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Murthy SS, Are C. Education of the cancer surgical workforce: Gaps, priorities, and strategies. J Surg Oncol 2023; 128:938-942. [PMID: 37818912 DOI: 10.1002/jso.27443] [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: 08/16/2023] [Accepted: 08/18/2023] [Indexed: 10/13/2023]
Abstract
Cancer is a leading cause of noncommunicable disease-related mortality. The predicted number of new cancer cases will increase from 19.3 million in 2020 to 30.2 million by 2040. To mitigate the cancer burden, it is critical to build capacity of the cancer workforce, especially in systems with limited resources. We provide a global overview of gaps and implementation strategies that can increase the quality and quantity of the global surgical cancer workforce.
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Affiliation(s)
- Shilpa S Murthy
- Division of Colon and Rectal Surgery, Yale University Department of Surgery, New Haven, Connecticut, USA
| | - Chandrakanth Are
- Division of Surgical Oncology, University of Nebraska, Department of Surgery, Omaha, Nebraska, USA
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Ding YN, Xue M, Tang QS, Wang LJ, Ding HY, Li H, Gao CC, Yu WP. Immunotherapy-based novel nanoparticles in the treatment of gastrointestinal cancer: Trends and challenges. World J Gastroenterol 2022; 28:5403-5419. [PMID: 36312831 PMCID: PMC9611702 DOI: 10.3748/wjg.v28.i37.5403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/27/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023] Open
Abstract
Gastrointestinal cancer (GIC) is the most common cancer with a poor prognosis. Currently, surgery is the main treatment for GIC. However, the high rate of postoperative recurrence leads to a low five-year survival rate. In recent years, immunotherapy has received much attention. As the only immunotherapy drugs approved by the Food and Drug Administration (FDA), immune checkpoint blockade (ICB) drugs have great potential in cancer therapy. Nevertheless, the efficacy of ICB treatment is greatly limited by the low immunogenicity and immunosuppressive microenvironment of GIC. Therefore, the targets of immunotherapy have expanded from ICB to increasing tumor immunogenicity, increasing the recruitment and maturation of immune cells and reducing the proportion of inhibitory immune cells, such as M2-like macrophages, regulatory T cells and myeloid-derived suppressor cells. Moreover, with the development of nanotechnology, a variety of nanoparticles have been approved by the FDA for clinical therapy, so novel nanodrug delivery systems have become a research focus for anticancer therapy. In this review, we summarize recent advances in the application of immunotherapy-based nanoparticles in GICs, such as gastric cancer, hepatocellular carcinoma, colorectal cancer and pancreatic cancer, and described the existing challenges and future trends.
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Affiliation(s)
- Yi-Nan Ding
- Department of Pathophysiology, College of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Ming Xue
- Department of Critical Care Medicine, Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Qiu-Sha Tang
- Department of Pathophysiology, College of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Li-Jun Wang
- Department of Pathophysiology, College of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Hui-Yan Ding
- Department of Pathophysiology, College of Medicine, Southeast University, Nanjing 210000, Jiangsu Province, China
| | - Han Li
- Department of Tuberculosis, The Second Hospital of Nanjing, Nanjing University of Chinese Medicine, Nanjing 210000, Jiangsu Province, China
| | - Cheng-Cheng Gao
- Department of Radiology, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou 310000, Zhejiang Province, China
| | - Wei-Ping Yu
- Medical School, Southeast University, Nanjing 210009, Jiangsu Province, China
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Crema E, Melani AGF, Romagnolo LGC, Marescaux J. Ten years of IRCAD, Barretos, SP, Brazil. Acta Cir Bras 2022; 37:e370608. [PMID: 36134854 PMCID: PMC9488511 DOI: 10.1590/acb370608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 05/20/2022] [Indexed: 11/22/2022] Open
Abstract
Minimally invasive surgery represented a significant milestone in modern surgery; however, continuous innovation and the emergence of new technologies pose new challenges in terms of surgical learning curves since new interventions are associated with increased surgical complexity and a higher risk of complications. For this reason, surgeons are aware of the beneficial effects of "learning before doing" and the importance of safely implementing new surgical procedures in order to obtain better patient outcomes. Considered the largest Latin American training center in minimally invasive surgery, IRCAD Barretos, São Paulo, Brazil, makes it possible to acquire surgical skills through training in different and the most complex areas of medicine, providing the experience of real and simulated situations, with focus on innovation. The center possesses state-of-the-art infrastructure and technology, with a very high-level teaching staff and an affectionate and hospitable reception. Since its inauguration, in 2011, the center has already qualified numerous professionals and has placed the country in a privileged position in terms of surgical knowledge. The present article describes the activities developed over these ten years of the institute in Brazil as the largest training center for surgeons of the continent in order to address the importance of surgical skills training.
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Affiliation(s)
- Eduardo Crema
- PhD, full professor. Universidade Federal do Triângulo Mineiro - Division of Digestive Tract Surgery - Uberaba (MG), Brazil
| | - Armando Geraldo Franchini Melani
- MSc, technical and scientific director. IRCAD Latin America, and physician at Americas Integrated Oncology Center - Rio de Janeiro (RJ), Brazil
| | - Luís Gustavo Capochin Romagnolo
- MD. Hospital de Câncer de Barretos - Pio XII Foundation, and scientific coordinator, IRCAD Latin America - Barretos (SP), Brazil
| | - Jacques Marescaux
- MD, founder and scientific coordinator. IRCAD Latin America - Barretos (SP), Brazil
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Da Vinci Robot-Assisted Video Image Processing under Artificial Intelligence Vision Processing Technology. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:2752444. [PMID: 35535225 PMCID: PMC9078793 DOI: 10.1155/2022/2752444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 03/31/2022] [Accepted: 04/01/2022] [Indexed: 11/17/2022]
Abstract
This research was aimed to explore the application value of intelligent algorithm-based digital images in Da Vinci robot-assisted treatment of patients with gastric cancer surgery. 154 patients were included as the research objects, with 89 cases in the control group underwent laparoscopic surgery, and 65 cases in the experimental group underwent robotic surgery. According to the propensity score, the patients in two groups were pair matched (1: 1), of which 104 cases (52 cases in each group) were successfully matched. The general data of patients, the changes in the images before and after the algorithm processing, the intraoperative and postoperative conditions, the pathological examination results, and the follow-up information were observed after matching. Compared with the original images, the images processed by the thread image edge detection algorithm had the significantly improved clarity, as well as highly reduced artifacts and noises. The sensitivity, specificity, and accuracy of image-assisted diagnosis were improved remarkably, showing the differences of statistical significance (
). The total time of surgery, intraoperative bleeding, CRP (1d and 3d after surgery), and postoperative total abdominal drainage showed the significant differences as well (
). The surgeries of patients in both groups met R0 resection (no tumor infiltration within 1 mm of the surgical margin), but there was a significant difference in the number of lymph node dissections (
). The overall survival rates of patients in the experimental group and the control group were 83.0% and 76.1%, respectively, 2 years after surgery, with no significant difference (
). The thread image edge detection algorithm produced a better processing effect on the images, which greatly improved the diagnostic sensitivity, specificity, and accuracy. Compared with endoscopic surgery, robotic surgery has better postoperative recovery, safety and reliability, and obvious advantages of minimally invasive surgery.
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Liu F, Wu ZR, Hu HJ, Jin YW, Ma WJ, Wang JK, Li FY. Current status and future perspectives of minimally invasive surgery in gallbladder carcinoma. ANZ J Surg 2020; 91:264-268. [PMID: 32627337 DOI: 10.1111/ans.16125] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/07/2020] [Accepted: 06/15/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gallbladder carcinoma (GBC) is the most common biliary tract malignancy, which is characterized by easy local invasion, lymph nodes metastasis, local vascular invasion. Hence, minimally invasive surgery (MIS) can be performed in a limited number of patients. In our study, we reviewed the current studies on laparoscopic surgery (LS) and robotic surgery (RS) for GBC and analysed the limitations and difficulties of MIS for GBC. METHODS Multiple electronic databases were used for a systematic literature retrieval. All studies involving MIS of GBC were included (up to August 2019). RESULTS A total of 24 studies were included, of which 18 studies involved LS for GBC and six studies concerned RS of GBC. For LS, 16 studies contained relevant information of T stage, and 323 patients (98.8%) had T3 or lower stage; the average rate of R0 resection, conversion, postoperative complications and mortality was 95.3% (range 80.5-100%), 1.9% (range 0-16.7%), 13.4% (range 0-33.3%) and 1.0% (range 0-10%), respectively. For RS, four studies contained relevant information of T stage, and all patients were T3 or lower stage; the average rate of R0 resection, conversion and postoperative complications was 96.8% (range 81.8-100%), 5.5% (range 0-14.8%) and11.9% (range 0-36.4%), respectively. In addition, no patient had perioperative mortality. CONCLUSIONS MIS for GBC is limited to highly selected patients and is considered to be technically feasible in experienced surgeons. However, improvements in technical and instrumental are needed to reduce the associated postoperative complications and implantation metastasis, and to promote MIS in the treatment of GBC.
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Affiliation(s)
- Fei Liu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Zhen-Ru Wu
- Laboratory of Pathology, West China Hospital, Sichuan University, Chengdu, China
| | - Hai-Jie Hu
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Yan-Wen Jin
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Wen-Jie Ma
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Jun-Ke Wang
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Fu-Yu Li
- Department of Biliary Surgery, West China Hospital of Sichuan University, Chengdu, China
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Ryan S, Tameron A, Murphy A, Hussain L, Dunki-Jacobs E, Lee DY. Robotic Versus Laparoscopic Gastrectomy for Gastric Adenocarcinoma: Propensity-Matched Analysis. Surg Innov 2019; 27:26-31. [PMID: 31441711 DOI: 10.1177/1553350619868113] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background. We compared the outcomes of laparoscopic-assisted (LA) and robotic-assisted (RA) gastrectomies performed for gastric adenocarcinoma in the National Cancer Database. Methods. The National Cancer Database was queried for patients 18 years old with stages I to III gastric adenocarcinoma who underwent LA or RA gastrectomy. Propensity matching was performed between the 2 groups with regard to clinical staging, adjuvant treatment, demographics, and the extent of surgery. Results. A cohort of 1893 (1262 = LA, 631 = RA) patients was identified in a 2:1 propensity matching. The groups were well matched. The rate of negative margin as well as 30- and 90-day mortality were similar between the 2 cohorts. Long-term survival was similar between the 2 groups (median survival 49.2 months in LA vs 56.2 months for RA, P = .405). However, the average number of lymph nodes (LNs) sampled was significantly higher in the RA group compared with the LA group (19.6 vs 17.4, P < .001). Similarly, the percentage of surgeries in which ≥15 LNs were sampled was also greater in the RA group compared with the LA group (63.9% vs 57.6%, P = .010). On multivariable analysis, having 15 LNs or more examined was associated with better survival (hazard ratio = 0.72, 95% confidence interval = 0.60-0.87, P < .001). Advanced age, nodal positivity, and advanced clinical stages were significantly associated with worse survival. Conclusions. RA gastrectomy may allow a greater harvest of LNs, and thus more accurate staging, without increasing short-term adverse outcomes compared with LA gastrectomy. Short-term and long-term outcomes in this well-matched cohort appear comparable for both approaches.
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Affiliation(s)
- Sean Ryan
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Ashley Tameron
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Amy Murphy
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Lala Hussain
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA
| | - Erik Dunki-Jacobs
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA.,TriHealth Cancer Institute, Cincinnati, OH, USA
| | - David Y Lee
- Good Samaritan General Surgery Residency Program, Cincinnati, OH, USA.,TriHealth Cancer Institute, Cincinnati, OH, USA
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Ronellenfitsch U, Hohenberger P. Surgery for Gastrointestinal Stromal Tumors: State of the Art of Laparoscopic Resection and Surgery for M1 Tumors. Visc Med 2018; 34:367-374. [PMID: 30498704 PMCID: PMC6257156 DOI: 10.1159/000491799] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The principles of surgery for primary gastrointestinal stromal tumor (GIST) are resection with clear margins without lymphadenectomy, thus enabling organ-preserving resection in many cases. Tumor rupture needs to be avoided, because it entails peritoneal sarcomatosis. Given these preconditions, there is a rationale for laparoscopic resection of primary GIST. In metastatic GIST, surgery cannot achieve cure, but constitutes an important cornerstone of treatment. Resection can be performed either for residual lesions in responding patients, for focally progressive lesions, or as palliative measure in generalized progression. METHODS Selective literature review. RESULTS There is ample evidence on laparoscopic resection of gastric GIST, but none from randomized trials. The studies show favorable perioperative outcomes and suggest adequate oncological results; however, a direct comparison to open resection is difficult. For surgery in M1 stages, survival outcomes are better for resection in generalized response than in focal progression. Perioperative morbidity is acceptable. Surgery in generalized progression does not prolong survival and bears relevant morbidity risks. CONCLUSION Laparoscopy seems an adequate surgical approach for primary gastric GIST, as long as the surgical principles relevant for this entity are respected. For other tumor sites, there is no sufficient evidence available. In M1 stages, selected patients may benefit from surgery. Survival differences between resection at different stages probably mirror the biology of the disease rather than the effect of the timing of the operation.
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Affiliation(s)
- Ulrich Ronellenfitsch
- Department of Vascular and Endovascular Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Hohenberger
- Division of Surgical Oncology and Thoracic Surgery, Department of Surgery, Medical Faculty Mannheim of the University of Heidelberg, Mannheim, Germany
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KONDO YOSHIHIRO, TANIGUCHI DAISUKE, MATSUMOTO KEITARO, NAGAYASU TAKESHI, LAWN MURRAYJOHN, YAMAMOTO IKUO. DEVELOPMENT OF BALLOON-BASED ORGAN RETRACTOR FOR LAPAROSCOPIC SURGERY. J MECH MED BIOL 2017. [DOI: 10.1142/s0219519417400243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Effective organ retraction is essential to ensure safe and efficient surgery, in the case of laparoscopic surgery, organ retraction is particularly difficult to achieve. Currently such as cherry dissectors are used for retraction, however the small size results in excessive stress on the organ being retracted. Therefore, we are developing a balloon-based retractor that provides similar functionality as the cherry dissector, particularly being able to pass through a small port, yet being expandable to provide a much greater contact area as well as improved traction, thus providing increased operating efficiency and improved safety in organ retraction. In this paper, the relative merits and demerits of a number of currently available retractors are compared. Parameters under consideration include shape, size, effective traction (coefficient of friction), type of actuation and ease of use. While parameters such as pressure distribution and effective traction have been objectively measured, other attributes unique to the individual mechanisms are discussed, and finally feedback is provided from surgeons regarding the respective retractor’s ease of use and perceived efficacy.
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Affiliation(s)
- YOSHIHIRO KONDO
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamotomachi, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - DAISUKE TANIGUCHI
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamotomachi, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - KEITARO MATSUMOTO
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamotomachi, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - TAKESHI NAGAYASU
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamotomachi, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - MURRAY JOHN LAWN
- Nagasaki University Graduate School of Biomedical Sciences, 1-12-4 Sakamotomachi, Nagasaki-shi, Nagasaki 852-8523, Japan
| | - IKUO YAMAMOTO
- Department of Mechanical Science, Nagasaki University Graduate School, 1-14 Bunkyomachi, Nagasaki-shi, Nagasaki 852-8521, Japan
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