World Journal of Gastrointestinal Surgery最新文献

Background: Transabdominal ultrasound monitoring can predict the occurrence of intraperitoneal effusion after laparoscopic gastrectomy and provide data reference for early intervention for postoperative complications.

Aim: To investigate dynamic monitoring of intraperitoneal effusion after laparoscopic gastrectomy and correlation with prognosis to guide intervention for postoperative complications.

Methods: Eighty patients who underwent laparoscopic gastric cancer surgery in a general surgery department over four years was selected. Standardized transabdominal ultrasonography was performed on 1^st, 3^rd and 7^th day after surgery. The incidence and nature of the effusion and inflammatory indicators were measured simultaneously. Intraperitoneal effusion risk was analyzed using the generalized estimating equation, linear mixed model was used to evaluate the factors influencing effusion collection, and Cox regression and receiver operating characteristic curves were used to evaluate the effectiveness of complication prediction.

Results: The incidence of intraperitoneal effusion peaked on the 3^rd postoperative day (52.50%, 42/80). Subgroup analysis showed a higher risk of fluid accumulation after total gastrectomy. The risk of intraperitoneal effusion after total gastrectomy was 2.10 times that of distal gastrectomy [odds ratio = 2.10, 95% confidence interval (CI): 1.14-3.87] and the risk of diabetes mellitus was increased by 85% (odds ratio = 1.85, 95%CI: 1.04-3.31). The complication risk of mixed effusion increased 3.86 times (hazard ratio = 3.86, 95%CI: 1.62-9.18), and the total complication rate reached 53.57% (15/28). Procalcitonin > 0.47 ng/mL on day 3 was the best predictor of infectious complications (area under the curve = 0.874, sensitivity: 82.9%, specificity: 81.7%), followed by C-reactive protein > 48.5 mg/L (area under the curve = 0.852). There was no significant difference in outcomes between the age subgroups.

Conclusion: Transabdominal ultrasonography accurately captures the evolution of effusion after laparoscopic gastrectomy. It is recommended that high-risk patients undergo focused ultrasonographic at 72 hours postoperatively to facilitate early intervention.

Background: Staging laparoscopy (SL) is a valuable tool for detecting occult peritoneal or hepatic metastases in patients with gastroesophageal junction (GEJ) cancer, especially when imaging suggests resectability. Despite advances in cross-sectional imaging methodologies such as computed tomography, positron emission tomography/computed tomography and endoscopic ultrasound, these techniques may miss low-volume or superficial peritoneal disease. Early identification of metastatic spread through SL can avoid unnecessary surgery, reduce morbidity, and improve treatment planning. However, its use in GEJ tumors - particularly Siewert types I and II - remains debated. Understanding the diagnostic performance (DP) of SL is essential for optimizing staging strategies.

Aim: To evaluate the DP of SL in identifying abdominal metastatic disease in patients with clinically resectable GEJ tumors.

Methods: Systematic review and meta-analysis in accordance with PRISMA 2020 guidelines. A comprehensive PubMed search was performed up to March 29, 2024, using Medical Subject Headings terms related to GEJ, laparoscopy, and cancer staging. Inclusion criteria: Studies assessing SL in patients with GEJ tumors. Primary outcome was the rate of upstaging to stage IV due to peritoneal or hepatic metastases. Secondary outcomes included details on techniques, patient characteristics, and procedural factors. Risk of bias was evaluated using Risk of Bias in Non-randomised Studies of Interventions and certainty of evidence with Grading of Recommendations, Assessment, Development and Evaluation.

Results: Eighteen studies involving 1591 patients were included. SL upstaged 22% of patients (95% confidence interval: 17-27) to stage IV due to occult metastatic disease. The pooled positivity rates were positive peritoneal malignancy (17.5%), peritoneal carcinomatosis (13%), malignant peritoneal cytology (9%), and hepatic metastases (9.2%). SL avoided unnecessary surgery in 19.8% of cases. Subgroup analysis revealed consistent performance in Siewert II tumors (DP = 13%, I ² = 0), while in Siewert I tumors it was more heterogeneous (DP = 18%, I ² = 93.7%). Only five studies reported complications, mostly minor, with no procedure-related mortality. No comorbidities, carcinomatosis scoring, conversion to open surgery, complications of follow-up, readmissions, postoperative length of stay, or delay in initiating neoadjuvant therapy were recorded.

Conclusion: SL improves staging accuracy in GEJ cancers, especially Siewert II. Despite heterogeneity and limited data stratification, SL may guide therapeutic decisions and help avoid unnecessary or futile surgeries.

Background: Postoperative recurrence remains a major challenge in gastric cancer management. Monitoring serum biomarkers such as carcinoembryonic antigen (CEA) may enable earlier detection of recurrence and improve patient outcomes.

Aim: To evaluate postoperative serum CEA expression and its efficacy in predicting gastric cancer recurrence.

Methods: This retrospective study analyzed clinical data from 120 patients with primary gastric cancer treated between January 2022 and January 2023. Patients were categorized into recurrence and non-recurrence groups. Serum levels of CEA, alpha-fetoprotein (AFP), and carbohydrate antigen 19-9 (CA19-9) were measured at one week, three months, and six months postoperatively. Logistic regression identified independent risk factors for recurrence, Pearson correlation assessed the association with recurrence timing, and receiver operating characteristic (ROC) curves evaluated the predictive performance of combined CEA and AFP levels.

Results: During 24 months of follow-up, 39 patients (32.50%) experienced recurrence. No significant baseline differences were observed between groups (P > 0.05). CEA, AFP, and CA19-9 levels at one week were comparable between groups (P > 0.05), whereas levels at three and six months were significantly higher in the recurrence group (P < 0.05). Logistic regression identified postoperative CEA and AFP as independent risk factors for recurrence (P < 0.05). Pearson correlation showed a negative association between CEA and AFP levels and recurrence interval (P < 0.05). ROC curve analysis demonstrated that combined CEA and AFP yielded an area under the curve of 0.826, with specificity of 94.36% and sensitivity of 90.50%, outperforming either marker alone (P < 0.05).

Conclusion: Dynamic postoperative monitoring of serum CEA and AFP enables early prediction and detection of gastric cancer recurrence.

Background: Castleman disease (CD) is a rare lymphoproliferative disorder most commonly occurring in the mediastinum and hilar regions. Mesenteric involvement is rare, and diagnosis primarily relies on histopathological examination.

Case summary: We report two cases of mesenteric CD with gastrointestinal symptoms accompanied by weight loss. Case 1 underwent complete surgical resection of the lesion. Postoperative pathology confirmed the hyaline vascular type, and the prognosis was favorable. Case 2 also underwent complete surgical resection initially, with postoperative pathology confirming the plasma cell type. However, the disease followed an aggressive course. A second surgery was performed five months later, and postoperative pathology confirmed mesenteric peripheral T-cell lymphoma, not otherwise specified (PTCL-NOS). The patient died postoperatively due to acute renal failure.

Conclusion: To our knowledge, this is the first reported case of mesenteric CD transforming into PTCL-NOS, highlighting the complexity and heterogeneity of the clinical course of mesenteric CD. These findings provide insights into the personalized treatment and clinical management of this disease.

Background: Cerebral infarction (CI) is a major subtype of ischemic stroke, with high incidence, recurrence rate, disability rate, and mortality rate in the elderly. Elderly CI patients are prone to peptic ulcer due to long-term use of antiplatelet drugs and stress factors, which further leads to gastrointestinal dysfunction, seriously affecting nutritional intake and rehabilitation. Naloxone, an opioid receptor antagonist, has neuroprotective potential, and enteral nutrition (EN) can improve gastrointestinal function. This study aims to explore the intervention effect of their combination.

Aim: To investigate the efficacy of naloxone combined with EN on gastrointestinal dysfunction in elderly patients with CI and peptic ulcer.

Methods: In this randomized controlled trial, 110 elderly patients with CI and peptic ulcer were equally assigned to a control group (receiving standard therapy combined with EN) or a combination group (receiving standard therapy, EN, and naloxone). The National Institute of Health Stroke Scale (NIHSS) scores, Barthel Index (BI), Chinese version of the MOS 36-Item Short Form Health Survey (SF-36) scores, gastrointestinal function scores, and serum levels of motilin (MTL), gastrin (GAS), and somatostatin (SS) were compared. Adverse reactions were also recorded.

Results: Compared with the control group, the combination group had lower NIHSS scores (5.88 ± 1.07 vs 8.73 ± 1.14, P < 0.001) and gastrointestinal dysfunction scores (5.14 ± 1.27 vs 8.62 ± 1.31, P < 0.001), higher BI (87.36 ± 4.42 vs 72.29 ± 3.23, P < 0.001) and SF-36 scores (76.26 ± 3.85 vs 70.21 ± 3.66, P < 0.001), increased serum MTL (201.31 ± 12.35 ng/L vs 186.81 ± 11.18 ng/L, P < 0.001) and GAS levels (94.46 ± 9.64 pg/mL vs 103.15 ± 10.52 pg/mL, P < 0.001), and decreased SS levels (5.69 ± 1.25 pg/mL vs 8.31 ± 1.19 pg/mL, P < 0.001). No significant difference in the incidence of adverse reactions was found between the two groups.

Conclusion: The combination of naloxone and EN is a safe and efficacious therapeutic approach for ameliorating gastrointestinal dysfunction and promoting overall recovery in elderly individuals with CI and peptic ulcer.

This letter systematically evaluated a retrospective comparative study by Qiu et al investigating ultrasound-guided percutaneous catheter drainage (PCD) for pyogenic liver abscess management during the non-liquefaction phase. The results demonstrated that early ultrasound-guided PCD significantly shortened hospitalization duration, accelerated fever resolution, and promoted > 50% abscess volume reduction compared to delayed intervention after liquefaction, without increasing procedural risks. While challenging the conventional "wait-for-liquefaction" paradigm, the evidence quality limitations warrant caution, highlighting the need for multicenter prospective randomized controlled trials. Current clinical practice recommends early PCD for severe manifestations (persistent fever, leukocytosis) or immunocompromised patients (including those with diabetes), while prioritizing antibiotic therapy for small abscesses (diameter < 3 cm) or mild cases. Dynamic imaging reassessment and multidisciplinary collaboration remain essential for individualized management. This study provides critical evidence supporting the paradigm shift from empirical observation to precision intervention in pyogenic liver abscess management, though risk-benefit evaluation should precede widespread clinical adoption.

Background: Pancreatic surgery is highly invasive and associated with prolonged postoperative recovery. Safe, effective postoperative nutritional support is essential for patient recovery. The impact of two modes of nutritional support-jejunostomy tube (JT) and nasojejunal tube (NJT), on recovery after resolution of novel coronavirus infection has been rarely reported.

Aim: To compare the effects of JT with those of NJT after pancreatectomy.

Methods: We retrospectively analyzed clinical data from 60 patients who underwent pancreatic surgery between January 2023 and May 2025 and classified them into an NJT group (n = 39) and a JT group (n = 21) according to the nutritional method used. Postoperative nutritional status and related complication rates were compared between the two groups.

Results: No statistically significant differences were observed in sex, age, body mass index, preoperative hemoglobin level, or preoperative jaundice status between the two groups; postoperative pathologic type, incidence of delayed gastric emptying, time to transoral feeding, and time to defecation also did not differ (P > 0.05). The postoperative albumin level in the JT group was higher than in the NJT group, whereas the incidences of vomiting, pharyngeal discomfort, and hypostatic pneumonia, as well as the postoperative length of stay, were significantly lower (P < 0.05).

Conclusion: The use of JT for nutritional support after pancreatectomy is safe and effective, significantly reducing complication incidence and shortening postoperative length of stay; therefore, it is worthy of clinical selection and standardized use.

Background: Pancreaticobiliary maljunction (PBM) is a congenital disease in which the pancreatic and bile ducts fuse outside the duodenal wall. Congenital biliary dilatation (CBD) involves PBM and dilatation of the extrahepatic bile duct. The lack of Oddi sphincter action at the confluence results in the retrograde flow of pancreatic juice into the bile duct, placing patients with CBD at high risk of biliary carcinoma. The standard treatment for CBD is complete extrahepatic bile duct resection (EHBR). Hepatolithiasis (HL), a late complication following CBD surgery, has a deleterious clinical impact; further research is necessary to elucidate its risk factors.

Aim: To clarify the clinical impact of and risk factors for HL after CBD surgery.

Methods: A retrospective study was conducted with 223 CBD patients who underwent EHBR across three tertiary hospitals to investigate postoperative complications. An exploratory analysis was performed to identify factors associated with HL development. Risk factors were subsequently identified using least absolute shrinkage and selection operator (LASSO) analysis.

Results: HL was observed in 15/223 (6.7%) patients. Two of those patients developed liver failure owing to biliary cirrhosis; one died, and the other received liver transplantation. Two patients required major hepatectomy. The majority of the remaining patients required repeated enteroscopic and/or percutaneous lithotomy procedures. LASSO analysis revealed older age at surgery as an independent risk factor for HL; the time-dependent receiver operating characteristic analysis at 6 years after surgery revealed a cutoff age of 31 years.

Conclusion: HL following CBD surgery has a markedly deleterious clinical impact. Advanced age at the time of CBD surgery was identified as an independent risk factor for HL.

Liver transplantation (LT) remains the definitive treatment for end-stage liver disease, yet early detection of graft dysfunction and rejection is still challenging. Conventional blood-based markers provide systemic information but lack hepatic specificity. Bile, directly secreted by hepatocytes and cholangiocytes, represents an organ-specific biofluid with diagnostic potential for assessing graft viability and early complications. This minireview examined the biochemical, immunological, and molecular features of bile as biomarkers in LT, focusing on pH, bicarbonate, glucose, lactate, bile acids, and proteomic/lipidomic profiles in relation to ischemia-reperfusion injury, early allograft dysfunction, and ischemic-type biliary lesions. The integration of bile-based parameters into ex situ perfusion and post-transplant monitoring, supported by omics technologies and predictive modeling, was also discussed. Building on these insights, we designed a single-center prospective study (ClinicalTrials.gov: NCT03882164) evaluating biliary tacrolimus (TACbile) as a predictor of acute rejection after LT. Paired daily TACbile and plasma tacrolimus levels are measured in recipients with Kehr T-tubes to define a blood-bile ratio of tacrolimus. The primary endpoint was the predictive accuracy of blood-bile ratio of tacrolimus for biopsy-proven rejection; secondary outcomes include associations with early allograft dysfunction. Bile-based biomarkers, particularly TACbile, may revolutionize graft monitoring and personalize immunological surveillance after LT.

Background: Early risk stratification in severe acute pancreatitis (SAP) remains challenging with traditional scoring systems overlooking etiological heterogeneity, particularly in hypertriglyceridemic acute pancreatitis (HTG-AP).

Aim: To develop and evaluate a machine learning (ML) model combining intra-abdominal pressure (IAP) and procalcitonin (PCT) for SAP prognosis and evaluate its clinical impact across different etiologies.

Methods: We retrospectively analyzed 245 patients with pancreatitis (98 patients with SAP). An ML model using 24-h peak IAP and PCT levels was used to predict 28-day mortality. Propensity score matching was used to compare IAP-PCT-guided management with conventional management.

Results: The ML-IAP-PCT model outperformed the Acute Physiology and Chronic Health Evaluation II score (area under the curve: 0.853 vs 0.801, P = 0.044) and Bedside Index of Severity in Acute Pancreatitis score. IAP-PCT-guided management was associated with lower mortality (15.8% vs 25.0%, P = 0.043) and multiple organ dysfunction syndrome (48.7% vs 61.8%, P = 0.027) rates. Patients with HTG-AP showed the greatest benefit (multiple organ dysfunction syndrome: 39.3% vs 60.7%, P = 0.018).

Conclusion: ML-optimized IAP-PCT monitoring provides superior prognostic accuracy and guides management associated with improved outcomes, especially in patients with HTG-AP. Prospective validation is needed to establish causality for this etiology-stratified approach.