Digestive Surgery最新文献

Introduction: Systematic reviews (SRs) provide crucial evidence for gastric cancer interventions, but their reliability can be compromised by methodological flaws. We aimed to evaluate the methodological quality of SRs on gastric cancer interventions and identify factors affecting their quality.

Methods: We searched MEDLINE, APA PsycInfo, Embase, and Cochrane Database of SRs for eligible SRs published between January 2014 and October 2023. The methodological quality was assessed using AMSTAR 2. Multivariable regression analyses were conducted to identify factors influencing quality.

Results: Among 119 identified SRs (including 1,305 RCTs with 233,197 participants), only 2.5% were rated as high quality, while 89.1% were critically low quality. Higher journal impact factor was associated with better performance in addressing heterogeneity (AOR: 1.37, 95% CI: 1.02-1.84), investigating publication bias (AOR: 1.41, 95% CI: 1.03-1.94), reporting conflicts of interest (AOR: 2.85, 95% CI: 1.59-5.11), and establishing protocols (AOR: 3.33, 95% CI: 1.89-5.87). More review authors predicted better statistical methods (AOR: 1.20, 95% CI: 1.03-1.40) and protocol establishment (AOR: 1.31, 95% CI: 1.06-1.63). Recent publications showed improved conflict of interest reporting (AOR: 1.54, 95% CI: 1.09-2.10) and risk of bias assessment (AOR: 1.34, 95% CI: 1.03-1.75). Non-pharmacological SRs better discussed heterogeneity compared to pharmacological (AOR: 0.27, 95% CI: 0.09-0.85) or mixed interventions (AOR: 0.12, 95% CI: 0.03-0.53).

Conclusion: The methodological quality of gastric cancer intervention SRs is unsatisfactory. Future SRs should focus on establishing protocols, explaining study design selection, using comprehensive search strategies, documenting excluded studies with reasons, and describing primary studies in detail.

Introduction: In this first preclinical evaluation study of the hinotori™ system in gastric resection procedure, its capabilities to perform distal and total gastrectomy while using human cadaver models were evaluated.

Methods: Three robotic distal gastrectomies (RADGs) and one total gastrectomy were performed in human cadavers using the same setup. A delta-shaped anastomosis in the RADG procedures were performed with a manual stapler.

Results: The mean operative time for three distal gastrectomies was 118 min, while the total gastrectomy procedure focused on the resection only. The dissection could be made up to pulmonary veins, while the entire setup was kept. The procedures were done safely according to the surgical standards with smooth instrument and overall performance without any complications seen. An ergonomic surgeon cockpit and head rest supported the outcome.

Conclusion: Docking-free design and human arm-like movement with a high degree of operation arm mobility showed a wide range of motion of the wristed robotic instruments. This could be beneficial for multiquadrant procedures resulting in potential shorter procedures times with smother performance, which should be evaluated in further studies.

Background: Long-limb Roux-en-Y (LLRY) reconstruction has recently been implemented as an oncometabolic surgery to improve glycemic control following surgery for gastric cancer (GC); however, data on its feasibility are insufficient. We investigated the 1-year outcomes of LLRY reconstruction for glycemic control in patients with type 2 diabetes (T2D).

Methods: We reviewed the records of 15 patients with GC and T2D who underwent LLRY reconstruction after gastrectomy, with biliopancreatic and Roux limb lengths of 130-250 cm, to improve postoperative glycemic control. The primary outcome was the T2D remission (glycated hemoglobin <6.5% without antidiabetic medication) rate at 12 months postoperatively. The diabetes prediction (DP) score and Korean nationwide average T2D remission rates following GC surgery were compared.

Results: The mean patient age was 66.5 years (standard deviation [SD] 9.6), mean body mass index was 26.4 kg/m2 (SD 4.4), and mean glycated hemoglobin level was 7.7% (SD 1.5). The overall T2D remission rate was 46.7%. The postoperative T2D remission rate was 12.9% higher than the DP score estimate (33.8%) and 25.7% higher than the Korean national average rate (21%) of T2D remission following GC surgery.

Conclusion: Our results show that LLRY reconstruction after gastrectomy is an effective oncometabolic surgery for treating T2D and GC.

Introduction: This study aimed to evaluate the influence of early oral feeding (EOF), a key component of enhanced recovery after surgery protocols, on postoperative outcomes in patients undergoing elective colorectal surgery.

Methods: We searched the MEDLINE, Embase, Cochrane Library, and KoreaMed databases to include randomized clinical trials comparing EOF that started on postoperative day 1 and conventional oral feeding that commenced after first flatus. Two authors independently screened the retrieved records and extracted data. The primary outcome was total complications. Data were pooled, and the overall effect size was calculated using a fixed-effect model.

Results: We screened 13 studies, and 1,556 patients were included in the analysis. The EOF group exhibited fewer total complications (odds ratio [OR] 0.50; 95% confidence interval [CI] 0.38-0.65). Anastomotic leakage was also reduced in the EOF group (OR: 0.40; 95% CI: 0.19-0.83); however, an increased incidence of vomiting (OR: 1.58; 95% CI: 1.11-2.26) as well as a tendency of higher rate of nasogastric tube reinsertion (OR: 1.49; 95% CI: 0.96-2.31) were observed. The EOF group demonstrated a decreased time to flatus (mean difference [MD] -0.87; 95% CI: -1.00 to -0.74) and shortened hospital stay (MD: -0.76; 95% CI: -0.89 to -0.6). No significant difference in mortality was observed between the two groups (OR: 0.54; 95% CI: 0.15-2.01).

Conclusion: EOF proved to be a safe and effective practice for patients undergoing elective colorectal surgery. However, the increased incidence of vomiting necessitates careful consideration.

Introduction: The effect of appendectomy on the development of Crohn's disease (CD) is a matter of debate. The aim of this systematic review and meta-analysis was to gather the latest published data to determine whether patients with a history of appendectomy have an increased risk of developing CD or not.

Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials were searched for case-control and cohort studies assessing the risk of developing CD after appendectomy. The pooled adjusted and not adjusted odds ratio (OR) with 95% confidence intervals (CIs) were calculated for case-control studies. Heterogeneity was assessed. Studies were ranked using the Newcastle-Ottawa Scale (NOS) and were all of good quality.

Results: Fourteen case-control studies and 6 cohort studies were included. Meta-analysis of case-control studies (33,243 patients) of raw OR shows a positive association between appendectomy and CD (OR: 1.51, 95% CI: 0.97-2.36, I2 = 87%), which was not statistically significant (p = 0.069). The meta-analysis of adjusted OR shows that appendectomy represents a statistically significant risk factor for the development of CD (OR: 1.86, 95% CI: 1.01-3.45, p = 0.047, I2 = 89%).

Conclusion: Appendectomy appears to be a risk factor for the development of CD. However, the discrepant results obtained by meta-analysis of unadjusted OR, the heterogeneity between studies, and the lack of precision of the magnitude of the association mandate confirmation by a large epidemiological study.

Introduction: Telementoring could increase the quality, reduce the time, and increase cost efficiency of the proctoring program for robot-assisted minimally invasive esophagectomy (RAMIE). However, feasibility is unclear as no studies assessed telementoring for RAMIE.

Methods: The feasibility of telementoring was assessed during the thoracic part of RAMIE procedures in three high-volume centers. RAMIEs were performed by trained surgeons, proctored by two experts. The primary outcome was the impact of the technology on conveying and understanding instructions.

Results: Between December 2021 and December 2022, nine RAMIE procedures were proctored using telementoring. Overall quality of the telementoring technique was scored good to excellent (median score: good). The vast majority of the 24 proctor instructions were conveyed and understood fluently (n = 21, 96%). Most proctor instructions were aimed at improving surgical exposure (n = 9, 38%). The major point of criticism was the use of the audio as the communication through the headset of the performing surgeon was not accessible by the complete team.

Discussion: Telementoring is deemed feasible for proctoring trained RAMIE surgeons after onsite proctoring. Technical improvements with regard to audio technology are warranted for broad implementation, especially in earlier training settings. The role of telementoring in the training pathway of learning surgeons needs clinical validation.

Introduction: The present study aimed to determine the clinical value of serum procalcitonin (PCT) level in predicting postoperative infections after hepatectomy.

Methods: Medical records of 301 consecutive patients who underwent hepatectomy were retrospectively reviewed. We divided the patients into infection-positive and infection-negative groups. We investigated the changes in perioperative inflammatory markers such as C-reactive protein level (CRP) and PCT level. Associations between infectious complications and perioperative inflammatory markers were evaluated to identify predictive factors of infectious complications after hepatectomy.

Results: Postoperative infectious complications occurred in 67 (22.3%) patients. The areas under the curve (AUCs) using PCT levels on postoperative days (PODs) 1 and 3 were 0.794 and 0.845, respectively, whereas those using CRP were 0.493 and 0.641, respectively. PCT level had a better AUC than CRP for predicting postoperative infectious complications on PODs 1 and 3. Multivariate analysis indicated PCT levels on PODs 1 and 3 were an independent predictor of infectious complications after hepatectomy.

Conclusion: PCT is the only predictive marker for infectious complications after hepatectomy and is valuable for detecting infectious complications from POD 1.

Introduction: The present study aimed to determine the clinical value of serum procalcitonin (PCT) level in predicting postoperative infections after hepatectomy.

Methods: Medical records of 301 consecutive patients who underwent hepatectomy were retrospectively reviewed. We divided the patients into infection-positive and infection-negative groups. We investigated the changes in perioperative inflammatory markers such as C-reactive protein level (CRP) and PCT level. Associations between infectious complications and perioperative inflammatory markers were evaluated to identify predictive factors of infectious complications after hepatectomy.

Results: Postoperative infectious complications occurred in 67 (22.3%) patients. The areas under the curve (AUCs) using PCT levels on postoperative days (PODs) 1 and 3 were 0.794 and 0.845, respectively, whereas those using CRP were 0.493 and 0.641, respectively. PCT level had a better AUC than CRP for predicting postoperative infectious complications on PODs 1 and 3. Multivariate analysis indicated PCT levels on PODs 1 and 3 were an independent predictor of infectious complications after hepatectomy.

Conclusion: PCT is the only predictive marker for infectious complications after hepatectomy and is valuable for detecting infectious complications from POD 1.

Introduction: There is a lack of sufficient evidence-based data to support personalized treatment decisions for Zenker's diverticulum. This study evaluates not only short-term outcomes of different treatment approaches but also identifies prognostic factors for long-term recurrence-free survival and quality of life.

Methods: We retrospectively analyzed all patients diagnosed with Zenker's diverticulum at our center between 2001 and 2021. Long-term follow-up data, including validated quality-of-life scores (EAT-10 and GIQLI), were evaluated.

Results: Overall, 97 patients underwent open surgery (OS), 37 received endoscopic surgery (ES), and 17 patients were treated conservatively. Treatment-related morbidity was 25% for OS, 5% for ES, and nil for conservative management (p = 0.004). After a median follow-up of 107 months, patients treated with OS or ES experienced less dysphagia (p < 0.001) and regurgitation (p < 0.001) compared to initial presentation. ES patients had a more favorable quality-of-life score than those treated conservatively (GIQLI: 125 vs. 106; p = 0.010 but not EAT-10: 2 vs. 6; p = 0.207). Recurrence rates were 28% for OS, 62% for ES, and 65% for conservative treatment (p < 0.001). OS was identified as an independent prognostic factor for improved recurrence-free survival.

Conclusion: Despite higher short-term morbidity, OS was associated with the best recurrence-free survival. Long-term symptoms and quality-of-life outcomes were favorable and comparable between OS and ES.