World Journal of Gastrointestinal Surgery最新文献

Gastrointestinal hemangioma (GIH) is clinically rare, accounting for 7%-10% of benign gastrointestinal tumors and 0.5% of systemic hemangiomas. GIH can occur as either solitary or multiple lesions, with gastrointestinal bleeding as a significant clinical manifestation. Understanding the clinical and endoscopic features of GIH is essential for improving diagnostic accuracy, particularly through endoscopy and selective arteriography, which are highly effective in diagnosing GIH and preventing misdiagnosis and inappropriate treatment. Upon confirmed diagnosis, it is essential to thoroughly evaluate the patient's condition to determine the most suitable treatment modality-whether surgical, endoscopic, or minimally invasive intervention. The minimally invasive interventional partial embolization therapy using polyvinyl alcohol particles, proposed and implemented by Pospisilova et al, has achieved excellent clinical outcomes. This approach reduces surgical trauma and the inherent risks of traditional surgical treatments.

Background: We investigated the utility of gamma-glutamyl transferase-to-lymphocyte ratio (GLR) as a predictive indicator for postoperative survival in patients with hepatocellular carcinoma (HCC) across different time periods and developed a predictive model based on this.

Aim: To evaluate the prognostic accuracy of GLR for overall survival (OS) in patients with HCC and its impact over time.

Methods: This study enrolled 301 patients with HCC treated with curative hepatectomy. Exclusion criteria included non-HCC hepatic malignancies, inadequate records, and prior cancer treatments. Baseline demographics, clinical features, and hematological parameters were recorded. Time-dependent receiver operating characteristic curve analysis was used to determine the optimal GLR threshold for survival prediction at 13 months. Statistical analyses included the Kaplan-Meier method, multivariate Cox regression, and the creation of a prognostic nomogram.

Results: Out of 301 patients, 293 were eligible for analysis, with a male predominance (84.6%). High preoperative GLR correlated with several adverse clinical features. Optimal cutoff values for GLR were significantly associated with stratification of 13-month OS. Multivariate analysis identified age, liver enzymes, postoperative transarterial chemoembolization, Child-Pugh grade, and inflammatory markers as independent predictors of OS. Notably, GLR had a significant impact on long-term postoperative OS, with its influence becoming more pronounced over time.

Conclusion: GLR can serve as a potent prognostic tool for postoperative HCC management, particularly in predicting long-term outcomes.

The recent study by Chen et al, published in the World Journal of Gastroenterology, introduces a groundbreaking assessment tool-the preoperative systemic immune-inflammation index/albumin (SII/ALB) ratio-for patients with hepatocellular carcinoma (HCC) undergoing curative resection. This study not only establishes the independent prognostic significance of the SII/ALB ratio but also incorporates it into a predictive nomogram, enhancing its utility for clinical decision-making. The SII/ALB ratio, by integrating inflammatory and nutritional biomarkers, offers a novel lens through which the prognosis of HCC patients can be viewed, suggesting a more tailored approach to patient management. The development of the nomogram, validated for its accuracy in predicting patient outcomes, marks a pivotal advance, potentially guiding surgical decisions and postoperative care. However, the study's focus on a single-center cohort prompts the need for validation in a broader, more diverse patient population to ensure its applicability across various clinical settings. Moreover, longitudinal studies could elucidate the dynamic changes in SII/ALB post-surgery, offering insights into its potential as a continuous monitor for recurrence and long-term survival. This abstract aim to underscore the critical findings of Chen et al's study while calling for further research to explore the full potential of the SII/ALB ratio in the global management of hepatocellular carcinoma.

Background: Duodenal adenocarcinoma (DA), a rare gastrointestinal malignancy, lacks clear natural history and management strategies. This study aimed to investigate the long-term outcomes of patients with DA, focusing on long-term survival and the impact of tumor characteristics, surgery, and adjuvant therapy.

Aim: To bridge this knowledge gap, we conducted a hospital-based cohort study in our 15-year experience with DA aimed at investigating the long-term outcomes of the patients with DA, along with analyzing the impact of the tumor characteristics, operations and adjuvant therapy on survival outcomes.

Methods: A retrospective analysis of 208 patients diagnosed with non-ampullary DA at a single institution between 2009 and 2023 was performed. This study used SPSS 26.0 software to make a comprehensive statistical analysis of demographic characteristics, clinical presentation, treatment modalities, and survival outcomes. The effectiveness of surgical resection and adjuvant therapy in 5-year oval survival (OS) and disease-free survival was evaluated using Kaplan-Meier survival curves, the Cox proportional hazards model, and statistical comparisons of survival distributions.

Results: The median OS time for the cohort was 39 months, with 3- and 5-year OS rates of 51.2% and 43.6%, respectively. Radical resection was performed in 82.6% of cases, and was significantly associated with an improved 5-year OS, with a rate of 57.8%. Adjuvant therapy showed a survival benefit in the specific patient subsets, particularly in tumor stage II or III tumors, with an improved OS. Adjuvant therapy (hazard ratio= 2.71, 95% confidence interval: 1.30-5.62, P = 0.008), pancreatic invasion and advanced tumor stage were identified as significant predictors of OS in multivariate analyses.

Conclusion: Radical operation for DA is associated with a remarkable improvement in the 5-year OS. Importantly, postoperative adjuvant therapy can significantly prolong the OS time in patients with radical operation, especially in patients with stage III. It highlights the necessity for early diagnosis, tailored surgical approaches, and a nuanced understanding of the role of adjuvant therapy.

In this letter, we discuss the article by Li et al published in the World Journal of Gastrointestinal Surgery. Gallbladder cancer is a rare but fatal cancer that is often detected unexpectedly and at an advanced stage following routine cholecystectomy. Although the prognosis is poor, curative resections often combined with postoperative chemotherapy and/or radiation therapy can improve survival. However, targeted patient selection for the appropriate therapeutic approach is critical to minimize unnecessary morbidity. Using advanced statistical techniques, the authors developed a nomogram with the potential to predict survival after gallbladder cancer resection, identifying factors associated with long- and short-term survival. This tool could improve patient selection for surgery and post-operative treatment. In this letter, we provide background on survival nomograms including an in-depth discussion of statistical methods employed in this study, the use of nomograms in other forms of cancer, limitations to the model, and directions for future research.

This article discusses Wang et al's essay. Endoscopic biliary stenting, a less invasive alternative to surgery, is effective for malignant obstructive jaundice. This article summarizes the pathophysiology of biliary obstruction, the technical aspects of stenting, and the clinical outcomes. By comparison of endoscopic stenting with percutaneous biliary drainage, improvements and complications are focused on. Additionally, patient selection for stenting and future advancements in stent technology are important. Overall, endoscopic biliary stenting is a valuable palliative option for patients with malignant jaundice, especially those ineligibles for surgery.

Background: Colorectal cancer (CRC) remains one of the most common malignancies worldwide, with a significant subset of patients exhibiting absence of carcinoembryonic-antigen (CEA) expression. The lack of effective diagnostic method for CEA-negative CRC prevents its early treatment.

Aim: To identify potentially valuable biomarkers for identifying CEA-negative CRC, the hematological characteristics of patients with CEA-negative CRC was investigated.

Methods: In this retrospective analysis, 74 patients were included who had been pathologically confirmed to have CEA-negative CRC, along with 79 individuals diagnosed with benign colorectal conditions. The utility of various biomarkers was evaluated using analysis of the receiver operating characteristic (ROC) curve.

Results: Compared with patients with benign colorectal diseases, those with CEA-negative CRC had lower hemoglobin-to-red blood cell distribution width ratio (HRR) and lymphocyte-to-red blood cell distribution width ratio (LRR), and higher platelet-to-lymphocyte ratio (PLR) (P < 0.05). Correlation analysis showed that HRR was negatively correlated with T stage (r = -0.237), LRR was negatively correlated with T stage (r = -0.265) and distant metastasis (r = -0.321), and PLR was positively correlated with T stage (r = 0.251) (all P < 0.05). ROC analysis indicated that HRR outperformed LRR and PLR in identifying CEA-negative CRC. Combining HRR and PLR provided the highest area under the curve (area under the curve = 0.808; sensitivity = 82.43%; specificity = 68.35%) for distinguishing CEA-negative CRC from benign colorectal diseases.

Conclusion: HRR, LRR, and PLR alone or in combination could be used to distinguish CEA-negative CRC from benign colorectal diseases.

Background: Ischemic bowel disease (IBD) is a critical condition caused by reduced blood flow to the intestines, leading to tissue damage and potentially severe complications. Early recognition and timely management are essential for improving patient outcomes and reducing morbidity and mortality associated with IBD.

Aim: To evaluate the knowledge, attitude and practice (KAP) of healthcare professionals regarding IBD.

Methods: This cross-sectional study was conducted among healthcare professionals in China from November 2023 to December 2023 using a self-designed questionnaire.

Results: A total of 315 valid questionnaires were analyzed, with 215 participants (68.25%) being female. The mean KAP scores were 17.55 ± 5.35 (range: 0-24), 27.65 ± 2.77 (range: 8-40), and 18.88 ± 4.23 (range: 6-30), respectively. Multivariate linear regression analysis revealed the following factors to be independently associated with knowledge: Age 26-35 years (β = 2.80, 95%CI: 0.31-5.30, P = 0.028), professional title (β = 2.66, 95%CI: 0.91-4.41, P = 0.003), position (β = -3.78, 95%CI: -5.45 to -2.11, P < 0.001), participation in IBD-related training (β = 3.45, 95%CI: 2.39-4.51, P < 0.001), and admission of more than five IBD cases in the past month (β = 3.25, 95%CI: 1.58-4.92, P < 0.001). Attitude was independently associated with knowledge (β = 0.20, 95%CI: 0.15-0.26, P < 0.001) and being a nurse or nursing supervisor (β = -1.30, 95%CI: -2.16 to -0.40, P = 0.003). Practice was independently associated with knowledge (β = 0.20, 95%CI: 0.10-0.30, P < 0.001) and attitude (β = 0.24, 95%CI: 0.06-0.42, P = 0.007). Structural equation modeling demonstrated direct effects of knowledge on attitude (β = 0.24, P < 0.001) and practice (β = 0.26, P < 0.001), as well as of attitude on practice (β = 0.22, P = 0.012).

Conclusion: Healthcare professionals demonstrated adequate knowledge but moderate attitude and inactive practice regarding IBD. Addressing the gaps in attitude and practice through targeted training programs and interventions is essential for improving patient care and outcomes.

Background: The stearoyl-coenzyme A desaturase (SCD) gene influences colorectal cancer (CRC) pathogenesis, with its expression linked to tumor cell survival and resistance, necessitating further investigation into its role in CRC.

Aim: To explore the clinical and pathological significance of SCD expression in CRC tissues and to evaluate the affinity between nitidine chloride (NC) and SCD as a target.

Methods: Multi-center high-throughput data related to CRC were integrated to calculate the standardized mean difference of SCD mRNA expression levels. Immunohistochemical staining results, Clustered Regularly Interspaced Short Palindromic Repeats knockout screening results of cell growth, and single-cell sequencing were employed to verify the significance of SCD expression in CRC. The clinical and pathological significance of SCD was assessed using pooled receiver operating characteristic curves, sensitivity, specificity, and likelihood ratios. The molecular mechanism of NC against CRC was clarified using the SwissTarget Prediction and functional enrichment, and molecular docking techniques were utilized to explore the targeting affinity between NC and SCD.

Results: Data from 18 platforms, including 2482 CRC samples and 1334 non-cancerous colorectal tissue controls. SCD expression was significantly upregulated in CRC, with a standardized mean difference of 2.05 [95% confidence interval (CI): 1.69-2.41]. The area under the pooled receiver operating characteristic curve was 0.95 (95%CI: 0.92-0.96), with a sensitivity of 0.86 (95%CI: 0.81-0.90) and a specificity of 0.90 (95%CI: 0.87-0.93). Positive and negative likelihood ratios were 9.02 (95%CI: 6.49-12.51) and 0.15 (95%CI: 0.10-0.22), respectively. High SCD protein expression was noted in 208 CRC patients, significantly associated with vascular invasion (P < 0.001). At the single-cell level, SCD was significantly overexpressed in CRC cells (P < 0.001). A total of 33 CRC cell lines depended on SCD for growth. The potential mechanism of NC against CRC might involve modulation of the cell cycle, positioning SCD as a potential target for NC.

Conclusion: SCD promotes CRC cell growth and thus acts as an oncogenic factor, making it a potential therapeutic target for NC in CRC treatment.

Background: Gastric cancer is the fifth most common cancer and the fourth leading cause of death worldwide. Most cases of newly diagnosed gastric cancer involve not only locally advanced tumor growth and regional lymph node metastases but also distant metastases. We report a rare case finding of a mass in the right inguinal area which is derived from gastric cancer.

Case summary: A 68-year-old male initially diagnosed with an inguinal hernia presented with a 2 cm mass in the right inguinal area. Gastrointestinal symptoms led to the discovery of a stomach tumor. Biopsy confirmed gastrointestinal adenocarcinoma. The diagnosis was advanced gastric cancer with peritoneal dissemination, and the inguinal mass was due to direct infiltration. Due to gastrointestinal bleeding, the patient underwent palliative gastrectomy and lymph node dissection. Postoperatively, the patient received hyperthermic intraperitoneal chemotherapy and localized radiation therapy.

Conclusion: This case indicates that a systematic evaluation should be conducted during the initial consultation to explore the potential connection between unrecognized distant masses and the primary tumor.