Surgical Endoscopy And Other Interventional Techniques最新文献

Background: A relatively high rate of early gastric cancer is missed during esophagogastroduodenoscopy (EGD). This study aimed to identify the risk factors associated with missed early gastric cancer (MEGC).

Methods: A retrospective study was conducted on 763 pathologically confirmed early gastric cancer lesions. Patients were categorized as initially detected early gastric cancer (IDEGC; no EGD in the previous 6-36 months) or MEGC (≥ 1 negative EGD in that interval). Independent risk factors for MEGC were identified through multivariable analysis.

Results: The MEGC rate was 22.0% (168/763). Independent risk factors were male sex (OR = 1.849) and endoscopists' age ≥ 45 years (OR = 2.737). Protective factors were lesion size ≥ 12 mm (OR = 0.616), sedation (OR = 0.376), observation time ≥ 5 min (OR = 0.625), and image-enhanced endoscopy (IEE) technology application (OR = 0.316). MEGC causes were categorized into exposure errors (35.1%), perceptual errors (34.5%), sampling errors (29.2%), and inadequate preparation (1.2%). Errors types correlated with lesion locations. 50.6% of MEGC cases were deemed potentially avoidable. A higher annual endoscopist EGD volume was inversely correlated with the technically attributable MEGC rate (r = -0.495).

Conclusion: MEGC risk may be reduced through targeted interventions for high-risk populations (male), optimized endoscopic examination protocols (ensuring adequate observation time, applying sedation and IEE technology), and enhanced training in advanced technologies for older endoscopists.

Background: Minimally invasive treatment for high-risk gastrointestinal stromal tumor (GIST) remains controversial for the concerns including intra-operative rupture and tumor spillage. This study aimed to compare the long-term oncological outcomes in the high-risk GIST patients receiving laparoscopic and open surgery.

Methods: We conducted a retrospective study on patients with high-risk GISTs of the stomach undergoing curative resection by laparoscopic or open approach from 2002 to 2024 at a single medical center. Propensity score matching was applied to adjust for tumor size and tumor location between these two groups at a 1:1 ratio. We evaluated the peri-operative and long-term oncological outcomes.

Results: There were 184 patients with high-risk GISTs of the stomach recruited. The clinical demographics including age and gender were similar between the laparoscopic and open groups. The mean tumor size was significantly larger in the open group (13.4 ± 7.4 cm versus 5.7 ± 3.5 cm, p < 0.001). After matching, 34 patients in each group were analyzed with comparable tumor sizes and locations. The laparoscopic group was associated with a shorter hospital stay (9.7 ± 2.3 days versus 12.4 ± 4.0 days, p = 0.013). Otherwise, the operation time, blood loss, and the ratio of receiving adjuvant target therapy were similar between groups. Kaplan-Meier RFS analysis showed no difference between the open and laparoscopic groups either in 10-year RFS (82.7% versus 73.6%, p = 0.739) or 10-year OS (90.0% versus 96.9%, p = 0.588). Multivariate analysis showed the surgical approach was not a significant risk factor affecting RFS or OS.

Conclusion: Laparoscopic resection is a safe and feasible surgical approach in selected gastric high-risk GIST patients, providing comparable oncologic outcomes to open surgery with a shorter hospital stay.

Background: Gastrectomy has evolved significantly with advancements in minimally invasive surgery, particularly with the advent of single-incision laparoscopic surgery (SILS). Despite its benefits, SILS faces challenges related to instrument crowding and loss of triangulation. Robotic assistance in SILS, known as single-incision robotic-assisted surgery (SIRAS), may overcome these issues, offering greater precision and maneuverability. This study aimed to explore the technical feasibility and safety of SIRAS for distal gastrectomy using the SHURUI System (SR-ENS-600).

Materials and methods: A cohort of 13 gastric cancer patients who underwent SIRAS between February and June 2024 were compared with a retrospective group of 25 patients who underwent multi-port robotic-assisted surgery (RAS) between September 2019 and May 2020. The primary endpoints were to evaluate surgical outcomes, including operation time, blood loss, lymph node retrieval, complications, postoperative recovery, and surgical task load.

Results: The mean (SD) surgical time for SIRAS was 287.00 (39.83) minutes, significantly longer than the RAS group (258.84[38.23]) (P = 0.041). The SIRAS group exhibited higher times for docking (P < 0.001) and lymph node dissection (P = 0.003). There were no significant differences in blood loss and lymph node retrieval between the two groups (P > 0.05). There was no short-term postoperative complication reported in the SIRAS group. One patient in the RAS group experienced intra-abdominal infection, and another patient in the RAS group had postoperative bleeding. The SIRAS group had lower postoperative pain scores (P = 0.011) and higher quality-of-life scores (P = 0.05) than the RAS group, while the first assistant had higher physical fatigue (P = 0.04).

Conclusion: SIRAS using the SR-ENS-600 system for distal gastrectomy is technically feasible and safe. Despite some challenges, it offers advantages in terms of reduced postoperative pain and improved quality of life. The small sample size of this initial experience limits the generalizability of the findings, and larger-scale studies are warranted.

Background: Although the clinical efficacy of body composition assessment has been explored in many other cancer types, few studies have focused on periampullary cancer. Furthermore, despite the global rise in minimally invasive pancreaticoduodenectomy (PD), its safety and feasibility in patients with sarcopenic obesity remain unclear. We aimed to investigate the impact of body composition assessment on outcomes after PD and to evaluate the safety of minimally invasive PD in patients with sarcopenic obesity.

Methods: Between 2015 and 2023, we included patients who underwent PD performed by surgeons who had surpassed the learning curve and were histologically diagnosed with periampullary cancer. Body composition was assessed using the axial images at the L3 vertebra level obtained from contrast-enhanced computed tomography.

Results: Among 717 patients, 558 (77.8%) underwent open PD and 159 (22.2%) received minimally invasive PD. In multivariate logistic regression analysis, sarcopenic obesity (odds ratio [95% confidence interval]: 1.84 [1.23-2.77]; P = 0.003) was identified as an independent predictor of complications after PD, whereas high body mass index (≥ 25 kg/m²) and sarcopenia were not. Among patients with sarcopenic obesity, the open and minimally invasive PD groups demonstrated comparable short-term surgical outcomes-including complication rates-as well as oncologic outcomes such as the number of harvested lymph nodes and R0 resection rates.

Conclusion: This study demonstrated that computed tomography-derived body composition variables could be helpful in predicting complications after PD. Additionally, minimally invasive PD could be carefully performed by experienced surgeons even in patients with sarcopenic obesity.

Background: Management of complete biliary obstruction remains challenging when conventional endoscopic or percutaneous approaches fail. Magnetic compression anastomosis (MCA) has emerged as a minimally invasive alternative; however, the evidence base is limited and methodologically heterogeneous. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of MCA in benign and malignant biliary obstruction.

Methods: On August 27, 2025, we conducted a comprehensive search using PubMed, Scopus, Web of Science, and Cochrane Library for studies evaluating MCA in patients with biliary obstruction. The primary outcome was technical success (anastomosis creation), and secondary outcomes included recurrence rate, incidence of cholangitis, and time to anastomosis creation. Pooled single-arm estimates were calculated using a random-effects model.

Results: Of 772 articles screened, eight studies were included: 5 on benign biliary stricture (BBS) involving 102 patients, and three on malignant obstruction involving 82 patients. In the BBS group, technical success was 0.91 (95% CI: 0.84-0.95), the recurrence rate was 0.13 (95% CI: 0.034-0.38), and the incidence of cholangitis was 0.029 (95% CI: 0.01-0.087); the mean time to anastomosis creation was 9.89 days. In the malignant obstruction group, technical success was 1.00, recurrence rate was 0.073 (95% CI: 0.033-0.15), and incidence of cholangitis was 0.073 (95% CI: 0.033-0.15).

Conclusion: In this systematic review and meta-analysis, MCA appears to be a feasible and safe procedure, with high technical success rates and low recurrence and cholangitis rates across both groups. Larger comparative studies and randomized controlled trials are needed to confirm these findings.

Background: With regard to laparoscopic approach, the objective arises whether standard multiorgan Whipple resection (PD) or parenchyma-sparing procedures (DPPHRt) are the most qualified surgical treatments for benign, premalignant neoplasms.

Methods: Pubmed, Embase, Medline, and Cochrane Libraries were searched for studies reporting results and late outcomes after laparoscopic DPPHRt (L-DPPHRt) and laparoscopic PD (L-PD) for benign tumors. Data of 19 cohort studies including 459 patients were assessed. Results of six controlled trials comprising 129 L-DPPHRt and 205 L-PD for benign neoplasms were compared.

Results: L-DPPHRt was performed for 123 IPMNs, 44 MCNs, 98 SPNs, 102 SCNs, and 59 PNETs. 90-day mortality was 2 of 459 patients (0.43%). Pancreatic fistula B/C occurred in 83 patients (18.08%) and biliary fistula in 35 patients (7.62%). Incidence of POPF B + C following complete and incomplete L-DPPHRt was 36/256 pats. (14.06%) and 40/167 pats. (23.95%) (p = 0.030), respectively. LHS was 14.24 days (mean). Laparoscopic total DPPHR unveiled very low risk of hospital mortality (1/459 pats.;0.21%), reoperation (9/364 pats.;2.47%), DGE (14/280 pats.;5.0%), CBD stenosis (2/459 pats.;0.43%), and ischemic lesion of CBD (2/459 pats.;0.43%). Comparing 129 L-DPPHRt with 205 L-PD patients revealed overall mean values of 239. vs. 343 min. for OP time and 128 ml vs. 240 ml for estimated blood loss. Meta analysis using standardized mean difference (SMD) demonstrated these differences to be significant (OP time: SMD - 1.20, 95% CI - 2.08 to 0.31; p = 0.008; blood loss: SMD - 1.77, 95% CI - 2.87 to - 0.66; p = 0.002). L-DPPHRt was associated with better intraoperative and early postoperative performance.

Conclusions: Laparoscopic DPPHR for cystic neoplasms and PNETs is a low-risk procedure leading to cure of patients. L-DPPHRt accomplishes the most appropriate goals for treatment of patients with benign, premalignant, cystic neoplasms, and PNETs (> 2 cm) of the pancreatic head.

Objective: While laparoendoscopic single-site surgery (LESS) theoretically improves cosmesis through a single umbilical incision, evidence on patient-reported cosmetic satisfaction remains equivocal. Technical challenges in umbilical incision closure and reliance on costly disposable devices further limit its adoption in resource-constrained settings. The transumbilical single-site dual-incision (SSDI) approach circumvents these challenges through strategic dual umbilical incision placement. This design enables surgeons to apply conventional instruments and umbilical incision suturing techniques which are comparable to multiport laparoscopy. This study aimed to compare surgical outcomes and cosmetic satisfaction between transumbilical SSDI laparoscopic surgery using conventional instruments and standard LESS for benign adnexal diseases.

Methods: A total of 116 patients with benign adnexal diseases underwent transumbilical SSDI laparoscopic surgery using conventional laparoscopic instruments (n = 52) or standard LESS (n = 64) were retrospectively analyzed.

Results: Both procedures were successfully performed in all patients. SSDI technique preserved the integrity of the base of umbilical fossa in 88.5% (46/52) of cases, obviating the need for complex umbilical reconstruction. Compared to the LESS group, the SSDI group demonstrated significantly shorter total operation time (44.6 ± 18.9 vs. 56.8 ± 14.9 min, P < 0.001) and incision suturing time (3.6 ± 4.4 vs. 15.4 ± 2.5 min, P < 0.001). Additionally, hospital costs were significantly lower in the SSDI group (9,137.4 ± 891.3 vs. 11,920.2 ± 924.5 RMB, P < 0.001). No significant differences were observed between the two groups in terms of estimated blood loss, delayed discharge, wound infection, trocar-site hernia, or cosmetic satisfaction. At the 3-month postoperative follow-up, the majority of patients in both groups reported great satisfaction with cosmetic outcomes.

Conclusion: Transumbilical SSDI laparoscopic surgery using conventional instruments represents a technically feasible and economically advantageous alternative to standard LESS for benign adnexal diseases. This "back-to-basics" approach may enhance the accessibility of single-site laparoscopy, particularly in resource-limited settings.

Introduction: Dumping Syndrome (DS) and Reactive Hypoglycaemia (RH) are common occurrences post bariatric surgery, particularly post Roux-En-Y Gastric Bypass (RYGB). We present our initial results using Transoral Outlet Reduction Endoscopy (TORE) in the management of patients who failed to respond to dietary and medical treatment for DS.

Methods: All patients identified to have symptoms consisting with DS were discussed in the complex bariatric MDT and assessed for suitability of TORE via an upper gastro-intestinal endoscopy to assess the length of the pouch, size of the gastro-jejunostomy and the presence of alternative pathologies.

Results: Since the onset of our TORE services in January 2025, we identified 17 patients for treatment with TORE. The median age was 45yrs (IQR 36-55). Sixteen patients (94%) were women and all patients scored ≥ 7 on the Sigstad scoring questionnaire. Two patients had previously undergone conversion of gastric sleeve to a RYGB whilst all others had a primary RYGB. 2 patients were found to have unfavourable anatomy and was not safe to proceed with the procedure whilst one patient was followed up privately hence no data were available for review. The data showed a complete response to treatment at 2 years for 66% of patients. Four patients did not respond to treatment with TORE and are being considered for surgical intervention.

Conclusions: TORE is an effective treatment for patients with DS not responsive to medical and dietary therapy. We believe it is an effective non-surgical treatment method prior to considering reversal of the original surgery (RYGB) with its associated weight regain. Further work is planned to assess its outcomes in larger groups of patients.

Background: The epidemiological shift toward non-B non-C hepatocellular carcinoma (NBNC-HCC) highlights the need for identifying prognostic markers in this population. While microvascular invasion (MVI) has been established in hepatitis virus-related HCC (HV-HCC), its role in NBNC-HCC remains unclear.

Methods: This multicenter retrospective study analyzed 3308 patients with HCC undergoing curative resection (2012-2023). Risk factors for MVI were identified using logistic regression in the overall cohort. From this cohort, 439 patients with NBNC-HCC were stratified based on the MVI status and balanced using propensity score matching (PSM). Cox regression models and Kaplan-Meier analysis with log-rank test were employed to compare recurrence-free survival (RFS) and overall survival (OS) between MVI-positive and MVI-negative subgroups.

Results: The incidence of MVI was lower in the NBNC-HCC group compared to the HV-HCC group (31.44% vs. 38.06%, P = 0.007), but viral hepatitis was not an independent risk factor for MVI (OR = 1.20, 95% CI 0.95-1.51, P = 0.118). After PSM, patients with MVI-positive NBNC-HCC had significantly worse RFS (median 30.0 vs. 47.0 months) and OS (median 41.0 months vs. not reached) compared to MVI-negative patients (both P < 0.01). MVI independently predicted postoperative recurrence (HR = 2.07, 95% CI 1.46-2.94) and mortality (HR = 2.17, 95% CI 1.45-3.26). MVI-positive cases also demonstrated adverse recurrence patterns, characterized by higher rates of simultaneous intrahepatic and extrahepatic recurrence (17.0% vs. 11.4%) and more frequent recurrence beyond the Milan criteria (39.8% vs. 22.9%).

Conclusion: MVI independently predicts adverse outcomes in NBNC-HCC, associated with adverse recurrence and reduced survival. The prognostic value of MVI is independent of viral hepatitis, supporting its importance for risk stratification in this population.

Background: Debate regarding whether additional surgery should be the preferred treatment option for patients with early gastric cancer who have undergone noncurative endoscopic resection is ongoing.

Objectives: This meta-analysis aims to provide clarity for clinicians and patients to facilitate better informed treatment decisions.

Methods: Our meta-analysis involved searches of PubMed, Embase, and Web of Science databases. We analyzed the following prognosis-related indicators in groups receiving additional surgical or nonsurgical treatment: 5-year overall survival (OS), 8-year overall survival (OS), 5-year disease-specific survival (DSS), 5-year disease-free survival (DFS), 5-year recurrence-free survival (RFS), 5-year cancer-specific survival (CSS), and clinicopathological data.

Results: After applying strict inclusion and exclusion criteria, 26 studies published in English through May 2024 were included, comprising data from 9177 patients with early-stage gastric tumors following noncurative endoscopic resection. These patients were categorized into additional surgery (n = 4903) and nonsurgical (n = 4274) groups. The following outcomes were significantly better in the additional surgery group: 5-year OS (odds ratio [OR] = 3.37, 95% confidence interval [CI] = 2.91-3.91, p < 0.00001; hazard ratio [HR] = 0.51, 95% CI = 0.41-0.64, p < 0.00001), 8-year OS (OR = 1.96, 95% CI = 1.22-3.16, p = 0.005), 5-year DSS (OR = 3.08, 95% CI = 2.08-4.55, p < 0.00001), 5-year DFS (OR = 4.17, 95% CI = 1.53-11.4, p = 0.005), 5-year RFS (OR = 9.14, 95% CI = 3.63-23.01, p < 0.00001), and 5-year CSS (OR = 2.54, 95% CI = 1.32-4.9, p = 0.005). Additionally, subgroup analysis revealed that patients over 70 years old benefitted more from surgery (OR = 3.09, 95% CI = 2.37-4.02, p < 0.00001). The results of the analysis were significant, with minimal heterogeneity.

Conclusions: Our review revealed that the prognostic indicators of patients in the additional surgery group were greater and cannot be ignored.