Journal of Gastrointestinal Surgery最新文献

Background: Patterns of work loss among patients with GI cancer remain relatively unknown, particularly regarding the impact of neoadjuvant therapy (NAT). We sought to assess employment disruption and missed workdays among patients with esophageal, pancreatic, and rectal cancers, with a particular focus on the role of NAT.

Methods: Adult patients with esophageal, pancreatic, or rectal cancer were identified from the IBM MarketScan Commercial Claims and Encounters database (2013-2020). Full- or part-time employed patients were matched using entropy balancing to cancer-free individuals with benign GI conditions. Outcomes included employment disruption within 12 months and number of missed workdays. Multivariable Cox and negative binomial regression models were used to estimate adjusted hazard ratios (HRs) and incidence rate ratios (IRRs).

Results: Among 40,008 patients, 5.8% (n=2,314) had a GI cancer diagnosis. In total, 14.4% (n=333) of patients with GI cancer experienced employment disruption compared with 5.2% (n=1,963) of controls (p<0.001). Among patients with cancer, 43.9% (n=1,017) received NAT prior to surgery. NAT recipients were mostly male (67.5% vs. 62.1%) and less likely to have CCI>2 (3.4% vs. 6.2%) than patients undergoing upfront surgery (both p<0.001). Patients receiving NAT more frequently experienced employment disruption (17.9% vs. 11.6%) and more missed workdays (76 days vs. 58 days). On multivariable analysis, NAT receipt was associated with greater hazards of employment disruption (aHR 4.01, 95%CI 3.44-4.68) and more missed workdays (IRR 9.16, 95%CI 8.65-9.70).

Conclusion: A GI cancer diagnosis was associated with employment disruption with a higher impact among patients treated with NAT. Tailored occupational and socioeconomic interventions are needed to improve employment stability among cancer patients.

Objective: To assess and compare the application of stapled and hand-sewn anastomoses in video-assisted thoracoscopic and laparoscopic McKeown esophagectomy in the treatment of esophageal cancer.

Methods: This retrospective study included patients with esophageal cancer treated at our hospital over the period from 2019 to 2022. After a series of preoperative examinations and preparations, as based on current international esophageal cancer surgery protocols, strict quality control indicators were formulated and surgical indications documented (cT1-3N0-2M0). Based on the anastomosis technique employed, patients were divided into either a stapled anastomosis group (stapled anastomosis, n=79) or hand-sewn anastomosis group (hand-sewn anastomosis, n=40). The incidence of postoperative complications and short-term postoperative quality of life were compared between the two groups. With these data, it was possible to assess the reliability of by-layer anastomosis in cervical thoracoscopic McKeown's thoracoscopic and laparoscopic approaches.

Results: There were no significant differences in age, gender, tumor location or cancer stage between the two groups (P>0.05). Statistically significant differences were obtained with regard to the incidence of postoperative anastomotic leakage and stenosis between the hand-sewn anastomosis and the stapled anastomosis group (P<0.05), with the former group showing lower rates of these complications.

Conclusions: The incidence of anastomosis-related complications is lower with manual layer-to-layer anastomosis, a technique which represents a relatively safe surgical procedure for use in McKeown esophagectomy.

Background: The survival differences between splenic flexure cancer (SFC) and descending colon cancer (DCC) are unclear due to their distinct anatomical and molecular features. This study compares their survival outcomes and genetic differences using data from the Surveillance, Epidemiology, and End Results (SEER) and The Cancer Genome Atlas (TCGA) databases.

Methods: This study used SEER data (2000-2022) to compare postoperative patients with splenic flexure cancer (SFC) and descending colon cancer (DCC). Propensity score matching (PSM) was performed to balance baseline characteristics. Overall survival (OS) and cancer-specific survival (CSS) were assessed using the Kaplan-Meier method, and competing-risk analysis with a multivariable Fine-Gray model was applied to evaluate cancer-specific death (CSD). TCGA transcriptomic data were analyzed to identify differentially expressed genes (DEGs) and enriched pathways between SFC and DCC.

Results: A total of 7,579 patients were identified from SEER, including 2,636 with SFC and 4,943 with DCC. After PSM, DCC remained associated with significantly better OS and CSS than SFC. Competing-risk analysis showed that SFC had higher cumulative incidences of both CSD and OCD, and multivariable Fine-Gray analysis further demonstrated that DCC was independently associated with a lower risk of CSD than SFC (sHR=0.73, P=0.019). Younger age and adequate nodal evaluation were protective, whereas advanced tumour burden, particularly T4 and N2 disease, remained strongly adverse. TCGA analysis further demonstrated distinct transcriptional profiles between the two subsites, with SNHG4 upregulated and AHCYL2 downregulated in SFC, alongside subsite-associated differences in fatty acid metabolism, spliceosome-related signalling, and ribosome-associated processes.

Conclusion: SFC is associated with worse survival than DCC, and transcriptomic profiles are distinct between the two subsites in TCGA.

Objective: To explore the effect of the whole individualized comprehensive nursing program on the incidence of anastomotic leakage and prognosis of patients after esophageal cancer surgery.

Methods: A total of 120 patients who planned to undergo radical resection of esophageal cancer from March 2022 to March 2025 were randomly divided into an experimental group (n=60) and a control group (n=60). The experimental group received whole-course individualized comprehensive nursing, including preoperative nutritional risk screening and intervention, precise management of basic diseases, psychological intervention, perioperative preparation under the concept of enhanced recovery after surgery, postoperative fistula targeted nursing, multi-channel fine management, and complication prevention. The control group received routine nursing. The incidence of anastomotic leakage, healing time, hospitalization days, medical expenses, total incidence of postoperative complications, SF-36 quality of life score and nursing satisfaction were compared between the two groups.

Results: The incidence of anastomotic leakage in the experimental group (3.33%) was significantly lower than that in the control group (11.67%). The healing time of fistula and length of hospital stay in the experimental group were shorter than those in the control group, and the medical cost was lower than that in the control group (P<0.05). The total incidence of postoperative complications in the experimental group (8.33%) was lower than that in the control group (20.00%), and the physical health general score, mental health general score and nursing satisfaction score of SF-36 scale at 1 month after operation were significantly higher than those in the control group (P<0.05).

Conclusion: The whole course individualized comprehensive nursing program can effectively reduce the incidence of anastomotic leakage after esophageal cancer surgery, reduce the risk of complications, and improve the quality of life of patients after surgery, which has important clinical application value.

Background: Minimally invasive surgery has been associated with reduced postoperative morbidity compared to traditional open approaches, suggesting that it may be advantageous for frail patients. However, its effect on frail individuals with intraductal papillary mucinous neoplasms (IPMNs) undergoing distal pancreatectomy (DP) remains unclear. This study evaluated the association between surgical approach and postoperative outcomes in the context of patient frailty.

Study design: Using the American College of Surgeons National Surgical Quality Improvement Program database, we identified 1,120 patients with non-malignant IPMN who underwent DP between 2019 and 2023. Frailty was defined as a modified frailty index (mFI) of ≥2, calculated using five variables: diabetes, hypertension, functional dependency, COPD, and CHF. Patients were categorized according to their frailty status and surgical approach (MIS vs. open). Postoperative outcomes, including complications, major complications, readmission, reoperation, and mortality, were compared between groups using univariate and multivariate analyses.

Results: Frail patients comprised 27.7% of the cohort (n=310) and were more likely to experience complications (35.1% vs 28.4%, p=0.042) and longer hospital stay (mean 5.9 versus 5.3 days, p=0.009). In the overall cohort, frailty independently predicted higher odds of complications (OR 1.44, 95% CI: 1.05-1.97) and readmission (OR 1.68, 95% CI: 1.16-2.45), whereas male sex and older age were associated with increased mortality. MIS was not associated with reduced odds of complications, readmission, reoperation, or mortality in the frail or non-frail populations.

Conclusions: Frailty is an independent predictor of complications and readmission after DP for IPMN. However, MIS does not appear to confer benefits over open surgery in frail or non-frail patients.

Background: To evaluate the association between preoperative antithrombin (AT) activity and postoperative outcomes in patients undergoing emergency surgery for non-occlusive mesenteric ischemia (NOMI).

Methods: This study retrospectively analyzed the preoperative AT measurements of 35 patients who underwent emergency surgery for NOMI between January 2012 and December 2025. The primary outcome was the 30-day postoperative mortality. Receiver operating characteristic (ROC) analysis determined the optimal AT cutoff, and outcomes were compared between patients with preoperative AT <75% and ≥75%, with further stratification by preoperative Sequential Organ Failure Assessment (SOFA) score.

Results: Preoperative AT activity was significantly lower in 30-day postoperative non-survivors than survivors (54% vs 77%, p=0.009). A preoperative AT level of <75% was associated with higher rates of postoperative disseminated intravascular coagulation (DIC), greater organ dysfunction, and increased 30-day and in-hospital mortality. Prognostic value was most evident in patients with SOFA <10; all patients with SOFA ≥10 had AT <75% and poor outcomes.

Conclusion: Lower preoperative AT activity may be associated with 30-day postoperative mortality in NOMI. Preoperative AT measurement may help facilitate early risk stratification before the development of advanced multi-organ dysfunction.

Background: Liver metastases from non-colorectal tumors (NONCOLMET) comprise a heterogeneous group historically associated with poor outcomes. Advances in systemic therapy and liver interventions have renewed interest in liver resection (LR) for selected patients, but evidence remains inconsistent and indications vary across tumor types.

Methods: A comprehensive MEDLINE and EMBASE search, up to February 2025, following PRISMA guidelines identified studies assessing outcomes of liver interventions for NONCOLMET. Studies were grouped by primary tumor. Data extracted and summarized included overall survival (OS), prognostic determinants and comparisons with non-surgical management, RESULTS: From 899 screened records, survival after LR varied markedly. The most favorable outcomes were seen in neuroendocrine tumors (median OS 84-120 months) and gastrointestinal stromal tumors (GIST) responding to tyrosine kinase inhibitors (median OS 70-90 months). Breast, and selected uro-gynecological cancers showed a median OS above 36 months. While esophageal, gastric and pancreatic cancer showed benefit only in exceptionally selected, chemo-responsive liver-only disease. Across tumor types, specific favorable prognostic factors included: oligometastatic and liver only disease; longer disease-free interval; radiologic or biomarker response to systemic therapy such as CA19-9 decline in pancreatic cancer, ER/PR positivity in breast cancer, HER2 or PD-L1 expression in gastro-esophageal cancer, TKI response in GIST; well-differentiated histology. Comparative and propensity-matched analyses consistently suggested survival benefit from LR in favorable subsets of patients with NONCOLMET.

Conclusions: LR may provide meaningful survival benefit in carefully selected patients with biologically favorable, liver-dominant NONCOLMET. Multidisciplinary evaluation and tumor-specific selection criteria remain essential. Prospective studies are needed to refine indications.

Background: Post-pancreatectomy acute pancreatitis (PPAP) is increasingly recognized but still disputed clinical entity. Defined by the ISGPS in 2022 as a 48-hour postoperative elevation of serum amylase and radiographic confirmation of pancreatitis. PPAP is graded as postoperative hyperamylasemia (POH), Grade B, and Grade C. The 2023 National Surgical Quality Improvement Program's (NSQIP) pancreatectomy targeted participant use file included for the first time PPAP variables. We hypothesized that these data will reflect the incidence of PPAP in a national sample.

Methods: Patients who underwent a pancreatectomy at 168 participating institutions between January 1^st and December 31^st 2023 were included in the NSQIP pancreatectomy targeted dataset. Cases were identified via CPT codes; variables were captured retrospectively. Data were amassed and managed by the American College of Surgeons NSQIP.

Results: Of 8,015 patients included in the analysis, 1,273 (17%) patients had amylase values. Among them, 782 (61%) had normal serum amylase, 430 (34%) patients had POH, 53 (4.1%), Grade B PPAP, and 8 (0.01%) Grade C PPAP. Multivariable logistic regression found a small pancreatic duct and soft pancreatic texture to be significantly associated with POH and CR-PPAP for head resections. Patients with POH and CR-PPAP were significantly more likely to have any cause morbidity and complications Clavien-Dindo ≥3 (p<0.05, p<0.05).

Conclusions: This first national survey of pancreatectomy patients confirmed a high incidence of POH and PPAP. The low rate of amylase measurement suggests that general education about this disease process will be important. Normal pancreas texture is the most significant risk factor for developing POH/PPAP, and these patients should be considered for mitigation strategies and more liberal use of early post operative imaging.