Journal of Gastrointestinal Surgery最新文献_第9页

Reduction of postoperative ileus in gastrointestinal surgery: systematic review and meta-analysis 胃肠道手术中术后肠梗阻的减少。系统回顾和荟萃分析。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-07 DOI: 10.1016/j.gassur.2025.101960

Doris Sarmiento-Altamirano , Daniel Arce-Jara , Pablo Balarezo-Guerrero , Rafael Valdivieso-Espinoza

Background

Postoperative ileus is a surgical complication that affects intestinal motility. There are measures to reduce this problem, but not all have conclusive evidence. This study aimed to determine which measures, such as coffee, chewing gum (CG), electroacupuncture (EA), daikenchuto (DKT), and prokinetic agents, are most effective in reducing postoperative ileus in patients undergoing gastrointestinal surgeries.

Methods

A systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Google Scholar, PubMed, ScienceDirect, and Web of Science. The following measures were studied to define postoperative ileus: time to passage of the first flatus and time to passage of the first stool. The mean differences were determined by subgroup analyses.

Results

Of 176 studies, 37 were selected for the systematic review, which involved 4647 patients. The reduction in time to passage of the first flatus was −18.33 h (95% CI, −26.46 to −10.20; P <.01) for EA, −5.83 h (95% CI, −9.40 to −2.26; P <.01) for DKT, −14.87 h (95% CI, −26.84 to −2.90; P =.01) for CG, and −1.90 h (95% CI, −8.28 to 4.48; P =.56) for coffee. The reduction in time to passage of the first stool was −32.27 h (95% CI, −39.28 to −25.26; P <.01) for prokinetic agents, −23.05 h (95% CI, −29.31 to −16.78; P <.01) for CG, −12.89 h (95% CI, −17.78 to −8.01; P <.01) for coffee, −19.76 h (95% CI, −32.79 to −6.72; P <.01) for EA, and −0.70 h (95% CI, −25.51 to 26.92; P =.96) for DKT.

Conclusion

The use of CG, EA, and prokinetic agents decreased the time to passage of the first flatus and time to passage of the first stool and indirectly reduced postoperative ileus.

背景：术后肠梗阻是一种影响肠道运动的手术并发症。有一些措施可以减少这个问题，但并不是所有的措施都有确凿的证据。目的：探讨咖啡、口香糖、电针、大kenchuto （DKT）和促动力药物等措施对减轻胃肠道手术患者术后肠梗阻的效果。方法：按照PRISMA指南在谷歌Scholar、PubMed、ScienceDirect和Web of Science上进行系统检索。提取术后肠梗阻的指标：第一次放屁时间和第一次大便时间。亚组分析平均差异。结果：176项研究中，37项入选系统评价，涉及4647例患者。第一次排气时间缩短为-18.33小时(95% CI -26.46, -10.20；结论：使用口香糖、电针和促动力药物可缩短首次放屁时间和首次大便通过时间，间接减轻术后肠梗阻。

{"title":"Reduction of postoperative ileus in gastrointestinal surgery: systematic review and meta-analysis","authors":"Doris Sarmiento-Altamirano , Daniel Arce-Jara , Pablo Balarezo-Guerrero , Rafael Valdivieso-Espinoza","doi":"10.1016/j.gassur.2025.101960","DOIUrl":"10.1016/j.gassur.2025.101960","url":null,"abstract":"<div><h3>Background</h3><div>Postoperative ileus is a surgical complication that affects intestinal motility. There are measures to reduce this problem, but not all have conclusive evidence. This study aimed to determine which measures, such as coffee, chewing gum (CG), electroacupuncture (EA), daikenchuto (DKT), and prokinetic agents, are most effective in reducing postoperative ileus in patients undergoing gastrointestinal surgeries.</div></div><div><h3>Methods</h3><div>A systematic search was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines on Google Scholar, PubMed, ScienceDirect, and Web of Science. The following measures were studied to define postoperative ileus: time to passage of the first flatus and time to passage of the first stool. The mean differences were determined by subgroup analyses.</div></div><div><h3>Results</h3><div>Of 176 studies, 37 were selected for the systematic review, which involved 4647 patients. The reduction in time to passage of the first flatus was −18.33 h (95% CI, −26.46 to −10.20; <em>P</em> <.01) for EA, −5.83 h (95% CI, −9.40 to −2.26; <em>P</em> <.01) for DKT, −14.87 h (95% CI, −26.84 to −2.90; <em>P</em> =.01) for CG, and −1.90 h (95% CI, −8.28 to 4.48; <em>P</em> =.56) for coffee. The reduction in time to passage of the first stool was −32.27 h (95% CI, −39.28 to −25.26; <em>P</em> <.01) for prokinetic agents, −23.05 h (95% CI, −29.31 to −16.78; <em>P</em> <.01) for CG, −12.89 h (95% CI, −17.78 to −8.01; <em>P</em> <.01) for coffee, −19.76 h (95% CI, −32.79 to −6.72; <em>P</em> <.01) for EA, and −0.70 h (95% CI, −25.51 to 26.92; <em>P</em> =.96) for DKT.</div></div><div><h3>Conclusion</h3><div>The use of CG, EA, and prokinetic agents decreased the time to passage of the first flatus and time to passage of the first stool and indirectly reduced postoperative ileus.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101960"},"PeriodicalIF":2.2,"publicationDate":"2025-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142950038","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

Optimizing surgical outcomes in gastric cancer: a comparison of laparoscopic and open total gastrectomy 优化胃癌的手术效果：腹腔镜和开放式全胃切除术的比较。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-07 DOI: 10.1016/j.gassur.2025.101955

Julien De Martino , Alexandre Challine , Maxime K. Collard , Jeremie H. Lefevre , Yann Parc , François Paye , Thibault Voron

Background

The efficacy of the laparoscopic approach for total gastrectomy (TG) in Western countries remains under discussion. Recently, textbook outcome (TO) has gained recognition as a comprehensive measure of quality of care in upper gastrointestinal surgery. Although predictive factors for TO after TG are well documented, the influence of the surgical approach requires further analysis. This study aimed to compare the TO completion rate after TG for gastric cancer between the open (OTG) and laparoscopic TG (LTG) approaches.

Methods

TO was defined by 10 criteria: (1) absence of intraoperative complications, (2) macroscopically complete resection, (3) R0 margin, (4) retrieval of ≥15 lymph nodes, (5) absence of postoperative complications with Clavien-Dindo grade ≥ 2, (6) no surgical reintervention within 30 days, (7) no unplanned intensive care unit admission within 30 days, (8) no mortality within 30 days, (9) length of stay ≤ 21 days, and (10) no readmission within 30 days. Propensity score matching was used to adjust for potential selection bias. Predictive factors associated with TO were identified through univariate and multivariate analyses.

Results

Among the 188 patients, 34 underwent LTG. TO was achieved in 46.8% of cases, with no significant difference between OTG and LTG (45.5% vs 52.9%; P =.43). After propensity score matching, similar outcomes were observed (44.1% vs 52.9%; P =.47). However, LTG was associated with fewer postoperative complications of Clavien-Dindo grade ≥ 2 (P =.049), particularly pulmonary complications (P =.041).

Conclusion

This study confirms the feasibility and safety of LTG for cancer. The laparoscopic approach yields a TO completion rate comparable with that of the open approach while reducing postoperative complications.

背景：在西方国家，腹腔镜下全胃切除术（TG）的疗效仍在讨论中。最近，教科书结果（TO）已获得认可，作为上消化道手术护理质量的综合衡量标准。虽然TG后TO的预测因素有充分的文献记载，但手术入路的影响需要进一步分析。本研究旨在比较开放式（OTG）和腹腔镜（LTG）胃癌全胃切除术后to完成率。方法：根据10个标准定义TO: (a)术中无并发症，(b)宏观完全切除，(c)R0切缘，(d)切除≥15个淋巴结，(e)术后无并发症，Clavien-Dindo分级≥2，(f) 30天内无手术再干预，(g) 30天内无意外ICU住院，(h) 30天内无死亡，(i)住院时间≤21天，(j) 30天内无再入院。倾向评分匹配用于调整潜在的选择偏差。通过单变量和多变量分析确定与TO相关的预测因素。结果：188例患者中，34例行LTG。46.8%的病例达到了TO， OTG和LTG之间无显著差异（45.5% vs 52.9%, p=0.43）。倾向评分匹配后，观察到相似的结果（44.1% vs 52.9%, p=0.47）。然而，LTG与Clavien-Dindo分级≥2的术后并发症较少相关（p=0.049），尤其是肺部并发症（p=0.041）。结论：本研究证实了腹腔镜全胃切除术治疗肿瘤的可行性和安全性。腹腔镜入路的TO完成率与开放入路相当，同时减少了术后并发症。

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引用次数: 0

Effectiveness of bariatric surgery in patients with severe obesity obstructive sleep apnea 重度肥胖阻塞性睡眠呼吸暂停患者的减肥手术效果。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-06 DOI: 10.1016/j.gassur.2025.101957

Jaime Ruíz-Tovar , Carolina Llavero , Ana Isabel Turrión , Rafael Martín-Holguera

引用次数: 0

Is stapled Kono-S anastomosis a protective factor against postoperative endoscopic recurrence in Crohn disease? A single-center, retrospective cohort study 吻合器Kono-S吻合术是防止克罗恩病术后内镜下复发的保护因素吗？单中心回顾性队列研究。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-06 DOI: 10.1016/j.gassur.2024.101941

Tianrun Song , Yang Chen , Liqun Wang , Chunjie Zhang , Changsheng Zhou , Yanqing Diao , Jianfeng Gong , Lei Cao , Weiming Zhu , Ming Duan , Yi Li

Background

Handsewn Kono-S anastomosis is safe and associated with a reduction in postoperative recurrence (POR) in Crohn disease (CD). This study aimed to investigate the advantages of stapled Kono-S anastomosis in patients with CD who underwent intestinal anastomosis.

Methods

Patients with CD who underwent intestinal anastomosis were reviewed via a prospectively maintained database. Patients who underwent conventional stapled side-to-side anastomosis were classified into the conventional group, and those who underwent stapled Kono-S anastomosis were classified into the Kono-S group. The primary endpoint was modified endoscopic recurrence (mER; ≥i2b). Other endpoints were endoscopic recurrence (ER; ≥i2); severe ER (i3 and i4); intra- and postoperative outcomes, including morbidity and hospital stay; and cross-sectional parameters. Multivariate logistic regression analysis was performed to assess the independent risk factors for mER.

Results

Between 2020 and 2023, 199 patients (63 in the Kono-S group) were included in this study. After matching the 63 patients in each group, the overall rates of mER, ER, and severe ER were 19.0%, 24.6%, and 8.7%, respectively. The mER, ER, and severe ER rates were lower in the Kono-S group than in the conventional group (12.7% vs 25.4% [P =.07], 20.6% vs 28.6% [P =.30], and 6.3% vs 11.1% [P =.34], respectively). Multivariate analysis indicated that stapled Kono-S anastomosis (odds ratio [OR], 0.35; 95% CI, 0.12–0.98; P =.047) was an independent protective factor for mER, whereas male gender (OR, 7.75; 95% CI, 1.50–40.00; P =.01) and BMI of <18.5 kg/m² (OR, 3.27; 95% CI, 1.11–9.67; P =.03) were independent risk factors for mER.

Conclusion

Stapled Kono-S anastomosis is safe for patients with CD. However, stapled Kono-S anastomosis may not be a protective factor against POR compared with conventional stapled side-to-side anastomosis.

背景：手工缝合的Kono-S吻合是安全的，并且与克罗恩病（CD）术后复发（POR）的减少有关。本研究旨在探讨吻合器Kono-S在克罗恩病患者肠吻合术中的优势。方法：通过前瞻性维护的数据库对行肠吻合术的克罗恩病患者进行回顾性分析。采用常规侧侧吻合术的患者为常规组，采用Kono-S吻合术的患者为Kono-S组。主要终点是改良内镜下复发（mER,≥i2b）。其他终点包括ER（≥i2）、严重ER （i3和i4）、术中和术后结局（包括发病率和住院时间）以及横断面参数。采用多变量logistic分析评估mER的独立风险。结果：2020 - 2023年共纳入199例患者，其中Kono-S组63例。匹配后，每组63例患者，轻度急性发作、ER急性发作和重度ER急性发作的总发生率分别为19.0%、24.6%和8.7%。Kono-S组mER、ER及重度ER发生率均低于常规组(12.7% vs. 25.4%, p=0.07；20.6% vs. 28.6%, p=0.30；6.3% vs. 11.1%, p=0.34)。多因素分析表明，装订的Kono-S (OR=0.35；95% CI: 0.12-0.98, p=0.047)是mER的独立保护因素，而男性(OR=7.75；95% CI: 1.5-40.0, p=0.01)和bmic结论：与传统的侧对侧吻合术相比，吻合式Kono-S吻合术对CD是安全的，但可能不是预防POR的保护因素。

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引用次数: 0

Effectiveness of Enhanced Recovery After Surgery protocol in pancreatic surgery: a systematic review and meta-analysis of randomized controlled trials 胰腺手术后增强恢复（ERAS）方案的有效性-随机对照试验的系统回顾和荟萃分析。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-02 DOI: 10.1016/j.gassur.2024.101939

Maurício Prätzel Ellwanger , Manuela Pozza Ellwanger , Matheus Budahazi Jardine , Victoria Bramucci , Stephany Aparecida Pereira Hammes , Lucca Moreira Lopes , Antônio Carlos Mattar Munhoz

Background

The Enhanced Recovery After Surgery (ERAS) protocol represents an advancement in perioperative care to reduce surgical stress and accelerate recovery. This meta-analysis aimed to evaluate the effectiveness of ERAS in pancreatic surgery and to assess the effect of the ERAS protocol vs conventional hospital care on postoperative outcomes, including length of stay (LOS) in the hospital, hospital costs, readmission rates, and infection rates in patients undergoing pancreatic surgery.

Methods

A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant RCTs. Data were extracted and analyzed using a random effects model. Statistical analyses were performed using RStudio.

Results

A total of 7 RCTs involving 731 patients were included. The meta-analysis showed a statistically significant reduction in LOS by 2.49 days (mean difference, −2.49; 95% CI, −4.20 to −0.79; P <.01) with considerable heterogeneity (I² = 86%). Hospital costs were significantly reduced (standardized mean difference, −0.36; 95% CI, −0.65 to −0.06; P =.02) with moderate heterogeneity (I² = 52%). The readmission and infection rates showed no statistically significant differences between the ERAS and control groups. The Egger test indicated no significant publication bias.

Conclusion

The ERAS protocol significantly reduced LOS and hospital costs in patients who underwent pancreatic surgery. Our findings support the implementation of ERAS protocols to enhance recovery and optimize outcomes. To the best of our knowledge, our study is the first to demonstrate these results using an RCT-only meta-analysis approach in pancreatic surgery, highlighting the value of ERAS in improving perioperative care.

简介：手术后增强恢复（ERAS）协议代表了围手术期护理的进步，以减少手术压力和加速恢复。本荟萃分析评估了ERAS在胰腺手术中的有效性。目的：评估ERAS方案与传统医院护理相比对胰腺手术患者术后结局的影响，包括住院时间（LOS）、住院费用、再入院率和感染率。方法：对遵循PRISMA指南的随机对照试验（rct）进行系统评价和荟萃分析。我们检索了PubMed、Cochrane Central Register of Controlled Trials和Embase以确定相关的随机对照试验。数据提取和分析使用随机效应模型。使用RStudio进行统计分析。结果：纳入7项随机对照试验，共731例患者。荟萃分析显示，LOS减少了2.49天，具有统计学意义(MD = -2.49；95% ci [-4.20；-0.79);p < 0.01)，异质性显著（I2 = 86%）。住院费用显著降低(SMD = -0.36；95% ci [-0.65；-0.06);p = 0.02)，异质性中等（I2 = 52%）。ERAS组与对照组再入院率和感染率无统计学差异。Egger检验未发现显著的发表偏倚。结论：ERAS方案可显著降低胰腺手术患者的LOS和住院费用。这些发现支持ERAS方案的实施，以提高采收率和优化结果。我们的研究首次在胰腺手术中使用rct荟萃分析方法证明了这些结果，强调了ERAS在改善围手术期护理方面的价值。

{"title":"Effectiveness of Enhanced Recovery After Surgery protocol in pancreatic surgery: a systematic review and meta-analysis of randomized controlled trials","authors":"Maurício Prätzel Ellwanger , Manuela Pozza Ellwanger , Matheus Budahazi Jardine , Victoria Bramucci , Stephany Aparecida Pereira Hammes , Lucca Moreira Lopes , Antônio Carlos Mattar Munhoz","doi":"10.1016/j.gassur.2024.101939","DOIUrl":"10.1016/j.gassur.2024.101939","url":null,"abstract":"<div><h3>Background</h3><div>The Enhanced Recovery After Surgery (ERAS) protocol represents an advancement in perioperative care to reduce surgical stress and accelerate recovery. This meta-analysis aimed to evaluate the effectiveness of ERAS in pancreatic surgery and to assess the effect of the ERAS protocol vs conventional hospital care on postoperative outcomes, including length of stay (LOS) in the hospital, hospital costs, readmission rates, and infection rates in patients undergoing pancreatic surgery.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, Cochrane Central Register of Controlled Trials, and Embase were searched to identify relevant RCTs. Data were extracted and analyzed using a random effects model. Statistical analyses were performed using RStudio.</div></div><div><h3>Results</h3><div>A total of 7 RCTs involving 731 patients were included. The meta-analysis showed a statistically significant reduction in LOS by 2.49 days (mean difference, −2.49; 95% CI, −4.20 to −0.79; <em>P</em> <.01) with considerable heterogeneity (<em>I</em><sup><em>2</em></sup> = 86%). Hospital costs were significantly reduced (standardized mean difference, −0.36; 95% CI, −0.65 to −0.06; <em>P</em> =.02) with moderate heterogeneity (<em>I</em><sup><em>2</em></sup> = 52%). The readmission and infection rates showed no statistically significant differences between the ERAS and control groups. The Egger test indicated no significant publication bias.</div></div><div><h3>Conclusion</h3><div>The ERAS protocol significantly reduced LOS and hospital costs in patients who underwent pancreatic surgery. Our findings support the implementation of ERAS protocols to enhance recovery and optimize outcomes. To the best of our knowledge, our study is the first to demonstrate these results using an RCT-only meta-analysis approach in pancreatic surgery, highlighting the value of ERAS in improving perioperative care.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 3","pages":"Article 101939"},"PeriodicalIF":2.2,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142927285","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

Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach 使用多层次混合效应方法探索接受非选择性癌症胃肠道手术的城乡差异。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-01 DOI: 10.1016/j.gassur.2024.10.013

Crisanto M. Torres , Sara Myers , Megan G. Janeway , Sabrina E. Sanchez , Dane R. Scantling , Elizabeth S. Davis , Sing Chau Ng , Tracey Dechert , Teviah E. Sachs , Kelly M. Kenzik

Background

Rural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents.

Methods

This retrospective study included adult patients captured in the Surveillance, Epidemiology, and End Results–Medicare data between January 2008 and December 2015 with an incident stage I to IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was a nonelective cancer-directed surgery among rural vs urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering.

Results

The sample included 10,136 patients who underwent a surgical intervention; 2941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural than urban patients (351 [27%] and 2590 [29%]; P = .05). There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents (odds ratio, 0.88; 95% CI, 0.76–1.03; P = .11; adjusted odds ratio [aOR], 0.86; 95% CI, 0.72–1.02; P = .080). In addition, high social vulnerability index (SVI) counties or Black race was significantly associated with increase odds of nonelective surgery (aOR, 1.33; 95% CI, 1.07–1.65; P = .009; aOR, 1.49; 95% CI, 1.26–1.77; P < .0001, respectively).

Conclusion

This study found no difference in the odds of receiving nonelective surgery for gastrointestinal foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore whether disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.

背景：农村社区人口面临着各种影响健康结果的社会挑战。因此，癌症非选择性手术对农村人口的影响可能更大。我们探讨了导致农村居民和城市居民接受非选择性癌症特异性手术差异的患者和县级因素：这项回顾性研究纳入了 2008 年 1 月至 2015 年 12 月期间 SEER-Medicare 数据中记录的接受癌症特异性手术的 I-IV 期胃癌、肝癌/肝内胆管癌、胰腺癌、胆囊癌/其他胆管癌或小肠癌的成年患者。主要结果是农村居民与城市居民的非选择性癌症定向手术。我们建立了一个多变量混合效应逻辑回归模型来调整混杂因素，同时考虑县级聚类：样本包括 10,136 名接受手术治疗的患者，其中 2,941 人（29%）为非选择性手术。与城市患者相比，农村患者的非选择性手术发生率较低[分别为 351 例（27%）和 2590 例（29%）；P= 0.05]。农村居民和城市居民非选择性手术的未调整和调整后几率[OR 0.88，95% CI (0.76-1.03)；p= 0.11]和[aOR 0.86，95% CI (0.72-1.02)；p= 0.080]无统计学差异。此外，社会脆弱指数高的县或黑人种族与非选择性手术几率增加显著相关[aOR 1.33，95% CI (1.07-1.65)；p=0.009]和[aOR 1.49，95% CI (1.26-1.77)；p结论：本研究发现，农村人口和城市人口接受非选择性消化道前肠癌症手术的几率没有差异。然而，黑人种族和高 SVI 与接受非选择性手术的较高几率相关。尽管农村和城市社区接受非选择性手术的几率相当，但临床结果是否存在差异还需要进一步研究。

{"title":"Exploring rural-urban differences in the receipt of nonelective cancer-specific gastrointestinal surgery using a multilevel mixed-effects approach","authors":"Crisanto M. Torres , Sara Myers , Megan G. Janeway , Sabrina E. Sanchez , Dane R. Scantling , Elizabeth S. Davis , Sing Chau Ng , Tracey Dechert , Teviah E. Sachs , Kelly M. Kenzik","doi":"10.1016/j.gassur.2024.10.013","DOIUrl":"10.1016/j.gassur.2024.10.013","url":null,"abstract":"<div><h3>Background</h3><div>Rural communities constitute a populace marked by various social challenges influencing health outcomes. As such, nonelective surgeries for cancer may have a disproportionate impact on rural populations. We explored patient and county-level factors contributing to differences in the receipt of nonelective cancer-specific surgery between rural and urban residents.</div></div><div><h3>Methods</h3><div>This retrospective study included adult patients captured in the Surveillance, Epidemiology, and End Results–Medicare data between January 2008 and December 2015 with an incident stage I to IV cancer of the stomach, liver/intrahepatic bile duct, pancreas, gallbladder/other biliary origin, or small intestine who underwent a cancer-specific surgery. The primary outcome was a nonelective cancer-directed surgery among rural vs urban residents. We conducted a multivariable mixed-effects logistic regression model to adjust for confounders while accounting for county-level clustering.</div></div><div><h3>Results</h3><div>The sample included 10,136 patients who underwent a surgical intervention; 2941 (29%) were nonelective. The incidence of nonelective surgery was lower among rural than urban patients (351 [27%] and 2590 [29%]; <em>P</em> = .05). There was no statistically significant difference in the unadjusted and adjusted odds of nonelective surgery between rural and urban residents (odds ratio, 0.88; 95% CI, 0.76–1.03; <em>P</em> = .11; adjusted odds ratio [aOR], 0.86; 95% CI, 0.72–1.02; <em>P</em> = .080). In addition, high social vulnerability index (SVI) counties or Black race was significantly associated with increase odds of nonelective surgery (aOR, 1.33; 95% CI, 1.07–1.65; <em>P</em> = .009; aOR, 1.49; 95% CI, 1.26–1.77; <em>P</em> < .0001, respectively).</div></div><div><h3>Conclusion</h3><div>This study found no difference in the odds of receiving nonelective surgery for gastrointestinal foregut cancers between rural and urban populations. However, Black race and high SVI were associated with higher odds of the receipt of nonelective surgery. Further research is warranted to explore whether disparities in clinical outcomes exist despite the comparable likelihood of receiving nonelective surgery between rural and urban communities.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101858"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142467382","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

Letter to the editor: “Multifactorial risk prediction analysis of liver metastasis in colorectal cancer: incorporating programmed cell death ligand 1 combined positive score and other factors” 致编辑的信，内容涉及："结直肠癌肝转移的多因素风险预测分析：纳入程序性细胞死亡配体1联合阳性评分和其他因素"。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-01 DOI: 10.1016/j.gassur.2024.10.027

Jixuan Wu , Zili Zhang , Lei Zhang

引用次数: 0

Tunnel anastomosis: a modified flap technique in esophagogastrostomy as a novel antireflux technique after proximal gastrectomy 隧道吻合术--食管胃造口术中的一种改良皮瓣技术，是近端胃切除术后的一种新型抗反流技术。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-01 DOI: 10.1016/j.gassur.2024.10.026

Rui Peng , Yun Shi , Hao Zhang , Qing-Yu Xie , Chao Yue , Ling-Li Huang , Liang Chen , Guang-Li Sun , Wei-Guo Xu , Wei Wei , Rong-Min Gu , Xue-Zhi Ming , Huan-Qiu Chen , Gang Li

Background

The prevalence of proximal gastric cancer (PGC) has been increasing rapidly worldwide. Postoperative reflux esophagitis after conventional esophagogastrostomy (EG) is a major problem that haunts surgeons. This study designed a novel antireflux technique called tunnel anastomosis in EG after proximal gastrectomy (PG). This study aimed to present the detailed procedures of tunnel anastomosis and to assess its safety and feasibility by comparing the surgical outcomes, reflux, and nutritional status of patients undergoing tunnel anastomosis and those undergoing double-tract jejunal interposition reconstruction (DTJIR).

Methods

A total of 1718 patients undergoing gastrectomy were enrolled in this study. However, only 150 patients undergoing PG were ultimately analyzed, of which 21 patients underwent tunnel anastomosis and 129 patients underwent DTJIR. Propensity score matching (PSM) was used to reduce biases.

Results

After 1:1 PSM, there were 21 patients in both groups. No significant differences were observed between the 2 groups regarding surgical approach, blood loss, operative time, reconstruction time, postoperative hospital stay, morbidity, and mortality. The incidence of reflux esophagitis in both groups was 9.5% (2/21) according to the endoscopic examination at the 12-month postoperative follow-up. No patient in the tunnel group was classified as grade B or higher according to the Los Angeles classification. Patients in the tunnel and DTJIR groups exhibited comparable postoperative nutritional status when assessing the body weight, albumin levels and prognostic nutritional index value at 3 and 6 months after surgery.

Conclusion

Tunnel anastomosis is a safe technique that offers a robust antireflux effect and can be performed in some suitable patients with PGC.

背景：近端胃癌（PGC）的发病率在全球范围内迅速上升。传统食管胃切除术（EG）术后反流性食管炎是困扰外科医生的一大难题。我们在近端胃切除术后的食管胃切除术中设计了一种新的抗反流技术--隧道吻合术。本研究旨在介绍隧道式吻合术的详细过程，并通过比较隧道式吻合术与双道空肠间置重建术（DTJIR）患者的手术效果、反流和营养状况，评估其安全性和可行性。最终分析了150名接受胃切除术的患者，其中21名患者接受了隧道吻合术，129名患者接受了DTJIR。研究采用倾向评分匹配法（PSM）来减少偏差：经过 1:1 PSM 后，两组患者均为 21 人。两组患者在手术方式、失血量、手术时间、重建时间、术后住院时间、发病率和死亡率方面均无明显差异。根据术后 12 个月随访的内镜检查结果，两组反流性食管炎的发生率均为 9.5%（2/21）。根据洛杉矶分级法，隧道组患者中没有人被列为 B 级或以上。根据术后 3 个月和 6 个月的体重、白蛋白水平和 PNI 值评估，隧道组和 DTJIR 组患者的术后营养状况相当：隧道式吻合术是一种安全的技术，具有很强的抗反流效果，适用于部分 PGC 患者。

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引用次数: 0

Development and validation of a machine-learning model for preoperative risk of gastric gastrointestinal stromal tumors 针对胃肠道间质瘤术前风险的机器学习模型的开发与验证。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-01 DOI: 10.1016/j.gassur.2024.10.019

Shi-Qi Liang , Yu-Tong Cui , Guang-Bing Hu , Hai-Yang Guo , Xin-Rui Chen , Ji Zuo , Zhi-Rui Qi , Xian-Fei Wang

Background

Gastrointestinal stromal tumors (GISTs) have malignant potential, and treatment varies according to risk. However, no specific protocols exist for preoperative assessment of the malignant potential of gastric GISTs (gGISTs). This study aimed to use machine learning (ML) to develop and validate clinically relevant preoperative models to predict the malignant potential of gGISTs.

Methods

This study screened patients diagnosed with gGISTs at the Affiliated Hospital of North Sichuan Medical College. Moreover, this study employed the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to identify risk factors. Subsequently, an ensemble of ML models was used to determine the optimal classifier. In addition, this study used SHapley Additive exPlanations (SHAP) for tailored risk profiling.

Results

This study included 318 patients with gGISTs. Using LASSO regression and multifactorial logistic regression, this study analyzed the training dataset, revealing that the presence of endoscopic ultrasound (EUS) high-risk features, tumor border clarity, tumor diameter, and monocyte-to-lymphocyte ratio (MLR) were significant predictors of high malignancy risk in gGIST. As determined by our ML approach, the logistic classification model demonstrated optimal performance, with area under the receiver operating characteristic curves of 0.919 for the training set and 0.925 for the test set. Furthermore, decision curve analysis confirmed the clinical relevance of the model.

Conclusion

High-risk EUS features, ill-defined tumor margins, larger tumor diameters, and elevated MLR independently predicted increased malignant potential in gGIST. This study developed logistic regression models based on these factors, which were further interpreted using the SHAP methodology. This analytical approach facilitated personalized therapeutic decision-making among diverse patient populations.

背景：胃肠道间质瘤（GISTs）具有恶性潜能，治疗方法因风险而异。然而，目前还没有具体的方案用于术前评估胃间质瘤（gGISTs）的恶性可能性。本研究旨在利用机器学习（ML）开发并验证与临床相关的术前模型，以预测胃间质瘤的恶性可能性：方法：我们筛选了川北医学院附属医院确诊的 gGISTs 患者。我们采用最小绝对收缩和选择操作器（LASSO）和逻辑回归来识别风险因素。随后，我们部署了一组 ML 模型，以确定最佳分类器。此外，我们还利用SHapley Additive exPlanations（SHAP）进行了量身定制的风险分析：我们招募了 318 名 gGISTs 患者。我们利用 LASSO 回归和多因素逻辑回归分析了训练数据集，发现内镜超声（EUS）高风险特征、肿瘤边界清晰度、肿瘤直径和单核细胞与淋巴细胞比值（MLR）是 gGIST 高恶性风险的重要预测因素。根据我们的 ML 方法，逻辑分类模型表现出最佳性能，训练集和测试集的接收者操作特征曲线下面积分别为 0.919 和 0.925。此外，决策曲线分析证实了该模型的临床相关性：结论：高危 EUS 特征、肿瘤边缘不清晰、肿瘤直径较大和 MLR 升高可独立预测 gGIST 的恶性程度。我们根据这些因素建立了逻辑回归模型，并使用 SHAP 方法对其进行了进一步解释。这种分析方法有助于为不同的患者群体做出个性化的治疗决策。

{"title":"Development and validation of a machine-learning model for preoperative risk of gastric gastrointestinal stromal tumors","authors":"Shi-Qi Liang , Yu-Tong Cui , Guang-Bing Hu , Hai-Yang Guo , Xin-Rui Chen , Ji Zuo , Zhi-Rui Qi , Xian-Fei Wang","doi":"10.1016/j.gassur.2024.10.019","DOIUrl":"10.1016/j.gassur.2024.10.019","url":null,"abstract":"<div><h3>Background</h3><div>Gastrointestinal stromal tumors (GISTs) have malignant potential, and treatment varies according to risk. However, no specific protocols exist for preoperative assessment of the malignant potential of gastric GISTs (gGISTs). This study aimed to use machine learning (ML) to develop and validate clinically relevant preoperative models to predict the malignant potential of gGISTs.</div></div><div><h3>Methods</h3><div>This study screened patients diagnosed with gGISTs at the Affiliated Hospital of North Sichuan Medical College. Moreover, this study employed the Least Absolute Shrinkage and Selection Operator (LASSO) and logistic regression to identify risk factors. Subsequently, an ensemble of ML models was used to determine the optimal classifier. In addition, this study used SHapley Additive exPlanations (SHAP) for tailored risk profiling.</div></div><div><h3>Results</h3><div>This study included 318 patients with gGISTs. Using LASSO regression and multifactorial logistic regression, this study analyzed the training dataset, revealing that the presence of endoscopic ultrasound (EUS) high-risk features, tumor border clarity, tumor diameter, and monocyte-to-lymphocyte ratio (MLR) were significant predictors of high malignancy risk in gGIST. As determined by our ML approach, the logistic classification model demonstrated optimal performance, with area under the receiver operating characteristic curves of 0.919 for the training set and 0.925 for the test set. Furthermore, decision curve analysis confirmed the clinical relevance of the model.</div></div><div><h3>Conclusion</h3><div>High-risk EUS features, ill-defined tumor margins, larger tumor diameters, and elevated MLR independently predicted increased malignant potential in gGIST. This study developed logistic regression models based on these factors, which were further interpreted using the SHAP methodology. This analytical approach facilitated personalized therapeutic decision-making among diverse patient populations.</div></div>","PeriodicalId":15893,"journal":{"name":"Journal of Gastrointestinal Surgery","volume":"29 1","pages":"Article 101864"},"PeriodicalIF":2.2,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142501930","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Invited commentary: toward a better understanding of recurrence after hepatectomy for metastatic colorectal cancer 特邀评论：更好地理解转移性结直肠癌肝切除术后的复发。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery

Pub Date : 2025-01-01 DOI: 10.1016/j.gassur.2024.101878

Matthew P. Vivero , Jason S. Gold

引用次数: 0