International journal of surgery最新文献

Background: Local anesthetics as a part of intraarticular therapies (IATs) are widely used for treating knee osteoarthritis (KOA). Whether the substitution of liposomal bupivacaine (LB) for lidocaine is safe and effective in reducing the incidence of injection-emergent adverse events (AEs) after IATs remains unclear.

Methods: We recruited outpatients who had a clinical diagnosis of KOA and decided to receive IATs from November 2023 to April 2024. The type of IATs (glucocorticoids, platelet-rich plasma, and hyaluronic acid) for each participant was decided by the preference of patients after consulting with his or her treating physicians. Using lidocaine or LB as local anesthetics was determined by enrollment timing due to considerations of safety. The primary outcome was injection-emergent AEs after IATs. Secondary outcome measures included the Visual Analog Scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score.

Results: In this study, 123 and 103 patients, respectively, received lidocaine and LB according to their enrollment date. Compared with lidocaine, using LB yielded a reduced incidence of AEs in the overall 2 weeks (LB vs. lidocaine, 30.1% vs. 45.5%, P = 0.018) and week 1 (LB vs. lidocaine, 23.3% vs. 39.8%, P = 0.008). After adjusting for sex, baseline body mass index, age, baseline WOMAC pain subscale score, and K-L grade, the substitution of LB for lidocaine was significantly associated with the reduced incidence of AEs in 2 weeks (OR, 0.484; 95% CI, 0.274-0.853; P = 0.012). In the initial 3 days, the LB groups reported better outcomes in terms of VAS pain score (change from baseline of VAS pain, LB vs. lidocaine, day 1 -8.3 ± 8.9 vs. -1.9 ± 9.3, P < 0.001; day 2 -20.6 ± 16.1 vs. -13.7 ± 19.4, P = 0.005; day 3 -22.3 ± 18.5 vs. -16.3 ± 19.3, P = 0.020). The changes from the baseline of the WOMAC pain subscale at day 14 were similar between the two groups (LB vs. lidocaine, -32.2 ± 11.7 vs. -29.4 ± 11.3, P = 0.073).

Conclusion: With the substitution of LB for lidocaine, patients might have reported reduced incidence of AEs, mainly derived from the superiority in week 1. The substitution of LB for lidocaine was safe in different scenarios of IATs, and future randomized clinical trials were warranted by the current study.

Background: Researchers have long been interested in the potential relationship between osteoarthritis (OA), falls, and fractures; however, the evidence supporting this relationship has been conflicting. This study aimed to investigate the association between osteoarthritis and future fracture events.

Materials and methods: This study was designed as a prospective cohort study. We recruited a total of 440 476 individuals from the UK Biobank to investigate the impact of OA on the incidence of fracture. Among the total population, there were 54 581 participants diagnosed with OA. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

Results: A total of 26 083 fracture events were documented over a median follow-up period of 13.5 years. After multivariable adjustment, participants with osteoarthritis had an HR (95% CI) of 1.11 (1.08, 1.15) for future fracture events compared to participants without osteoarthritis ( P  < 0.0001). Falls explained 16.34% of the association between osteoarthritis and fracture events and 14.15% of the association between knee osteoarthritis and fracture events. The association was not substantially altered across the series of sensitivity analyses.

Conclusion: Osteoarthritis was associated with a greater risk of future fracture events. This finding highlights the importance of preventing future fracture events in people with osteoarthritis.

Background: Esophageal squamous cell carcinoma (ESCC) poses a substantial healthcare challenge, particularly in areas such as East Asia. The pathologic nodal (pN) stage of ESCC remains a controversial factor. Accurately predicting overall survival (OS) after esophagectomy is crucial for treatment planning and improving treatment outcomes.

Method: An analysis was conducted using data from Esophageal Cancer Case Management Database of Sichuan Cancer Hospital and Institute, spanning from January 2010 to December 2017. Our study aimed to examine the clinicopathological characteristics, lymph node resection at individual stations, and treatment details of patients with ESCC who underwent esophagectomy. In addition, a novel nodal stage (N stage) was based on the number of lymph node metastasis (LNM) stations, and a prediction model for OS was devised using the pN stage and the newly proposed N stage.

Results: After analyzing 49 indicators through univariate and multifactorial analyses, 25 of the most significant factors affecting OS after esophagectomy were identified. Further analysis using least absolute shrinkage and selection operator regression revealed six key factors. Models were developed based on the pN stage and the newly introduced N stage. Evaluation of the area under the curve indicated that Model 2 exhibited slightly superior clinical utility compared to Model 1.

Conclusions: Our study demonstrates that the newly introduced N stage, based on the number of LNM stations, exhibits comparable performance to the current American Joint Committee on Cancer/Union for International Cancer Control pN system, with a slight advantageous edge.

Background: We aimed to assess the efficacy and feasibility of applying patient-reported outcome (PRO) based symptom management in the early postoperative period after breast cancer surgery.

Materials and methods: Before surgery, patients diagnosed with breast cancer who met the inclusion criteria were randomly assigned in a 1:1 ratio to receive either postoperative PRO-based symptom management or usual care. All patients completed the MD Anderson Symptom Inventory-Chinese version (MDASI-C) via the electronic PRO system preoperatively, on a daily basis postoperatively, and twice weekly after discharge, for a duration up to 2 weeks. In the PRO-based care group, in addition to receiving usual care, patients whose symptoms reported by completing MDASI-C with a score of ≥4 will be managed symptomatically by the attending surgeon. Patients in the usual care group received routine care and their MDASI-C scores were unknown to their attending surgeon. The primary outcome was the MDASI-C score of patients at the time of discharge. Analyses were conducted in accordance with the established protocol.

Results: Of the 134 participants, 67 were randomly assigned to each group. At discharge, the total score of MDASI-C scale was significantly higher in the usual care group comapred to the PRO-based care group (median [interquartile range], 22 [19] vs. 35 [36]; P = 0.002). The score of FACT-B scale (adjusted mean difference, 0.39; 95% confidence interval, 0.11-1.06; P = 0.009) was significantly lower in the usual care group than in the PRO-based care group during the 14 days after surgery. In the PRO-based care group, 87.2% of patients found the PRO-based symptom management approach helpful in their early postoperative recovery.

Conclusion: The implementation of a PRO-based symptom management system within 2 weeks after breast cancer surgery effectively alleviates symptom burden and improves quality of life compared to usual care.

Osteosarcoma (OS) is a prevalent primary malignant bone tumor, typically managed through a combination of neoadjuvant chemotherapy and surgical interventions. Recent advancements in early detection and the use of novel chemotherapeutic agents have significantly improved the 5-year survival rate of OS patients. However, some patients fail to achieve the desired treatment outcomes despite undergoing intensive chemotherapy and surgical procedures, with chemotherapy resistance emerging as a critical factor contributing to therapeutic failure in OS. Noncoding RNAs (ncRNAs) are a group of RNAs that lack protein-coding capacity but play a crucial role in tumor progression by modulating various biological characteristics of cancer cells, such as proliferation, apoptosis, migration, invasion, and drug resistance. Emerging evidence indicates that the dysregulated expression of numerous ncRNAs in OS cells can influence the response to chemotherapeutic agents by modulating processes such as cell apoptosis, signaling pathways, intracellular drug concentrations, and cell autophagy. This review aims to elucidate the roles and mechanisms of ncRNAs in mediating drug resistance in OS, offering new insights for investigating novel pathways underlying drug resistance, overcoming tumor resistance to therapeutics, and developing innovative chemotherapeutic strategies.

Background and aims: Endoscopic submucosal dissection (ESD) is a pivotal technique for excision of early-stage esophageal tumors. However, its primary complication, postoperative esophageal stricture, is a significant challenge owing to the absence of effective preventive measures. Adipose-derived stem cells (ADSCs) have emerged as a promising treatment modality to address this concern. In this study, we aimed to investigate, for the first time, the efficacy of allogenic ADSC injections in preventing esophageal stenosis after ESD.

Methods: We administered allogeneic ADSC injections (same-species but different individual) to a porcine model of ESD as a way to observe the role of ADSC in preventing esophageal stricture. We also co-cultured rats' ADSCs with rats' esophageal fibroblasts and esophageal mucosal epithelial cells to investigate the mechanism.

Results: ADSCs notably facilitated epithelial-mesenchymal transition of epithelial cells. Furthermore, ADSC-conditioned medium exhibited a substantial inhibitory effect on fibroblast proliferation and migration, which was mediated by the transforming growth factor-beta pathway.

Conclusions: Our findings underscore the potential of ADSC injections as a promising therapeutic intervention to enhance recovery and prevent post-ESD complications.

This study aimed to develop a predictive nomogram model and a risk classification system to predict the likelihood of lymph node metastases for non-metastatic muscle-invasive bladder cancer (MIBC) patients using a large population-based cancer database. According to our nomogram, larger tumor size, overlapping lesions, young age, female, poorly differentiated histological grade, and advanced T stage, are independent risk factors for pN+. A precise nomogram model predicting pN+ probability for MIBC patients can support patient risk stratification and outcome estimation, and eventually guide clinical decision-making.

Background: This study aims to assess the comparative effectiveness and safety of robotic-assisted surgery (RAS), laparoscopy (LPS), and laparotomy (LPT) in improving perioperative indicators, lymph node dissection, and tumor survival outcomes in patients with endometrial carcinoma (EC) through a systematic review and network meta-analysis (NMA).

Materials and methods: We searched China National Knowledge Infrastructure, Wanfang, WeiPu, China Biology Medicine Disc, Embase, PubMed, Web of Science, and the Cochrane Library for randomized controlled trials (RCTs) and cohort studies (CSs) involving RAS, LPS and LPT in individuals with EC. The NMA employed a Bayesian framework to integrate direct and indirect evidence, calculating odds ratios (OR) and mean difference (MD). Markov chain Monte Carlo methods generated posterior distributions, comparing and ranking treatments using surface under the cumulative ranking (SUCRA) values. Regression and sensitivity analyses assessed the impact of different variables on the results.

Results: 37 eligible trials involving 3 surgical techniques and 6,558 participants were included in this NMA. Our data showed that RAS was the most effective way for reducing estimated blood loss (MD -193; 95% CI [-279.38 to -106.95]; SUCRA 80.3%), length of hospital stay (MD -3.8; 95% CI [-5.37 to -2.31]; SUCRA 90.2%), transfusion rate (OR 0.13; 95% CI [0.06 to 0.28]; SUCRA 87%), intraoperative complications (OR 0.23; 95% CI [0.06 to 0.8]; SUCRA 91.3%), postoperative complications (OR 0.29; 95% CI [0.18 to 0.51]; SUCRA 98.8%), and total complications (OR 0.24; 95% CI [0.1 to 0.61]; SUCRA 96%). However, the analysis showed no significant differences in the dissection of lymph nodes and tumor survival outcomes.

Conclusion: Our results showed that RAS was the most effective surgical method for improving perioperative indicators in EC. If hospital resources are limited, LPS is a suitable alternative. Further research is needed to confirm these findings and ensure that the benefits of minimally invasive surgeries extend to long-term survival outcomes.