Clinical Surgical Oncology最新文献_第3页

Artificial intelligence for hepatobiliary and pancreatic cancer: Ethics, equity, and real-world integration 人工智能治疗肝胆癌和胰腺癌：伦理、公平和现实世界的整合

Clinical Surgical Oncology

Pub Date : 2025-10-23 DOI: 10.1016/j.cson.2025.100100

Joseph A. Attard, Emily Siviter, Alice Millard, Eyad Issa, Giuseppe Garcea, Ashley Dennison, John Isherwood

Hepatobiliary and pancreatic (HPB) cancers present a major challenge due to their late presentation, limited treatment options, and high mortality. Artificial intelligence (AI) has emerged as a promising tool in revolutionising cancer care, offering potential advances in early detection, and treatment planning. However, real-world implementation of AI remains limited by ethical, technical, and systemic challenges. This narrative review explores the evolving landscape of AI in HPB oncology, with a focus on ethical integration, healthcare equity, and clinical applicability. Key issues discussed include algorithmic bias, informed consent, model explainability, and disparities in access to data and AI-driven tools. Promising innovations such as federated learning and large language models are explored for their potential to decentralise model training and enhance multidisciplinary workflows. The review also highlights the integration of AI into surgical navigation systems and intraoperative decision-making, as well as its application to omics data analysis for biomarker discovery. Crucially, it underscores the need for transparent and interpretable systems, the need for prospective validation in diverse populations, and the risk of clinician de-skilling. As AI technologies evolve, their safe and equitable integration into HPB oncology will require robust governance, regulatory foresight, and sustained investment in clinician education and infrastructure. This review concludes that, while AI shows potential in transforming HPB cancer care, its ethical and inclusive implementation will ultimately determine its clinical impact.

肝胆和胰腺（HPB）癌由于其出现较晚、治疗选择有限和高死亡率而面临重大挑战。人工智能（AI）已经成为一种有前途的工具，可以彻底改变癌症治疗，在早期发现和治疗计划方面提供潜在的进步。然而，人工智能在现实世界的实施仍然受到伦理、技术和系统挑战的限制。这篇叙述性综述探讨了HPB肿瘤学中人工智能的发展前景，重点是伦理整合、医疗公平和临床适用性。讨论的关键问题包括算法偏差、知情同意、模型可解释性以及获取数据和人工智能驱动工具方面的差异。有前途的创新，如联邦学习和大型语言模型，探索其分散模型训练和增强多学科工作流程的潜力。该综述还强调了人工智能与外科导航系统和术中决策的整合，以及它在生物标志物发现的组学数据分析中的应用。至关重要的是，它强调需要透明和可解释的系统，需要在不同人群中进行前瞻性验证，以及临床医生技能下降的风险。随着人工智能技术的发展，将其安全、公平地融入HPB肿瘤学将需要强有力的治理、监管远见以及对临床医生教育和基础设施的持续投资。本综述的结论是，尽管人工智能显示出改变HPB癌症治疗的潜力，但其伦理和包容性的实施将最终决定其临床影响。

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引用次数: 0

The management of Juvenile Tumour Systems implants following limb salvage surgery for bone sarcoma: A British consensus informing best practice and consistent care 骨肉瘤残肢手术后少年肿瘤系统植入物的管理：英国共识告知最佳实践和一致护理

Clinical Surgical Oncology

Pub Date : 2025-10-22 DOI: 10.1016/j.cson.2025.100099

Rebecca O'Keeffe , Sarah Massey

Aims

The aim of this study was to gain a consensus for best practice of follow up of patients following limb salvage surgery with a Juvenile tumour Systems (JTS) extendible implant to benchmark and guide consistent care.

Methods

A two-round modified Delphi study was conducted by paediatric sarcoma specialists. They identified 8 areas of follow up care that required consensus agreement. Statements were based around leg length measurement, long-leg X-Rays, joint range of movement, procedure within the lengthening appointment, physiotherapy, shoe raises, training, frequency of appointments. A pre-determined threshold of >70 % for consensus, with a threshold of >60 % being considered as ‘points to consider’.

Results

Sixteen professionals and manufacturers consented to be part of the consensus. A total of 63 statements were generated for the initial questionnaire, at the end of which 9 statements reached consensus. The remaining 54 statements were discussed and refined to 31 for the second questionnaire. Following two rounds of questionnaires and web conferences a total of 29 statements reached consensus.

Conclusion

Paediatric sarcoma specialists have reached expert consensus to provide a framework for consistent follow up management of JTS implants, many of which could be generalised to other non-invasive growing implants. We would recommend that clinicians use these statements to ensure follow-up care is consistent.

目的本研究的目的是为残肢保留手术后使用少年肿瘤系统（JTS）可扩展植入物的患者随访的最佳实践达成共识，以基准和指导一致的护理。方法采用两轮改良德尔菲法，由小儿肉瘤专家进行。他们确定了需要达成共识的8个后续护理领域。这些陈述是基于腿长测量、长腿x光片、关节活动范围、延长预约的程序、物理治疗、提鞋、训练、预约频率。预先确定的70%的共识阈值，60%的阈值被认为是“考虑点”。结果16名专业人员和生产厂家同意参与共识。最初的调查表共有63项陈述，最后有9项陈述达成协商一致意见。对剩下的54项陈述进行了讨论，并将其提炼为31项，用于第二份调查表。经过两轮问卷调查和网络会议，共有29项声明达成共识。结论小儿肉瘤专家已经达成专家共识，为JTS种植体的随访管理提供了一个框架，其中许多可以推广到其他非侵入性生长种植体。我们建议临床医生使用这些陈述来确保后续护理的一致性。

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引用次数: 0

Role of primary tumour surgery in the management of oligometastatic breast cancer 原发性肿瘤手术在低转移性乳腺癌治疗中的作用

Clinical Surgical Oncology

Pub Date : 2025-10-22 DOI: 10.1016/j.cson.2025.100101

Byung Choi, Amr Mousa, Tyler Longbone, Lavandan Jegatheeswaran, Mohammed Elsiddig, Vishal Patel, Ekambaram Babu, Arunmoy Chakravorty

Metastatic breast cancer has long considered an incurable disease, however a subset coined oligometastatic breast cancer (OMBC) has challenged this assumption. OMBC represents a stable entity that presents as an intermediary state between locoregional and widespread disease where metastasised cells are limited to suitable sites potentially amenable to treatment. However, the treatment for OMBC is not standardised and a major limitation is diagnostic difficulty as it relies only on imaging findings. In the United Kingdom, a case by case discussion of treatment is made due to lack of guidance or framework. The role of primary surgical excision of the breast tumour in OMBC has been scrutinised with varying outcomes to date. This review evaluates the role of primary surgical excision and future directions in the field of OMBC management. Most studies to date have been retrospective in nature, given the diagnostic challenges of OMBC and studies to date have failed to show conclusive evidence regarding surgery to the primary tumour. Some favourable factors seem to be hormone receptor positivity and bone pre-dominant metastasis, however there is a need for better understanding in the distinct biology of OMBC to characterise and determine the value of surgery to the primary tumour as well as adjuvant oncological treatments.

转移性乳腺癌长期以来被认为是一种无法治愈的疾病，然而，一种被称为寡转移性乳腺癌（OMBC）的亚型挑战了这一假设。OMBC是一种稳定的实体，表现为局部和广泛疾病之间的中间状态，其中转移细胞局限于可能适合治疗的合适部位。然而，OMBC的治疗尚未标准化，主要的限制是诊断困难，因为它仅依赖于影像学表现。在英国，由于缺乏指导或框架，对治疗进行个案讨论。原发性手术切除乳腺肿瘤在OMBC中的作用已被仔细审查，迄今为止有不同的结果。本文综述了原发性手术切除在OMBC治疗领域的作用和未来发展方向。鉴于OMBC的诊断挑战，迄今为止的大多数研究本质上都是回顾性的，而且迄今为止的研究未能提供有关原发肿瘤手术的确凿证据。一些有利因素似乎是激素受体阳性和骨前显性转移，然而，需要更好地了解OMBC的独特生物学特征，以确定手术对原发肿瘤以及辅助肿瘤治疗的价值。

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引用次数: 0

Breaking barriers: Pembrolizumab's role in overcoming targeted therapy resistance in BRAF-mutant melanoma 突破障碍：Pembrolizumab在克服braf突变黑色素瘤靶向治疗耐药中的作用

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100095

Omer A. Idris , Abdulaziz Shebrain , Ali Jawad , Sabrina C. Pacione , Delour Haj , Hanin Bzizi , Yaqub O. Ahmedfiqi , Bahar Saadaie Jahromi , Nicholas Deleon , Tiantian Zhang , Amanda Hunt , Ramona Meraz Lewis , Diana Westgate

Melanoma, a malignancy of melanocytes, has increased globally, posing significant treatment challenges. BRAF mutations, particularly V600E and V600K variants, occur in approximately 40–60 % of cutaneous melanomas and activate the MAPK/ERK signaling pathway. Although BRAF and MEK inhibitors have improved response rates and survival, acquired resistance—due to genetic alterations, activation of alternative pathways, and phenotypic changes—remains a major hurdle.

Pembrolizumab, an anti-PD-1 immune checkpoint inhibitor, has emerged as a promising option to overcome resistance to targeted therapies. This review explores the rationale for using pembrolizumab post-resistance, emphasizing its ability to enhance immune recognition through the immunogenic effects of prior targeted therapies and its synergistic potential when combined with BRAF and MEK inhibitors. Clinical evidence from KEYNOTE trials and real-world studies demonstrates pembrolizumab's efficacy as monotherapy and in combination regimens, leading to improved progression-free and overall survival in patients with advanced melanoma. Mechanistic insights from preclinical studies suggest that targeted therapies modulate the tumor microenvironment and enhance antigen presentation, augmenting the effectiveness of pembrolizumab. Novel biomarkers such as tumor mutational burden (TMB), PD-L1 expression, and circulating tumor DNA (ctDNA) are examined for their potential to predict treatment response and guide personalized therapy. Challenges related to increased toxicity in combination therapies, economic impact, and patient heterogeneity are discussed, highlighting the need for careful patient selection and management strategies. Future directions include optimizing treatment sequencing, exploring novel therapeutic combinations, and advancing personalized medicine through integrative genomic and immunologic data. This review underscores the pivotal role of pembrolizumab in managing BRAF-mutant melanoma and emphasizes the importance of integrated therapeutic strategies to improve patient outcomes.

黑色素瘤是一种黑色素细胞的恶性肿瘤，在全球范围内呈上升趋势，带来了重大的治疗挑战。BRAF突变，特别是V600E和V600K突变，发生在大约40 - 60%的皮肤黑色素瘤中，并激活MAPK/ERK信号通路。尽管BRAF和MEK抑制剂提高了反应率和生存率，但由于遗传改变、替代途径的激活和表型改变，获得性耐药仍然是一个主要障碍。Pembrolizumab是一种抗pd -1免疫检查点抑制剂，已成为克服靶向治疗耐药的有希望的选择。本综述探讨了耐药后使用派姆单抗的基本原理，强调其通过先前靶向治疗的免疫原性效应增强免疫识别的能力，以及与BRAF和MEK抑制剂联合使用时的协同潜力。KEYNOTE试验和现实世界研究的临床证据表明，pembrolizumab作为单药治疗和联合治疗方案的疗效，可改善晚期黑色素瘤患者的无进展和总生存期。临床前研究的机制见解表明，靶向治疗调节肿瘤微环境并增强抗原呈递，从而增强派姆单抗的有效性。新的生物标志物，如肿瘤突变负荷（TMB）， PD-L1表达和循环肿瘤DNA （ctDNA）被检查其预测治疗反应和指导个性化治疗的潜力。讨论了与联合治疗毒性增加、经济影响和患者异质性相关的挑战，强调了谨慎选择患者和管理策略的必要性。未来的发展方向包括优化治疗序列，探索新的治疗组合，以及通过整合基因组和免疫数据推进个性化医疗。本综述强调了派姆单抗在治疗braf突变黑色素瘤中的关键作用，并强调了综合治疗策略对改善患者预后的重要性。

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引用次数: 0

Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy 计划进行CRS和HIPEC但仅进行探查性剖腹手术的患者的结果

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100093

Valentinus Valdimarsson, Ingvar Syk, Victor Verwaal

Background

Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.

Methods

All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.

Results

A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 %) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 %). Three patients (11 %) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 %) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.

Conclusion

Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.

一些计划进行细胞减少手术（CRS）和腹腔内高温化疗（HIPEC）的患者由于肿瘤广泛扩散或难以实现完全细胞减少（CC0），只能进行探查性剖腹手术（开/闭手术）。本研究旨在评估腹膜表面恶性肿瘤（PSM）患者仅行开腹/闭腹手术的手术效果和总生存率。方法纳入2015年至2023年期间在瑞典Malmö进行CRS和HIPEC手术的所有仅行开腹/闭腹手术的患者。排除无恶性诊断的患者。分析临床、生存和并发症数据。结果28例患者仅行开腹/闭腹手术。开腹前，15例（54%）患者接受了诊断性腹腔镜检查，PCI评分中位数为13.0 （IQR 10.0-19.0）。剖腹手术时，PCI评分中位数为29.0 （IQR 25.5-33.0）。不进行CRS和HIPEC手术的最常见原因是PCI评分高（61%）。3例患者（11%）出现严重的术后并发症（Clavien-Dindo≥3b）， 1例患者在术后第一天死亡。探查性剖腹手术后，21例（78%）患者接受了姑息性化疗（中位生存期为13.4个月），而6例患者未接受姑息性化疗（中位生存期为3.5个月），其中1例患者数据缺失。结论单纯剖腹探查（开腹/闭腹）诊断为PSM的患者预后极差。剖腹探查术存在严重的术后并发症风险，并且住院时间较长。迫切需要改进的诊断工具来帮助确定适合CRS和HIPEC治疗的患者。

{"title":"Outcome of patients scheduled for CRS and HIPEC yet only undergoing explorative laparotomy","authors":"Valentinus Valdimarsson, Ingvar Syk, Victor Verwaal","doi":"10.1016/j.cson.2025.100093","DOIUrl":"10.1016/j.cson.2025.100093","url":null,"abstract":"<div><h3>Background</h3><div>Some patients scheduled for cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) only undergo explorative laparotomy (open/close procedure) due to extensive tumor spread or challenges in achieving complete cytoreduction (CC0). This study aimed to evaluate the surgical outcomes and overall survival in patients with peritoneal surface malignancy (PSM) who only undergo open/closed laparotomy.</div></div><div><h3>Methods</h3><div>All patients scheduled for CRS and HIPEC in Malmö, Sweden, between 2015 and 2023, who only underwent open/close laparotomy were included. Patients without malignant diagnoses were excluded. Clinical, survival, and complication data were analyzed.</div></div><div><h3>Results</h3><div>A total of 28 patients underwent open/closed laparotomy only. Before the laparotomy, 15 (54 %) patients had undergone diagnostic laparoscopy with a median PCI score of 13.0 (IQR 10.0–19.0). During the laparotomy, the median PCI score was found to be 29.0 (IQR 25.5–33.0). The most common reason for not proceeding with CRS and HIPEC surgery was a high PCI score (61 %). Three patients (11 %) experienced serious postoperative complications (Clavien-Dindo ≥3b), and one patient died during the first postoperative day. After the explorative laparotomy, twenty-one (78 %) patients received palliative chemotherapy (median survival of 13.4 months), whereas six received none (median survival of 3.5 months), with missing data from one patient.</div></div><div><h3>Conclusion</h3><div>Patients diagnosed with PSM who undergo only exploratory laparotomy (open/close) have a very poor prognosis. Exploratory laparotomy poses a significant risk of serious postoperative complications, as well as a lengthy hospital stay. Improved diagnostic tools are urgently needed to help identify the right patients for CRS and HIPEC treatment.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100093"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018766","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Evaluating the quality and readability of AI-generated ophthalmic surgery education: A four model comparison 评价人工智能眼科外科教育的质量和可读性：四种模式的比较

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100092

Rickvir S. Sidhu , Arrane Selvamogan

引用次数: 0

Neoadjuvant therapy for patients with advanced colon cancer: Analysis of the National Cancer Database (NCDB) 晚期结肠癌患者的新辅助治疗：国家癌症数据库（NCDB）分析

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100097

Guanming Chen , Jesus C. Fabregas , Zhigang Xie , Ilyas Sahin , Girish Mishra , Jiamin Hu , Rachel E. Liu-Galvin , Young-Rock Hong

Background

Few real-world studies have characterized the utilization pattern and overall survival (OS) benefits associated with neoadjuvant therapy (NAT) among patients diagnosed with colon cancer.

Patients and methods

In this retrospective cohort study, we identified adult patients diagnosed with stages II-IV colon cancer from 2015 to 2020 using the US National Cancer Database. Patients were grouped based on treatment modality and sequence: NAT and those treated by upfront surgery followed by adjuvant therapy (ADT). We examined utilization pattern of NAT by patients’ sociodemographic, medical, and facility characteristics. We then used Kaplan Meier method and Cox proportional hazards models to compare OS across cancer stages between two groups.

Results

Of the 116,905 patients who met inclusion criteria, 8110 (6.9 %) received NAT. Overall, patients underwent NAT were generally younger (age ≤64 years), privately insured, diagnosed with stage IV colon cancer, and with liver metastasis. Receipt of NAT was associated with significantly improved OS among patients with stage IV colon cancer after adjusting for covariates (hazard ratio, 0.79; 95 % CI: 0.76–0.83, p < 0.001). Subgroup analysis results showed that NAT was associated with better OS compared to those received ADT regardless of age, liver metastasis status, comorbidity score, and KRAS mutation status. For patients with stages II or III colon cancer, NAT was not associated with improved OS.

Conclusion

Neoadjuvant therapy was significantly associated with improved OS among patients with stage IV colon cancer. Future investigations are needed to understand the role of NAT in locally advanced colon cancer.

背景：很少有现实世界的研究描述了结肠癌患者新辅助治疗（NAT）的使用模式和总生存期（OS）获益。患者和方法在这项回顾性队列研究中，我们使用美国国家癌症数据库，确定了2015年至2020年诊断为II-IV期结肠癌的成年患者。患者根据治疗方式和顺序进行分组：NAT和术前手术后辅助治疗（ADT）。我们根据患者的社会人口学、医学和设施特征检查了NAT的使用模式。然后，我们使用Kaplan Meier方法和Cox比例风险模型来比较两组癌症分期的OS。结果在符合纳入标准的116,905例患者中，8110例（6.9%）接受了NAT治疗。总体而言，接受NAT治疗的患者通常较年轻（年龄≤64岁），有私人保险，诊断为IV期结肠癌，并有肝转移。调整协变量后，接受NAT治疗与IV期结肠癌患者的OS显著改善相关（风险比0.79;95% CI: 0.76-0.83, p < 0.001）。亚组分析结果显示，无论年龄、肝转移情况、合并症评分和KRAS突变状态如何，与接受ADT的患者相比，NAT与更好的OS相关。对于II期或III期结肠癌患者，NAT与改善OS无关。结论新辅助治疗可显著改善IV期结肠癌患者的OS。需要进一步的研究来了解NAT在局部晚期结肠癌中的作用。

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引用次数: 0

Assessing the quality and readability of AI chatbot responses to frequently asked questions about basal cell carcinoma 评估人工智能聊天机器人对基底细胞癌常见问题的回答的质量和可读性

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100094

Rickvir S. Sidhu , Arrane Selvamogan

引用次数: 0

Risk factors for anastomotic fistula after total mesorectal excision: A monocentric retrospective study of 78 patients 全直肠系膜切除术后吻合口瘘的危险因素：78例患者的单中心回顾性研究

Clinical Surgical Oncology

Pub Date : 2025-09-01 DOI: 10.1016/j.cson.2025.100096

Amine Majdoubi , Anass El Aachi , Mohammed El Hammouti , Haïtam Aabalou , Ayoub Kharkhach , Tariq Bouhout , Badr Serji

Introduction

Anastomotic fistulas remain one of the most feared complications following rectal surgery, particularly after Total Mesorectal Excision (TME). They compromise prognosis, prolong hospitalization, and increase costs due to the additional interventions they necessitate.

Aims

To identify predictive factors for the occurrence of anastomotic fistulas, with the goal of personalizing and optimizing surgical management—particularly to guide decisions regarding the use of defunctioning stomas.

Materials and methods

We conducted a retrospective observational study on 78 patients who underwent TME with low rectal anastomosis for rectal adenocarcinoma at Hassan II University Hospital in Oujda, between December 2017 and May 2024.

Results

Of the 78 patients, 21 developed anastomotic fistulas, yielding an incidence rate of 26.9 %. Late-onset cases were predominant (16 cases, 76.19 %) compared to early-onset cases (five cases, 23.81 %). In univariate analysis, diabetes (p = 0.002), intraoperative incidents (p = 0.014) - particularly blood loss exceeding 150 cc (p = 0.001) - and smoking (p = 0.005) were significant risk factors for fistula development. In multivariate analysis, diabetes (OR = 10.87; p = 0.003) and intraoperative blood loss >150 ml (OR = 7.38; p = 0.030) emerged as independent predictors of fistula development. Active smoking showed a borderline association (OR = 6.46; p = 0.056), suggesting a potential but not statistically confirmed impact on anastomotic fistula. These findings are consistent with the existing literature. In contrast, other factors commonly reported in the literature, such as male sex (p = 0.530), ASA score (p = 0.612), anemia (p = 0.324), and preoperative (p = 0.781) and postoperative albumin levels (p = 0.119), did not show a significant association in our study.

Discussion and conclusion

While the identified risk factors are relevant, they alone are insufficient to warrant major modifications in our surgical strategy, particularly regarding the decision to perform a defunctioning stoma. Further studies are necessary to validate these findings.

吻合口瘘是直肠手术后最可怕的并发症之一，特别是在全肠系膜切除术（TME）后。它们损害预后，延长住院时间，并由于需要额外干预而增加费用。目的确定吻合口瘘发生的预测因素，以实现个性化和优化手术治疗的目标，特别是指导关于使用功能障碍造口的决定。材料与方法我们对2017年12月至2024年5月在Oujda Hassan II大学医院行TME低位直肠吻合治疗直肠腺癌的78例患者进行了回顾性观察研究。结果78例患者中发生吻合口瘘21例，发生率26.9%。晚发病例16例（76.19%），早发病例5例（23.81%）。在单因素分析中，糖尿病（p = 0.002）、术中事件（p = 0.014）——特别是失血量超过150cc （p = 0.001）——和吸烟（p = 0.005）是瘘管发生的重要危险因素。在多因素分析中，糖尿病（OR = 10.87; p = 0.003）和术中出血量>；150 ml （OR = 7.38; p = 0.030）成为瘘发生的独立预测因素。积极吸烟呈边缘相关性（OR = 6.46; p = 0.056），提示对吻合口瘘有潜在的影响，但未得到统计学证实。这些发现与现有文献一致。相比之下，文献中常见的其他因素，如男性（p = 0.530）、ASA评分（p = 0.612）、贫血（p = 0.324）、术前（p = 0.781）和术后白蛋白水平（p = 0.119）等，在我们的研究中并没有显示出显著的相关性。讨论和结论虽然确定的危险因素是相关的，但它们本身不足以保证我们对手术策略进行重大修改，特别是在决定进行功能缺损时。需要进一步的研究来验证这些发现。

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引用次数: 0

Prophylactic stoma in robotic radical surgery for low-to-intermediate rectal cancer 低至中度直肠癌机器人根治术中的预防性造口

Clinical Surgical Oncology

Pub Date : 2025-08-13 DOI: 10.1016/j.cson.2025.100091

Zhekun Huang , Songbin Lin , Peiwen Zhou , Yang Lv , Guodong He , Ye Wei , Jianmin Xu , Wentao Tang

Background

Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.

Methods

We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.

Results

Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.

Conclusions

Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.

背景：吻合口瘘是低、中度直肠癌术后常见且严重的并发症；预防性造口术被认为可以减少吻合口瘘的发生率，减轻其严重的并发症。然而，它也带来了许多风险。本研究将探讨预防造口在机器人辅助的低、中度直肠癌根治术中的价值。方法纳入2016年6月至2022年10月在复旦大学两家医院行机器人辅助根治性切除术的670例低至中度直肠癌患者，其中77例行预防性造口术，593例未行预防性造口术。收集患者的临床资料，根据性别、糖尿病、体重指数、新辅助放化疗、肿瘤下缘距肛缘距离、肿瘤最大直径、术前不完全性梗阻等因素，采用倾向评分匹配法，按1:1比例进行分组匹配。结果预防造瘘组有症状性吻合口瘘发生率明显低于非造瘘组。两组患者术后总体并发症、非计划再入院或术后30天再手术率无显著差异；然而，预防性造口组术后住院天数较低，平均住院费用较低。术前肠梗阻是预防性造口组术后吻合口漏的独立危险因素。结论基于机器人平台的预防性造口术对部分中低危直肠癌患者是有益的。

{"title":"Prophylactic stoma in robotic radical surgery for low-to-intermediate rectal cancer","authors":"Zhekun Huang , Songbin Lin , Peiwen Zhou , Yang Lv , Guodong He , Ye Wei , Jianmin Xu , Wentao Tang","doi":"10.1016/j.cson.2025.100091","DOIUrl":"10.1016/j.cson.2025.100091","url":null,"abstract":"<div><h3>Background</h3><div>Anastomotic leakage are common and serious complications after surgery for low and intermediate rectal cancers; a prophylactic stoma is thought to reduce the incidence of anastomotic leakage and alleviate its serious complications. However, it also comes with numerous risks. This study will investigate the value of prophylactic stomas in robot-assisted radical surgery for low and intermediate rectal cancers.</div></div><div><h3>Methods</h3><div>We included 670 patients with low-to-intermediate rectal cancer who underwent robot-assisted radical resection at two hospitals within Fudan University from June 2016 to October 2022 (77 underwent prophylactic stoma and 593 did not have prophylactic stoma). The clinical data of the patients were collected and analyzed using a propensity score matching method that matched the groups at a 1:1 ratio based on sex, diabetes mellitus, body mass index, neoadjuvant chemoradiotherapy, distance of the lower edge of the tumor from the anal verge, maximum diameter of the tumor, and preoperative incomplete obstruction.</div></div><div><h3>Results</h3><div>Patients in the prophylactic stoma group had a significantly lower incidence of symptomatic anastomotic leakage than the non-stoma group. There were no significant differences in the overall postoperative complication, unplanned readmission, or 30-day postoperative reoperation rates between the groups; however, the prophylactic stoma group had a lower number of postoperative hospital days and lower average hospital costs. Preoperative bowel obstruction was an independent risk factor for postoperative anastomotic leakage in the prophylactic stoma group.</div></div><div><h3>Conclusions</h3><div>Prophylactic stomas based on a robotic platform are beneficial for some high-risk patients with low-to-intermediate rectal cancer.</div></div>","PeriodicalId":100278,"journal":{"name":"Clinical Surgical Oncology","volume":"4 3","pages":"Article 100091"},"PeriodicalIF":0.0,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144913137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0