151
|
Wu H, Xue D, Deng M, Guo R, Li H. Progress, challenges, and future perspectives of robot-assisted natural orifice specimen extraction surgery for colorectal cancer: a review. BMC Surg 2024; 24:255. [PMID: 39261821 PMCID: PMC11389085 DOI: 10.1186/s12893-024-02538-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Accepted: 08/22/2024] [Indexed: 09/13/2024] Open
Abstract
With the continuous advancements in precision medicine and the relentless pursuit of minimally invasive techniques, Natural Orifice Specimen Extraction Surgery (NOSES) has emerged. Compared to traditional surgical methods, NOSES better embodies the principles of minimally invasive surgery, making scar-free operations possible. In recent years, with the progress of science and technology, Robot-Assisted Laparoscopic Surgery has been widely applied in the treatment of colorectal cancer. Robotic surgical systems, with their clear surgical view and high operational precision, have shown significant advantages in the treatment process. To further improve the therapeutic outcomes for colorectal cancer patients, some scholars have attempted to combine robotic technology with NOSES. However, like traditional open surgery or laparoscopic surgery, the use of the robotic platform presents both advantages and limitations. Therefore, this study reviews the current research status, progress, and controversies regarding Robot-Assisted Laparoscopic Natural Orifice Specimen Extraction Surgery for colorectal cancer, aiming to provide clinicians with more options in the diagnosis and treatment of colorectal cancer.
Collapse
Affiliation(s)
- Huiming Wu
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China.
| | - Dingwen Xue
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Min Deng
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Renkai Guo
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China
| | - Huiyu Li
- Department of General Surgery, Shanxi Bethune Hospital, Third Hospital of Shanxi Medical University, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital, Taiyuan, Shanxi, China.
| |
Collapse
|
152
|
Yu Z, Li G, Xu W. Rapid detection of liver metastasis risk in colorectal cancer patients through blood test indicators. Front Oncol 2024; 14:1460136. [PMID: 39324006 PMCID: PMC11422013 DOI: 10.3389/fonc.2024.1460136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/20/2024] [Indexed: 09/27/2024] Open
Abstract
Introduction Colorectal cancer (CRC) is one of the most common malignancies, with liver metastasis being its most common form of metastasis. The diagnosis of colorectal cancer liver metastasis (CRCLM) mainly relies on imaging techniques and puncture biopsy techniques, but there is no simple and quick early diagnosisof CRCLM. Methods This study aims to develop a method for rapidly detecting the risk of liver metastasis in CRC patients through blood test indicators based on machine learning (ML) techniques, thereby improving treatment outcomes. To achieve this, blood test indicators from 246 CRC patients and 256 CRCLM patients were collected and analyzed, including routine blood tests, liver function tests, electrolyte tests, renal function tests, glucose determination, cardiac enzyme profiles, blood lipids, and tumor markers. Six commonly used ML models were used for CRC and CRCLM classification and optimized by using a feature selection strategy. Results The results showed that AdaBoost algorithm can achieve the highest accuracy of 89.3% among the six models, which improved to 91.1% after feature selection strategy, resulting with 20 key markers. Conclusions The results demonstrate that the combination of machine learning techniques with blood markers is feasible and effective for the rapid diagnosis of CRCLM, significantly im-proving diagnostic ac-curacy and patient prognosis.
Collapse
Affiliation(s)
- Zhou Yu
- Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Gang Li
- College of Mathematical Medicine, Zhejiang Normal University, Jinhua, China
| | - Wanxiu Xu
- Xingzhi College, Zhejiang Normal University, Jinhua, China
| |
Collapse
|
153
|
Xiao Q, Wu X, Yuan C, Gu Z, Tang X, Meng F, Wang D, Lang R, Zhai G, Tian X, Zhang Y, Zhao E, Zhao X, Cao F, Xu J, Xing Y, Wang C, Zhang J. Clinicopathologic features and surgery-related outcomes of duodenal adenocarcinoma: A multicenter retrospective study. Surgery 2024:S0039-6060(24)00586-5. [PMID: 39261238 DOI: 10.1016/j.surg.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/03/2024] [Accepted: 08/07/2024] [Indexed: 09/13/2024]
Abstract
BACKGROUND The incidence of duodenal adenocarcinoma is increasing, with limited studies on this disease published. This multicenter retrospective study aimed to analyze the clinicopathologic features of duodenal adenocarcinoma and identify prognostic factors for postoperative survival. METHODS Demographic characteristics, clinicopathologic features, treatment outcomes, and survival of patients with duodenal adenocarcinoma undergoing surgical treatment at 16 Chinese medical centers from 2012 to 2023 were retrospectively analyzed. RESULTS Among the 2,189 patients with duodenal adenocarcinoma included, 50.07% had extra-ampullary duodenal adenocarcinoma and 49.93% had peri-ampullary duodenal adenocarcinoma. The 1-, 3-, and 5-year overall survival rates for patients who underwent radical surgery were 91.78%, 69.30%, and 55.86%, respectively. The median overall survival was 73 months (range, 64-84), and the median progression-free survival was 64 months (range, 52-76). No differences in survival were observed between the laparotomy and minimally invasive surgery groups (log-rank P = .562); furthermore, no significant between-group differences in operation time, lymph node dissection, postoperative complications, or in-hospital mortality were observed (P > .05). The minimally invasive surgery group experienced less intraoperative blood loss (250 mL vs 100 mL, P < .001), fewer intraoperative blood transfusions (24.97% vs 18.84%, P = .002), and shorter hospital stays (28 days vs 23 days, P < .001). Multivariate Cox regression analysis revealed that advanced age, advanced stage, longer operation time, intraoperative blood transfusion, and postoperative hemorrhage were independent risk factors for poor prognosis. CONCLUSION Radical surgery was associated with favorable overall survival among patients with duodenal adenocarcinoma, and no difference in survival was observed between patients with extra-ampullary duodenal adenocarcinoma and peri-ampullary duodenal adenocarcinoma. Minimally invasive surgery is a reliable alternative for duodenal adenocarcinoma treatment.
Collapse
Affiliation(s)
- Qifeng Xiao
- Pancreatic and Gastric Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Wu
- Department of General Surgery, First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Chunhui Yuan
- Department of General Surgery, Peking University Third Hospital, Beijing, China
| | - Zongting Gu
- General Surgery, Cancer Center, Department of Hepatobiliary & Pancreatic Surgery and Minimally Invasive Surgery, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Xiaolong Tang
- Department of General Surgery, Qilu Hospital of Shandong University, Jinan, Shandong, China
| | - Fanbin Meng
- Department of Pancreatic and Biliary Surgery, The First Affiliated Hospital of China Medical University, Shenyang, Liaoning, China
| | - Dong Wang
- Department of General Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ren Lang
- Department of Hepatobiliary and Pancreaticosplenic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Gang Zhai
- Hepatobiliary and Pancreatogastric Surgery, Shanxi Provincial Cancer Hospital/Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, Shanxi, China
| | - Xiaodong Tian
- Department of General Surgery, Peking University First Hospital, Beijing, China
| | - Yu Zhang
- Department of Hepatobiliary Surgery, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China
| | - Enhong Zhao
- Gastrointestinal Surgery Department, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Xiaodong Zhao
- Department of Oncological Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei, China
| | - Feng Cao
- General Surgery Department, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Jingyong Xu
- Department of General Surgery, Beijing Hospital, Beijing, China
| | - Ying Xing
- General Surgery Department, Capital Medical University Beijing Affiliated Tiantan Hospital, Beijing, China
| | - Chengfeng Wang
- Pancreatic and Gastric Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Jianwei Zhang
- Pancreatic and Gastric Surgery Department, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| |
Collapse
|
154
|
Elsayed Abouzed DE, Ezelarab HAA, Selim HMRM, Elsayed MMA, El Hamd MA, Aboelez MO. Multimodal modulation of hepatic ischemia/reperfusion-induced injury by phytochemical agents: A mechanistic evaluation of hepatoprotective potential and safety profiles. Int Immunopharmacol 2024; 138:112445. [PMID: 38944946 DOI: 10.1016/j.intimp.2024.112445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Hepatic ischemia-reperfusion (I/R) injury is a clinically fundamental phenomenon that occurs through liver resection surgery, trauma, shock, and transplantation. AIMS OF THE REVIEW This review article affords an expanded and comprehensive overview of various natural herbal ingredients that have demonstrated hepatoprotective effects against I/R injury through preclinical studies in animal models. MATERIALS AND METHODS For the objective of this investigation, an extensive examination was carried out utilizing diverse scientific databases involving PubMed, Google Scholar, Science Direct, Egyptian Knowledge Bank (EKB), and Research Gate. The investigation was conducted based on specific identifiable terms, such as hepatic ischemia/reperfusion injury, liver resection and transplantation, cytokines, inflammation, NF-kB, interleukins, herbs, plants, natural ingredients, phenolic extract, and aqueous extract. RESULTS Bioactive ingredients derived from ginseng, curcumin, resveratrol, epigallocatechin gallate, quercetin, lycopene, punicalagin, crocin, celastrol, andrographolide, silymarin, and others and their effects on hepatic IRI were discussed. The specific mechanisms of action, signaling pathways, and clinical relevance for attenuation of liver enzymes, cytokine production, immune cell infiltration, oxidative damage, and cell death signaling in rodent studies are analyzed in depth. Their complex molecular actions involve modulation of pathways like TLR4, NF-κB, Nrf2, Bcl-2 family proteins, and others. CONCLUSION The natural ingredients have promising values in the protection and treatment of various chronic aggressive clinical conditions, and that need to be evaluated on humans by clinical studies.
Collapse
Affiliation(s)
- Deiaa E Elsayed Abouzed
- Department of Pharmacology & Toxicology, Faculty of Pharmacy, Sohag University, Sohag 82524, Egypt.
| | - Hend A A Ezelarab
- Department of Medicinal Chemistry, Faculty of Pharmacy, Minia University, 61519 Minia, Egypt.
| | - Heba Mohammed Refat M Selim
- Department of Pharmaceutical Sciences, Faculty of Pharmacy, AlMaarefa University, Diriyah 13713, Riyadh, Saudi Arabia; Department of Microbiology and Immunology, Faculty of Pharmacy (Girls), Al-Azhar University, Cairo 35527, Egypt.
| | - Mahmoud M A Elsayed
- Department of Pharmaceutics and Clinical Pharmacy, Faculty of Pharmacy, Sohag University, Sohag 82524, Egypt.
| | - Mohamed A El Hamd
- Department of Pharmaceutical Chemistry, College of Pharmacy, Shaqra University, Shaqra 11961, Saudi Arabia; Department of Pharmaceutical Analytical Chemistry, Faculty of Pharmacy, South Valley University, Qena 83523, Egypt.
| | - Moustafa O Aboelez
- Department of Pharmaceutical Chemistry, Faculty of Pharmacy, Sohag University, Sohag 82524, Egypt
| |
Collapse
|
155
|
Hu Q, Yang X. Impact of Comprehensive Geriatric Assessment on Treatment Strategies and Complications in Older Adults With Colorectal Cancer Considering Surgery. J Surg Oncol 2024. [PMID: 39257188 DOI: 10.1002/jso.27892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Revised: 08/26/2024] [Accepted: 08/31/2024] [Indexed: 09/12/2024]
Affiliation(s)
- Qiang Hu
- Second Clinical Medical College, Zhejiang Chinese Medicine University, Hangzhou, China
- Department of General Surgery, Tongde Hospital of Zhejiang Province, Hangzhou, China
| | - Xiyin Yang
- Department of Traditional Chinese Medicine, Community Health Service Center of Guali Town of Xiaoshan, Xiaoshan, China
| |
Collapse
|
156
|
Schmidt SV, Hinzmann J, Stammler A, Wilhelms Zu Bickern P, Macedo Santos E, Lehnhardt M, Wallner C. Surviving a classic heat stroke/hyperthermia > 42 °C - a case report. Int J Emerg Med 2024; 17:120. [PMID: 39256679 PMCID: PMC11385147 DOI: 10.1186/s12245-024-00705-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 09/01/2024] [Indexed: 09/12/2024] Open
Abstract
INTRODUCTION Classic heat stroke is a severe trauma which can lead to multi-organ dysfunctions and is associated with a high mortality. CASE PRESENTATION In this case report we present a 73-year-old patient with a classic heat stroke. His initial core body temperature was over 42 °C and he had a GCS of 3. Due to severe burn injuries the patient was transferred to a specialized burn center. The patient developed different organ failures and showed a prolonged course on the intensive care unit. Although the patient demonstrated different impaired organ systems, he recovered completely after receiving painstaking supportive therapy. CONCLUSIONS This is a rare case of a patient who fully recovered after a heat stroke with a temperature over 42 °C and severe sequelae.
Collapse
Affiliation(s)
- Sonja Verena Schmidt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany.
| | - Jannik Hinzmann
- Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Anna Stammler
- Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Paula Wilhelms Zu Bickern
- Department of Anesthesiology, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Elisabete Macedo Santos
- Department of Anesthesiology, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| | - Christoph Wallner
- Department of Plastic Surgery, BG University Hospital Bergmannsheil Bochum, Ruhr-University Bochum, Bürkle de la Camp-Platz 1, 44789, Bochum, Germany
| |
Collapse
|
157
|
Gentile M, Schiavone V, Franzese A, Di Lascio S, Velotti N. Tailored lateral internal sphincterotomy (T-LIS) for chronic anal fissure by LigaSure Small Jaws©: a comparison with other non-conservative treatments for anal fissures. Updates Surg 2024:10.1007/s13304-024-01943-y. [PMID: 39256270 DOI: 10.1007/s13304-024-01943-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 07/08/2024] [Indexed: 09/12/2024]
Abstract
An anal fissure is a small tear in the thin tissue (mucosa) that lines the anus. Anal fissures typically cause pain and bleeding with bowel movements. The cause is not fully understood, but low intake of dietary fiber may be a risk factor. Chronic anal fissure was defined as a split or ulceration in the posterior or anterior anoderm for at least 6 weeks: have distinct anatomic features such as muscle fibers visible in the wound. Anal fissures can be attributed to constipation or repeated straining: a hard fecal bolus cut the mucosa of anal canal that is relatively thigh at sphincter level management and optimal treatment of the disease is controversial. Many studies recommend conservative and medical treatment modalities as the initial treatment options since they are non-invasive and do not have risks such as anal sphincter injury. Lateral internal sphincterotomy (LIS) is considered the gold standard for treatment of chronic anal fissure. Nonetheless, anal incontinence is one of the worrisome complications of LIS. Fissurectomy is another option among those techniques which address the issues with LIS. LigaSure© (Valleylab) is a bipolar electrosurgical device designed to deliver high current and very low voltage to tissue. It monitors tissue impedance between the jaws of the instrument and continuously adjusts the delivery of energy. The use of LigaSure Small Jaw was never reported for anal fissures in literature. We have applied the use of this device to a group of patients complaining for chronic anal fissure in order to verify if there is any advantage to perform it compared to traditional technique (blade, scissors, electrocautery).
Collapse
Affiliation(s)
- Maurizio Gentile
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy.
| | - Vincenzo Schiavone
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | - Antonio Franzese
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | - Sebastiano Di Lascio
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| | - Nunzio Velotti
- Department of General Surgery, Endocrinology, Orthopedics and Rehabilitation, Federico II University of Naples, Naples, Italy
| |
Collapse
|
158
|
Wilson JP, Bonin B, Quinones C, Kumbhare D, Guthikonda B, Hoang S. Spinal Anesthesia for Awake Spine Surgery: A Paradigm Shift for Enhanced Recovery after Surgery. J Clin Med 2024; 13:5326. [PMID: 39274539 PMCID: PMC11396637 DOI: 10.3390/jcm13175326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/26/2024] [Accepted: 09/02/2024] [Indexed: 09/16/2024] Open
Abstract
Awake surgery has been applied for various surgical procedures with positive outcomes; however, in neurosurgery, the technique has traditionally been reserved for cranial surgery. Awake surgery for the spine (ASFS) is an alternative to general anesthesia (GA). As early studies report promising results, ASFS is progressively gaining more interest from spine surgeons. The history defining the range of adverse events facing patients undergoing GA has been well described. Adverse reactions resulting from GA can include postoperative nausea and vomiting, hemodynamic instability and cardiac complications, acute kidney injury or renal insufficiency, atelectasis, pulmonary emboli, postoperative cognitive dysfunction, or malignant hyperthermia and other direct drug reactions. For this reason, many high-risk populations who have typically been poor candidates under classifications for GA could benefit from the many advantages of ASFS. This narrative review will discuss the significant historical components related to ASFS, pertinent mechanisms of action, protocol overview, and the current trajectory of spine surgery with ASFS.
Collapse
Affiliation(s)
- John Preston Wilson
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Bryce Bonin
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Christian Quinones
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Deepak Kumbhare
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Bharat Guthikonda
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| | - Stanley Hoang
- Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, LA 71103, USA
| |
Collapse
|
159
|
Wu YJ, Chiao CC, Chuang PK, Hsieh CB, Ko CY, Ko CC, Chang CF, Chen TY, Nguyen NUN, Hsu CC, Chu TH, Fang CC, Tsai HY, Tsai HC, Anuraga G, Ta HDK, Xuan DTM, Kumar S, Dey S, Wulandari FS, Manalu RT, Ly NP, Wang CY, Lee YK. Comprehensive analysis of bulk and single-cell RNA sequencing data reveals Schlafen-5 (SLFN5) as a novel prognosis and immunity. Int J Med Sci 2024; 21:2348-2364. [PMID: 39310264 PMCID: PMC11413889 DOI: 10.7150/ijms.97975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 08/13/2024] [Indexed: 09/25/2024] Open
Abstract
Recent advancements have elucidated the multifaceted roles of the Schlafen (SLFN) family, including SLFN5, SLFN11, SLFN12, SLFN13, and SLFN14, which are implicated in immunological responses. However, little is known about the roles of this gene family in relation to malignancy development. The current study aimed to explore the diagnostic and prognostic potential of Schlafen family genes in colorectal adenocarcinoma (COAD) through bioinformatics analysis. Leveraging advanced bioinformatics tools of bulk RNA-sequencing and single-cell sequencing, we conducted in-depth analyses of gene expressions, functional enrichment, and survival patterns of patients with colorectal cancer compared to normal tissue. Among Schlafen family genes, the transcription levels of SLFN5 in COAD tissues were significantly elevated and correlated with poor survival outcomes. Furthermore, SLFN5 regulated the immune response via Janus kinase (JAK)/signal transduction and activator of transcription (STAT)/interferon (IFN)-alpha/beta signaling. These chemokines in inflammation are associated with diabetes and metabolism, suggesting their involvement in altered cellular energetics for COAD progress. In addition, an immune cell deconvolution analysis indicated a correlation between SLFN5 expression and immune-related cell populations, such as regulatory T cells (Tregs). These findings highlighted the potential clinical significance of SLFN5 in COAD and provided insights into its involvement in the tumor microenvironment and immune regulation. Meanwhile, the drug discovery data of SFLN5 with potential targeted small molecules suggested its therapeutic potential for COAD. Collectively, the current research demonstrated that SFLN5 play crucial roles in tumor development and serve as a prospective biomarker for COAD.
Collapse
Affiliation(s)
- Yueh-Jung Wu
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Chung-Chieh Chiao
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Po-Kai Chuang
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
| | - Chung-Bao Hsieh
- Division of General Surgery, Department of Surgery, Tri-Service General Hospital, Taipei 114202, Taiwan
- Division of General Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Chou-Yuan Ko
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Ching-Chung Ko
- Department of Medical Imaging, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chuan-Fa Chang
- Institute of Basic Medical Science, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Tung-Yuan Chen
- Division of Colorectal Surgery, Department of Surgery, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Ngoc Uyen Nhi Nguyen
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas TX 75390, USA
| | - Ching-Cheng Hsu
- Department of Internal Medicine, Division of Cardiology, The University of Texas Southwestern Medical Center, Dallas TX 75390, USA
| | - Tian-Huei Chu
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Medical Laboratory, Medical Education and Research Center, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Cheng-Chieh Fang
- Medical Laboratory, Medical Education and Research Center, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| | - Hsuan-Yen Tsai
- Institute of Molecular Medicine, College of Medicine, National Taiwan University, Taiwan
| | - Hsien-Chun Tsai
- Department of Life Sciences, National University of Kaohsiung, Taiwan
| | - Gangga Anuraga
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Department of Statistics, Faculty of Science and Technology, PGRI Adi Buana University, East Java, Surabaya 60234, Indonesia
| | - Hoang Dang Khoa Ta
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Do Thi Minh Xuan
- Faculty of Pharmacy, Van Lang University, 69/68 Dang Thuy Tram Street, Ward 13, Binh Thanh District, Ho Chi Minh City 70000, Vietnam
| | - Sachin Kumar
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Faculty of Biotechnology and Applied Sciences, Shoolini University of Biotechnology and Management Sciences, Himachal Pradesh, India
| | - Sanskriti Dey
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Fitria Sari Wulandari
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Rosario Trijuliamos Manalu
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Department of Pharmacy, Faculty of Pharmacy, National Institute of Science and Technology, Jakarta, 12640, Indonesia
| | - Ngoc Phung Ly
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Natural Product Research Center, Korea Institute of Science and Technology (KIST), Gangneung 25451, Republic of Korea
- Division of Bio-Medical Science and Technology, KIST School, University of Science and Technology (UST), Seoul 02792, Republic of Korea
| | - Chih-Yang Wang
- PhD Program for Cancer Molecular Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
- Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan
| | - Yung-Kuo Lee
- Institute of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan
- Medical Laboratory, Medical Education and Research Center, Kaohsiung Armed Forces General Hospital, Kaohsiung 80284, Taiwan
| |
Collapse
|
160
|
Gerçel G, Anadolulu AI. Neonatal Gastrointestinal Perforations: A 4-year Experience in a Single Centre. Afr J Paediatr Surg 2024:01434821-990000000-00016. [PMID: 39254062 DOI: 10.4103/ajps.ajps_96_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 01/05/2024] [Indexed: 09/11/2024] Open
Abstract
BACKGROUND Gastrointestinal perforation (GIP) during the neonatal period is still a significant problem despite improved neonatal care. The study aimed to report on incidence, management, morbidity and mortality. MATERIAL AND METHODS Records of neonates with GIPs between October 2018 and November 2022 were retrospectively analysed. RESULTS There were 47 patients, 22 (46.8%) males and 25 (53.2%) females. The incidence of neonatal GIP was 0.39% amongst all newborns treated in the neonatal intensive care unit. The mean gestational age was 30.4 ± 4.5 (23-38) weeks, and the mean birth weight was 1493.08 ± 753 (580-2940) g. Of 47 neonates, 5 (10.6%) were full term and 42 (89.4%) were preterm. The mean age of surgery was 12.25 ± 9.89 (0-41) days. A laparotomy was performed in 43 (91.4%) of 47 neonates, while seven of the patients underwent surgical intervention after decompression by percutaneous drainage. Four patients were managed with peritoneal drainage alone due to poor general condition. The pathologies unrelated to necrotising enterocolitis (NEC) were the most common cause of GIPs (55.3%) and included spontaneous intestinal perforation (n = 18), stomach perforation (n = 4), segmental volvulus (n = 2), acute mesenteric ischaemia (n = 1) and meconium peritonitis (n = 1). Overall survival was 55.4%. CONCLUSION GIPs are one of the most significant causes of mortality in newborns. The most common cause of perforations is non-NEC entities and can be seen in the entire intestinal system from the stomach to the colon. Surgical exploration is still the primary management model.
Collapse
Affiliation(s)
- Gonca Gerçel
- Department of Pediatric Surgery, Şanlıurfa Training and Research Hospital, Şanlıurfa, Turkey
- Department of Pediatric Surgery, İstanbul Sancaktepe Şehit Prof. Dr. İlhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Ali Ihsan Anadolulu
- Department of Pediatric Surgery, Mehmet Akif İnan Training and Research Hospital, Şanlıurfa, Turkey
- Department of Pediatric Surgery, Faculty of Medicine, Goztepe Prof. Dr. Suleyman Yalcin City Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
161
|
Kumar A, Saha L. Colorectal cancer cell dormancy: An insight into pathways. World J Gastroenterol 2024; 30:3810-3817. [PMID: 39351431 PMCID: PMC11438629 DOI: 10.3748/wjg.v30.i33.3810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2024] [Revised: 07/23/2024] [Accepted: 07/26/2024] [Indexed: 09/02/2024] Open
Abstract
Cancer cell dormancy (CCD) in colorectal cancer (CRC) poses a significant challenge to effective treatment. In CRC, CCD contributes to tumour recurrence, drug resistance, and amplifying the disease's burden. The molecular mechanisms governing CCD and strategies for eliminating dormant cancer cells remain largely unexplored. Therefore, understanding the molecular mechanisms governing dormancy is crucial for improving patient outcomes and developing targeted therapies. This editorial highlights the complex interplay of signalling pathways and factors involved in colorectal CCD, emphasizing the roles of Hippo/YAP, pluripotent transcription factors such as NANOG, HIF-1α signalling, and Notch signalling pathways. Additionally, ERK/p38α/β/MAPK pathways, AKT signalling pathway, and Extracellular Matrix Metalloproteinase Inducer, along with some potential less explored pathways such as STAT/p53 switch and canonical and non-canonical Wnt and SMAD signalling, are also involved in promoting colorectal CCD. Highlighting their clinical significance, these findings may offer the potential for identifying key dormancy regulator pathways, improving treatment strategies, surmounting drug resistance, and advancing personalized medicine approaches. Moreover, insights into dormancy mechanisms could lead to the development of predictive biomarkers for identifying patients at risk of recurrence and the tailoring of targeted therapies based on individual dormancy profiles. It is essential to conduct further research into these pathways and their modulation to fully comprehend CRC dormancy mechanisms and enhance patient outcomes.
Collapse
Affiliation(s)
- Anil Kumar
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| | - Lekha Saha
- Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh 160012, India
| |
Collapse
|
162
|
Kumar P, Singh A, Triveni GS, Chandrashekhara SH, Gamanagatti S, Nichat V. Celiac trunk arterial variations and their clinical implications: Role of imaging. Indian J Gastroenterol 2024:10.1007/s12664-024-01656-5. [PMID: 39243342 DOI: 10.1007/s12664-024-01656-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 07/23/2024] [Indexed: 09/09/2024]
Abstract
The awareness of anatomical variations of hepatic arteries and celiac trunk is very important in interventional radiology, liver transplant and intra-abdominal oncologic surgeries. Radiology plays an important role in the identification of these variants non-invasively. Digital subtraction angiography was the gold standard for their identification. Computed tomography (CT) angiography non-invasively provides detailed knowledge of various anatomical vascular variations. This pictorial review highlights the role of multidetector computed tomography (MDCT) in the identification of celiac trunk-hepatic arterial system variations and clinical consequences.
Collapse
Affiliation(s)
- Pawan Kumar
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Anuradha Singh
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - G S Triveni
- Department of Obstetrics and Gynecology, Lady Hardinge Medical College, Delhi, 110 001, India
| | - S H Chandrashekhara
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India.
| | - Shivanand Gamanagatti
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| | - Vaibhav Nichat
- Department of Radio-Diagnosis, IRCH, All India Institute of Medical Sciences, New Delhi, 110 029, India
| |
Collapse
|
163
|
Sabuncuoglu MZ, Sozen I, Zihni I, Celik G, Sen Acar A, Dal F, Gunduz D. Lili-Hics trial: Efficacy of the lipid test in liver hydatid cyst surgery. BIOMOLECULES & BIOMEDICINE 2024; 24:1361-1369. [PMID: 38696705 PMCID: PMC11378992 DOI: 10.17305/bb.2024.10371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 04/07/2024] [Indexed: 05/04/2024]
Abstract
Bile leakage is a common complication following liver surgeries, particularly in the cases of liver hydatid cyst operations. Currently, there is no adequate method which could be utilized to prevent this complication effectively. Our study aimed to assess the efficacy of the biliary lipid test (BLT) in reducing biliary complications after hydatid cyst surgery. We retrospectively included patients who underwent open liver hydatid cyst surgery between January 2011 and January 2024. The study encompassed 122 patients, with 41 males and 81 females, ranging in age from 18 to 79 years. In the BLT group, a lipid solution was injected transcystically after cholecystectomy. The BLT was performed on 65 patients, while 57 patients did not undergo the test. Following the transcystic injection of the lipid solution, orifices at the site of lipid droplets that became visible were ligated with 5.0 prolene sutures. A total of 200 leak sites were sutured. Remarkably, none of the patients in the BLT group experienced postoperative bile leakage lasting longer than one week. Consequently, a shorter hospital stay was observed in this group. Transcystic injection of the lipid solution with distal clamping effectively demonstrated leak sites, and suturing these sites prevented postoperative bile leakage. Our study demonstrates the effectiveness of the LIpid test in LIver Hydatid Cyst Surgery (Lili-Hics) in reducing biliary complications following hydatid cyst surgery.
Collapse
Affiliation(s)
- Mehmet Zafer Sabuncuoglu
- Hepatopancreatobiliary and Liver Transplantation Unit, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Isa Sozen
- Hepatopancreatobiliary and Liver Transplantation Unit, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ismail Zihni
- Hepatopancreatobiliary and Liver Transplantation Unit, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Girayhan Celik
- Hepatopancreatobiliary and Liver Transplantation Unit, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Ayfer Sen Acar
- Hepatopancreatobiliary and Liver Transplantation Unit, Department of General Surgery, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Fatmanur Dal
- Department of Biostatistic and Medical Informatics, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| | - Demet Gunduz
- Department of Radiology, Faculty of Medicine, Suleyman Demirel University, Isparta, Turkey
| |
Collapse
|
164
|
Zhang Y, Cui YF. Severe acute pancreatitis complicated with intra-abdominal infection secondary to trauma: A case report. World J Clin Cases 2024; 12:5821-5831. [PMID: 39247729 PMCID: PMC11263061 DOI: 10.12998/wjcc.v12.i25.5821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/12/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Pancreatic trauma (PT) is rare among traumatic injuries and has a low incidence, but it can still lead to severe infectious complications, resulting in a high mortality rate. Acute pancreatitis (AP) is a common complication after PT, and when combined with organ dysfunction and sepsis, it will result in a poorer prognosis. CASE SUMMARY We report a 25-year-old patient with multiple organ injuries, including the pancreas, due to abdominal trauma, who developed necrotising pancreatitis secondary to emergency caesarean section, combined with intra-abdominal infection (IAI). The patient underwent performed percutaneous drainage, pancreatic necrotic tissue debridement, and abdominal infection foci debridement on the patient. CONCLUSION We report a case of severe AP and IAI secondary to trauma. This patient was managed by a combination of conservative treatment such as antibiotic therapy and fluid support with surgery, and a better outcome was obtained.
Collapse
Affiliation(s)
- Yu Zhang
- Department of Surgery, Tianjin Nankai Hospital, Tianjin Medical University, Tianjin 300070, China
| | - Yun-Feng Cui
- Department of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin 300100, China
| |
Collapse
|
165
|
Pan K, Wang S, Li X, Wu S. Efficacy and safety of ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma: A meta-analysis. PLoS One 2024; 19:e0305965. [PMID: 39240946 PMCID: PMC11379279 DOI: 10.1371/journal.pone.0305965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 06/08/2024] [Indexed: 09/08/2024] Open
Abstract
OBJECTIVE Meta-analysis was used to assess the efficacy and safety of ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma. METHODS Randomized controlled studies on ultrasound-guided radiofrequency ablation combined with transhepatic artery embolization chemotherapy for hepatocellular carcinoma were searched in the databases of PubMed, Embase, Cochrane library, web of science with a search deadline of March 14, 2024. Data were analyzed using Stata 15.0. RESULT Six randomized controlled studies involving 520 individuals were finally included, the results of meta-analysis showed that ultrasound-guided radiofrequency ablation combined with TACE can improve objective response rate [RR = 1.52, 95%CI (1.28, 1.81)], improve disease control rate [RR = 1.15, 95%CI (1.06, 1.24)], The survival rate [RR = 1.34, 95%CI (1.19,1.51)] did not increase adverse reactions [RR = 1.34, 95%CI (1.00,1.79)]. CONCLUSION Based on the findings of the current study, ultrasound-guided radiofrequency ablation combined with TACE was found to improve the objective remission rate, disease control rate, and did not increase adverse events in patients with hepatocellular carcinoma.
Collapse
Affiliation(s)
- Kerui Pan
- Lianyungang First People's Hospital, China
| | - Sisi Wang
- Lianyungang First People's Hospital, China
| | - Xueping Li
- Lianyungang First People's Hospital, China
| | | |
Collapse
|
166
|
Chan LY, Chern YJ, Hsu YJ, Jong BK, Lai IL, Hsieh PS, Liao CK, You JF. Short-term outcomes of Transrectal Natural Orifice Specimen extraction compared with conventional minimally invasive surgery for selected patients with colorectal cancer: a propensity score matching analysis and literature review. World J Surg Oncol 2024; 22:237. [PMID: 39242550 PMCID: PMC11380319 DOI: 10.1186/s12957-024-03513-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2024] [Accepted: 08/27/2024] [Indexed: 09/09/2024] Open
Abstract
PURPOSE Conventional minimally invasive surgery requires mini-laparotomy to extract the pathological specimen. However, by using a natural orifice as the delivery route, natural orifice specimen extraction (NOSE) surgery avoids the need for a large incision. This study analyzed the short-term outcome of NOSE compared with conventional mini-laparotomy (CL) for colorectal cancer surgery. METHODS We conducted a retrospective analysis of 1,189 patients who underwent surgery for primary colorectal cancer between the cecum and upper rectum. Propensity score analyses were applied to the NOSE and CL groups in a 1:1 matched cohort. RESULTS After propensity score matching, each group included 201 patients. The NOSE group and CL group did not differ significantly in terms of baseline characteristics. Postoperative morbidity and mortality rates were comparable. Compared with the CL group, the NOSE group experienced a shorter time to first flatus (1.6 ± 0.8 vs. 2.0 ± 1.2 days, p < 0.001), first stool (2.7 ± 1.5 vs. 4.1 ± 1.9, p < 0.001), liquid diet (2.3 ± 1.3 vs. 3.6 ± 1.8 days, p < 0.001), soft diet (3.9 ± 2.0 vs. 5.2 ± 1.9 days, p < 0.001) and a shorter hospital stay (5.1 ± 3.5 vs. 7.4 ± 4.8 days, p < 0.001). The NOSE group exhibited lower mean pain intensity and lower highest pain intensity on postoperative days 1, 2, and 3. CONCLUSION NOSE has several advantages over conventional mini-laparotomy following minimally invasive surgery for colon cancer. These advantages include reduced time to oral intake, shorter hospital stays, and less postoperative pain. NOSE can be adopted and applied to highly selective patients without additional risk of short-term complications.
Collapse
Affiliation(s)
- Li-Yang Chan
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yih-Jong Chern
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Jen Hsu
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Bor-Kang Jong
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - I-Li Lai
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Pao-Shiu Hsieh
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Kai Liao
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Jeng-Fu You
- Division of Colon and Rectal Surgery, College of Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University, Taoyuan, Taiwan.
| |
Collapse
|
167
|
Wishahi M, Kamal NM, Hedaya MS. Enhanced recovery after surgery: Progress in adapted pathways for implementation in standard and emerging surgical settings. World J Clin Cases 2024; 12:5636-5641. [PMID: 39247727 PMCID: PMC11263044 DOI: 10.12998/wjcc.v12.i25.5636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 04/29/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024] Open
Abstract
The concept of enhanced recovery after surgery (ERAS) has been practiced for decades and has been implemented in numerous surgical specialties. ERAS is a global surgical quality improvement initiative, and it is an element in the field of perioperative care. ERAS had shown significant clinical outcomes, patient-reported satisfaction, and improvements in medical service cost. ERAS has been developed for specific surgical procedures, but with the fast progress of newly introduced surgical procedures, the original ERAS have been developed and modified. Recently appearing Topics and future research trends encompass ERAS protocols for other types of surgery and the enhancement of perioperative status, including but not limited to pediatric surgery, laparoscopic and robotic assisted surgery, bariatric surgery, thoracic surgery, and renal transplantation. The elements and pathways of ERAS have been developed with the introduction of up-to-date methodologies in the pre-operative, operative, and post-operative pathways. ERAS costs are higher than traditional care, but the patient's clinical outcome and satisfaction are higher. ERAS is in progress in the fields of anesthetic tasks, pediatric surgery, and organ transplantation. Although ERAS has shown significant clinical outcomes, there are needs to modify the protocol for specific cases, hospital facilities, resources, and nurses training on elements of ERAS. Several challenges and limitations exist in the implementation of ERAS that deserve consideration, it includes: Frailty, maximizing nutrition, prehabilitation, treating preoperative anemia, and enhancing ERAS adoption globally are all included.
Collapse
Affiliation(s)
- Mohamed Wishahi
- Department of Urology, Theodor Bilharz Research Institute, Cairo 12411, Egypt
| | - Nabawya M Kamal
- Department of Anaesthesia and Surgical Intensive Care, Theodor Bilharz Research Institute, Cairo 12411, Egypt
| | | |
Collapse
|
168
|
Zhou H, Liu C, Yu X, Su M, Yan J, Shi X. Efficacy and safety of endoscopic nasobiliary drainage versus percutaneous transhepatic cholangial drainage in the treatment of advanced hilar cholangiocarcinoma: a systematic review and meta-analysis. BMC Gastroenterol 2024; 24:302. [PMID: 39243020 PMCID: PMC11378551 DOI: 10.1186/s12876-024-03397-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/30/2024] [Indexed: 09/09/2024] Open
Abstract
OBJECTIVE To evaluate and compare the efficacy and safety of Endoscopic Nasobiliary Drainage (ENBD) and Percutaneous Transhepatic Cholangiography Drainage (PTCD) in patients with advanced Hilar Cholangiocarcinoma (HCCA) through a meta-analysis of clinical studies. METHODS We searched Chinese and English databases, including China National Knowledge Infrastructure (CNKI), Wanfang database, PubMed, Embase, Scopus, and Web of Science, for relevant literatures on PTCD and ENBD for advanced HCCA clinical trials. Two investigators independently screened the literatures, and the quality of the included studies was evaluated using the Newcastle-Ottawa Scale (NOS). The primary endpoint was the success rate of biliary drainage operation, while secondary endpoints included Total Bilirubin (TBIL) change, acute pancreatitis, biliary tract infection, hemobilia, and other complications. R software was used for data analysis. RESULTS A comprehensive database search, based on predefined inclusion and exclusion criteria, yielded 26 articles for this study. Analysis revealed that PTCD had a significantly higher success rate than ENBD [OR (95% CI) = 2.63 (1.98, 3.49), Z=6.70, P<0.05]. PTCD was also more effective in reducing TBIL levels post-drainage [SMD (95%CI) =-0.13 (-0.23, -0.03), Z=-2.61, P<0.05]. While ENBD demonstrated a lower overall complication rate [OR (95%CI) = 0.60 (0.43, 0.84), Z=-2.99, P<0.05], it was associated with a significantly lower incidence of post-drainage biliary hemorrhage compared to PTCD [OR=3.02, 95%CI: (1.94-4.71), Z= 4.89, P<0.01]. CONCLUSIONS This meta-analysis compares the efficacy and safety of ENBD and PTCD for palliative treatment of advanced HCCA. While both are effective, PTCD showed superiority in achieving successful drainage, reducing TBIL, and lowering the incidence of acute pancreatitis and biliary infections. However, ENBD had a lower risk of post-drainage bleeding. Clinicians should weigh these risks and benefits when choosing between ENBD and PTCD for individual patients. Further research is needed to confirm these findings and explore long-term outcomes.
Collapse
Affiliation(s)
- Huiling Zhou
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Chunxia Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Xianhuan Yu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Mingye Su
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China
| | - Jingwen Yan
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China.
| | - Xiangde Shi
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, P. R. China.
| |
Collapse
|
169
|
Wang J, Liang Y, Xue A, Xiao J, Zhao X, Cao S, Li P, Dong J, Li Y, Xu Z, Yang L. Intratumoral CXCL13 + CD160 + CD8 + T cells promote the formation of tertiary lymphoid structures to enhance the efficacy of immunotherapy in advanced gastric cancer. J Immunother Cancer 2024; 12:e009603. [PMID: 39244216 PMCID: PMC11381742 DOI: 10.1136/jitc-2024-009603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/19/2024] [Indexed: 09/09/2024] Open
Abstract
BACKGROUND Stage IV gastric cancer is a highly heterogeneous and lethal tumor with few therapeutic strategies. The combination of programmed cell death protein 1 inhibitors and chemotherapy is currently the standard frontline treatment regimen for advanced gastric cancer. Nevertheless, it remains a great challenge to screen the beneficiaries of immunochemotherapy and expand indications for this treatment regimen. METHODS We conducted a pathological assessment to ascertain the importance of tertiary lymphoid structures based on the tissue samples collected from patients with stage IV gastric cancer (n=15) both prior to and following immunochemotherapy treatment. Additionally, we used spatial (n=10) and single-cell transcriptional analysis (n=97) to investigate the key regulators of tertiary lymphoid structures (TLSs). Multiplex immunofluorescence and image analysis (n=34) were performed to explore the association between tumor-infiltrating CXCL13+ CD160+ CD8+ T cells and TLSs. The relationship between CXCL13+ CD160+ CD8+ T cells and the responsiveness to immunotherapy was also evaluated by multiplex immunofluorescence and image analysis approaches (n=15). Furthermore, we explored the intrinsic characteristics of CXCL13+ CD160+ CD8+ T cells through various experimental techniques, including quantitative reverse transcription-PCR, western blot, and flow cytometry. RESULTS We found that responders exhibited higher levels of TLSs and CXCL13+ CD160+ CD8+ T cells in biopsy tissues prior to immunochemotherapy compared with non-responders. Following conversion therapy, responders also had a higher percentage of mature TLSs and a higher number of CXCL13+ CD160+ CD8+ T cells in surgical resections. Moreover, we discovered that vitamin B6 in CD160+ CD8+ T cells could reduce the ubiquitination modification of HIF-1α by MDM2, thereby attenuating the degradation of HIF-1α. Consequently, this led to the transcriptional upregulation of CXCL13 expression, facilitating the recruitment of CXCR5+ B cells and the formation of TLSs. CONCLUSION The number and maturity of TLSs, along with the extent of CXCL13+ CD160+ CD8+ T-cell infiltration, might function as potential indicators for assessing the effectiveness of immunotherapy in treating gastric malignancies. Furthermore, our research suggests that vitamin B6 could enhance the secretion of CXCL13 by CD160+ CD8+ T cells by reducing the degradation of HIF-1α. Additionally, we demonstrate that vitamin B6 supplementation or targeting pyridoxal kinase could substantially improve the efficacy of immunotherapies for gastric cancer.
Collapse
Affiliation(s)
- Jiawei Wang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Liang
- Southeast University, Nanjing, Jiangsu, China
| | - Ao Xue
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jian Xiao
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xinyu Zhao
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shuqing Cao
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Pengyu Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Jiacheng Dong
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yuan Li
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Zekuan Xu
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Li Yang
- Department of General Surgery, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| |
Collapse
|
170
|
Fukunaga Y, Maeda H, Yamaguchi S, Tsutsui M, Okamoto K, Tanaka T, Maeda M, Marui A, Namikawa T, Kobayashi M, Seo S. An actinomycosis infection resembling peritoneal dissemination of rectal cancer: a case report. Surg Case Rep 2024; 10:207. [PMID: 39237794 PMCID: PMC11377367 DOI: 10.1186/s40792-024-02005-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Actinomycosis is a suppurative and granulomatous inflammation commonly caused by Actinomyces israelii. Due to its rarity and the paucity of characteristic clinical features, diagnosis of intra-abdominal actinomycosis is challenging, especially when the patient has a treatment history of abdominal cancer. CASE PRESENTATION The patient is a 72-year-old man who has a history of multiple abdominal surgeries for rectal cancer, including low anterior resection for primary rectal cancer, partial hepatic resection for metachronous liver metastasis, and Hartmann surgery for local recurrence. The patient has also undergone parastomal hernia repair using the Sugarbaker method. One year after hernia repair, computed tomography (CT) identified a mass lesion between the abdominal wall and the mesh, suggesting the possibility of peritoneal recurrence of rectal cancer. The accumulation of fluorodeoxyglucose (FDG) was evident via positron emission tomography-CT (PET-CT), while tumor marker levels were within the normal range. On laparotomy, the small intestine, abdominal wall, mesh, colon, and stoma were observed to be associated with the mass lesion, and en bloc resection was carried out. However, postoperative histopathological examination revealed an actinomyces infection without any cancerous cells. CONCLUSIONS This case highlights the challenges faced by surgeons regarding preoperative diagnosis of actinomycosis, especially when it occurs after the resection of abdominal cancer. Also, this case reminds us of the importance of a histopathological examination for abdominal masses or nodules before starting chemotherapy.
Collapse
Affiliation(s)
- Yukiko Fukunaga
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan.
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Miho Tsutsui
- Department of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, Japan
| | - Ken Okamoto
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Tomoki Tanaka
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kochi University, Kohasu, Oko-Cho, Nankoku, Kochi, 783-8505, Japan
| |
Collapse
|
171
|
Zhang Y, Li J, Li J, Wang J. Dysregulation of systemic immunity and its clinical application in gastric cancer. Front Immunol 2024; 15:1450128. [PMID: 39301031 PMCID: PMC11410619 DOI: 10.3389/fimmu.2024.1450128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2024] [Accepted: 08/22/2024] [Indexed: 09/22/2024] Open
Abstract
Immunotherapy has profoundly changed the treatment of gastric cancer, but only a minority of patients benefit from immunotherapy. Therefore, numerous studies have been devoted to clarifying the mechanisms underlying resistance to immunotherapy or developing biomarkers for patient stratification. However, previous studies have focused mainly on the tumor microenvironment. Systemic immune perturbations have long been observed in patients with gastric cancer, and the involvement of the peripheral immune system in effective anticancer responses has attracted much attention in recent years. Therefore, understanding the distinct types of systemic immune organization in gastric cancer will aid personalized treatment designed to pair with traditional therapies to alleviate their detrimental effects on systemic immunity or to directly activate the anticancer response of systemic immunity. Herein, this review aims to comprehensively summarize systemic immunity in gastric cancer, including perturbations in systemic immunity induced by cancer and traditional therapies, and the potential clinical applications of systemic immunity in the detection, prediction, prognosis and therapy of gastric cancer.
Collapse
Affiliation(s)
- Yao Zhang
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Junfeng Li
- School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
- Department of Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Jian Li
- Department of General Surgery, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| | - Jisheng Wang
- School of Pharmacy, Southwest Medical University, Luzhou, Sichuan, China
- Department of Pharmacy, The Third Hospital of Mianyang, Sichuan Mental Health Center, Mianyang, Sichuan, China
| |
Collapse
|
172
|
Ghabisha S, Ahmed F, Almohtadi AM, Alghazali KA, Badheeb M, Al-Wageeh S. Demographic, Clinical, Radiological, and Surgical Outcome of Patients with Intestinal Tuberculosis: A Single-Center Retrospective Study. Res Rep Trop Med 2024; 15:79-90. [PMID: 39253062 PMCID: PMC11382657 DOI: 10.2147/rrtm.s465571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Accepted: 08/31/2024] [Indexed: 09/11/2024] Open
Abstract
Background Intestinal tuberculosis (iTB) represents a potentially underrecognized clinical entity with limited clinical and radiological differentiating features. This study aims to assess the patterns of iTB clinical and radiological findings, along with the treatment approaches and the overall outcome. Methods This retrospective cross-sectional study included patients with histopathologically confirmed iTB who presented with acute abdomen and were surgically managed between September 2005 and October 2023. Clinical and sociodemographic variables, imaging features, surgical treatments, and overall outcomes were retrospectively analyzed. Results 96 patients with iTB were included, with a mean age of 36.1 ± 11.5 years and a relatively proportionate gender distribution. Abdominal pain was the most common presenting symptom (45.8%). The radiological features varied by the modality. Plain imaging showed non-specific findings, while ultrasonography showed loculated ascites (25%), and lymphadenopathy (22%). In computed tomography scans, multi-segmental symmetric intestinal thickening (53.1%) was the most prevalent finding. The most commonly performed surgical procedure was adhesiolysis (29.2%), with the ileocecal junction being the most commonly involved structure (39.6%). Histopathological examination of all the tissue biopsies revealed epithelioid granulomas. Postoperative complications occurred in 19 patients (19.8%), with surgical site infection being the most common complication (10.4%). Conclusion Intestinal obstruction is an underrecognized manifestation of tuberculosis, particularly in endemic regions. The non-specific clinical presentation, coupled with the limited utility of laboratory and radiological tests, often leads to delayed recognition and treatment. Maintaining a high index of suspicion is essential, especially in younger patients, inhabitants of endemic areas, or those with laboratory findings indicative of chronic inflammation. Prompt recognition is crucial to ensure the timely initiation of anti-tuberculosis therapy and to optimize patient outcomes through appropriate follow-up.
Collapse
Affiliation(s)
- Saif Ghabisha
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
| | - Faisal Ahmed
- Department of Urology, School of Medicine, Ibb University, Ibb, Yemen
| | - Abdullatif Mothanna Almohtadi
- Department of Radiology, School of Medicine, Ibb University, Ibb, Yemen
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
| | - Khairalah Abdulkarem Alghazali
- Department of Radiology, Ibb Scan Center, Ibb, Yemen
- Department of Medical Immunology and Microbiology, School of Medicine, Jiblah University for Medical and Health Sciences, Ibb, Yemen
| | - Mohamed Badheeb
- Internal Medicine, Yale New-Haven Health/Bridgeport Hospital, Bridgeport, CT, USA
| | - Saleh Al-Wageeh
- Department of General Surgery, School of Medicine, Ibb University, Ibb, Yemen
| |
Collapse
|
173
|
Palenca I, Basili Franzin S, Zilli A, Seguella L, Troiani A, Pepi F, Vincenzi M, Giugliano G, Catapano V, Di Filippo I, Sarnelli G, Esposito G. N-palmitoyl-d-glucosamine limits mucosal damage and VEGF-mediated angiogenesis by PPARα-dependent suppression of pAkt/mTOR/HIF1α pathway and increase in PEA levels in AOM/DSS colorectal carcinoma in mice. Phytother Res 2024. [PMID: 39235753 DOI: 10.1002/ptr.8303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2024] [Revised: 07/15/2024] [Accepted: 07/18/2024] [Indexed: 09/06/2024]
Abstract
Chronic intestinal inflammation and neo-angiogenesis are interconnected in colorectal carcinoma (CRC) pathogenesis. Molecules reducing inflammation and angiogenesis hold promise for CRC prevention and treatment. N-Palmitoyl-d-glucosamine (PGA), a natural glycolipid analog with anti-inflammatory properties, has shown efficacy against acute colitis. Micronized PGA (mPGA) formulations exhibit superior anti-inflammatory activity. This study investigates the in vivo anti-angiogenic and protective effects of mPGA in a mouse model of colitis-associated CRC induced by azoxymethane/dextran sodium sulfate (AOM/DSS). CRC was induced in C57BL/6J mice using intraperitoneal azoxymethane followed by three cycles of 2.5% dextran sodium sulfate (DSS) in drinking water. Mice were treated with mPGA (30-150 mg/kg) with or without the PPARα inhibitor MK886 (10 mg/kg). At Day 70 post-azoxymethane injection, mice underwent anesthetized endoscopic colon evaluation. Post-mortem analysis of tumorigenesis and angiogenesis was performed using histological, immunohistochemical, and immunoblotting techniques. mPGA improved disease progression and survival rates in a dose- and PPARα-dependent manner in AOM/DSS-exposed mice. It reduced polyp formation, decreased pro-angiogenic CD31, pro-proliferative Ki67, and pro-inflammatory TLR4 expression levels, and inhibited VEGF and MMP-9 secretion by disrupting the pAkt/mTOR/HIF1α pathway. mPGA increased colon PEA levels, restoring anti-tumoral PPARα and wtp53 protein expression. Given its lack of toxicity, mPGA shows potential as a nutritional intervention to counteract inflammation-related angiogenesis in CRC.
Collapse
Affiliation(s)
- Irene Palenca
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Silvia Basili Franzin
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Aurora Zilli
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Luisa Seguella
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Anna Troiani
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, Rome, Italy
| | - Federico Pepi
- Department of Chemistry and Drug Technologies, Sapienza University of Rome, Rome, Italy
| | - Martina Vincenzi
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| | - Giuseppe Giugliano
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Viviana Catapano
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Italia Di Filippo
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giovanni Sarnelli
- Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Esposito
- Department of Physiology and Pharmacology "V. Erspamer", Sapienza University of Rome, Rome, Italy
| |
Collapse
|
174
|
Khalil M, Woldesenbet S, Iyer S, Rashid Z, Altaf A, Katayama E, Chatzipanagiotou OP, Carpenter KM, Pawlik TM. Impact of Spousal Mental Illness on Healthcare Utilization Among Patients With Gastrointestinal Cancer. J Surg Oncol 2024. [PMID: 39233565 DOI: 10.1002/jso.27860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Accepted: 08/08/2024] [Indexed: 09/06/2024]
Abstract
BACKGROUND Informal caregiving involves increased responsibilities, with financial and emotional challenges, thereby affecting the well-being of the caregiver. We aimed to investigate the effect of spousal mental illness on hospital visits and medical spending among patients with gastrointestinal (GI) cancer. METHODS Patients who underwent GI cancer surgery between 2013 and 2020 were identified from the IBM Marketscan database. Multivariable regression analysis was used to examine the association between spousal mental illness and healthcare utilization. RESULTS A total of 6,035 patients underwent GI surgery for a malignant indication. Median age was 54 years (IQR: 49-59), most patients were male (n = 3592, 59.5%), and had a CCI score of ≤ 2 (n = 5512, 91.3%). Of note, in the 1 year follow-up period, 19.4% (anxiety: n = 509, 8.4%; depression: n = 301, 5.0%; both anxiety and depression: n = 273, 4.5%; severe mental illness: n = 86, 1.4%) of spouses developed a mental illness. On multivariable analysis, after controlling for competing factors, spousal mental illness remained independently associated with increased odds of emergency department visits (OR 1.20, 95% CI 1.05-1.38) and becoming a super healthcare utilizer (OR 1.37, 95% CI 1.04-1.79), as well as 12.1% (95% CI 10.6-15.3) higher medical spending. CONCLUSION Among patients with GI cancer spousal mental illness is associated with higher rates of outpatient visits, emergency department visits, and expenditures during the 1-year postoperative period. These findings underscore the importance of caregiving resources and counseling in alleviating caregiver burden, thereby reducing the overall burden on the healthcare system.
Collapse
Affiliation(s)
- Mujtaba Khalil
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Selamawit Woldesenbet
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Sidharth Iyer
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Zayed Rashid
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Abdullah Altaf
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Erryk Katayama
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Odysseas P Chatzipanagiotou
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| | - Kristen M Carpenter
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, Ohio, USA
| | - Timothy M Pawlik
- Department of Surgery, The Ohio State University Wexner Medical Center and James Comprehensive Cancer Center, Columbus, Ohio, USA
| |
Collapse
|
175
|
Wang X, Bai Y, Chai N, Li Y, Linghu E, Wang L, Liu Y. Chinese national clinical practice guideline on diagnosis and treatment of biliary tract cancers. Chin Med J (Engl) 2024; 137:00029330-990000000-01212. [PMID: 39238075 PMCID: PMC11441919 DOI: 10.1097/cm9.0000000000003258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND Biliary tract carcinoma (BTC) is relatively rare and comprises a spectrum of invasive tumors arising from the biliary tree. The prognosis is extremely poor. The incidence of BTC is relatively high in Asian countries, and a high number of cases are diagnosed annually in China owing to the large population. Therefore, it is necessary to clarify the epidemiology and high-risk factors for BTC in China. The signs associated with BTC are complex, often require collaborative treatment from surgeons, endoscopists, oncologists, and radiation therapists. Thus, it is necessary to develop a comprehensive Chinese guideline for BTC. METHODS This clinical practice guideline (CPG) was developed following the process recommended by the World Health Organization. The Grading of Recommendations Assessment, Development, and Evaluation approach was used to assess the certainty of evidence and make recommendations. The full CPG report was reviewed by external guideline methodologists and clinicians with no direct involvement in the development of this CPG. Two guideline reporting checklists have been adhered to: Appraisal of Guidelines for Research and Evaluation (AGREE) and Reporting Items for practice Guidelines in Healthcare (RIGHT). RESULTS The guideline development group, which comprised 85 multidisciplinary clinical experts across China. After a controversies conference, 17 clinical questions concerning the prevention, diagnosis, and treatment of BTC were proposed. Additionally, detailed descriptions of the surgical principles, perioperative management, chemotherapy, immunotherapy, targeted therapy, radiotherapy, and endoscopic management were proposed. CONCLUSIONS The guideline development group created a comprehensive Chinese guideline for the diagnosis and treatment of BTC, covering various aspects of epidemiology, diagnosis, and treatment. The 17 clinical questions have important reference value for the management of BTC.
Collapse
Affiliation(s)
- Xu’an Wang
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Systems Medicine for Cancers, Shanghai Cancer Institute; Shanghai Key Laboratory for Cancer Systems Regulation and Clinical Translation, Shanghai 200127, China
| | - Yongrui Bai
- Department of Radiation Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Ningli Chai
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Yexiong Li
- State Key Laboratory of Molecular Oncology and Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing 100853, China
| | - Enqiang Linghu
- Department of Gastroenterology and Hepatology, the First Medical Center, Chinese People’s Liberation Army General Hospital, Beijing 100853, China
| | - Liwei Wang
- State Key Laboratory of Oncogenes and Related Genes, Shanghai Cancer Institute; Department of Oncology, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
| | - Yingbin Liu
- Department of Biliary and Pancreatic Surgery, Renji Hospital, Shanghai Jiao Tong University School of Medicine; State Key Laboratory of Systems Medicine for Cancers, Shanghai Cancer Institute; Shanghai Key Laboratory for Cancer Systems Regulation and Clinical Translation, Shanghai 200127, China
| | | |
Collapse
|
176
|
Tepelenis K, Stefanou CK, Stefanou SK, Sitos E, Steliou F, Mpakas K, Lepida D, Chatzoglou T, Smyris TI, Kefala MA. Post-colonoscopy appendicitis: A systematic review. Asian J Surg 2024:S1015-9584(24)01871-2. [PMID: 39237412 DOI: 10.1016/j.asjsur.2024.08.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 07/24/2024] [Accepted: 08/20/2024] [Indexed: 09/07/2024] Open
Abstract
Post-colonoscopy appendicitis is an infrequent complication of colonoscopy. This systematic review aimed to summarize the literature's current notions, clinical features, and management of post-colonoscopy appendicitis. PubMed and Embase were searched from inception until December 31, 2023. Two reviewers independently screened titles/abstracts and full-text papers for any study design about post-colonoscopy appendicitis and abstracted data. 56 articles with a total of 67 patients were included in the systematic review. The median age was 54.9 years (range 24-84), with more male individuals affected (64.2 %). The main indication of colonoscopy was investigation (37.3 %). Forty-three patients had colonoscopy with additional procedures (64.2 %). Most patients (79.1 %) presented with symptoms within two days after the colonoscopy. The clinical manifestation was the same as acute appendicitis. The diagnosis of post-colonoscopy appendicitis was confirmed in 70.2 % of the cases, mainly with abdominal computed tomography or, alternatively, ultrasound. Most patients were successfully treated with surgery (88.1 %), either open (56.8 %) or laparoscopic appendectomy (31.3 %). The conversion rate of laparoscopic appendectomy was 19.2 %. Non-operative management with intravenous antibiotics was attempted in 17 patients with a success rate of 41.2 %. Histopathology revealed acute appendicitis in 30 cases (44.8 %) and complicated appendicitis in 29 (49.2 %). Fecalith was found in 21 cases (31.3 %). Post-colonoscopy appendicitis is an infrequent but potential complication of colonoscopy. The onset of symptoms, especially pain, fever, nausea, and vomiting after a colonoscopy, should raise suspicion of this entity. A satisfactory outcome depends on timely diagnosis and appropriate management.
Collapse
Affiliation(s)
- Kostas Tepelenis
- Department of Surgery, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece.
| | | | | | - Evangelos Sitos
- Department of Anesthesia and Postoperative Intensive Care, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece
| | - Frideriki Steliou
- Department of Anesthesia and Postoperative Intensive Care, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece
| | - Konstantinos Mpakas
- Intensive Care Unit, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece
| | - Dimitra Lepida
- Intensive Care Unit, General Hospital of Ioannina "G. Xatzikosta", Ioannina, Greece
| | | | | | | |
Collapse
|
177
|
Esquiroz Lizaur I, Zambom-Ferraresi F, Zambom-Ferraresi F, Ollo-Martínez I, De la Casa-Marín A, Martínez-Velilla N, Recreo Baquedano A, Galbete Jimenez A, González Alvarez G, Yarnoz Irazabal MC, Eguaras Córdoba I. Postoperative physical rehabilitation in the elderly patient after emergency surgery. Influence on functional, cognitive and quality of live recovery: study protocol for a randomized clinical trial. Trials 2024; 25:584. [PMID: 39232792 PMCID: PMC11373425 DOI: 10.1186/s13063-024-08406-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/16/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND The progressive aging of the population has meant the increase in elderly patients requiring an urgent surgery. Older adults, especially those with frailty, have a higher risk for complications, functional and cognitive decline after urgent surgery. These patients have their functional and physiological reserve reduced which makes them more vulnerable to the effects of being bedridden. The consequences are at multiple levels emphasizing the functional loss or cognitive impairment, longer stays, mortality and institutionalization, delirium, poor quality of life and increased use of resources related to health. We aim to determine whether postoperative physical rehabilitation can prevent functional and cognitive decline and modify the posterior trajectory. METHODS/DESIGN This study is a randomized clinical trial, simple blinded, conducted in the Department of Surgery of a tertiary public hospital in Navarra (Hospital Universitario de Navarra), Spain. Patients > = 70 years old undergoing urgent abdominal surgery who meet inclusion criteria will be randomly assigned to the intervention or control group. The intervention will consist of a multicomponent physical training programme, which will include progressive and supervised endurance, resistance and balance training for 4 weeks, twice weekly sessions with a total of 8 sessions, and the group control will receive the usual care. The primary outcome measure is the change in functional (SPPB) and cognitive status (Mini-Mental State Examination) and the change of quality of life (EuroQol-5D-VAS) during the study period. The secondary outcomes are postoperative complications, length of stay, delirium, mortality, use of health resources, functional status (Barthel Index and handgrip strength tests), cost per quality-adjusted life year and mininutritional assessment. The data for both the intervention group and the control group will be obtained at four different times: the initial visit during hospital admission and at months 1, 3 and 6 months after hospital discharge. DISCUSSION If our hypothesis is correct, this project could show that individualized and progressive exercise programme provides effective therapy for improving the functional capacity and achieve a better functional, cognitive and quality of life recovery. This measure, without entailing a significant expense for the administration, probably has an important repercussion both in the short- and long-term recovery, improving care and functional parameters and could determine a lower subsequent need for health resources. To verify this, we will carry out a cost-effectiveness study. The clinical impact of this trial can be significant if we help to modify the traditional management of the elderly patients from an illness model to a more person-centred and functionally oriented perspective. Moreover, the prescription of individualized exercise can be routinely included in the clinical practice of these patients. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT05290532. Version 1. Registered on March 13, 2022.
Collapse
Affiliation(s)
- Irene Esquiroz Lizaur
- Surgery Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain.
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain.
| | - Fabricio Zambom-Ferraresi
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
| | - Fabiola Zambom-Ferraresi
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
| | - Iranzu Ollo-Martínez
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
| | - Antón De la Casa-Marín
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
| | - Nicolás Martínez-Velilla
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
- CIBER of Frailty and Healthy Aging (CIBERFES), Instituto de Salud Carlos III, Madrid, Spain
- Geriatric Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain
| | - Ana Recreo Baquedano
- Surgery Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain
| | - Arkaitz Galbete Jimenez
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain
- Biomedical Research Centre of the Government of Navarre (Navarrabiomed), Navarra Institute for Health Research (IdiSNA), Pamplona, Navarra, Spain
| | | | - María Concepción Yarnoz Irazabal
- Surgery Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain
| | - Inés Eguaras Córdoba
- Surgery Department, Hospital Universitario de Navarra (HUN), Pamplona, Navarra, Spain
- Department of Health Sciences, Public University of Navarra (UPNA), Pamplona, Navarra, Spain
| |
Collapse
|
178
|
Radenković N, Nikodijević D, Jovankić J, Blagojević S, Milutinović M. Resistance to 5-fluorouracil: The molecular mechanisms of development in colon cancer cells. Eur J Pharmacol 2024; 983:176979. [PMID: 39241942 DOI: 10.1016/j.ejphar.2024.176979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 08/22/2024] [Accepted: 09/03/2024] [Indexed: 09/09/2024]
Abstract
Colon cancer is a significant health problem worldwide as it is one of the most common and deadliest cancers. The standard approach for the treatment of colon cancer is 5-fluorouracil (5-FU) based chemotherapy, which is limited by the development of resistance to this drug. Therefore, our study aimed to establish 5-FU resistance in SW-480 and HT-29 colon cancer cells and to precisely determine the molecular mechanisms and biomarkers that contribute to its development, both after short-term exposure and in cells with already developed resistance (SW-480-5FUR and HT-29-5FUR). The expression of various molecules involved in the different mechanisms of resistance development was monitored at the gene (qPCR) and protein (immunocytochemistry) levels. Based on the obtained results, alterations in the 5-FU anabolic pathway, biotransformation, drug efflux, mismatch repair, and apoptosis process together contributed to the development of 5-FU resistance in SW-480 and HT-29 colon cancer cells. In addition, UMPS, ABCC1, ABCC5, and MLH1, as well as the disturbed ratio of pro-apoptotic BAX and anti-apoptotic BCL2, should be taken into consideration as potential targets for the discovery of 5-FU resistance-related biomarkers in colon cancer cells. We suggest that future investigations focus on further validation of these findings by additional in vitro and in vivo testing, which is a limitation of our study.
Collapse
Affiliation(s)
- Nikola Radenković
- University of Kragujevac, Faculty of Science, Department of Biology and Ecology, Radoja Domanovića 12, 34000, Kragujevac, Serbia
| | - Danijela Nikodijević
- University of Kragujevac, Faculty of Science, Department of Biology and Ecology, Radoja Domanovića 12, 34000, Kragujevac, Serbia
| | - Jovana Jovankić
- University of Kragujevac, Faculty of Science, Department of Biology and Ecology, Radoja Domanovića 12, 34000, Kragujevac, Serbia
| | - Stefan Blagojević
- University of Kragujevac, Faculty of Science, Department of Biology and Ecology, Radoja Domanovića 12, 34000, Kragujevac, Serbia
| | - Milena Milutinović
- University of Kragujevac, Faculty of Science, Department of Biology and Ecology, Radoja Domanovića 12, 34000, Kragujevac, Serbia.
| |
Collapse
|
179
|
Hansen SB, Fonnes S, Oggesen BT, Rosenberg J. High prevalence of erectile dysfunction within the first year after surgery for rectal cancer: A systematic review and meta-analysis. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2024; 50:108662. [PMID: 39255591 DOI: 10.1016/j.ejso.2024.108662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Revised: 08/01/2024] [Accepted: 09/02/2024] [Indexed: 09/12/2024]
Abstract
OBJECTIVE We aimed to determine the prevalence of erectile dysfunction following rectal cancer surgery within the first year. SUMMARY BACKGROUND DATA Erectile dysfunction is a late complication of surgery for rectal cancer. Intraoperative mechanical nerve damage is a probable cause, but it can also be attributed to radio- and chemotherapy. METHODS We conducted a systematic review per our protocol (CRD42023472998), searching PubMed, Embase, and Cochrane CENTRAL in August 2023. We included studies reporting on men having surgery for rectal cancer and providing a prevalence of erectile dysfunction based on validated questionnaires published after 1997. The prevalence was estimated through forest plots. Bias was evaluated according to a checklist from the Joanna Briggs Institute. RESULTS Of the 4105 records identified in the search, we included 74 studies reporting on 9006 patients operated for rectal cancer. The studies evaluated erectile dysfunction through six validated questionnaires, especially the International Index of Erectile Function (IIEF) version 5 or 15 (84 %). The meta-analysis on 22 studies using IIEF showed that the prevalence of moderate to severe erectile dysfunction was 35 % (95 % CI 24-47 %) within the first year after surgery with very low certainty of evidence. Meta-regression on the prevalence of moderate to severe erectile dysfunction did not show a decrease in erectile dysfunction within the first year postoperatively. CONCLUSIONS Around every third patient experienced moderate to severe erectile dysfunction within the first year after surgery for rectum cancer, and the prevalence of erectile dysfunction did not improve within the first year after surgery. MINI-ABSTRACT This is a meta-analysis investigating the prevalence of erectile dysfunction following rectal cancer surgery within the first year. Erectile dysfunction was determined on the base of validated self-administered questionnaires. Moderate to severe erectile dysfunction was seen in one-third of patients within the first year after surgery for rectal cancer.
Collapse
Affiliation(s)
- Sebastian B Hansen
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK, 2730, Herlev, Denmark; The Late-Complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark.
| | - Siv Fonnes
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK, 2730, Herlev, Denmark
| | - Birthe Thing Oggesen
- The Late-Complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| | - Jacob Rosenberg
- Center for Perioperative Optimization, Department of Surgery, Copenhagen University Hospital - Herlev and Gentofte, Borgmester Ib Juuls Vej 1, DK, 2730, Herlev, Denmark; The Late-Complication Clinic, Capital Region of Denmark, Department of Surgery, Herlev and Gentofte Hospital, University of Copenhagen, Borgmester Ib Juuls Vej 1, DK-2730, Herlev, Denmark
| |
Collapse
|
180
|
Pokharel A, Singh JK, Khadka BR, Adhikari S, Dhakal S. Rectal foreign body and its association with social stigma and mental health: A case report. Int J Surg Case Rep 2024; 124:110236. [PMID: 39341159 DOI: 10.1016/j.ijscr.2024.110236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Revised: 08/22/2024] [Accepted: 08/31/2024] [Indexed: 09/30/2024] Open
Abstract
INTRODUCTION Rectal foreign bodies (FB), as a cause of surgical emergency are on the rise. The management is usually uneventful but delays in presentation are associated with complications and morbidity. Psychiatric illnesses account for a vast majority of FB insertion cases which is usually overlooked. CASE PRESENTATION 56 year male with alleged history of insertion of a discarded bottle of insecticide into his rectum 6 weeks ago. He presented late, in sepsis due to lack of family support and social taboo, in sepsis. The foreign body was extracted by trans-anal approach with no evidence of bowel injury on laparoscopy. Psychiatry consultation revealed alcohol-induced psychosis which was managed. CLINICAL DISCUSSION Insertion of foreign bodies voluntarily for sexual gratification is common, apart from some accidental cases. There is delay in seeking medical attention, complicated by many social factors. Multiple approaches to management are in practice. Psychiatric component is linked in part to the primary act, delayed presentation and recurrence. CONCLUSION Foreign body insertion into anatomical orifices is on the rise. Management can be complicated by body of interest, patient and social factors. Psychiatric history, evaluation and corresponding management is a must for all cases. Social awareness can help reduce incidence and the delay in seeking medical care.
Collapse
|
181
|
Ma Y, Wang X, Luo Y, Song S, Liang H, Yue Y, Li W. Symptom Cluster Assessment Tools for Gastric Cancer Care in China: A Comprehensive Review. Med Sci Monit 2024; 30:e944414. [PMID: 39219113 PMCID: PMC11378685 DOI: 10.12659/msm.944414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
Gastric cancer is a common malignant tumor, and its incidence rate ranks first among malignant tumors of the digestive tract, seriously endangering human physical and mental health. Changes in the physiological state of gastric cancer patients can bring about many physical and psychological symptoms and have a serious impact on their quality of life. Symptom clusters are 2 or more concurrently occurring and interrelated symptoms, with the core symptoms within the cluster remaining stable over time and the symptoms in the cluster being independent of each other. The prerequisite for solving this problem is to screen out appropriate symptom assessment tools according to the clinical situation. The aim of this study was to provide a reference for the development of assessment tools suitable for symptom clusters of gastric cancer patients in China, and to provide evidence for the subsequent optimization of symptom management and some clinical decisions. The contents, application, advantages, and disadvantages of symptom cluster assessment tools for gastric cancer patients in China and abroad were reviewed, and the basic situation and contents of each assessment tool were compared. In China, most of the assessment tools used in domestic gastric cancer research institutes were imported from foreign scales, with a long time span and low specificity for symptoms in various stages of disease development at present. Scholars should be encouraged to develop time-specific assessment tools for the disease characteristics of gastric cancer patients in China, and actively explore the pathogenesis and influencing factors of symptom clusters in this population.
Collapse
Affiliation(s)
- Yuexuan Ma
- West China School of Nursing, Sichuan University, Chengdu, Sichuan, China
| | - Xiaoze Wang
- Department of Gastroenterology and Hepatology, Sichuan University - University of Oxford Huaxi Joint Centre for Gastrointestinal Cancer, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yue Luo
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| | - Shirui Song
- West China School of Nursing, Sichuan University, Chengdu, Chengdu, Sichuan, China
| | - Hui Liang
- West China School of Nursing, Sichuan University, Chengdu, Chengdu, Sichuan, China
| | - Yan Yue
- West China School of Nursing, Sichuan University, Chengdu, Chengdu, Sichuan, China
| | - Wei Li
- Interventional Radiology Center, West China Hospital of Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
182
|
Reese KL, Pantel K, Smit DJ. Multibiomarker panels in liquid biopsy for early detection of pancreatic cancer - a comprehensive review. J Exp Clin Cancer Res 2024; 43:250. [PMID: 39218911 PMCID: PMC11367781 DOI: 10.1186/s13046-024-03166-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 08/16/2024] [Indexed: 09/04/2024] Open
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is frequently detected in late stages, which leads to limited therapeutic options and a dismal overall survival rate. To date, no robust method for the detection of early-stage PDAC that can be used for targeted screening approaches is available. Liquid biopsy allows the minimally invasive collection of body fluids (typically peripheral blood) and the subsequent analysis of circulating tumor cells or tumor-associated molecules such as nucleic acids, proteins, or metabolites that may be useful for the early diagnosis of PDAC. Single biomarkers may lack sensitivity and/or specificity to reliably detect PDAC, while combinations of these circulating biomarkers in multimarker panels may improve the sensitivity and specificity of blood test-based diagnosis. In this narrative review, we present an overview of different liquid biopsy biomarkers for the early diagnosis of PDAC and discuss the validity of multimarker panels.
Collapse
Affiliation(s)
- Kim-Lea Reese
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Klaus Pantel
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Daniel J Smit
- Institute of Tumor Biology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| |
Collapse
|
183
|
Ji Y, Huang W, Guo J, Hu B. Endoscopic Management of Benign Gallbladder Diseases. THE TURKISH JOURNAL OF GASTROENTEROLOGY : THE OFFICIAL JOURNAL OF TURKISH SOCIETY OF GASTROENTEROLOGY 2024; 35:681-689. [PMID: 39344501 PMCID: PMC11391231 DOI: 10.5152/tjg.2024.24149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Accepted: 05/01/2024] [Indexed: 10/01/2024]
Abstract
Acute cholecystitis, cholelithiasis, and gallbladder polyps represent the most gallbladder benign diseases. Endoscopic approaches for the management of these diseases were an alternative to standard laparoscopic cholecystectomy. These endoscopic approaches include transpapillary approaches via endoscopic retrograde cholangiopancreatography, transmural access approaches via endoscopic ultrasound, and endoscopic surgical approaches using natural orifice transluminal endoscopic surgery approaches. However, it's still uncertain which approach is associated with the superior clinical outcomes due to the lack of high-level evidence. Our review provides new insight into the endoscopic approaches for the management of gallbladder benign diseases, with the latest evidence included.
Collapse
Affiliation(s)
- Yimei Ji
- Corresponding author: Jiefang Guo, e-mail:
| | | | - Jiefang Guo
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| | - Bing Hu
- Department of Gastroenterology and Endoscopy, Eastern Hepatobiliary Surgery Hospital, Naval Medical University, Shanghai, China
| |
Collapse
|
184
|
Lytvyak E, Zarrinpar A, Ore CD, Lee E, Yazdani-Boset K, Horgan S, Grunvald E. Stronger control of eating 3 months after sleeve gastrectomy predicts successful weight loss outcomes at one year. OBESITY PILLARS 2024; 11:100111. [PMID: 38770521 PMCID: PMC11103426 DOI: 10.1016/j.obpill.2024.100111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2024] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/22/2024]
Abstract
Background Weight loss response to sleeve gastrectomy (SG) is variable and predicting the effectiveness of surgery is challenging and elusive. The aim of our study was to assess and quantify the association between eating control and weight loss outcomes and identify the control of eating (CoE) attributes during the early postoperative period that might predict good vs. poor response to SG at one year. Methods A prospective longitudinal cohort study using the Control of Eating Questionnaire (CoEQ) was designed as a series before and at 3-, 6-, and 12-months post-SG. Primary outcomes were changes in CoE attributes and percent of total weight loss (%TWL) 12-months post-surgery. Subjects were categorized based on %TWL as good (GR, ≥25 %) or poor responders (PR, <25 %). A receiver operating characteristic and logistic regression analyses were performed. Results We included 41 participants (80.5% females, 51.2% Hispanic, mean age 41.7±10.6, median baseline body mass index (BMI) 43.6 kg/m2 [range 35.2-66.3]) who completed the CoEQ at all four timepoints. The "Difficulty to control eating" score at 3 months revealed the highest area under the curve (AUC) (AUC 0.711; 95%CI 0.524-0.898; p=0.032). In a trade-off between a high Youden index and high sensitivity, the "Difficulty to control eating" score of 7 at 3 months was identified as the optimal cut-off for distinguishing between GRs and PRs. Score ≤7 at 3 months was strongly independently associated with a successful weight loss target of 25%TWL at one-year post-SG (Relative Risk 4.43; 95%CI 1.06-18.54; p=0.042). Conclusion "Difficulty to control eating" score at 3 months post-SG is an independent early predictor of optimal response (achieving a successful TWL target of ≥25 % at one-year post-SG). Our results support the utility of this easy-to-administer validated tool for predicting the effectiveness of SG and may assist in identifying individuals with suboptimal response early and helping them with interventions to attain optimal weight loss targets.
Collapse
Affiliation(s)
- Ellina Lytvyak
- Division of Preventive Medicine, Department of Medicine, University of Alberta, 5-30 University Terrace, 8303 112 Street, Edmonton, Alberta, T6G 2T4, Canada
| | - Amir Zarrinpar
- Division of Gastroenterology, University of California San Diego, La Jolla, CA, USA
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Cecilia Dalle Ore
- School of Medicine, University of California San Diego, La Jolla, CA, USA
| | - Euyhyun Lee
- Altman Clinical and Translational Research Institute, University of California San Diego, La Jolla, CA, USA
| | | | - Santiago Horgan
- Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, University of California San Diego, 4303 La Jolla Village Drive, Suite 2110, San Diego, CA, 92122, USA
| | - Eduardo Grunvald
- School of Medicine, University of California San Diego, La Jolla, CA, USA
- Division of General Internal Medicine, University of California San Diego, La Jolla, CA, USA
- Bariatric and Metabolic Institute, Division of Minimally Invasive Surgery, University of California San Diego, 4303 La Jolla Village Drive, Suite 2110, San Diego, CA, 92122, USA
| |
Collapse
|
185
|
El-Shoura EAM, Abdelzaher LA, Ahmed AAN, Abdel-Wahab BA, Sharkawi SMZ, Mohamed SA, Salem EA. Reno-protective effect of nicorandil and pentoxifylline against potassium dichromate-induced acute renal injury via modulation p38MAPK/Nrf2/HO-1 and Notch1/TLR4/NF-κB signaling pathways. J Trace Elem Med Biol 2024; 85:127474. [PMID: 38788404 DOI: 10.1016/j.jtemb.2024.127474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/09/2024] [Accepted: 05/16/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND Occupational and environmental exposure to chromium compounds such as potassium dichromate (PDC) (K2Cr2O7) has emerged as a potential aetiologic cause for renal disease through apoptotic, and inflammatory reactions. The known potent antioxidants such as nicorandil (NIC) and/or pentoxifylline (PTX) were studied for their possible nephroprotective effect in PDC-treated rats. METHODS Forty male Wistar rats were divided into five groups; control, PDC group, NIC+PDC, PTX+PDC group, and combination+PDC group. Nephrotoxicity was evaluated histopathologically and biochemically. Invasive blood pressure, renal function parameters urea, creatinine, uric acid and albumin, glomerular filtration rate markers Cys-C, Kim-1 and NGAL, inflammatory markers IL-1β, IL-6, TNF-α, TGF-β, COX-II, p38MAPK, NF-κB and TLR4, oxidative stress SOD, GSH, MDA, MPO, HO-1 and Nrf2 and apoptotic mediators Notch1 and PCNA were evaluated. Besides, renal cortical histopathology was assayed as well. RESULTS PDC led to a considerable increase in indicators for kidney injury, renal function parameters, invasive blood pressure, oxidative stress, and inflammatory markers. They were markedly reduced by coadministration of PDC with either/or NIC and PTX. The NIC and PTX combination regimen showed a more significant improvement than either medication used alone. Our results demonstrated the nephroprotective effect of NIC, PTX, and their combined regimen on PDC-induced kidney injury through suppression of oxidative stress, apoptosis, and inflammatory response. CONCLUSION Renal recovery from PDC injury was achieved through enhanced MAPK/Nrf2/HO-1 and suppressed Notch1/TLR4/NF-κB signaling pathways. This study highlights the role of NIC and PTX as effective interventions to ameliorate nephrotoxicity in patients undergoing PDC toxicity.
Collapse
Affiliation(s)
- Ehab A M El-Shoura
- Department of Clinical Pharmacy, Faculty of Pharmacy, Al-Azhar University, Assiut Branch, Assiut 71524, Egypt; Department of Pharmacy Practice, Faculty of Pharmacy, Horus University, New Damietta, Egypt.
| | - Lobna A Abdelzaher
- Department of Pharmacology, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Ahmed A N Ahmed
- Department of Pharmacology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Basel A Abdel-Wahab
- Department of Pharmacology, College of Pharmacy, Najran University, P.O. Box 1988, Najran, Saudi Arabia
| | - Souty M Z Sharkawi
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt
| | | | - Esraa A Salem
- Department of Medical Physiology, Faculty of Medicine, Menoufia University, Shebeen ElKom 32511, Egypt
| |
Collapse
|
186
|
Wang Y, Wang C, Zhong R, Wang L, Sun L. Research progress of DNA methylation in colorectal cancer (Review). Mol Med Rep 2024; 30:154. [PMID: 38963030 PMCID: PMC11240861 DOI: 10.3892/mmr.2024.13278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/14/2024] [Indexed: 07/05/2024] Open
Abstract
DNA methylation is one of the earliest and most significant epigenetic mechanisms discovered. DNA methylation refers, in general, to the addition of a methyl group to a specific base in the DNA sequence under the catalysis of DNA methyltransferase, with S‑adenosine methionine as the methyl donor, via covalent bonding and chemical modifications. DNA methylation is an important factor in inducing cancer. There are different types of DNA methylation, and methylation at different sites plays different roles. It is well known that the progression of colorectal cancer (CRC) is affected by the methylation of key genes. The present review did not only discuss the potential relationship between DNA methylation and CRC but also discussed how DNA methylation affects the development of CRC by affecting key genes. Furthermore, the clinical significance of DNA methylation in CRC was highlighted, including that of the therapeutic targets and biomarkers of methylation; and the importance of DNA methylation inhibitors was discussed as a novel strategy for treatment of CRC. The present review did not only focus upon the latest research findings, but earlier reviews were also cited as references to older literature.
Collapse
Affiliation(s)
- Yuxin Wang
- Emergency Department, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| | - Chengcheng Wang
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Ruiqi Zhong
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Liang Wang
- Comparative Medicine Department of Researching and Teaching, Dalian Medical University, Dalian, Liaoning 116044, P.R. China
| | - Lei Sun
- Emergency Department, The Second Hospital of Dalian Medical University, Dalian, Liaoning 116027, P.R. China
| |
Collapse
|
187
|
Khan AA, Ahluwalia C, Ahuja S, Kumar S. Isolated tubercular cholecystitis: A rare diagnostic challenge. Radiol Case Rep 2024; 19:3994-3998. [PMID: 39072311 PMCID: PMC11282933 DOI: 10.1016/j.radcr.2024.06.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2024] [Revised: 05/22/2024] [Accepted: 06/08/2024] [Indexed: 07/30/2024] Open
Abstract
Abdominal tuberculosis, particularly affecting the hepatobiliary system, presents a diagnostic challenge due to its rarity and its tendency to mimic neoplastic conditions. Tuberculosis of the gallbladder, especially in the absence of pulmonary infection, is exceedingly rare. We present a case of isolated tubercular cholecystitis in a 41-year-old female initially suspected to have neoplastic etiology. Radiological imaging revealed thickened gallbladder wall with heterogenous enhancement extending into the subcutaneous plane. Histopathological examination post-cholecystectomy confirmed tubercular etiology with epithelioid cell granulomas and focal necrosis, alongside the presence of acid-fast bacilli. Such cases pose diagnostic dilemmas due to overlapping clinical and radiological features with gallbladder carcinoma. This report emphasizes the importance of considering tuberculosis in differentials, particularly in endemic regions like India, even without pulmonary symptoms. Treatment involves postoperative administration of anti-tubercular drugs, with the preoperative diagnosis being challenging and rarely achieved due to the avoidance of invasive procedures like fine needle aspiration in suspected carcinoma cases. The rarity of isolated gallbladder tuberculosis underscores the necessity for comprehensive diagnostic evaluations and awareness among clinicians in endemic regions.
Collapse
Affiliation(s)
- Adil Aziz Khan
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Charanjeet Ahluwalia
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Sana Ahuja
- Department of Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Shruti Kumar
- Department of Radiodiagnosis, University of Arkansas for Medical Sciences, Little Rock, USA
| |
Collapse
|
188
|
Van Loon K, Rega F, Pirenne J, Jansen K, Van De Bruaene A, Dewinter G, Rex S, Eerdekens GJ. Anesthesia for Combined Heart-Liver Transplantation: A Narrative Review. J Cardiothorac Vasc Anesth 2024; 38:2059-2069. [PMID: 38918097 DOI: 10.1053/j.jvca.2024.03.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 03/04/2024] [Accepted: 03/25/2024] [Indexed: 06/27/2024]
Abstract
In 1984, 21 years after the first liver transplantation, Thomas Starzl achieved a milestone by performing the world's first combined heart-liver transplantation. While still uncommon, the practice of combined heart-liver transplants is on the rise globally. In this review, the authors delve into the current literature on this procedure, highlighting the evolving landscape and key considerations for anesthesiologists. Over the years, there has been a remarkable increase in the number of combined heart-liver transplantations conducted worldwide. This surge is largely attributed to the growing population of adult survivors with single-ventricle physiology, palliated with a Fontan procedure, who later present with late Fontan failure and Fontan-associated liver disease. Research indicates that combined heart-liver transplantation is an effective treatment option, with reported outcomes comparable with isolated heart or liver transplants. Managing anesthesia during a combined heart-liver transplant procedure is challenging, especially in the context of underlying Fontan physiology. International experience in this field remains somewhat limited, with most techniques derived from expert opinions or experiences with single-organ heart and liver transplants. These procedures are highly complex and performed infrequently. As the number of combined heart-liver transplants continues to rise globally, there is a growing need for clear guidance on periprocedural surgical and anesthetic management. Anesthesiologists overseeing these patients must consider multiple factors, balancing various comorbidities with significant hemodynamic and metabolic shifts. An increase in (multicenter) studies focusing on specific interventions to enhance patient and organ outcomes is anticipated in the coming years.
Collapse
Affiliation(s)
- Kathleen Van Loon
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium.
| | - Filip Rega
- Department of Cardiac Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of Abdominal Transplant Surgery and Coordination, University Hospitals Leuven, Leuven, Belgium
| | - Katrijn Jansen
- Adult Congenital and Paediatric Heart Unit, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | | | - Geertrui Dewinter
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| | - Steffen Rex
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
| | - Gert-Jan Eerdekens
- Department of Anesthesiology, University Hospitals Leuven, Leuven, Belgium
| |
Collapse
|
189
|
Agarwal L, Dash NR, Pal S, Madhusudhan KS, Mani V. Single-Center Randomized Trial Comparing Feeding Jejunostomy with Nasojejunal Tube Placement in Patients Undergoing Transhiatal Esophagectomy Post-Neoadjuvant Therapy for Esophageal Cancer. J Gastrointest Cancer 2024; 55:1282-1290. [PMID: 38954187 DOI: 10.1007/s12029-024-01080-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/13/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Enteral nutrition is the preferred mode of nutrition following esophagectomy. However, the preferred mode of enteral nutrition (feeding jejunostomy (FJ) vs. nasojejunal (NJ) tube) remains contentious. In this randomized controlled trial (RCT), we compared FJ with NJ tube feeding in terms of safety, feasibility, efficacy, and quality-of-life (QOL) parameters in Indian patients undergoing trans-hiatal esophagectomy (THE) for carcinoma esophagus. MATERIALS AND METHODS This single-center, two-armed (FJ and NJ tube), non-inferiority RCT was conducted from March 2020 to January 2024. Forty-eight patients underwent THE with posterior-mediastinal-gastric pull-up and were randomized to NJ and FJ arms (24 in each group). The postoperative complications, catheter efficacy, and QOL parameters were compared between the two groups till the 6-week follow-up. RESULTS In this RCT, we found no significant difference in the occurrence of catheter-related complications, postoperative complication rate, catheter efficacy, and visual analog pain scores between patients with NJ tube and FJ, following THE for esophageal cancer. There was a significantly better self-reported physical domain QOL score noted in the NJ group, both at the time of discharge (44.7 ± 6.2 vs 39.8 + 5.6; p value, 0.005) and at the 6-week follow-up (55.4 ± 5.2 vs 48.6 ± 4.5; p value, < 0.001). CONCLUSION Based on the findings of our RCT, we conclude that both enteral access methods (NJ vs. FJ) exhibit comparable incidences of catheter-related complications. The use of NJ tube is a viable alternative to a surgical FJ, has the benefit of early removal, and saves the distress associated with a tube per abdomen.
Collapse
Affiliation(s)
- Lokesh Agarwal
- Department of Surgical Gastroenterology, All India Institute of Medical Sciences (AIIMS), Jodhpur, India
| | - Nihar Ranjan Dash
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), New Delhi, India.
| | - Sujoy Pal
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | | | - Vignesh Mani
- Department of Gastrointestinal Surgery and Liver Transplant, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| |
Collapse
|
190
|
Qiu W, Liu J, He K, Hu G, Mei S, Guan X, Wang X, Tian J, Tang J. Blood perfusion assessment by near-infrared fluorescence angiography of epiploic appendages in prevention of anastomotic leakage after laparoscopic intersphincteric resection for ultra-low rectal cancer: a case-matched study. Surg Endosc 2024; 38:5446-5456. [PMID: 39090199 DOI: 10.1007/s00464-024-11085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 07/13/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The role of intraoperative near-infrared fluorescence angiography with indocyanine green in reducing anastomotic leakage (AL) has been demonstrated in colorectal surgery, however, its perfusion assessment mode, and efficacy in reducing anastomotic leakage after laparoscopic intersphincteric resection (LsISR) need to be further elucidated. AIM Aim was to study near-infrared fluorescent angiography to help identify bowel ischemia to reduce AL after LsISR. MATERIAL AND METHODS A retrospective case-matched study was conducted in one referral center. A total of 556 consecutive patients with ultra-low rectal cancer including 140 patients with fluorescence angiography of epiploic appendages (FAEA)were enrolled. Perfusion assessment by FAEA in the monochrome fluorescence mode. Patients were divided into two groups based on perfusion assessment by FAEA. The primary endpoint was the AL rate within 6 months, and the secondary endpoint was the structural sequelae of anastomotic leakage (SSAL). RESULTS After matching, the study group (n = 109) and control group (n = 190) were well-balanced. The AL rate in the FAEA group was lower before (3.6% vs. 10.1%, P = 0.026) and after matching (3.7% vs. 10.5%, P = 0.036). Propensity scores matching analysis (OR 0.275, 95% CI 0.035-0.937, P 0.039), inverse probability of treatment weighting (OR 0.814, 95% CI 0.765-0.921, P 0.002), and regression analysis (OR 0.298, 95% CI 0.112-0.790, P = 0.015), showed that FAEA was an independent protector factor for AL. This technique can significantly shorten postoperative hospital stay [9 (6-13) vs. 10 (8-13), P = 0.024] and reduce the risk of SSAL (1.4% vs. 6.0%, P = 0.029). CONCLUSIONS Perfusion assessment by FAEA can achieve better visualization in LsISR and reduce the incidence of AL, subsequently avoiding SSAL after LsISR.
Collapse
Affiliation(s)
- Wenlong Qiu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China
| | - Junguang Liu
- Department of General Surgery, Peking University First Hospital, Beijing, 100034, China
| | - Kunshan He
- Key Laboratory of Molecular Imaging Chinese Academy of Sciences, Beijing Key Laboratory of Molecular Imaging. Key Laboratory of Big Data-Based Precision Medicine, Ministry of Industry and Information Technology, Beijing, 100000, China
| | - Gang Hu
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China
| | - Shiwen Mei
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China
| | - Xu Guan
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China
| | - Xishan Wang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China
| | - Jie Tian
- Key Laboratory of Molecular Imaging Chinese Academy of Sciences, Beijing Key Laboratory of Molecular Imaging. Key Laboratory of Big Data-Based Precision Medicine, Ministry of Industry and Information Technology, Beijing, 100000, China
| | - Jianqiang Tang
- Department of Colorectal Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100000, China.
| |
Collapse
|
191
|
Ltaimi A, Hasnaoui A, Triki W, Baraket O, Bouchoucha S. Early drain site tumor recurrence post adjuvant chemotherapy for locally advanced colon carcinoma: Case report and literature review. Int J Surg Case Rep 2024; 122:110163. [PMID: 39142187 PMCID: PMC11379565 DOI: 10.1016/j.ijscr.2024.110163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2024] [Revised: 08/09/2024] [Accepted: 08/10/2024] [Indexed: 08/16/2024] Open
Abstract
INTRODUCTION Colon carcinoma is the most common type of gastro-intestinal cancer. Despite radical surgery, locoregional recurrence has been observed in 4-11.5 % of patients. Abdominal wall metastasis at the drainage site is an extremely rare finding and only a few cases are described in the literature. The mechanism of this metastasis is unknown, and its management remains unclear due to the rarity of the condition. CASE PRESENTATION A 66-year-old patient underwent left colectomy for locally advanced colonic adenocarcinoma. Eight months after the end of adjuvant chemotherapy, the patient complained of a progressive mass of the left lumbar centered on the previous drain site scar. Abdominal wall recurrence was suspected. The patient had R0 mass excision. Histopathologic examination showed a parietal infiltration by a colloid adenocarcinoma. The patient underwent adjuvant chemotherapy. No recurrence was observed. DISCUSSION Since 1999 only six cases of colon cancer drainage site metastasis have been reported. Metachronous solitary abdominal wall metastasis after radical colectomy may occur via cancer cell implantation, lymphatic or hematogenous route, or direct invasion. In case of drain site metastasis, the most likely hypothesis is the implantation of tumor cells into the abdominal wall through the drainage route performed during surgery. CONCLUSION The appearance of abdominal wall mass after colon cancer resection must always be considered suspicious. To reduce the risk of abdominal wall metastasis we recommend minimizing tumor manipulation, resection the route of previous percutaneous drainage and performing a radical surgery. Metastasis resection combined with chemotherapy is the appropriate approach to treat these metastases.
Collapse
Affiliation(s)
- Ahmed Ltaimi
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Bougatfa Hospital, Tunisia
| | - Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia.
| | - Wissem Triki
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Bougatfa Hospital, Tunisia
| | - Oussema Baraket
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Bougatfa Hospital, Tunisia
| | - Sami Bouchoucha
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Habib Bougatfa Hospital, Tunisia
| |
Collapse
|
192
|
De Luca M, Silverii A, Zese M, Galasso G, Bellini R, Carbonelli MG, Cataldo R, Cerbone M, Chianelli M, Gregoris FC, Conigliaro R, Cuttica CM, de Werra C, Di Simone M, Docimo L, Musella M, Gagliardi G, Angrisani L, Di Lorenzo N, Boskoski I, Genco A, Raffaelli M, Anderloni A, Casella G, Galloro G, Goracci A, Lorenzoni V, Manta R, Marzullo P, Medea G, Navarra G, Ortenzi M, Paolini B, Piazza L, Porri D, Rahimi F, Rugolotto S, Pontesilli G, Sarnelli G, Sessa L, Zani I, Zappa MA, Bandini G, Ragghianti B, Monami M. Upcoming Italian clinical practice guidelines on endoscopic bariatric treatment of overweight and obesity: design and methodological aspects. Updates Surg 2024; 76:1865-1877. [PMID: 38985376 DOI: 10.1007/s13304-024-01843-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 04/05/2024] [Indexed: 07/11/2024]
Abstract
Obesity/overweight and its complications are a growing problem in many countries. Italian Society of Bariatric and Metabolic Surgery for Obesity (Società Italiana di Chirurgia dell'Obesità e delle Malattie Metaboliche-SICOB) decided to develop the first Italian guidelines for the endoscopic bariatric treatment of obesity. The creation of SICOB Guidelines is based on an extended work made by a panel of 44 members and a coordinator. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology has been used to decide the aims, reference population, and target health professionals. Clinical questions have been created using the PICO (patient, intervention, comparison, outcome) conceptual framework. We will perform systematic reviews, formal meta-analyses, and network meta-analyses for each PICO and critical outcomes aimed at assessing and rating the efficacy and safety of endoscopic bariatric procedures in comparison with either no interventions, lifestyle interventions, or approved anti-obesity treatments in trials with a follow-up of at least 52 weeks. For PICO on temporary endoscopic bariatric treatments, we will also consider RCT with a minimum duration of 6 months. The panel proposed 8 questions, organized into four domains: A. Indication for endoscopic bariatric surgery; B. Revisional surgery; C. Temporary gastric and duodenal-jejunal procedures; D. Endoscopic diagnosis/treatment of bariatric and metabolic surgery complications. These guidelines will apply to patients aged ≥ 14 years) with body mass index (BMI) ≥ 27 kg/m2 and requiring endoscopic bariatric surgery or endoscopic diagnostic and/or therapeutic procedures. The areas covered by the clinical questions included indications of endoscopic bariatric surgery, types of surgery, revisional surgery, and management of bariatric and metabolic surgery complications.
Collapse
Affiliation(s)
- Maurizio De Luca
- Surgery Unit, Azienda ULSS5 Polesana, Ospedale di Rovigo, Rovigo, Italy
| | | | - Monica Zese
- Surgery Unit, Azienda ULSS5 Polesana, Ospedale di Rovigo, Rovigo, Italy.
| | - Giovanni Galasso
- Endoscopy Unit, Pineta Grande Hospital, Castel Volturno, Caserta, Italy
| | | | | | - Rita Cataldo
- Research Unit of Anesthesia and Intensive Care, Università Campus Bio Medico di Roma e Fondazione Policlinico, Rome, Italy
| | | | - Marco Chianelli
- Unit of Endocrinology, Ospedale Regina Apostolorum Albano, Rome, Italy
| | | | - Rita Conigliaro
- Gastroenterology and Digestive Endoscopy Unit_AOU-Modena, Modena, Italy
| | | | | | - Massimo Di Simone
- Surgery of the Alimentary Tract, Sant'Orsola Hospital, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ludovico Docimo
- Division of General, Oncologic, Mini-Invasive and Obesity Surgery, University of Study of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Giuseppe Gagliardi
- AULSS 5 Polesana, Anesthesiology, Intensive Care and Pain Medicine, Rovigo, Italy
| | | | | | - Ivo Boskoski
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Alfredo Genco
- Department of Obesity Surgery, Policlinico Umberto I, Rome, Italy
| | - Marco Raffaelli
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Andrea Anderloni
- Department of Gastroenterology and Endoscopy, IRCCS San Matteo Pavia, Pavia, Italy
| | | | - Giuseppe Galloro
- Digestive Surgical Endoscopy Unit, University of Naples, Naples, Italy
| | - Arianna Goracci
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | | | - Raffaele Manta
- UOC di Gastroenterologia ed Endoscopia Digestiva, Ospedali Riuniti di Livorno, Livorno, Italy
| | - Paolo Marzullo
- Endocrinology, Department of Translational Medicine, Università del Piemonte Orientale, Novara, Italy
| | | | - Giuseppe Navarra
- Department of Human Pathology, University of Messina, Messina, Italy
| | - Monica Ortenzi
- Clinica Chirurgica Generale e d'Urgenza, AOU Umberto I-Lancisi-Salesi, Ancona, Italy
| | - Barbara Paolini
- Dietology, UOSA Dietetical and Clinical Nutrition, Santa Maria alle Scotte Hospital, Siena, Italy
| | - Luigi Piazza
- UOC Chirurgia Generale e d'Urgenza, Arnas Garibaldi, Catania, Italy
| | | | - Farnaz Rahimi
- Clinical Nutrition Unit, Molinette University Hospital of Turin, Turin, Italy
| | | | | | - Giovanni Sarnelli
- Unit of Digestive and Nutritional Pathophysiology, Department of Clinical Medicine and Surgery, University of Naples "Federico II", Naples, Italy
| | - Luca Sessa
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A Gemelli IRCCS, Rome, Italy
| | - Iris Zani
- Amici Obesi ONLUS Milano, 20128, Milan, Italy
| | | | - Giulia Bandini
- Division of Internal Medicine, Careggi University Hospital, Florence, Italy
| | | | - Matteo Monami
- Diabetology, Careggi University Hospital, Florence, Italy
| |
Collapse
|
193
|
Challakere Ramaswamy VM, Han Suyin K. Massive gastropathy due to gallstone obstruction of the duodenum (Bourveret syndrome). J Forensic Sci 2024; 69:1932-1934. [PMID: 38922918 DOI: 10.1111/1556-4029.15573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024]
Abstract
Gallstones are common in the general population and are often asymptomatic, but they can also cause complications such as cholecystitis and pancreatitis. In rare instances, they can lead to the formation of a cholecystoduodenal fistula and gallstone ileus. Gastric dilatation and distension following gallstone ileus are extremely uncommon and have rarely been reported in the literature. We report a fatal case of massive gastropathy as a result of Bouveret syndrome secondary to gallstone obstruction.
Collapse
Affiliation(s)
| | - Kathleen Han Suyin
- Department of Pathology, Raja Isteri Pengiran Anak Saleha Hospital, Bandar Seri Begawan, Brunei Darussalam
| |
Collapse
|
194
|
Malik S, Farooq U, Schwartz DA, Adler DG. Analysis of patients with Crohn's disease and intestinal obstruction: a National Inpatient Sample study. Ann Gastroenterol 2024; 37:543-551. [PMID: 39238789 PMCID: PMC11372534 DOI: 10.20524/aog.2024.0911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 07/11/2024] [Indexed: 09/07/2024] Open
Abstract
Background Crohn's disease (CD) predisposes patients to intestinal obstruction (IO), a severe complication. This study examined the outcomes and healthcare utilization of patients with CD and IO using data from the National Inpatient Sample (NIS). Methods This retrospective analysis of NIS data from 2016-2020 compared hospitalized adult CD patients with and without IO. Outcomes studied include in-hospital mortality, length of stay (LOS), hospitalization charges, and the requirement for intervention, using regression models for adjustment. Results Among the 304,149 CD patients, 27,024 had IO. These patients experienced higher in-hospital mortality (3.9% vs. 1.8% for non-IO, adjusted odds ratio [aOR] 1.78, 95% confidence interval [CI] 1.09-2.89; P=0.02), longer mean LOS (7.23 vs. 4.53 days for non-IO, P<0.001), and higher average hospitalization charges ($71,775 vs. $43,717 for non-IO, P<0.001). Additionally, they had higher odds of requiring admission to the intensive care unit (aOR 1.99, 95%CI 1.45-2.73; P<0.001), intubation (aOR 2.53, 95%CI 1.74-3.68; P<0.001), balloon dilation (aOR 1.50, 95%CI 1.132-1.98; P=0.005), or intestinal resection (aOR 2.29, 95%CI 2.11-2.49; P<0.001). Conclusions CD patients with IO face considerable challenges, including greater mortality, longer hospital stays, and higher hospitalization costs. The need for intensive care and surgical interventions highlights the urgent need for improved management and treatment strategies to enhance outcomes for these patients.
Collapse
Affiliation(s)
- Sheza Malik
- Internal Medicine, Rochester General Hospital, Rochester, NY (Sheza Malik)
| | - Umer Farooq
- Gastroenterology & Hepatology, Saint Louis University, St. Louis, MO (Umer Farooq)
| | - David A Schwartz
- Gastroenterology & Hepatology, Vanderbilt University Medical Center, Nashville, Tennessee (David A. Schwartz)
| | - Douglas G Adler
- Gastroenterology and Hepatology, Center for Advanced Therapeutic Endoscopy, Centura Health, Denver, Colorado (Douglas G. Adler), USA
| |
Collapse
|
195
|
Abstract
In this review, the authors outlined concepts and strategies to achieve immune tolerance through inducing hematopoietic chimerism after solid organ transplantation and introduced challenges and opportunities in harnessing two-way alloresponses to improve outcomes after intestinal transplantation (ITx). Next, the authors discussed the dynamics and phenotypes of peripheral blood and intestinal graft T-cell subset chimerism and their association with outcomes. The authors also summarized studies on other types of immune cells after ITx and their potential participation in chimerism-mediated tolerance. The authors further discussed strategies and future directions to promote chimerism-associated tolerance after ITx to overcome rejection and minimize immunosuppression.
Collapse
Affiliation(s)
- Kevin Crosby
- Columbia University Medical Center, New York, NY 10032, USA
| | - Katherine D Long
- Washington University School of Medicine in St. Louis, St Louis, MO 63110, USA
| | - Jianing Fu
- Department of Medicine, Columbia Center for Translational Immunology, Columbia University Medical Center, New York, NY 10032, USA.
| |
Collapse
|
196
|
Barnes A, Viscomi B, Gorham JK. Surgical Management of the Horrible Gallbladder. Adv Surg 2024; 58:143-160. [PMID: 39089774 DOI: 10.1016/j.yasu.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
Laparoscopic cholecystectomy is one of the most frequently performed operations by general surgeons, with up to 1 million cholecystectomies performed annually in the United States alone. Despite familiarity, common bile duct injury occurs in no less than 0.2% of cholecystectomies, with significant associated morbidity. Understanding biliary anatomy, surgical techniques, pitfalls, and bailout maneuvers is critical to optimizing outcomes when encountering the horrible gallbladder. This article describes normal and aberrant biliary anatomy, complicated cholelithiasis, ways to recognize cholecystitis, and considerations of surgical approach.
Collapse
Affiliation(s)
- Andrew Barnes
- Department of General Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Brian Viscomi
- Department of General Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA
| | - Jessica Koller Gorham
- Department of General Surgery, Ochsner Medical Center, 1514 Jefferson Highway, New Orleans, LA 70121, USA.
| |
Collapse
|
197
|
Yee EJ, Torphy RJ, Thielen ON, Easwaran L, Franklin O, Sugawara T, Bartsch C, Garduno N, McCarter MM, Ahrendt SA, Schulick RD, Del Chiaro M. Radiologic Occult Metastases in Pancreatic Cancer: Analysis of Risk Factors and Survival Outcomes in the Age of Contemporary Neoadjuvant Multi-agent Chemotherapy. Ann Surg Oncol 2024; 31:6127-6137. [PMID: 38780693 DOI: 10.1245/s10434-024-15443-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 04/25/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Radiologic occult metastatic disease (ROMD) in patients with pancreatic ductal adenocarcinoma (PDAC) who undergo contemporary neoadjuvant chemotherapy (NAC) has not been well studied. This study sought to analyze the incidence, risk factors, and oncologic outcomes for patients who underwent the NAC approach for PDAC. METHODS A retrospective review analyzed a prospectively maintained database of patients who had potentially resectable PDAC treated with NAC and were offered pancreatectomy at our institution from 2011 to 2022. Multivariable regression analysis was performed to assess risk factors associated with ROMD. Kaplan-Meier curves with log-rank analyses were generated to estimate time-to-event end points. RESULTS The study enrolled 366 patients. Upfront and borderline resectable anatomic staging comprised 80% of the cohort, whereas 20% had locally advanced disease. The most common NAC regimen was FOLFIRINOX (n = 274, 75%). For 55 patients (15%) who harbored ROMD, the most common site was liver-only metastases (n = 33, 60%). The independent risk factors for ROMD were increasing CA19-9 levels during NAC (odds ratio [OR], 7.01; confidence interval [CI], 1.97-24.96; p = 0.008), indeterminate liver lesions (OR, 2.19; CI, 1.09-4.39; p = 0.028), and enlarged para-aortic lymph nodes (OR, 6.87; CI, 2.07-22.74; p = 0.002) on preoperative cross-sectional imaging. Receipt of palliative chemotherapy (p < 0.001) and eventual formal pancreatectomy (p = 0.04) were associated with survival benefit in the log-rank analysis. The median overall survival (OS) of the patients with ROMD was nearly 15 months from the initial diagnosis, with radiologic evidence of metastases occurring after a median of 2 months. CONCLUSIONS Radiologic occult metastatic disease remains a clinical challenge associated with poor outcomes for patients who have PDAC treated with multi-agent NAC.
Collapse
Affiliation(s)
- Elliott J Yee
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Robert J Torphy
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Otto N Thielen
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lavanya Easwaran
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Oskar Franklin
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Surgical and Perioperative Sciences, Surgery, Umeå University, Umeå, Sweden
| | - Toshitaka Sugawara
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Christan Bartsch
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Nicole Garduno
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Martin M McCarter
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Steven A Ahrendt
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Richard D Schulick
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Marco Del Chiaro
- Department of Surgery, Division of Surgical Oncology, University of Colorado School of Medicine, Aurora, CO, USA.
| |
Collapse
|
198
|
Sawchuk T, Verhoeff K, Jogiat U, Mocanu V, Shapiro AMJ, Anderson B, Dajani K, Bigam DL. Impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy: a NSQIP retrospective cohort analysis of 25,848 patients. Surg Endosc 2024; 38:5030-5040. [PMID: 39009724 DOI: 10.1007/s00464-024-11018-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 06/30/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Efforts to preoperatively risk stratify and optimize patients before pancreaticoduodenectomy continue to improve outcomes. This study aims to determine the impact of hypoalbuminemia on outcomes following pancreaticoduodenectomy and outline optimal hypoalbuminemia cut-off values in this population. METHODS The ACS-NSQIP (2016-2021) database was used to extract patients who underwent pancreaticoduodenectomy, comparing those with hypoalbuminemia (< 3.0 g/L) to those with normal albumin. Demographics and 30-day outcomes were compared. Multivariable modeling evaluated factors including hypoalbuminemia to characterize their independent effect on serious complications, and mortality. Optimal albumin cut-offs for serious complications and mortality were evaluated using receiver-operating characteristic curves. RESULTS We evaluated 25,848 pancreaticoduodenectomy patients with 2712 (10.5%) having preoperative hypoalbuminemia. Patients with hypoalbuminemia were older (68.2 vs. 65.1; p < 0.0001), and were significantly more likely to be ASA class 4 or higher (13.9% vs. 6.7%; p < 0.0001). Patients with hypoalbuminemia had significantly more 30-day complications and after controlling for comorbidities hypoalbuminemia remained a significant independent factor associated with 30-day serious complications (OR 1.80, p < 0.0001) but not mortality (OR 1.37, p = 0.152). CONCLUSIONS Hypoalbuminemia plays a significant role in 30-day morbidity following pancreaticoduodenectomy. Preoperative albumin may serve as a useful marker for risk stratification and optimization.
Collapse
Affiliation(s)
- Taylor Sawchuk
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Kevin Verhoeff
- Department of Surgery, University of Alberta, Edmonton, AB, Canada.
| | - Uzair Jogiat
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Valentin Mocanu
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Blaire Anderson
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Khaled Dajani
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - David L Bigam
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| |
Collapse
|
199
|
Adegboyega G, Gillespie CS, Watson M, Lee KS, Brannigan J, Mazzoleni A, Goacher E, Mantle O, Omar V, Gamage G, Touzet AY, Mowforth O, Stubbs DJ, Davies BM, Hutchinson PJ. Seniority of Surgeon in Chronic Subdural Hematoma Recurrence: A Systematic Review and Meta-analysis. World Neurosurg 2024; 189:381-386.e1. [PMID: 38901476 DOI: 10.1016/j.wneu.2024.06.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/13/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
Chronic subdural hematoma (CSDH) is increasingly common, particularly in the older and multimorbid population. Surgical proficiency in management is required in the early years of U.K. neurosurgical training with most cases performed by nonconsultant-grade surgeons. The aim of this systematic review was to examine the effect of surgeon seniority on recurrence for patients with CSDH. Full-text articles comparing surgical treatment for CSDH with a "senior" (consultant/attending level) or "junior" (resident/registrar or similar) lead surgeon were identified. MEDLine and EMBASE databases were searched. The primary outcome of this study was recurrence. Secondary outcomes included postoperative complications and mortality rate. A random effects meta-analysis was performed. The risk of bias was assessed using the National Institute of Health risk of bias toolkit. Five studies were included in the final analysis (n = 941 total patients). Individually, no study identified a significant difference in recurrence rate and postoperative complications between senior and junior neurosurgeons. On meta-analysis, junior-led evacuations had lower recurrence rates on pooled univariable analysis (12.0% vs. 17.9% [odds ratio 0.48, 95% confidence interval 0.29-0.78, I2 = 0%]) (3 studies). Seniority of surgeon was not associated with increased rates of recurrence patients undergoing CSDH surgery. Complexity of operation may be a confounding factor in observed lower recurrence rates with more junior operators.
Collapse
Affiliation(s)
- Gideon Adegboyega
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Conor S Gillespie
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Matthew Watson
- Clinical School of Medicine, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Keng Siang Lee
- Department of Neurosurgery, King's College Hospital, London, United Kingdom
| | - Jamie Brannigan
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Adele Mazzoleni
- Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Edward Goacher
- Sheffield University Teaching Hospitals NHS Trust, Sheffield, United Kingdom
| | - Orla Mantle
- King's College Medical School, London, United Kingdom
| | - Vian Omar
- University of Buckingham Medical School, Buckingham, United Kingdom
| | - Githmi Gamage
- Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Alvaro Yanez Touzet
- School of Medical Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, United Kingdom
| | - Oliver Mowforth
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Daniel J Stubbs
- Division of Anaesthesia, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Benjamin M Davies
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom.
| | - Peter J Hutchinson
- Department of Clinical Neurosciences, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| |
Collapse
|
200
|
Behi H, Omry A, Dallagi R, Changuel A, Troudi D, Khalifa MB. Diagnosing and managing small bowel neuroendocrine tumors presenting as acute obstruction in an elderly patient: A case report and comprehensive management overview. Int J Surg Case Rep 2024; 122:110126. [PMID: 39126932 PMCID: PMC11363995 DOI: 10.1016/j.ijscr.2024.110126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2024] [Revised: 08/01/2024] [Accepted: 08/06/2024] [Indexed: 08/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Neuroendocrine tumors (NETs) of the small bowel are rare but clinically significant due to their challenging diagnostic pathways and potential for insidious progression. Early identification is critical for effective management and improved prognosis in these cases. CLINICAL PRESENTATION Here, we present a case of a 75-year-old patient with no significant medical history who presented acutely with diffuse abdominal pain, vomiting, and signs of bowel obstruction. Diagnostic workup, including CT imaging, revealed a distal ileal neuroendocrine mass with mesenteric lymphadenopathy, necessitating urgent surgical intervention. DISCUSSION This case underscores the diagnostic complexities and therapeutic challenges associated with small bowel NETs. Surgical resection with meticulous lymph node dissection remains the cornerstone of treatment, aimed at achieving complete tumor excision and optimal disease control. The role of imaging modalities and biochemical markers in guiding clinical decisions and postoperative management strategies is discussed considering the patient's clinical course. CONCLUSION Timely recognition and intervention are crucial in the management of small bowel NETs, given their potential for late presentation and nonspecific symptoms. Despite diagnostic and procedural challenges highlighted in this case, early surgical intervention and comprehensive follow-up are essential for achieving favorable outcomes and minimizing recurrence risks in patients with small bowel NETs.
Collapse
Affiliation(s)
- Hager Behi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Ahmed Omry
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia.
| | - Rania Dallagi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Amel Changuel
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Dholkefl Troudi
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| | - Med Bachir Khalifa
- General Surgery Department, Military Hospital of Tunis, Mont Fleury-1008, Tunis, Tunisia; Faculty of Medicine of Tunis, 15, Djebel Lakhdhar Street - 1007 Bab Saadoun, Tunis, Tunisia
| |
Collapse
|