Journal of Gastrointestinal Surgery最新文献_第8页

Challenges faced by patients undergoing fecal ostomy surgery: a qualitative study of colorectal cancer patient perspectives 直肠造口手术患者面临的挑战：结直肠癌患者观点的定性研究。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-15 DOI: 10.1016/j.gassur.2025.101963

Stefanie J. Soelling , Atziri Rubio-Chavez , Zoe Ingram , Laura Baird , Mary E. Brindle , Zara Cooper , Ana-Maria Vranceanu , Christine S. Ritchie , Christy E. Cauley

Background

Education and support for ostomy are instrumental in surgical recovery and adaptation. This study aimed to evaluate (i) the challenges faced by fecal ostomy patients with colorectal cancer and (ii) the resources necessary for recovery.

Methods

This study recruited patients 21 to 90 days after scheduled fecal ostomy surgery for locally advanced or metastatic colorectal cancer from a single tertiary academic center. This study conducted 1:1 semistructured interviews until thematic saturation using hybrid deductive-inductive coding.

Results

This study interviewed 20 patients (80% male; mean age of 59.7 years). Several major themes emerged, including challenges in (i) practical ostomy management, (ii) emotional distress, (iii) adaptation to daily life, and (iv) provider relationships. The participants faced ostomy care challenges owing to peristomal skin issues, leaks, and difficulty ordering supplies. Many participants noted significant distress or anxiety related to embarrassment caused by leaks, odors, or noise. This distress led participants to fear going out in public, embarrassment from the ostomy, and anxiety about their daily activities (eg, returning to work and relationships). When adapting to life with an ostomy, several participants noted that anxiety affected their ability to care for the ostomy and resume their daily activities, leading to social isolation. Patients reported challenges with provider relationships and a lack of anticipatory guidance from the surgical team preoperatively, including insufficient education on practical management, ordering of ostomy supplies, ensuring adequate hydration, and maintaining proper nutrition.

Conclusion

Patients with colorectal cancer who require fecal ostomy face several challenges related to ostomy. Interventions that address practical management, navigating distress, adaptation, and provider education are needed to provide tailored education and support.

背景：造口教育和支持有助于手术恢复和适应。我们的目的是评估1)结肠直肠癌患者粪便造口术面临的挑战和2)恢复所需的资源。方法：我们从一个单一的三级学术中心招募了局部晚期或转移性结直肠癌患者，他们在预定的粪便造口手术后21-90天。我们进行了1:1的半结构化访谈，直到主题饱和，使用混合演绎-归纳编码。结果：我们采访了20例患者，其中80%为男性，平均年龄59.7岁。出现了几个主要的主题，包括：1)实际造口管理的挑战，2)情绪困扰，3)适应日常生活，4)医生关系。由于口周皮肤问题，泄漏和订购物资困难，参与者面临造口护理挑战。许多参与者注意到与泄漏、气味或噪音有关的尴尬严重的痛苦/焦虑。这种痛苦导致参与者害怕在公共场合外出，因造口手术而感到尴尬，以及对日常活动（例如，重返工作和人际关系）感到焦虑。在适应造口术的生活时，一些参与者指出，焦虑影响了他们照顾造口术和恢复日常活动的能力，导致社会孤立。患者报告了与医生关系的挑战，术前缺乏手术团队的预期指导，包括对实际管理的教育不足，订购造口用品，确保充足的水合作用和维持适当的营养。结论：结直肠癌患者粪便造口术面临诸多挑战。干预措施，解决实际管理，导航窘迫，适应和提供者教育需要提供量身定制的教育和支持。

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引用次数: 0

Data leakage of the National Surgical Quality Improvement Program present at time of surgery variables NSQIP在手术变量时的数据泄露。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-14 DOI: 10.1016/j.gassur.2025.101965

Tyler Zander , Melissa A. Kendall , Rachel L. Wolansky , Rajavi Parikh , Joseph Sujka , Paul C. Kuo

引用次数: 0

Dual automated segmentation of nerves and loose connective tissue with artificial intelligence during suprapancreatic lymph node dissection in robotic gastrectomy 机器人胃切除术胰上淋巴结清扫过程中神经和松散结缔组织的人工智能双重自动分割。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-14 DOI: 10.1016/j.gassur.2025.101964

Motoki Murakami, Tatsuro Nakamura, Hisashi Shinohara

引用次数: 0

Quality of gastrointestinal surgical oncology care according to insurance status 基于保险状况的胃肠外科肿瘤护理质量。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-10 DOI: 10.1016/j.gassur.2025.101961

Samuel D. Butensky , Daniel Kerekes , Baylee F. Bakkila , Kevin G. Billingsley , Nita Ahuja , Caroline H. Johnson , Sajid A. Khan

Background

Despite efforts to expand insurance coverage, substantial inequalities persist, particularly in cancer treatment. This study aimed to evaluate whether quality disparities exist across major insurance plans for patients undergoing curative-intent resection for gastrointestinal (GI) cancers.

Methods

This was a retrospective study of adult patients in the National Cancer Database diagnosed with GI malignant neoplasms between January 1, 2004, and December 31, 2020. The primary tumor organ sites include the anus, colon, esophagus, gallbladder, liver, other biliary organ, pancreas, peritoneum, rectum, rectosigmoid, small intestine, and stomach. Multivariate linear regression was used to evaluate the effect of insurance status on resection margin, adequacy of lymphadenectomy, and receipt of lymphadenectomy. A Cox proportional hazards model was used for survival analysis.

Results

Of the 1,084,555 patients in this study, 594,013 (54.8%) had Medicare insurance, 380,287 (35.1%) had private insurance, 57,402 (5.3%) had Medicaid insurance, and 29,133 (2.7%) were uninsured. Privately insured patients were more likely to have negative margins (odds ratio [OR], 1.08; 95% CI, 1.06–1.10) and adequate lymphadenectomies (OR, 1.06; 95% CI, 1.04–1.06) than Medicare-insured patients. Uninsured patients were the least likely to have negative margins (OR, 0.78; 95% CI, 0.75–0.81) and adequate lymphadenectomies (OR, 0.95; 95% CI, 0.92–0.99) than Medicare-insured patients. Non–Medicare-insured patients were more likely to receive adjuvant therapy, whereas Medicare-insured patients had higher omission rates because of comorbidities. Finally, multivariate survival analysis showed that Medicare-insured patients had a 14% increased risk of death compared with non–Medicare-insured patients.

Conclusion

Significant disparities in the quality of surgical oncology care exist based on insurance status. Healthcare policy interventions may be necessary to ensure equitable access to high-quality surgical GI cancer care in the United States.

背景：尽管努力扩大保险覆盖范围，但实质性的不平等仍然存在，特别是在癌症治疗方面。我们的目的是评估是否存在质量差异的主要保险计划的患者接受治疗意图切除胃肠道（GI）癌症。方法：对2004年1月1日至2020年12月31日期间在国家癌症数据库（NCDB）中诊断为胃肠道恶性肿瘤的成年患者进行回顾性研究。原发肿瘤的器官部位有：肛门、结肠、食道、胆囊、肝脏、其他胆道、胰腺、腹膜、直肠、直肠乙状结肠、小肠和胃。采用多变量线性回归评估保险状况对切除边缘、淋巴结切除是否充分和接受淋巴结切除的影响。生存率分析采用Cox比例风险模型。结果：在本研究的1,084,555名患者中，54.8%的人有医疗保险，35.1%的人有私人保险，5.3%的人有医疗补助，2.7%的人没有保险。与医疗保险患者相比，私人保险患者更有可能出现负切缘（OR, 1.08 [95% CI, 1.06-1.10]）和充分的淋巴结切除术（OR, 1.06 [95% CI, 1.04-1.06]）。与有医疗保险的患者相比，未投保的患者最不可能出现阴性切缘（OR, 0.78 [95% CI, 0.75-0.81]）和充分的淋巴结切除术（OR, 0.95 [95% CI, 0.92-0.99]）。非医疗保险患者更有可能接受辅助治疗，而医疗保险患者由于合并症而有更高的遗漏率。最后，多变量生存分析显示，与非医保患者相比，医保患者的死亡风险增加了14%。结论：不同的保险状况在肿瘤外科治疗质量上存在显著差异。在美国，医疗保健政策干预可能是必要的，以确保公平获得高质量的胃肠道肿瘤手术治疗。

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引用次数: 0

Impact of anastomotic leak vs pneumonia on failure to rescue after transthoracic esophagectomy for cancer 吻合口漏与肺炎对经胸食管癌切除术后抢救失败的影响。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-09 DOI: 10.1016/j.gassur.2024.101936

Luca Giulini , Melissa Kemeter , Filitsa Farmaki , Lucas Thumfart , Felix J. Hüttner , Patrick Heger , Oliver Koch , Michael Grechenig , Michael Weitzendorfer , Klaus Emmanuel , Wolfgang Hitzl , Konstantin E. Thiel , Markus K. Diener , Attila Dubecz

Background

Data about failure to rescue (FTR) after esophagectomy for cancer and its association with patient and procedure-related risk factors are limited. This study aimed to analyze such aspects, particularly focusing on the effect of pneumonia and anastomotic leak on FTR.

Methods

Patients who underwent an Ivor Lewis esophagectomy for cancer between 2008 and 2022 in 2 tertiary European centers were prospectively identified. Patients were classified and compared according to the type of operation (open, laparoscopic hybrid, robotic hybrid, minimally invasive, or robotic minimally invasive). FTR was defined as in-hospital death after a major complication. Risk factors for FTR were identified using a univariate model. Mortality after pneumonia and anastomotic leak were calculated and compared between the groups.

Results

A total of 708 patients were included. There were 355 open procedures (50.1%), 204 laparoscopic hybrid procedures (28.8%), 121 hybrid robotic procedures (17.1%), 15 standard minimally invasive procedures (2.1%), and 11 robotic minimally invasive procedures (1.6%). The overall morbidity was 60.0%, and the FTR rate was 4.5%. Anastomotic leak, pneumonia, postoperative bleeding, sepsis, pulmonary embolism, arrhythmia, and need for blood transfusion were the risk factors significantly associated with in-hospital mortality (P <.05). There was no particular type of operation significantly associated with mortality (P =.42). Pneumonia- and leak-associated FTR rates did not significantly differ among the groups (P =.99).

Conclusion

Anastomotic leak and pneumonia are equally dangerous complications after esophagectomy for cancer. If performed in high-volume centers, hybrid or minimally invasive methods do not seem to negatively affect the FTR rates. Further efforts should be made to improve both tailored-approach and postoperative care.

背景：关于食管癌切除术后抢救失败（FTR）及其与患者和手术相关危险因素的关系的数据有限。本研究旨在分析这些方面，特别关注肺炎和吻合口漏对FTR的影响。方法：对2008年至2022年间在2个欧洲三级中心接受Ivor Lewis食管癌切除术的患者进行前瞻性研究。根据手术类型（开放、腹腔镜混合、机器人混合、微创或机器人微创）对患者进行分类和比较。FTR定义为主要并发症后的院内死亡。使用单变量模型确定FTR的危险因素。计算两组肺炎和吻合口瘘后的死亡率并进行比较。结果：共纳入708例患者。其中开放手术355例（50.1%），腹腔镜混合手术204例（28.8%），混合机器人手术121例（17.1%），标准微创手术15例（2.1%），机器人微创手术11例（1.6%）。总发病率为60.0%，FTR为4.5%。吻合口漏、肺炎、术后出血、败血症、肺栓塞、心律失常、需要输血是与住院死亡率显著相关的危险因素(P结论：吻合口漏与肺炎是癌性食管切除术后同样危险的并发症。如果在大容量中心进行，混合或微创方法似乎不会对FTR率产生负面影响。应进一步努力改善量身定制的方法和术后护理。

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引用次数: 0

SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS. 亚厘米侧支ipns的监测：侵袭性疾病的风险和随访建议。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-08 DOI: 10.1016/j.gassur.2025.101959

Chase J Wehrle, R Matthew Walsh, Pranav Kumar, Breanna Perlmutter, Jenny H Chang, Abby Gross, Rob Naples, Kathryn A Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon

Objective: Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort.

Background: SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (<1cm) lesions. Data are absent regarding the risk of progression in sub-centimeter cysts.

Methods: A prospectively maintained database was queried for SB-IPMNs undergoing non-operative surveillance with >2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.

Results: One-thousand patients were included, 291 (29.1%) with SB-IPMN<1cm. Median follow-up from diagnosis was 7.1 years (IQR 3.2-10.4 years) in sub-centimeter cysts vs. 6.4 years (IQR 2.8-10.0 years) in those >1cm (p=0.090). CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p<0.001). Cysts that progressed did so at similar time intervals (Median=3.7 vs. 3.3 years, p=0.707). Sub-centimeter cysts developed both IC (1.4% vs 1.8%, log-rank p=0.608), and high-risk pathology (HGD/IC) at a similar rate ( p=0.198) to larger cysts. Cysts that were initially stable for 5 years of surveillance (n=547) developed high-risk pathology in 4.7% (n=25). This was not different by initial cyst size (log-rank p=0.116). Spline curves demonstrate consistently low risk of HGD/IC across increasing cyst size despite a higher rate of CR-progression. CR-progression criteria best discriminated high-risk patholgogy in sub-centimeter cysts. Rate of size growth did not correlate with high-risk pathology (HR=1.14, 95%CI 0.88-1.50).

Conclusion: Sub-centimeter SB-IPMNs develop malignant potential as frequently as their larger counterparts and do so at similar time courses. Often incidental, sub-centimeter presumed SB-IPMNs are diagnosed at arbitrary points in their disease course, and require similar surveillance duration to their larger counterparts., Rate of growth is not predictive of high-risk pathology. t These cysts do not develop CR-progression as frequently, but such features better discriminate high risk pathology in sub centimeter cysts, making development of such features more concerning when they occur.

目的：明确亚厘米侧支导管内乳头状粘液瘤（SB-IPMN）的相关风险，并提出基于该队列的监测策略。背景：随着高保真横断面成像，特别是亚厘米横断面成像的使用越来越多，越来越多地发现sb - ipmn（方法：对一个前瞻性维护的数据库进行查询，以进行非手术监测，间隔>6个月进行>2横断面成像研究。）临床相关进展（CR-Progression）以前被定义为症状的发展、令人担忧的/高风险的污点或浸润性癌症（IC）。2年内增长0.5 mm被认为是cr进展；仅bbbb30厘米的尺寸就不是。结果：纳入患者1000例，其中SB-IPMN1cm 291例（29.1%），差异有统计学意义（p=0.090）。亚厘米组的cr进展较少见（7.2% vs. 19%, log-rank p）。结论：亚厘米sb - ipmn发生恶性潜能的频率与较大的sb - ipmn相同，且发生时间相同。通常是偶然的，亚厘米推定的sb - ipmn在其病程中的任意点被诊断出来，并且需要与较大的同类相似的监测时间。生长速度不能预测高危病理。这些囊肿不经常发展为cr进展，但这些特征可以更好地区分亚厘米囊肿的高风险病理，使得这些特征的发展在发生时更加值得关注。

{"title":"SURVEILLANCE OF SUB-CENTIMETER SIDE-BRANCH IPMNS: RISK OF INVASIVE DISEASE AND FOLLOW-UP RECOMMENDATIONS.","authors":"Chase J Wehrle, R Matthew Walsh, Pranav Kumar, Breanna Perlmutter, Jenny H Chang, Abby Gross, Rob Naples, Kathryn A Stackhouse, Samer Naffouje, Daniel Joyce, Toms Augustin, Robert Simon","doi":"10.1016/j.gassur.2025.101959","DOIUrl":"https://doi.org/10.1016/j.gassur.2025.101959","url":null,"abstract":"<p><strong>Objective: </strong>Define the risk associated with sub-centimeter Side-Branch Intraductal Papillary Mucinous Neoplasms (SB-IPMN) and propose a surveillance strategy based on this cohort.</p><p><strong>Background: </strong>SB-IPMNs are increasingly discovered with the growing use of high-fidelity cross-sectional imaging, particularly sub-centimeter (<1cm) lesions. Data are absent regarding the risk of progression in sub-centimeter cysts.</p><p><strong>Methods: </strong>A prospectively maintained database was queried for SB-IPMNs undergoing non-operative surveillance with >2 cross-sectional imaging studies >6 months apart. Clinically-relevant progression (CR-Progression) has been previously defined by development of symptoms, worrisome/high-risk stigmata, or invasive cancer (IC). Growth >5mm in 2years is considered CR-Progression; size>3cm alone is not.</p><p><strong>Results: </strong>One-thousand patients were included, 291 (29.1%) with SB-IPMN<1cm. Median follow-up from diagnosis was 7.1 years (IQR 3.2-10.4 years) in sub-centimeter cysts vs. 6.4 years (IQR 2.8-10.0 years) in those >1cm (p=0.090). CR-progression was less common in the sub-centimeter group (7.2% vs. 19%, log-rank p<0.001). Cysts that progressed did so at similar time intervals (Median=3.7 vs. 3.3 years, p=0.707). Sub-centimeter cysts developed both IC (1.4% vs 1.8%, log-rank p=0.608), and high-risk pathology (HGD/IC) at a similar rate ( p=0.198) to larger cysts. Cysts that were initially stable for 5 years of surveillance (n=547) developed high-risk pathology in 4.7% (n=25). This was not different by initial cyst size (log-rank p=0.116). Spline curves demonstrate consistently low risk of HGD/IC across increasing cyst size despite a higher rate of CR-progression. CR-progression criteria best discriminated high-risk patholgogy in sub-centimeter cysts. Rate of size growth did not correlate with high-risk pathology (HR=1.14, 95%CI 0.88-1.50).</p><p><strong>Conclusion: </strong>Sub-centimeter SB-IPMNs develop malignant potential as frequently as their larger counterparts and do so at similar time courses. Often incidental, sub-centimeter presumed SB-IPMNs are diagnosed at arbitrary points in their disease course, and require similar surveillance duration to their larger counterparts., Rate of growth is not predictive of high-risk pathology. t These cysts do not develop CR-progression as frequently, but such features better discriminate high risk pathology in sub centimeter cysts, making development of such features more concerning when they occur.</p>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":" ","pages":"101959"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965535","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Ileosigmoid knotting: an unusual case of small bowel strangulation 回肠乙状结肠结：小肠绞窄的罕见病例。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-08 DOI: 10.1016/j.gassur.2025.101953

Rahul Gupta , Jyoti Gupta

引用次数: 0

Effects of location of primary tumor on survival after pulmonary metastasectomy for colorectal cancer 原发肿瘤的位置影响结直肠癌肺转移切除术后的生存。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-08 DOI: 10.1016/j.gassur.2025.101954

Vijay Putatunda , Frank Villa Hernandez , Max J. Freidlin , Chuong D. Hoang , Jonathan M. Hernandez , Shamus R. Carr

Background

The benefit of pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) with isolated lung metastases remains unclear, and failure to separate colon from rectal cancer may contribute. Using a large national database, we investigate whether PM is associated with survival benefits in patients presenting with CRC with synchronous lung metastases based on primary tumor location.

Methods

The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 was queried to identify patients with stage IV CRC with isolated synchronous lung metastases at initial diagnosis. These patients were restricted to include only those in which the location of the primary tumor being either colon or rectum could be conclusively identified, and the primary site was resected. SEER-Medicare linked claims were also queried to identify cases of PM that were not adequately recorded in SEER alone. Patients were then analyzed using Kaplan-Meier (K-M) methods and multivariate analysis was performed to identify variables associated with overall survival (OS).

Results

From the SEER database 185,871 patients with metastatic CRC were identified. Only 588 had isolated synchronous lung metastases, with 441 with colon cancer and 147 with rectal cancer. PM was performed in 15.3% (n = 90) with two-thirds being colon cancer. Univariate K-M demonstrated worse OS for rectal cancer than colon cancer, which remained significant on multivariate analysis.

Conclusion

OS is associated with the site of primary CRC in patients undergoing PM. Distinct mutational and molecular characteristics differences between colon and rectal cancer may explain these findings and are an area for future research.

背景：肺转移切除术（PM）对分离性肺转移的结直肠癌（CRC）患者的益处尚不清楚，未能将结肠癌与直肠癌分开可能是原因之一。利用一个大型的国家数据库，我们研究了基于原发肿瘤位置的同步肺转移的结直肠癌患者的PM是否与生存获益相关。方法：查询2010年至2015年的监测、流行病学和最终结果（SEER）数据库，以确定初诊时伴有分离性同步肺转移的IV期结直肠癌患者。这些患者仅限于那些原发肿瘤在结肠或直肠的位置可以确定的患者，并且原发部位被切除。还查询了与SEER相关的医疗保险索赔，以确定单独在SEER中未充分记录的PM病例。然后使用Kaplan-Meier （K-M）方法对患者进行分析，并进行多变量分析以确定与总生存期（OS）相关的变量。结果：从SEER数据库中确定了185,871例转移性结直肠癌患者。只有588例肺同步转移，其中441例为结肠癌，147例为直肠癌。15.3% （n=90）患者行PM，其中三分之二为结肠癌。单变量K-M显示直肠癌的OS比结肠癌差，多变量分析中仍然显着。结论：OS与PM患者原发性结直肠癌部位相关。结肠癌和直肠癌之间不同的突变和分子特征差异可能解释了这些发现，这是未来研究的一个领域。

{"title":"Effects of location of primary tumor on survival after pulmonary metastasectomy for colorectal cancer","authors":"Vijay Putatunda , Frank Villa Hernandez , Max J. Freidlin , Chuong D. Hoang , Jonathan M. Hernandez , Shamus R. Carr","doi":"10.1016/j.gassur.2025.101954","DOIUrl":"10.1016/j.gassur.2025.101954","url":null,"abstract":"<div><h3>Background</h3><div>The benefit of pulmonary metastasectomy (PM) in patients with colorectal cancer (CRC) with isolated lung metastases remains unclear, and failure to separate colon from rectal cancer may contribute. Using a large national database, we investigate whether PM is associated with survival benefits in patients presenting with CRC with synchronous lung metastases based on primary tumor location.</div></div><div><h3>Methods</h3><div>The Surveillance, Epidemiology, and End Results (SEER) database from 2010 to 2015 was queried to identify patients with stage IV CRC with isolated synchronous lung metastases at initial diagnosis. These patients were restricted to include only those in which the location of the primary tumor being either colon or rectum could be conclusively identified, and the primary site was resected. SEER-Medicare linked claims were also queried to identify cases of PM that were not adequately recorded in SEER alone. Patients were then analyzed using Kaplan-Meier (K-M) methods and multivariate analysis was performed to identify variables associated with overall survival (OS).</div></div><div><h3>Results</h3><div>From the SEER database 185,871 patients with metastatic CRC were identified. Only 588 had isolated synchronous lung metastases, with 441 with colon cancer and 147 with rectal cancer. PM was performed in 15.3% (n = 90) with two-thirds being colon cancer. Univariate K-M demonstrated worse OS for rectal cancer than colon cancer, which remained significant on multivariate analysis.</div></div><div><h3>Conclusion</h3><div>OS is associated with the site of primary CRC in patients undergoing PM. Distinct mutational and molecular characteristics differences between colon and rectal cancer may explain these findings and are an area for future research.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101954"},"PeriodicalIF":2.2,"publicationDate":"2025-01-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142965531","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Prognostic factors for relapse-free 5-year survivors after gastrectomy for gastric cancer 胃癌切除术后无复发5年存活者的预后因素分析。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-08 DOI: 10.1016/j.gassur.2025.101958

Genta Yano , Hideo Miyake , Hidemasa Nagai , Yuichiro Yoshioka , Koji Shibata , Junichi Takamizawa , Norihiro Yuasa

Background

Few studies have examined the prognosis of long-term survivors with gastric cancer (GC) after gastrectomy. This study aimed to identify the prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC.

Methods

A total of 721 patients with pathologic stage Ⅰ to Ⅲ GC who underwent gastrectomy between 2005 and 2018 and survived for 5 years without recurrence were enrolled. Conditional overall survival (cOS), conditional disease-specific survival (cDSS), and conditional non–disease-specific survival (cNDSS) of 5-year recurrence-free survivors were calculated. The association between cOS, cDSS, and cNDSS and clinicopathologic factors was evaluated using univariate and multivariate analyses.

Results

The mean age of the patients was 70.5 ± 10.1 years, 68.5% of the patients were male, and 491, 128, and 102 had stage Ⅰ, Ⅱ, and Ⅲ GC, respectively. Of note, 17 patients relapsed, and 65 patients died (disease-specific, non–disease-specific, and unknown: 12, 45, and 6, respectively) during a median follow-up of 36 months. The 5-year cOS, cDSS, and cNDSS rates were 90.3%, 97.3%, and 93.3%, respectively. Multivariate analysis showed that age of ≥80 years and neutrophil-to-lymphocyte ratio (NLR) of ≥2.7 were significantly associated with poorer cOS. Stage Ⅲ GC was associated with decreased cDSS, and age of ≥80 years, NLR of ≥2.7, and mean corpuscular volume (MCV) of ≥93.4 fL were associated with lower cNDSS.

Conclusion

Age of ≥80 years, stage Ⅲ GC, NLR of ≥2.7, and MCV of ≥93.4 fL were unfavorable prognostic factors for 5-year recurrence-free survivors after gastrectomy for GC. Long-term surveillance after gastrectomy could be tailored based on these factors.

背景：很少有研究调查胃切除术后胃癌（GC）长期存活者的预后。本研究旨在确定胃癌切除术后5年无复发幸存者的预后因素。方法：入选2005 - 2018年间行胃切除术的病理期Ⅰ-Ⅲ胃癌患者721例，存活5年无复发。计算5年无复发幸存者的条件总生存期（cOS）、条件疾病特异性生存期（cDSS）和条件非疾病特异性生存期（cNDSS）。使用单因素和多因素分析评估cOS、cDSS和cNDSS与临床病理因素之间的关系。结果：患者平均年龄为70.5±10.1岁，男性占68.5%，分别有491、128、102例为Ⅰ、Ⅱ、Ⅲ期GC。在中位随访36个月期间，17例患者复发，65例患者死亡（疾病特异性、非疾病特异性和未知：分别为12例、45例和6例）。5年期cOS、cDSS和cNDSS的比率分别为90.3%、97.3%和93.3%。多因素分析显示，年龄≥80岁、中性粒细胞与淋巴细胞比值(NLR)≥2.7与较差的cOS显著相关；Ⅲ期GC与cDSS降低相关；年龄≥80岁、NLR≥2.7、平均红细胞体积(MCV)≥93.4 fl与较低的cNDSS相关。结论：年龄≥80岁，分期ⅢGC， NLR≥2.7,MCV≥93.4 fl是胃癌切除术后5年无复发幸存者的不利预后因素。胃切除术后的长期监测可以根据这些因素进行调整。

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引用次数: 0

Distinct clinical phenotypes in gastric pathologies: a cluster analysis of demographic and biomarker profiles in a diverse patient population 胃病理的不同临床表型：不同患者群体中人口统计学和生物标志物概况的聚类分析。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-08 DOI: 10.1016/j.gassur.2025.101956

Neda Gorjizadeh , Ali Sheibani Arani , Seyed Amir Miratashi Yazdi , Mohammad Biglari , Massih Bahar

Background

Understanding the heterogeneity of a population at risk is an important step in the early detection of gastric cancer. This study aimed to cluster demographic, hematologic, and biochemical markers of gastric cancer in a heterogeneous sample of patients.

Methods

Data of 695 adult patients (50.0% women) who were diagnosed with histologically confirmed gastric cancer or benign gastric disease or identified as healthy individuals (December 2018 to August 2019; Hangzhou, China) were analyzed. A hierarchical clustering was performed using a factorial analysis of mixed data. To assess the clustering scheme, a machine-learning classification model was developed using the Extreme Gradient Boosting algorithm and subsequently ranked the variables for differentiating patient phenotypes.

Results

Of note, 3 clusters were identified using patient characteristics. The classification model demonstrated high performance (multiclass area under the curve = 0.921) in recognizing the clusters. The top 5 important variables in differentiating the clusters were sex (male/female), hemoglobin, albumin, creatinine, and high-density lipoprotein (all analysis of variance P <.001) in decreasing order of importance. The prevalence rates of gastric cancer in clusters I, II, and III were 95.8%, 53.8%, and 34%, respectively (χ²(2) = 164.050; P <.001). Cluster I (n = 167) predominantly had an inflammatory profile, cluster II (n = 240) had metabolic disturbances, and cluster III (n = 288) had a relatively favorable metabolic and inflammatory profile.

Conclusion

There were distinct clinical phenotypes in the population, each with varying prevalence of gastric cancer. A combination of routine clinical data outperformed carbohydrate or carcinoembryonic antigens in capturing the heterogeneity of the population regarding gastric pathologies.

背景：了解高危人群的异质性是早期发现胃癌的重要一步。我们的目的是在异质患者样本中聚集胃癌的人口统计学、血液学和生化标志物。方法：对2018年12月至2019年8月中国杭州695例经组织学确诊为胃癌、良性胃疾病或健康个体的成年患者（50.0%为女性）的资料进行分析。我们使用混合数据的析因分析进行分层聚类。为了评估聚类方案，我们还开发了一个使用极端梯度增强算法的机器学习分类模型，随后对用于区分患者表型的变量进行排序。结果：根据患者特征确定了三组。该分类模型具有较好的聚类识别性能（多类AUC = 0.921）。性别、血红蛋白、白蛋白、肌酐、高密度脂蛋白是鉴别胃癌聚集性的前5个重要变量（方差分析P 2(2) = 164.050， P）。结论：人群中存在不同的临床表型，每种表型具有不同的胃癌患病率。常规临床数据的组合优于碳水化合物或癌胚抗原在捕获有关胃病理人群的异质性。

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引用次数: 0