Journal of Gastrointestinal Surgery最新文献

Background: The incidence of appendiceal cancer has increased over the last two decades. The current study aims to investigate the overall survival and prognostic factors of appendiceal cancer using the National Cancer Data Bank (NCDB) database.

Methods: We used the NCDB (2004-2020) in the current retrospective analysis to include patients with appendiceal cancer. We meticulously selected histologies that corresponded to goblet cell adenocarcinoma (GCA), neuroendocrine neoplasm (NEN), non-mucinous adenocarcinoma (NMA), and mucinous adenocarcinoma (MA).

Results: The GCA, MA, NEN, and NMA groups consist of 6,111, 16,471, 19,199, and 11,065 patients, respectively. The NMA group had significantly lower overall survival (101.40 months, 95% CI (99.13-103.67)) compared to the other groups (p<0.001). The NEN group had significantly higher overall survival (170.88 months, 95% CI (168.56-173.20)) compared to the other groups (p<0.001). Importantly, NMA type of appendiceal tumor (HR: 1.37, reference: GCA), intraoperative chemotherapy (HR: 0.60, reference: neoadjuvant therapy), and laparoscopic approach surgery (HR: 0.74, reference: open approach) were independent predictors of overall survival in patients with appendiceal cancer.

Conclusion: Our study revealed that NMA and NEN types had the poorest and best overall survival rates, respectively, compared to other types. In addition, intraoperative systemic therapy and laparoscopic approach surgery were independently associated with better survival in patients with appendiceal cancer.

Background: Esophageal fistula is a severe clinical condition associated with high mortality rates. Currently, there is no standardized treatment for esophageal fistula. This study aims to investigate the therapeutic outcomes between the conventional treatment group and the transnasal fistula drainage group, while analyzing relevant factors influencing fistula healing.

Methods: This single-center retrospective study analyzed patients diagnosed with benign esophageal fistula and treated at nanchong central hospital between September 2019 and November 2024. Treatment allocation was primarily based on fistula size: patients with small fistulas were assigned to conventional therapy (conventional treatment group), while those with large fistulas received conventional therapy combined with endoscopic transnasal fistula drainage (transnasal fistula drainage group).

Results: The conventional treatment group achieved a healing rate of 88.6%, while the transnasal fistula drainage group showed a healing rate of 85.0%, demonstrating comparable ultimate healing rates between the two approaches. Multivariate analysis identified fistula size and albumin level as two independent prognostic factors affecting patient recovery.

Conclusions: For patients with small fistulas, conventional therapy alone achieves satisfactory healing outcomes. In cases of larger fistulas, the combination of conventional treatment with endoscopic transnasal fistula drainage yields comparable therapeutic efficacy to that observed in small fistulas.

Objectives: Uni-port mediastinoscopic-assisted transhiatal esophagectomy (UMATHE) is increasingly applied in minimally invasive esophageal cancer surgery, particularly for patients unsuitable for transthoracic procedures. This study aimed to quantitatively assess the independent impact of first-assistant experience on surgical efficiency and outcomes in UMATHE.

Methods: We retrospectively analyzed 179 consecutive UMATHE procedures performed by a single surgeon with two fixed assistants. Joinpoint regression identified the learning-curve inflection point. To explore temporal synchrony between assistant experience and surgical performance, we applied seasonal-trend decomposition using Loess (STL) and cross-correlation analysis. Assistant experience (cumulative case count), identity, and surgeon learning phase were then incorporated into linear mixed-effects models (LMMs) and robust linear regression (RLMs) to evaluate their effects on operative time and blood loss.

Results: Joinpoint regression identified a learning curve inflection at case 42. STL and cross-correlation analyses demonstrated synchronized improvement between assistant experience and operative performance. Assistant experience consistently predicted shorter operative time, with significance emerging in the basic model (P = 0.012) and strengthening after adjustment for learning phase and clinical covariates (P < 0.001). The association with blood loss was marginally significant in basic models (P = 0.043) but lost significance with full adjustment. RLMs confirmed these patterns.

Conclusions: First-assistant experience independently enhances operative efficiency once the surgeon has reached procedural proficiency, whereas its influence on blood loss is modest and more team-dependent. Targeted assistant training may unlock further efficiency in complex minimally invasive esophagectomy.

Trial registration: Chinese Clinical Trial Registry, ChiCTR2400093263.

Data availability statement: The data underlying this article will be shared on reasonable request to the corresponding author.

Background: This study aimed to investigate the usefulness of preoperative assessment of grip strength and frailty in predicting surgical outcomes and loss of independence (LOI) after hepatobiliary-pancreatic (HBP) surgery among older adult patients.

Methods: This was a retrospective study that analyzed data of 224 older adults (≥70 years) who underwent HBP surgery for malignancies between June 2020 and May 2023. Grip strength and frailty assessment using a frailty checkup were assessed preoperatively at the first visit. LOI was defined as postoperative transfer for rehabilitation, readmission or mortality, new need for long-term health care, or an increase in the level of care within 6 months postoperatively.

Results: Overall, 49 patients had reduced grip strength, and those with low grip strength were older and had poor nutritional status. Patients with low grip strength had a significantly longer postoperative hospital stay and higher complication and transfer rates than those with normal grip strength. The postoperative LOI was significantly high in patients with low grip strength (P <.001). According to the frailty checkup, low grip strength was significantly associated with falling and decreased frequency of going out. Multivariate analysis revealed that low grip strength was an independent risk factor for postoperative LOI (odds ratio, 7.24; P <.001). Exploratory risk factors for postoperative LOI included a low prognostic nutritional index, pancreatectomy, and low grip strength, and the LOI rate increased significantly as the number of risk factors increased.

Conclusion: Low grip strength may be a useful screening tool for predicting postoperative LOI in older adults undergoing HBP surgery.

Background: Isolated extra-pancreatic metastatic disease within the pancreas is uncommon. The aim of this study was to examine the indications and outcomes of pancreatic resection for metastatic disease in non-pancreatic, non-neuroendocrine malignancy at a high-volume centre.

Methods: This is a retrospective analysis of a prospectively managed database of pancreatic resections for metastatic disease for primary non-pancreatic, non-neuroendocrine tumours at University Hospital Southampton. Data collected and analysed included patient demographics, operative and peri-operative outcomes, survival and recurrence.

Results: 844 patients who underwent pancreatic resection were examined. 26 consecutive patients met the inclusion criteria, representing 3.3% of the units throughout. The median disease-free interval was 65 months. Most resections were for renal cell carcinoma, followed by melanoma, breast and colorectal cancers. The perioperative morbidity was 42.9% with 12 cases of post-operative complications. There were no perioperative deaths. Median overall survival was 41 months, while the median disease-free survival was 17 months for the whole cohort.

Conclusion: When coupled with the low morbidity and mortality rates of a high-volume pancreatic surgery centre using careful patient selection, pancreatic metastectomy has the potential to result in good long-term survival.

Background: Although several postoperative adjuvant therapies for hepatocellular carcinoma (HCC) have shown efficacy in reducing recurrence, no globally accepted guidelines exist for patients with vascular invasion after curative resection. This study aimed to evaluate the efficacy and safety of lenvatinib as adjuvant therapy for HCC patients with vascular invasion after curative liver resection (LR).

Methods: HCC patients with vascular invasion, including microvascular invasion (MVI) and portal vein tumor thrombus (PVTT), who underwent curative resection at two hospitals were retrospectively reviewed. Overall survival (OS), recurrence-free survival (RFS), and recurrence patterns were compared between patients treated with LR alone and those receiving postoperative lenvatinib (LR+Len) using propensity score matching (PSM).

Results: A total of 326 HCC patients with vascular invasion were enrolled. Among them, 248 (76.1%) had MVI. 79 patients were allocated to the LR+Len group, and the others were the LR group. After PSM (1:3), 73 patients were included in the LR+Len group and 172 patients in the LR group. In the matched cohort, patients in the LR+Len group had significantly longer RFS (hazard ratio [HR], 1.54; 95% confidence interval [CI], 1.03-2.29; P=0.032) and OS (HR, 2.11; 95% CI, 1.08-4.10; P=0.025) compared with those undergoing LR alone. Subgroup analysis revealed that adjuvant lenvatinib significantly improved both RFS and OS in patients with MVI but it conferred no benefit for those with PVTT.

Conclusions: Postoperative adjuvant lenvatinib therapy was associated with longer OS and RFS for HCC patients with vascular invasion, particularly for those with MVI.