiliation(s)
- Yu Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Heng-Hui Cheng
- Institution of Pathology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
| | - Wen-Juan Fan
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, Hubei Province, China
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Wang XD, Ge NJ, Yang YF. Portal vein embolization for closure of marked arterioportal shunt of hepatocellular carcinoma to enable radioembolization: A case report. World J Gastrointest Surg 2023; 15:2926-2931. [PMID: 38222008 PMCID: PMC10784826 DOI: 10.4240/wjgs.v15.i12.2926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/24/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Marked arterioportal shunt (APS) can be a contraindication for transarterial radioembolization (TARE) because of the risk of radiation-induced liver toxicity or pneumonitis. To date, the best method to close marked APS to reduce intrahepatic shunt (IHS) and hepatopulmonary shunt (HPS) before TARE has not been elucidated. CASE SUMMARY This case report describes a novel strategy of embolization of the portal venous outlet to reduce IHS and HPS caused by marked APS before TARE in a patient with advanced hepatocellular carcinoma (HCC). The patient had a significant intratumoral shunt from the tumor artery to the portal vein and had already been suspected based on pre-interventional magnetic resonance angiography, and digital subtraction angiography (DSA) confirmed the shunt. Selective right portal vein embolization (PVE) was performed to close the APS outlet and DSA confirmed complete closure. Technetium-99m macroaggregated albumin was administered and single photon emission computed tomography revealed a low HPS with 8.4%. Successful TARE was subsequently performed. No major procedure-related complication occurred. CONCLUSION Closure of APS with PVE during mapping angiography of advanced-stage HCC to enable reduction of HPS and subsequent TARE is feasible.
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Affiliation(s)
- Xiang-Dong Wang
- Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
| | - Nai-Jian Ge
- Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
| | - Ye-Fa Yang
- Department of Interventional Radiology, Shanghai Eastern Hepatobiliary Surgery Hospital, Shanghai 200438, China
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130
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Leng ZY, Wang JH, Gao L, Shi K, Hua HB. Efficacy of pantoprazole plus perforation repair for peptic ulcer and its effect on the stress response. World J Gastrointest Surg 2023; 15:2757-2764. [PMID: 38222001 PMCID: PMC10784820 DOI: 10.4240/wjgs.v15.i12.2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Peptic ulcer (PU) is an abnormal phenomenon in which there is rupture of the mucosa of the digestive tract, which not only affects patients' normal life but also causes an economic burden due to its high medical costs. AIM To investigate the efficacy of pantoprazole (PPZ) plus perforation repair in patients with PU and its effect on the stress response. METHODS The study subjects were 108 PU patients admitted between July 2018 and July 2022, including 58 patients receiving PPZ plus perforation repair [research group (RG)] and 50 patients given simple perforation repair [control group (CG)]. The efficacy, somatostatin (SS) concentration, stress reaction [malondialdehyde (MDA), lipid peroxide (LPO)], inflammatory indices [tumor necrosis factor (TNF)-α, C-reactive protein (CRP), interleukin (IL)-1β], recurrence, and complications (perforation, hemorrhage, and pyloric obstruction) were compared. RESULTS The overall response rate was higher in the RG than in the CG. Patients in the RG had markedly elevated SS after treatment, which was higher than that of the CG, while MDA, LPO, TNF-, CRP, and IL-1β were significantly reduced to lower levels than those in the CG. Lower recurrence and complication rates were identified in the RG group. CONCLUSION Therefore, PPZ plus perforation repair is conducive to enhancing treatment outcomes in PU patients, reducing oxidative stress injury and excessive inflammatory reactions, and contributing to low recurrence and complication rates.
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Affiliation(s)
- Zi-Yan Leng
- The Second Hospital of Traditional Chinese Medicine of Jiangsu Province, Affiliated to Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Jia-Hao Wang
- Institute of Literature in Chinese Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Lei Gao
- School of Chinese Medicine & School of Integrated, Chinese and Western Medicine, Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Ke Shi
- Department of Spleen and Gastroenterology, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin 214400, Jiangsu Province, China
| | - Hai-Bing Hua
- Department of Spleen and Gastroenterology, Jiangyin Hospital Affiliated to Nanjing University of Chinese Medicine, Jiangyin 214400, Jiangsu Province, China
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Delvecchio A, Pavone G, Conticchio M, Piacente C, Varvara M, Ferraro V, Stasi M, Casella A, Filippo R, Tedeschi M, Pullano C, Inchingolo R, Delmonte V, Memeo R. Awake robotic liver surgery: A case report. World J Gastrointest Surg 2023; 15:2954-2961. [PMID: 38222022 PMCID: PMC10784833 DOI: 10.4240/wjgs.v15.i12.2954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/30/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND In recent years, minimally invasive liver resection has become a standard of care for liver tumors. Considering the need to treat increasingly fragile patients, general anesthesia is sometimes avoided due to respiratory complications. Therefore, surgical treatment with curative intent is abandoned in favor of a less invasive and less radical approach. Epidural anesthesia has been shown to reduce respiratory complications, especially in elderly patients with pre-existing lung disease. CASE SUMMARY A 77-year-old man with hepatitis-C-virus-related chronic liver disease underwent robotic liver resection for hepatocellular carcinoma. The patient was suffering from hypertension, diabetes and chronic obstructive pulmonary disease. The National Surgical Quality Improvement Program score for developing pneumonia was 9.2%. We planned a combined spinal-epidural anesthesia with conscious sedation to avoid general anesthesia. No modification of the standard surgical technique was necessary. Hemodynamics were stable and bleeding was minimal. The postoperative course was uneventful. CONCLUSION Robotic surgery in locoregional anesthesia with conscious sedation could be considered a safe and suitable approach in specialized centers and in selected patients.
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Affiliation(s)
- Antonella Delvecchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Gaetano Pavone
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Maria Conticchio
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Claudia Piacente
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Miriam Varvara
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Valentina Ferraro
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Matteo Stasi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Annachiara Casella
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Rosalinda Filippo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Michele Tedeschi
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | | | - Riccardo Inchingolo
- Unit of Interventional Radiology, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Vito Delmonte
- Unit of Anesthesia and Perioperative Medicine, “F. Miulli” Regional General Hospital, Bari 70021, Italy
| | - Riccardo Memeo
- Unit of Hepato-Pancreatic-Biliary Surgery, “F. Miulli” Regional General Hospital, Bari 70021, Italy
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Zhang HK, Li XQ, Song HX, Liu SQ, Wang FH, Wen J, Xiao M, Yang AP, Duan XF, Gao ZZ, Hu KL, Zhang W, Lv Y, Zhou XH, Cao ZJ. Primary repair of esophageal atresia Gross type C via thoracoscopic magnetic compression anastomosis: A case report. World J Gastrointest Surg 2023; 15:2919-2925. [PMID: 38222016 PMCID: PMC10784821 DOI: 10.4240/wjgs.v15.i12.2919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/12/2023] [Accepted: 12/11/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Esophageal atresia (EA) is a life-threatening congenital malformation in newborns, and the traditional repair approaches pose technical challenges and are extremely invasive. Therefore, surgeons have been actively investigating new minimally invasive techniques to address this issue. Magnetic compression anastomosis has been reported in several studies for its potential in repairing EA. In this paper, the primary repair of EA with magnetic compression anastomosis under thoracoscopy was reported.
CASE SUMMARY A full-term male weighing 3500 g was diagnosed with EA Gross type C. The magnetic devices used in this procedure consisted of two magnetic rings and several catheters. Tracheoesophageal fistula ligation and two purse strings were performed. The magnetic compression anastomosis was then completed thoracoscopically. After the primary repair, no additional operation was conducted. A patent anastomosis was observed on the 15th day postoperatively, and the magnets were removed on the 23rd day. No leakage existed when the transoral feeding started.
CONCLUSION Thoracoscopic magnetic compression anastomosis may be a promising minimally invasive approach for repairing EA.
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Affiliation(s)
- Hong-Ke Zhang
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Xiao-Quan Li
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Hong-Xia Song
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Shi-Qi Liu
- Department of Neonatal Surgery, Xi’an Children’s Hospital, Xi’an 710003, Shannxi Province, China
| | - Fang-Hui Wang
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Jian Wen
- Department of Anesthesiology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Mi Xiao
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - A-Ping Yang
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Xu-Feng Duan
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Zhen-Zhen Gao
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Kai-Lun Hu
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Wei Zhang
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Yi Lv
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Xi-Hui Zhou
- Department of Neonatology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
| | - Zhen-Jie Cao
- Department of Pediatric Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shannxi Province, China
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Fiore M, Corrente A, Di Franco S, Alfieri A, Pace MC, Martora F, Petrou S, Mauriello C, Leone S. Antimicrobial approach of abdominal post-surgical infections. World J Gastrointest Surg 2023; 15:2674-2692. [PMID: 38222012 PMCID: PMC10784838 DOI: 10.4240/wjgs.v15.i12.2674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 10/24/2023] [Accepted: 11/21/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
Abdominal surgical site infections (SSIs) are infections that occur after abdominal surgery. They can be superficial, involving the skin tissue only, or more profound, involving deeper skin tissues including organs and implanted materials. Currently, SSIs are large global health problem with an incidence that varies significantly depending on the United Nations' Human Development Index. The purpose of this review is to provide a practical update on the latest available literature on SSIs, focusing on causative pathogens and treatment with an overview of the ongoing studies of new therapeutic strategies.
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Affiliation(s)
- Marco Fiore
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Antonio Corrente
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Sveva Di Franco
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Aniello Alfieri
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Maria Caterina Pace
- Department of Women, Child and General and Specialized Surgery, University of Campania “Luigi Vanvitelli,” Naples 80138, Italy
| | - Francesca Martora
- Unit of Virology and Microbiology, “Umberto I” Hospital, Nocera Inferiore 84018, Italy
| | - Stephen Petrou
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA 94143, United States
| | - Claudio Mauriello
- Department of General Surgery, “Santa Maria delle Grazie” Hospital, Pozzuoli 80078, Italy
| | - Sebastiano Leone
- Division of Infectious Diseases, “San Giuseppe Moscati” Hospital, Avellino 83100, Italy
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Zhou H, Xu JL, Huang SX, He Y, He XW, Lu S, Yao B. Hepatic vagotomy blunts liver regeneration after hepatectomy by downregulating the expression of interleukin-22. World J Gastrointest Surg 2023; 15:2866-2878. [PMID: 38222006 PMCID: PMC10784834 DOI: 10.4240/wjgs.v15.i12.2866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 11/01/2023] [Accepted: 11/17/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Rapid regeneration of the residual liver is one of the key determinants of successful partial hepatectomy (PHx). At present, there is a lack of recognized safe, effective, and stable drugs to promote liver regeneration. It has been reported that vagus nerve signaling is beneficial to liver regeneration, but the potential mechanism at play here is not fully understood. AIM To explore the effect and mechanism of hepatic vagus nerve in liver regeneration after PHx. METHODS A PHx plus hepatic vagotomy (Hv) mouse model was established. The effect of Hv on liver regeneration after PHx was determined by comparing the liver regeneration levels of the PHx-Hv group and the PHx-sham group mice. In order to further investigate the role of interleukin (IL)-22 in liver regeneration inhibition mediated by Hv, the levels of IL-22 in the PHx-Hv group and the PHx-sham group was measured. The degree of liver injury in the PHx-Hv group and the PHx-sham group mice was detected to determine the role of the hepatic vagus nerve in liver injury after PHx. RESULTS Compared to control-group mice, Hv mice showed severe liver injury and weakened liver regeneration after PHx. Further research found that Hv downregulates the production of IL-22 induced by PHx and blocks activation of the signal transducer and activator of transcription 3 (STAT3) pathway then reduces the expression of various mitogenic and anti-apoptotic proteins after PHx. Exogenous IL-22 reverses the inhibition of liver regeneration induced by Hv and alleviates liver injury, while treatment with IL-22 binding protein (an inhibitor of IL-22 signaling) reduce the concentration of IL-22 induced by PHx, inhibits the activation of the STAT3 signaling pathway in the liver after PHx, thereby hindering liver regeneration and aggravating liver injury in PHx-sham mice. CONCLUSION Hv attenuates liver regeneration after hepatectomy, and the mechanism may be related to the fact that Hv downregulates the production of IL-22, then blocks activation of the STAT3 pathway.
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Affiliation(s)
- Heng Zhou
- Department of Pharmacy, The First People’s Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Ju-Ling Xu
- Department of Medicine, Medical School of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - San-Xiong Huang
- Department of Hepatobiliary Surgery, The First People’s Hospital of Huzhou, Huzhou 313000, Zhejiang Province, China
| | - Ying He
- Zhejiang Provincial Key Laboratory of Media Biology and Pathogenic Control, Central Laboratory, First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Xiao-Wei He
- Department of Pharmacy, The First People’s Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Sheng Lu
- Department of Pharmacy, The First People’s Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
| | - Bin Yao
- Department of Pharmacy, The First People’s Hospital of Huzhou, First Affiliated Hospital of Huzhou University, Huzhou 313000, Zhejiang Province, China
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Ishinuki T, Shinkawa H, Kouzu K, Shinji S, Goda E, Ohyanagi T, Kobayashi M, Kobayashi M, Suzuki K, Kitagawa Y, Yamashita C, Mohri Y, Shimizu J, Uchino M, Haji S, Yoshida M, Ohge H, Mayumi T, Mizuguchi T. Recent evidence for subcutaneous drains to prevent surgical site infections after abdominal surgery: A systematic review and meta-analysis. World J Gastrointest Surg 2023; 15:2879-2889. [PMID: 38222020 PMCID: PMC10784836 DOI: 10.4240/wjgs.v15.i12.2879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 10/23/2023] [Accepted: 11/27/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Surgical site infections (SSIs) increase mortality, hospital stays, additional medical treatment, and medical costs. Subcutaneous drains prevent SSIs in gynecological and breast surgeries; however, their clinical impact in abdominal surgery remains unclear. AIM To investigate whether subcutaneous drains were beneficial in abdominal surgery using a systematic review and meta-analysis. METHODS The database search used PubMed, MEDLINE, and the Cochrane Library. The following inclusion criteria were set for the systematic review: (1) Randomized controlled trial studies comparing SSIs after abdominal surgery with or without subcutaneous drains; and (2) Studies that described clinical outcomes, such as SSIs, seroma formation, the length of hospital stays, and mortality. RESULTS Eight studies were included in this meta-analysis. The rate of total SSIs was significantly lower in the drained group (54/771, 7.0%) than in the control group (89/759, 11.7%), particularly in gastrointestinal surgery. Furthermore, the rate of superficial SSIs was slightly lower in the drained group (31/517, 6.0%) than in the control group (49/521, 9.4%). No significant differences were observed in seroma formation between the groups. Hospital stays were shorter in the drained group than in the control group. CONCLUSION Subcutaneous drains after abdominal surgery prevented SSIs and reduced hospital stays but did not significantly affect seroma formation. The timing of drain removal needs to be reconsidered in future studies.
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Affiliation(s)
- Tomohiro Ishinuki
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 060-8556, Hokkaido, Japan
| | - Hiroji Shinkawa
- Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Abeno-Ku 545-0051, Japan
| | - Keita Kouzu
- Department of Surgery, National Defense Medical College, Tokorozawa 359-8513, Japan
| | - Seiichi Shinji
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo 113-8602, Japan
| | - Erika Goda
- Department of Nursing, Japan Health Care University, Sapporo 062-0053, Japan
| | - Toshio Ohyanagi
- Department of Liberal Arts and Sciences, Center for Medical Education, Sapporo Medical University, Sapporo 060-8556, Japan
| | - Masahiro Kobayashi
- Department of Clinical Pharmacokinetics, Research and Education Center for Clinical Pharmacy, Kitasato University, Tokyo 108-8641, Japan
| | - Motomu Kobayashi
- Department of Anesthesiology, Hokushinkai Megumino Hospital, Eniwa 061-1395, Japan
| | - Katsunori Suzuki
- Department of Infectious Disease Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu 807-8555, Japan
| | - Yuichi Kitagawa
- Department of Gastrointestinal Surgery, National Center for Geriatrics and Gerontology, Obu 474-8511, Japan
| | - Chizuru Yamashita
- Department of Anesthesiology and Critical Care Medicine, Fujita Health University, Toyoake 470-1192, Japan
| | - Yasuhiko Mohri
- Department of Gastrointestinal Surgery, Mie Prefectural General Medical Center, Yokkaich 510-8561, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka 560-8565, Japan
| | - Motoi Uchino
- Department of Gastroenterological Surgery, Hyogo Medical University, Nishinomiya 663-8501, Japan
| | - Seiji Haji
- Department of Surgery, Soseikai General Hospital, Kyoto 612-8473, Japan
| | - Masahiro Yoshida
- Department of Hepato-Biliary-Pancreatic & Gastrointestinal Surgery, International University of Health and Welfare, Ichikawa 272-0827, Japan
| | - Hiroki Ohge
- Department of Infectious Disease, Hiroshima University Hospital, Hiroshima 734-8551, Japan
| | - Toshihiko Mayumi
- Department of Intensive Care Unit, Chukyo Hospital, Japan Community Health Care Organization, Nagoya 457-8510, Japan
| | - Toru Mizuguchi
- Department of Nursing, Surgical Sciences, Sapporo Medical University, Sapporo 060-8556, Hokkaido, Japan
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Kalayarasan R, Chandrasekar M, Sai Krishna P, Shanmugam D. Indocyanine green fluorescence in gastrointestinal surgery: Appraisal of current evidence. World J Gastrointest Surg 2023; 15:2693-2708. [PMID: 38222003 PMCID: PMC10784830 DOI: 10.4240/wjgs.v15.i12.2693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/12/2023] [Accepted: 11/09/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
Applying indocyanine green (ICG) fluorescence in surgery has created a new dimension of navigation surgery to advance in various disciplines. The research in this field is nascent and fragmented, necessitating academic efforts to gain a comprehensive understanding. The present review aims to integrate diverse perspectives and recent advances in its application in gastrointestinal surgery. The relevant articles were selected by using the appropriate keyword search in PubMed. The angiography and cholangiography property of ICG fluorescence is helpful in various hepatobiliary disorders. In gastroesophageal and colorectal surgery, the lymphangiography and angiography property of ICG is applied to evaluate bowel vascularity and guide lymphadenectomy. The lack of objective parameters to assess ICG fluorescence has been the primary limitation when ICG is used to evaluate bowel perfusion. The optimum dose and timing of ICG administration need to be standardized in some new application areas in gastrointestinal surgery. Binding tumor-specific ligands with fluorophores can potentially widen the fluorescence application to detect primary and metastatic gastrointestinal tumors. The narrative review outlines prior contributions, limitations, and research opportunities for future studies across gastrointestinal sub-specialty. The findings of the present review would be helpful for scholars and practitioners to explore and progress in this exciting domain of gastrointestinal surgery.
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Affiliation(s)
- Raja Kalayarasan
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Murugesan Chandrasekar
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Pothugunta Sai Krishna
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
| | - Dasarathan Shanmugam
- Department of Surgical Gastroenterology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry 605006, India
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Han JW, Choi JY, Jung ES, Kim JH, Cho HS, Yoo JS, Sung PS, Jang JW, Yoon SK, Choi HJ, You YK. Association between the early high level of serum tacrolimus and recurrence of hepatocellular carcinoma in ABO-incompatible liver transplantation. World J Gastrointest Surg 2023; 15:2727-2738. [PMID: 38222009 PMCID: PMC10784835 DOI: 10.4240/wjgs.v15.i12.2727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/18/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Clinical factors predicting graft survival (GS) after ABO-incompatible (ABOi) liver transplantation (LT), and differences between recipients with and without hepatocellular carcinoma (HCC) are unclear. AIM To analyze the impact of serial serum tacrolimus trough concentration in recipients with or without HCC) in ABOi living-donor liver transplantation (LDLT). METHODS We analyzed a historical cohort of 89 recipients who underwent ABOi LDLT, including 47 patients with HCC. RESULTS The 1-, 3-, 5-, and 10-year GS rates were 85.9%, 73.3%, 71.4%, and 71.4%, respectively, and there were no significant differences between HCC and non-HCC recipients. In multivariate Cox-regression analyses, tacrolimus trough concentrations below 5.4 ng/mL at 24 wk post-LT, in addition to the antibody-mediated rejection (AMR) were associated with poor-graft outcomes. In HCC patients, AMR [hazard ratio (HR) = 63.20, P < 0.01] and HCC recurrence (HR = 20.72, P = 0.01) were significantly associated with poor graft outcomes. HCCs outside Milan criteria, and tacrolimus concentrations at 4 wk post-LT > 7.3 ng/mL were significant predictive factors for HCC recurrence. After propensity score matching, patients with high tacrolimus concentrations at 4 wk had significantly poor recurrence-free survival. CONCLUSION Elevated tacrolimus levels at 4 wk after ABOi LDLT have been found to correlate with HCC recurrence. Therefore, careful monitoring and control of tacrolimus levels are imperative in ABOi LT recipients with HCC.
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Affiliation(s)
- Ji Won Han
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jong Young Choi
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Eun Sun Jung
- Department of Hospital Pathology, The Catholic University of Korea, Seoul 06591, South Korea
| | - Ji Hoon Kim
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Hee Sun Cho
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jae-Sung Yoo
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Pil Soo Sung
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Jeong Won Jang
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Seung Kew Yoon
- Department of Internal Medicine, The Catholic University of Korea, Seoul 06591, South Korea
- The Catholic University Liver Research Center, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
| | - Ho Joong Choi
- Department of Surgery, The Catholic University of Korea, Seoul 06591, South Korea
| | - Young Kyoung You
- Department of Surgery, The Catholic University of Korea, Seoul 06591, South Korea
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Wang J, Qiao JH. Holistic conditions after colon cancer: A randomized controlled trial of systematic holistic care vs primary care. World J Gastrointest Surg 2023; 15:2844-2854. [PMID: 38221998 PMCID: PMC10784843 DOI: 10.4240/wjgs.v15.i12.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Study showed that systemic holistic care not only aids in disease treatment and physical recovery to a certain extent but also effectively enhances patient psychological well-being, social support, and overall quality of life (QoL). AIM To assess systematic holistic care impact on the recovery and well-being of postoperative patients with colon cancer. METHODS Our randomized controlled trial included 98 postoperative patients with colon cancer admitted to our hospital from June 2021 to June 2022. Patients were divided into control and study groups. The control group received conventional postoperative nursing care, whereas the study group received systematic holistic nursing care. We monitored gastrointestinal function recovery, and recorded changes in serum albumin (ALB), prealbumin (PA), psychological state, self-management, self-efficacy, QoL, and the occurrence of complications in patients before, at discharge, and 2 wk post-discharge. Spearman analysis assessed correlations between psychological state, self-management, self-efficacy, and QoL of patients in the study group 2 wk post-discharge. RESULTS Following the nursing intervention, we observed significantly shorter postoperative bowel sound recovery time, anal exhaust time, and defecation time in the study group than in the control group (P < 0.05). Patient ALB and PA levels, psychological status, self-management ability, self-efficacy and QoL at discharge and 2 wk post-discharge significantly improved, with greater improvements observed in the study group (P < 0.05). Both groups experienced complications post-interventions, but the intervention group had significantly lower complication rate (3/49, 6.12%) (P < 0.05). In the study group, patient anxiety, depression, self-management and QoL scores at 2 wk post-discharge exhibited a significant negative correlation (3/49, 6.12%) with QoL scores, with correlation coefficients of r = -0.273, -0.522, -0.344, and P < 0.01, respectively. Conversely, patient self-efficacy scores 2 wk post-discharge showed a positive correlation with QoL scores (r = 0.410, P = 0.000). CONCLUSION Systemic holistic nursing significantly benefits postoperative patients with colon cancer by promoting gastrointestinal recovery, improving post-operation well-being, reducing complications, and enhancing QoL.
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Affiliation(s)
- Jing Wang
- Department of General Surgery, Sunshine Union Hospital, Weifang 261205, Shandong Province, China
| | - Jian-Hong Qiao
- Department of Clinic, The First Affiliated Hospital of Shandong First Medical University (Shandong Provincial Qianfoshan Hospital), Jinan 250014, Shandong Province, China
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Lin ZP, Huang DB, Zou XG, Chen Y, Li XQ, Zhang J. Percutaneous microwave ablation and transcatheter arterial chemoembolization for serum tumor markers and prognostics of middle-late primary hepatic carcinoma. World J Gastrointest Surg 2023; 15:2783-2791. [PMID: 38222024 PMCID: PMC10784823 DOI: 10.4240/wjgs.v15.i12.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/17/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Primary hepatic carcinoma (PHC) has an insidious onset and is usually diagnosed in the middle and late stages. Although transcatheter arterial chemoembolization (TACE) is the preferred option for treating middle- and advanced-stage PHC, it has limited efficacy in killing tumor cells and poor long-term efficacy. TACE plus percutaneous microwave coagulation therapy (PMCT) is more effective than interventional therapy alone and can improve survival time. However, there are few reports on the effects of TACE and PMCT on serum marker levels and the prognosis of patients with advanced PHC. AIM To investigate the effect of PMCT + TACE on serum tumor markers and the prognosis of middle-late PHC. METHODS This retrospective study included 150 patients with middle-late PHC admitted to Zhongshan People's Hospital between March 2018 and February 2021. Patients were divided into a single group (treated with TACE, n = 75) and a combined group (treated with TACE + PMCT, n = 75). Before and after treatment, the clinical efficacy and serum tumor marker levels [carbohydrate antigen 19-9 (CA19-9), alpha-fetoprotein (AFP), and carcinoembryonic antigen (CEA)] of both groups were observed. The 1-year survival rates and prognostic factors of the two groups were analyzed. RESULTS The combined group had 21 and 35 cases of complete remission (CR) and partial remission (PR), respectively. The single group had 13 and 25 cases of CR and PR, respectively. After 4 wk of treatment, the serum CA19-9, CEA, and AFP levels in the single and combined groups decreased, with the decrease in the combined group being more significant (P < 0.05). The 1-year survival rate of the combined group (80.00%) was higher than that of the single group (60.00%) (P < 0.05). The average survival time within 1 year in the combined group was 299.38 ± 61.13 d, longer than that in the single group (214.41 ± 72.97 d, P < 0.05). COX analysis revealed that tumor diameter, tumor number, and the treatment method were prognostic factors for patients with middle-late PHC (P < 0.05). CONCLUSION TACE + PMCT is effective in treating patients with mid-late PHC. It reduces the levels of tumor markers, prolongs survival, and improves prognosis.
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Affiliation(s)
- Zhi-Peng Lin
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Da-Bei Huang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xu-Gong Zou
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Yuan Chen
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Xiao-Qun Li
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
| | - Jian Zhang
- Department of Interventional Medicine, Zhongshan People’s Hospital, Zhongshan 528400, Guangdong Province, China
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Ma CY, Zhao J, Qian KY, Xu Z, Xu XT, Zhou JY. Analysis of nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis. World J Gastrointest Surg 2023; 15:2831-2843. [PMID: 38222011 PMCID: PMC10784828 DOI: 10.4240/wjgs.v15.i12.2831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/15/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Radiation enteritis, which often occurs during radiation-induced acute intestinal symptoms (RIAIS), is the most common and important complication during radiotherapy for cervical cancer. RIAIS caused by abdominal and pelvic radiotherapy will affect nutrient intake, digestion, absorption, and metabolism, leading to malnutrition or poorer nutritional status. In patients with malignant tumors, malnutrition can adversely affect the curative effect and response of radiotherapy by reducing radiosensitivity, affecting the precision of radiotherapy placement and increasing the incidence of radiotherapy-related adverse reactions. AIM To analyze nutritional risk, skeletal muscle depletion, and lipid metabolism phenotype in acute radiation enteritis. METHODS Fifty patients with cervical cancer received external beam radiotherapy, and 15 patients received brachytherapy after external beam radiotherapy. Body weight, body composition parameters, nutritional risk screening (NRS) 2002 score, and blood biochemical indices of patients with cervical cancer during periradiation were tested by a one-way repeated measures analysis of variance. Metabolomics analysis was used to identify characteristic lipid metabolism pathways. Clinical factors that affect linoleic acid changes were screened using the generalized evaluation equation. RESULTS Among the 50 patients, 37 had RIAIS, including 34 patients with grade 1-2 RIAIS and 3 patients with grade 3 RIAIS. The NRS 2002 score of patients who underwent cervical cancer radiotherapy continued to increase during the periradiation period, and 42 patients who underwent cancer radiotherapy had nutritional deficits (NRS 2002 score ≥ 3 points) at the end of radiotherapy. Correlation analyses revealed that body weight and body mass index changes were closely associated with body fat content (R2 = 0.64/0.51). The results of the univariate analysis showed that radiotherapy time, percentage reduction of serum albumin, and percentage reduction of serum prealbumin were the key factors affecting skeletal muscle exhaustion (P < 0.05). Metabolomic analysis of fecal supernatants of cervical cancer patients during the periradiation period revealed the involvement of linoleic acid, cholic acid, arachidonic acid, and N-acetyl-L-benzene alanine in the metabolic pathway of linoleic acid. CONCLUSION Cervical cancer radiotherapy patients faced nutritional risks, decreased serum albumin synthesis, and increased risk of skeletal muscle exhaustion. Linoleic acid was a biomarker of high nutritional risk.
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Affiliation(s)
- Chen-Ying Ma
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Jing Zhao
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ke-Yan Qian
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zhe Xu
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xiao-Ting Xu
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Ju-Ying Zhou
- Department of Radiation Oncology, the First Affiliated Hospital of Soochow University, Suzhou 215006, China
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Huang J, Tian WJ. Effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing resection of rectal carcinoma. World J Gastrointest Surg 2023; 15:2774-2782. [PMID: 38222023 PMCID: PMC10784818 DOI: 10.4240/wjgs.v15.i12.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 11/20/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Rectal carcinoma (RC) treatment primarily involves laparoscopic surgery, which may induce significant hemodynamic changes and weaken immune function. Certain anesthetic approaches using opioid drugs (including remifentanil and sufentanil) pose risks, such as hypotension. AIM To determine the effects of remifentanil combined with propofol on hemodynamics and oxidative stress in patients undergoing RC resection. METHODS A total of 211 patients one hundred and four patients with RC treated at the First Affiliated Hospital of Dalian Medical University between November 2018 and November 2022 were retrospectively analyzed. Among them, the remifentanil group included 45 patients receiving remifentanil with propofol anesthesia and the sufentanil group included 59 patients receiving sufentanil with propofol anesthesia. Changes in the hemodynamic index, oxidative stress index, general data, consumption of remifentanil, and use of vasoactive drugs were compared. The incidences of adverse reactions were calculated. RESULTS The two groups did not significantly differ in terms of operation, anesthesia, and extubation times (P > 0.05). At 1 min after intubation, the sufentanil group showed a notably higher heart rate, systolic blood pressure (SBP), diastolic blood pressure, and mean arterial pressure (MAP) compared with the remifentanil group (P < 0.05), whereas the sufentanil group showed a notably higher SBP and MAP compared with the remifentanil group at 5 min after pneumoperitoneum (P < 0.05). Thirty minutes after surgery, the remifentanil group showed significantly lower plasma cortisol, noradrenaline, and glucose levels than the sufentanil group (P < 0.001). The remifentanil group consumed significantly less remifentanil than the sufentanil group (P < 0.05), and the adoption frequency of ephedrine was lower in the remifentanil group than that in the sufentanil group (P < 0.05). The incidence of hypotension was notably higher in the sufentanil group than that in the remifentanil group (P < 0.05). CONCLUSION Remifentanil combined with propofol can improve hemodynamics and relieve oxidative stress in patients undergoing RC resection.
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Affiliation(s)
- Jing Huang
- Department of First Anesthesiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
| | - Wen-Jun Tian
- Department of Fourth Anesthesiology, the First Affiliated Hospital of Dalian Medical University, Dalian 116011, Liaoning Province, China
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Pérez Lara FJ, Zubizarreta Jimenez R, Prieto-Puga Arjona T, Gutierrez Delgado P, Hernández Carmona JM, Hernández Gonzalez JM, Pitarch Martinez M. Determining the need for a thoracoscopic approach to treat a giant hiatal hernia when abdominal access is poor. World J Gastrointest Surg 2023; 15:2739-2746. [PMID: 38222019 PMCID: PMC10784824 DOI: 10.4240/wjgs.v15.i12.2739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/09/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Giant hernias present a significant challenge for digestive surgeons. The approach taken (laparoscopic vs thoracoscopic) depends largely on the preferences and skills of each surgeon, although in most cases today the laparoscopic approach is preferred. AIM To determine whether patients presenting inadequate laparoscopic access to the intrathoracic hernial sac obtain poorer postoperative results than those with no such problem, in order to assess the need for a thoracoscopic approach. METHODS For the retrospective series of patients treated in our hospital for hiatal hernia (n = 112), we calculated the laparoscopic field of view and the working area accessible to surgical instruments, by means of preoperative imaging tests, to assess the likely outcome for cases inaccessible to laparoscopy. RESULTS Patients with giant hiatal hernias for whom a preoperative calculation suggested that the laparoscopic route would not access all areas of the intrathoracic sac presented higher rates of perioperative complications and recurrence during follow-up than those for whom laparoscopy was unimpeded. The difference was statistically significant. Moreover, the insertion of mesh did not improve results for the non-accessible group. CONCLUSION For patients with giant hiatal hernias, it is essential to conduct a preoperative evaluation of the angle of vision and the working area for surgery. When parts of the intrathoracic sac are inaccessible laparoscopically, the thoracoscopic approach should be considered.
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Affiliation(s)
| | | | | | - Pilar Gutierrez Delgado
- Department of Surgery, HRU Carlos Haya, Unidad Cirugia Hepatobiliopancreat & Trasplantes, Malaga 29200, Spain
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Zheng HD, Huang QY, Hu YH, Ye K, Xu JH. Laparoscopic resection and endoscopic submucosal dissection for treating gastric ectopic pancreas. World J Gastrointest Surg 2023; 15:2799-2808. [PMID: 38222013 PMCID: PMC10784817 DOI: 10.4240/wjgs.v15.i12.2799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 11/11/2023] [Accepted: 11/26/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Gastric ectopic pancreas (GEP) is a rare developmental abnormality that refers to the existence of pancreatic tissue in the stomach with no anatomical relationship with the main pancreas. It is usually difficult to diagnose through histological examination, and the choice of treatment method is crucial. AIM To describe the endoscopic ultrasound characteristics of GEP and evaluate the value of laparoscopic resection (LR) and endoscopic submucosal dissection (ESD). METHODS Forty-nine patients with GEP who underwent ESD and LR in the Second Affiliated Hospital of Fujian Medical University from May 2018 to July 2023 were retrospectively included. Data on clinical characteristics, endoscopic ultrasonography (EUS), ESD, and LR were collected and analyzed. The characteristics of EUS and the efficacy of the two treatments were analyzed. RESULTS The average age of the patients was 43.31 ± 13.50 years, and the average maximum diameter of the lesions was 1.55 ± 0.70 cm. The lesion originated from the mucosa in one patient (2.04%), from the submucosa in 42 patients (85.71%), and from the muscularis propria in 6 patients (12.25%). Twenty-nine patients (59.20%) with GEP showed umbilical depression on endoscopy. The most common initial symptom of GEP was abdominal pain (40.82%). Tumor markers, including carcinoembryonic antigen (CEA) and carbohydrate antigen 19-9 (CA-19-9), were generally within the normal range. One patient (2.04%) with GEP had increased CEA and CA-19-9 levels. However, no cancer tissue was found on postoperative pathological examination, and tumor markers returned to normal levels after resecting the lesion. There was no significant difference in surgery duration (72.42 ± 23.84 vs 74.17 ± 12.81 min) or hospital stay (3.70 ± 0.91 vs 3.83 ± 0.75 d) between the two methods. LR was more often used for patients with larger tumors and deeper origins. The amount of bleeding was significantly higher in LR than in ESD (11.28 ± 16.87 vs 16.67 ± 8.76 mL, P < 0.05). Surgery was associated with complete resection of the lesion without any serious complications; there were no cases of recurrence during the follow-up period. CONCLUSION GEP has unique characteristics in EUS. LR and ESD seem to be good choices for treating GEP. LR is better for large GEP with a deep origin. However, due to the rarity of GEP, multicenter large-scale studies are needed to describe its characteristics and evaluate the safety of LR and ESD.
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Affiliation(s)
- Hui-Da Zheng
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Qiao-Yi Huang
- Department of Gynaecology and Obstetrics, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Yun-Huang Hu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Kai Ye
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
| | - Jian-Hua Xu
- Department of Gastrointestinal Surgery, The Second Affiliated Hospital of Fujian Medical University, Quanzhou 362000, Fujian Province, China
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Xu LL, Xiang NJ, Cheng TC, Li YX, Chen P, Jiang ZW, Liu XX. Application of electroacupuncture in the prevention of low anterior resection syndrome after rectal cancer surgery. World J Gastrointest Surg 2023; 15:2765-2773. [PMID: 38221997 PMCID: PMC10784840 DOI: 10.4240/wjgs.v15.i12.2765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/10/2023] [Accepted: 11/24/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Low anterior resection syndrome (LARS) is one of the common postoperative complications in patients with rectal cancer, which seriously affects their postoperative recovery and quality of life (QoL). Electroacupuncture therapy is one of the characteristic therapies of traditional Chinese medicine. There are few reports on the prevention and treatment of LARS by electroacupuncture therapy. AIM To explore the clinical effectiveness of electroacupuncture in managing rectal cancer patients with postoperative LARS. METHODS A total of 50 patients with LARS after rectal cancer surgery were retrospectively selected as the research subjects. According to the treatment methods, they were divided into an observation group (n = 25) and a control group (n = 25). During the four-week treatment period, the control group received standard defecation function training, while the observation group received electroacupuncture care and traditional defecation function training. The anal pressure index (which includes anal resting pressure, anal systolic pressure, and maximum tolerable volume), European Organization of Research and Treatment of Cancer (EORTC) QoL C30 (QLQ-C30) score, LARS Scale (LARSS) score, Wexner anal incontinence scale score, Xu Zhongfa five-item 10-point scale score, and the occurrence of adverse reactions were compared between the two groups before and after treatment. RESULTS The experimental group showed considerably enhanced LARSS scores compared to those in the control group after four weeks of treatment. In the first week, second week, and fourth week, the LARSS score and Wexner anal incontinence scale score decreased, and the Xu Zhong method five-item 10-point scale score increased, with significant differences (P < 0.05). The experimental group showed substantial improvements in anal resting pressure, anal systolic pressure, and maximum tolerance volume after undergoing 4 wk of therapy in the untreated group (P < 0.05). The experimental group's QLQ-C30 score on the EORTC QoL questionnaire was higher than that of the control group during the 1st, 2nd, and 4th wk (P < 0.05). No significant variation between the groups in the frequency of adverse reactions (P > 0.05) was observed. CONCLUSION Electroacupuncture positively impacted LARS following rectal cancer surgery, effectively improving clinical symptoms and anal pressure indicators and patients' standard of life.
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Affiliation(s)
- Lu-Lu Xu
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Neng-Jun Xiang
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Tian-Cheng Cheng
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Yi-Xian Li
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Peng Chen
- The First Clinical Medical College, Nanjing University of Traditional Chinese Medicine, Nanjing 210023, Jiangsu Province, China
| | - Zhi-Wei Jiang
- Department of General Surger, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 210029, Jiangsu Province, China
| | - Xin-Xin Liu
- Department of General Surger, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing 210029, Jiangsu Province, China
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Hui L, Zhang YY, Hu XD. Multidisciplinary diagnosis and treatment nutritional support intervention for gastrointestinal tumor radiotherapy: Impact on nutrition and quality of life. World J Gastrointest Surg 2023; 15:2719-2726. [PMID: 38222015 PMCID: PMC10784837 DOI: 10.4240/wjgs.v15.i12.2719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 09/19/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Gastrointestinal tumors are a major cause of cancer-related deaths and have become a major public health problem. This study aims to provide a scientific basis for improving clinical treatment effects, quality of life, and prognosis of patients with gastrointestinal tumors. AIM To explore the clinical effect of the multidisciplinary diagnosis and treatment (MDT) nutrition intervention model on patients with gastrointestinal tumors. METHODS This was a case control study which included patients with gastrointestinal tumors who received radiotherapy at the Department of Oncology between January 2021 and January 2023. Using a random number table, 120 patients were randomly divided into MDT and control groups with 60 patients in each group. To analyze the effect of MDT on the nutritional status and quality of life of the patients, the nutritional status and quality of life scores of the patients were measured before and after the treatment. RESULTS Albumin (ALB), transferrin (TRF), hemoglobin (Hb), and total protein (TP) levels significantly decreased after the treatment. The control group had significantly lower ALB, TRF, Hb, and TP levels than the MDT group, and the differences in these levels between the two groups were statistically significant (P < 0.05). After the treatment, the MDT group had significantly more well-nourished patients than the control group (P < 0.05). The quality of life total score, somatic functioning, role functioning, and emotional functioning were higher in the MDT group than in the control group. By contrast, pain, fatigue, nausea, and vomiting scores were lower in the MDT group than in the control group (P < 0.05). CONCLUSION MDT nutritional intervention model effectively improves the nutritional status and quality of life of the patients. The study provides a rigorous theoretical basis for improving the prognosis of cancer patients. In the future, we intend to provide additional treatment methods for improving the quality of life of patients with cancer.
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Affiliation(s)
- Lin Hui
- Head, Neck and Chest Radiotherapy Department 1, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
| | - Ying-Ying Zhang
- Department of Gastroenterology, The People’s Hospital of Danyang, Danyang 212300, Jiangsu Province, China
| | - Xiao-Dan Hu
- Department of Gastroenterology, Affiliated Hospital of Jiangnan University, Wuxi 214000, Jiangsu Province, China
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Polese L. Removal of a large rectal polyp with endoscopic submucosal dissection-trans-anal rectoscopic assisted minimally invasive surgery hybrid technique: A case report. World J Gastrointest Surg 2023; 15:2932-2937. [PMID: 38221999 PMCID: PMC10784841 DOI: 10.4240/wjgs.v15.i12.2932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/08/2023] [Accepted: 12/08/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Endoscopic submucosal dissection (ESD) can be used for the en-bloc removal of superficial rectal lesions; however, the lack of a traction system makes the procedure long and difficult in the presence of extensive lesions. CASE SUMMARY A large polyp occupying 2/3 of the rectal circumference and extending 5 cm in length was removed by ESD with the help of laparoscopic forceps introduced via trans-anal rectoscopic assisted minimally invasive surgery, a disposable platform designed to aid in transanal minimally invasive surgery. Traction of the polyp by forceps during the operation was dynamic, and applied at various points and in various directions. The polyp was removed en-bloc without complications in 1 h and 55 min. A sigmoidoscopy performed 50 d later showed normal healing without polyp recurrence. CONCLUSION The technique presented here could overcome the issues caused by lack of traction during ESD for rectal lesions.
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Affiliation(s)
- Lino Polese
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova 35128, Italy
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147
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Wang R, Wang Q, Li P. Significance of carcinoembryonic antigen detection in the early diagnosis of colorectal cancer: A systematic review and meta-analysis. World J Gastrointest Surg 2023; 15:2907-2918. [PMID: 38222002 PMCID: PMC10784816 DOI: 10.4240/wjgs.v15.i12.2907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a prevalent malignant tumor involving adenomas that develop into malignant lesions. Carcinoembryonic antigen (CEA) is a non-specific serum biomarker upregulated in CRC. The concentration of CEA is modulated by tumor stage and grade, tumor site in the colon, ploidy status, and patient smoking status. This study aimed to evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults. AIM To evaluate current evidence regarding the diagnostic power of CEA levels in the early detection of CRC recurrence in adults. METHODS A systematic search was performed using four databases: MEDLINE, Cochrane Trials, EMBASE, and the Web of Science. The inclusion criteria were as follows: Adult patients aged ≥ 18 years who had completed CRC curative treatment and were followed up postoperatively; reporting the number of CRC recurrences as an outcome; and randomized, clinical, cohort, and case-control study designs. Studies that were not published in English and animal studies were excluded. The following data were extracted by three independent reviewers: Study design, index tests, follow-up, patient characteristics, and primary outcomes. All statistical analyses were performed using the RevMan 5.4.1. RESULTS A total of 3232 studies were identified, with 73 remaining following the elimination of duplicates. After screening on predetermined criteria, 12 studies were included in the final analysis. At a reference standard of 5 mg/L, CEA detected only approximately half of recurrent CRCs, with a pooled sensitivity of 59% (range, 33%-83%) and sensitivity of 89% (range, 58%-97%). CONCLUSION CEA is a significant marker for CRC diagnosis. However, it has insufficient sensitivity and specificity to be used as a single biomarker of early CRC recurrence, with an essential proportion of false negatives.
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Affiliation(s)
- Rui Wang
- Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
| | - Qin Wang
- Delivery Room, Chengdu Women’s and Children’s Central Hospital, Chengdu 610000, Sichuan Province, China
| | - Pan Li
- Department of Nuclear Medicine, Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610072, Sichuan Province, China
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148
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Hajibandeh S, Hajibandeh S, Evans L, Miller B, Waterman J, Ahmad SJS, Hale J, Higgi A, Johnson B, Pearce D, Helmy AH, Naguib N, Maw A. Predictive value of Hajibandeh index in determining peritoneal contamination in acute abdomen: A cohort study and meta-analysis. World J Gastrointest Surg 2023; 15:2747-2756. [PMID: 38222004 PMCID: PMC10784831 DOI: 10.4240/wjgs.v15.i12.2747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 11/01/2023] [Accepted: 12/01/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Hajibandeh index (HI), derived from combined levels of C-reactive protein, lactate, neutrophils, lymphocytes and albumin, is a modern predictor of peritoneal contamination and mortality in patients with acute abdominal pathology. AIM To validate the performance of HI in predicting the presence and nature of peritoneal contamination in patients with acute abdominal pathology in a larger cohort study and to synthesis evidence in a systematic review and meta-analysis. METHODS The STROBE guidelines and the PRISMA statement standards were followed to conduct a cohort study (ChiCTR2200056183) and a meta-analysis (CRD42022306018), respectively. All adult patients undergoing emergency laparotomy for acute abdominal pathology were eligible. The accuracy of the HI was evaluated using receiver operating characteristic (ROC) curve analysis in the cohort study and using weighted summary area under the curve (AUC) under the fixed and random effects modelling in the meta-analysis. The Quality Assessment of Diagnostic Accuracy Studies 2 criteria were used for methodological quality assessment of the included studies. RESULTS A total of 1437 patients were included (700 from the cohort study and 737 from the literature search). ROC curve analysis of the cohort study showed that the AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 [95% confidence interval (CI): 0.76-0.82, P < 0.0001], 0.76 (95%CI: 0.72-0.80, P < 0.0001), and 0.83 (95%CI: 0.79-0.86, P < 0.0001), respectively. The meta-analysis showed that the pooled AUC of HI for presence of contamination, purulent contamination and feculent contamination were 0.79 (95%CI: 0.75-0.83), 0.78 (95%CI: 0.74-0.81), and 0.80 (95%CI: 0.77-0.83), respectively. CONCLUSION The HI is a strong and accurate predictor of intraperitoneal contamination. Although the available evidence is robust, it is limited to the studies conducted by our evidence synthesis group. We encourage other researchers to validate performance of HI in predicting the presence of intraperitoneal contamination and more importantly in predicting mortality following emergency laparotomy.
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Affiliation(s)
- Shahab Hajibandeh
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Shahin Hajibandeh
- Department of General Surgery, Royal Stoke University Hospital, Stoke-on-Trent ST4 6QG, United Kingdom
| | - Louis Evans
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Bethany Miller
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Jennifer Waterman
- Department of General Surgery, University Hospital of Wales, Cardiff CF14 4XW, United Kingdom
| | - Suhaib JS Ahmad
- Department of General Surgery, Ysbyty Gwynedd, Bangor LL57 2PW, United Kingdom
| | - Jay Hale
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Adnan Higgi
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Bethan Johnson
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Dafydd Pearce
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Ahmed Hazem Helmy
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Nader Naguib
- Department of General Surgery, Royal Glamorgan Hospital, Pontyclun CF72 8XR, United Kingdom
| | - Andrew Maw
- Department of General Surgery, Glan Clwyd Hospital, Rhyl LL18 5UJ, United Kingdom
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149
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Zhang PJ, Lu ZH, Cao LJ, Chen H, Sun Y. Successful treatment of invasive liver abscess syndrome caused by Klebsiella variicola with intracranial infection and septic shock: A case report. World J Gastrointest Surg 2023; 15:2938-2944. [PMID: 38222021 PMCID: PMC10784832 DOI: 10.4240/wjgs.v15.i12.2938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/11/2023] [Accepted: 11/10/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Klebsiella variicola (K. variicola) is a member of the Klebsiella genus and is often misidentified as Klebsiella pneumoniae. In this report, we present a rare case of invasive liver abscess caused by K. variicola. CASE SUMMARY We report a rare case of liver abscess due to K. variicola. A 57-year-old female patient presented with back pain for a month. She developed a high-grade fever associated with chills, and went into a coma and developed shock. The clinical examinations and tests after admission confirmed a diagnosis of primary liver abscess caused by K. variicola complicated by intracranial infection and septic shock. The patient successfully recovered following early percutaneous drainage of the abscess, prompt appropriate antibiotic administration, and timely open surgical drainage. CONCLUSION This is a case of successful treatment of invasive liver abscess syndrome caused by K. variicola, which has rarely been reported. The findings of this report point to the need for further study of this disease.
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Affiliation(s)
- Pin-Jie Zhang
- The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Zhong-Hua Lu
- The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Li-Jun Cao
- The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Hu Chen
- The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
| | - Yun Sun
- The First Department of Critical Care Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei 230601, Anhui Province, China
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150
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Liu YL, Zhu HB, Chen ML, Sun W, Li XT, Sun YS. Prediction of the lymphatic, microvascular, and perineural invasion of pancreatic neuroendocrine tumors using preoperative magnetic resonance imaging. World J Gastrointest Surg 2023; 15:2809-2819. [PMID: 38222000 PMCID: PMC10784819 DOI: 10.4240/wjgs.v15.i12.2809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 11/06/2023] [Accepted: 12/06/2023] [Indexed: 12/27/2023] [Imported: 12/27/2023] Open
Abstract
BACKGROUND Significant correlation between lymphatic, microvascular, and perineural invasion (LMPI) and the prognosis of pancreatic neuroendocrine tumors (PENTs) was confirmed by previous studies. There was no previous study reported the relationship between magnetic resonance imaging (MRI) parameters and LMPI. AIM To determine the feasibility of using preoperative MRI of the pancreas to predict LMPI in patients with non-functioning PENTs (NFPNETs). METHODS A total of 61 patients with NFPNETs who underwent MRI scans and lymphadenectomy from May 2011 to June 2018 were included in this retrospective study. The patients were divided into group 1 (n = 34, LMPI negative) and group 2 (n = 27, LMPI positive). The clinical characteristics and qualitative MRI features were collected. In order to predict LMPI status in NF-PNETs, a multivariate logistic regression model was constructed. Diagnostic performance was evaluated by calculating the receiver operator characteristic (ROC) curve with area under ROC, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and accuracy. RESULTS There were significant differences in the lymph node metastasis stage, tumor grade, neuron-specific enolase levels, tumor margin, main pancreatic ductal dilatation, common bile duct dilatation, enhancement pattern, vascular and adjacent tissue involvement, synchronous liver metastases, the long axis of the largest lymph node, the short axis of the largest lymph node, number of the lymph nodes with short axis > 5 or 10 mm, and tumor volume between two groups (P < 0.05). Multivariate analysis showed that tumor margin (odds ratio = 11.523, P < 0.001) was a predictive factor for LMPI of NF-PNETs. The area under the receiver value for the predictive performance of combined predictive factors was 0.855. The sensitivity, specificity, PPV, NPV and accuracy of the model were 48.1% (14/27), 97.1% (33/34), 97.1% (13/14), 70.2% (33/47) and 0.754, respectively. CONCLUSION Using preoperative MRI, ill-defined tumor margins can effectively predict LMPI in patients with NF-PNETs.
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Affiliation(s)
- Yu-Liang Liu
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Hai-Bin Zhu
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Mai-Lin Chen
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Wei Sun
- Department of Pathology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Xiao-Ting Li
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
| | - Ying-Shi Sun
- Department of Radiology, Peking University Cancer Hospital and Institute, Beijing 100142, China
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