World Journal of Gastrointestinal Surgery最新文献

Pancreatic ductal adenocarcinoma (PDAC), a "silent killer" with elusive early symptoms and poor prognosis, sees nearly half of patients experience recurrence within a year post-curative-intent surgery. Very early recurrence (VER), defined as recurrence within 12 weeks postoperatively and first termed "biological R2 resection" by Belfiori et al, remains a clinical puzzle. Martlı et al's recent retrospective cohort study offers crucial insights into this understudied issue, identifies predictive factors that challenge long-held beliefs, and calls for a rethink of risk stratification and postoperative management for PDAC patients. Martlı et al studied 303 PDAC patients at a high-volume center from 2019 to 2024, with VER affecting 9.24% (28 patients) of the cohort. The study's strength lies in combining traditional statistical analyses and machine learning (random forest modeling) to capture nonlinear relationships between clinicopathological factors and VER risk. Key findings include: (1) Poorly differentiated (G3) tumors are the strongest VER predictor (OR = 2.43, P < 0.001; random forest importance score = 0.35), with 92.85% of VER patients having G3 tumors (vs 45.81% of non-VER patients); (2) Contrary to prior studies, pancreatic head tumors (89.28% of VER patients vs 83.66% of non-VER patients, P = 0.031) were linked to VER; (3) Elevated red cell distribution width is a weaker predictor (random forest importance score = 0.20, P = 0.03 for group difference, P = 0.079 in multivariate analysis); and (4) VER correlates with significantly higher 6-month mortality (32.44% vs 14.77% in non-VER patients, P = 0.032).

Upper gastrointestinal (UGI) endoscopy has become increasingly popular with the recent advancements in technology and the increase of minimally invasive techniques. UGI endoscopy is indicated for diagnostic, staging, and therapeutic purposes and significantly influences the management of patients with a spectrum of foregut diseases, including esophageal and gastric malignancies, achalasia, and gastroesophageal reflux disease. There is growing evidence that intraoperative UGI endoscopy can be a useful adjunct and a powerful tool to enhance tumor localization, offering a direct evaluation of the surgical reconstruction and identifying potential sources of postoperative complications. However, its widespread utilization has been limited by concerns over cost, accessibility, and sufficient training and expertise. The aim of the current study was to review and elaborate on the available literature while presenting our experience in an academic institution specializing in esophagogastric surgery with intraoperative UGI endoscopy. We focused on the indications, added benefits, and related complications.

Background: Unplanned extubation (UE) after endoscopic retrograde cholangiopancreatography plus endoscopic nasobiliary drainage (ENBD) increases patient morbidity and prolongs hospitalization duration.

Aim: To construct a risk prediction model for UE in patients undergoing ENBD to provide evidence for clinical nursing.

Methods: A multicenter retrospective study was conducted, collecting data from 981 patients undergoing ENBD from three hospitals in Chongqing from January 2018 to June 2024, randomly allocated to modeling and validation groups in a 7:3 ratio. Logistic regression analysis was used to screen independent risk factors, construct prediction models, and draw nomograms.

Results: The overall incidence of UE was 6.12% (60/981). The majority (70.00%) of extubations occurred within 24-72 h postoperatively. Multivariate logistic regression analysis identified age ≥ 61 years [odds ratio (OR) = 2.341, 95% confidence interval (CI): 1.28-4.27], smoking history (OR = 2.876, 95%CI: 1.54-5.37), prolonged fasting time (OR = 1.124, 95%CI: 1.05-1.20), prolonged catheter duration (OR = 1.286, 95%CI: 1.09-1.52), and consciousness changes (OR = 3.152, 95%CI: 1.69-5.89) were independent risk factors while serum albumin was a protective factor (OR = 0.912, 95%CI: 0.87-0.95). The model receiver operating characteristic area under curve was 0.881 with accuracy of 80.36%, sensitivity of 83.59%, and specificity of 74.88%. A nomogram total score ≥ 199 points corresponded to a high-risk threshold.

Conclusion: The six-factor risk prediction model had good discrimination and accuracy, which can provide clinical nursing staff with scientific evidence to identify patients at high risk and help reduce the incidence of UE.

Background: Endoscopic submucosal dissection (ESD) is a minimally invasive, safe, and efficient treatment technique for patients diagnosed with early esophageal cancer. However, postoperative disease recurrence remains an important clinical challenge because it negatively alters patient prognosis and quality of life. As such, identification of relevant risk factors for recurrence can help optimize postoperative management strategies.

Aim: To assess factors that contribute to the risk for disease recurrence after ESD for early esophageal cancer.

Methods: Clinical data from 210 patients diagnosed with early stage esophageal cancer, who underwent ESD at the authors' center between March 2012 and March 2025, were retrospectively collected and analyzed. Patients were categorized into 2 groups according to postoperative disease recurrence: Recurrence (n = 30), and without recurrence (n = 180). Disease recurrence was defined as the appearance of new tumor lesions or pathologically confirmed tumor recurrence during the postoperative follow-up period. Risk factors associated with postoperative recurrence were identified using univariate and multivariate logistic regression analyses.

Results: During the follow-up period, 30 patients experienced tumor recurrence, corresponding to a recurrence rate of 14.19%. Multivariate analysis revealed that poor differentiation was a significant potential cause of esophageal cancer recurrence [odds ratio (OR) = 1.782, 95% confidence interval (CI): 1.154-2.196; P < 0.001]. Tumors infiltrating the submucosa were more likely to recur than those penetrating the lamina propria or muscularis mucosa (OR = 1.573, 95%CI: 1.073-2.481; P < 0.001). Furthermore, inability to completely resect the tumor greatly increased the likelihood of recurrence (OR = 2.189, 95%CI: 1.193-3.125; P = 0.001). Tumor diameter ≥ 2 cm was an independent risk factor for postoperative recurrence (OR = 1.981, 95%CI: 1.482-2.862; P = 0.005).

Conclusion: Recurrence of early esophageal cancer after ESD is largely influenced by the degree of differentiation, depth of lesion invasion, complete resection status of the tumor, and tumor diameter.

Background: Obesity is a major global health concern associated with increased morbidity and mortality. Sleeve gastrectomy is an effective bariatric surgery; however, the impact of resected gastric volume (RGV) on postoperative weight loss remains controversial.

Aim: To evaluate the effect of RGV on weight loss and body mass index (BMI) changes in patients undergoing sleeve gastrectomy.

Methods: This retrospective study included 49 patients. Preoperative and postoperative body weight and BMI (at 6 months and 12 months after surgery) were recorded. RGV was calculated using the ellipsoid formula based on the specimen's length, width, and thickness measurements. Statistical analyses included parametric tests, repeated-measures one-way analysis of variance, Bonferroni post-hoc tests, and Pearson correlation analysis.

Results: Both body weight and BMI significantly decreased over time (weight: F = 951.34, P < 0.01, η² = 0.95; BMI: F = 345.97, P < 0.01, η² = 0.88). A positive and statistically significant correlation was found between preoperative body weight and RGV (r = 0.285, P < 0.05). However, no significant associations were identified between RGV and weight or BMI at 6 months and 12 months.

Conclusion: RGV correlated with preoperative weight but not with postoperative outcomes, indicating that weight loss after sleeve gastrectomy is a multifactorial process and influenced by hormonal, metabolic, and lifestyle factors.

Background: In the intensive care unit (ICU) setting, patients with end-stage gastrointestinal cancer (GIC) frequently bear a heavier symptom burden, see faster functional regression, and struggle with eating impairments. These further increase the demands and complexities of nursing care.

Aim: To discuss the development of Kano model-driven ICU end-of-life care (ICU-EOLC) strategies for patients with GIC and its implications for quality of death (QoD).

Methods: This study enrolled 115 patients with end-stage GIC admitted to the ICU from June 2021 to June 2024. A Kano model-driven ICU-EOLC protocol was applied to the observation group (n = 65), contrasting with routine care in the control group (n = 50). Pre-intervention and post-intervention comparisons were made in terms of psychological well-being [Hospital Anxiety and Depression Scale (HADS)], quality of life (QoL) [European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 15 Palliative Care Version (EORTC QLQ-C15-PAL)], QoD (Chinese version of the Quality of Dying and Death in the ICU Scale), death-related attitudes [Revised Death Attitude Profile (DAP-R)], and nursing care satisfaction.

Results: Compared with controls, patients in the observation group scored markedly lower on HADS (all domains), EORTC QLQ-C15-PAL (symptom domain), and DAP-R (escape acceptance, fear of death, and death avoidance), while achieving statistically higher scores on EORTC QLQ-C15-PAL (physical function and overall QoL dimensions), C-QDD-ICU, DAP-R (natural and approaching acceptance), and nursing care satisfaction measures.

Conclusion: Kano model-driven ICU-EOLC interventions significantly reduced anxiety and depression in patients with end-stage GIC, and patients' quality of life, QoD, death-related attitudes, and nursing satisfaction were improved.

Background: The pleiotropic effects of statins, including anti-inflammatory and immunomodulatory actions, have prompted investigation into their perioperative role in colorectal cancer (CRC) surgery. However, findings remain inconsistent due to heterogeneity in study designs, statin regimens, and outcome definitions. This reviews current observational evidence, emphasizing the duration of statin therapy and its association with postoperative outcomes.

Aim: To evaluate the association between statin therapy and postoperative outcomes in patients undergoing CRC surgery.

Methods: A systematic literature search was conducted using PubMed and Google Scholar through March 2025. Five cohort studies evaluating statin use in CRC surgery were included. Primary outcomes assessed included anastomotic leak, surgical site infection, and 30-day and 90-day mortality. Data on statin duration and confounders such as comorbidities and surgical variables were also extracted.

Results: Three studies investigated the rates of anastomotic leaks in patients who used statins compared to those who did not. Two of the studies found no significant difference, while one noted a marginally higher leak rate among statin users. Diabetes, smoking habits, and operative time were found to be common confounding factors. Conversely, the use of statins was consistently linked to a decrease in 30-day mortality in propensity-matched groups, although findings regarding 90-day mortality were variable.

Conclusion: Statin therapy may confer short-term survival benefits in CRC surgical patients, potentially via anti-inflammatory or cytoprotective mechanisms. While evidence regarding anastomotic leaks remains inconclusive, trends suggest improved postoperative outcomes. These findings are constrained by methodological heterogeneity, underscoring the need for prospective, randomized studies to confirm benefits and identify optimal patient subgroups.

Fecal incontinence, a debilitating condition that significantly impairs quality of life, affects 2%-21% of adults worldwide. For patients whose structural defects are unresponsive to conservative therapies, sphincter reconstruction remains the primary treatment approach. Although traditional surgical techniques effectively restore anatomy in the short term, their long-term efficacy is constrained by progressive muscle atrophy and fibrotic scarring. In complex cases, alternative interventions, including dynamic gracilis or gluteus maximus transposition and artificial sphincter implantation, offer therapeutic options yet are associated with increased surgical risks and high complication rates. Emerging therapies such as regenerative medicine and neuromodulatory approaches have potential, although further rigorous clinical validation is needed to establish standardized protocols. Optimizing fecal incontinence management necessitates precise patient stratification, multidisciplinary collaboration, and the development of individualized treatment algorithms. Advancements in this field depend on large-scale clinical trials and comprehensive long-term outcome assessments to improve therapeutic efficacy and patient-centered care.

Pancreatogenic diabetes, also known as type 3c diabetes, arises from pancreatic dysfunction due to conditions such as chronic pancreatitis and pancreatic cancer. This form of diabetes is characterized by both endocrine and exocrine pancreatic insufficiency, leading to insulin deficiency, glycemic variability, and maldigestion. The diagnostic process remains complex, as it shares clinical features with type 2 diabetes, and there are no standardized diagnostic criteria. Current treatment approaches include insulin therapy and pancreatic enzyme replacement therapy, along with nutritional support. However, the efficacy of oral hypoglycemic agents is limited, particularly in the presence of exocrine insufficiency. Epidemiological data indicate a significant overlap between pancreatogenic diabetes and pancreatic cancer, necessitating enhanced screening in high-risk populations. In this minireview, we highlight the pathophysiological mechanisms, diagnostic challenges, and current management strategies, emphasizing the need for improved diagnostic criteria and individualized treatment regimens.

Background: The management of patients with colorectal cancer (CRC) mainly lies on the use of magnetic resonance imaging (MRI) technique as a diagnostic tool for both staging and restaging.

Aim: To explore the preoperative value of quantitative parameters of dynamic contrast-enhanced MRI (DCE-MRI) in evaluating clinical stages of CRC.

Methods: A total of 86 CRC patients undergoing DCE-MRI examinations were included and then classified into CRC group (n = 46) and benign tumor group (n = 40) according to surgical and pathological results. Quantitative parameters of DCE-MRI, including volume transfer constant (Ktrans), rate constant (Kep) and extravascular extracellular volume fraction (Ve), were analyzed between two groups and among CRC at different stages. Receiver operating characteristic (ROC) curves with of quantitative parameters of DCE-MRI for clinical diagnosis and preoperative staging of CRC were plotted.

Results: The CRC group had 9 cases with tumor in the upper segment, 21 cases in the middle segment, 16 in the low segment, 10 cases with well differentiation, 27 cases with moderate differentiation, and 9 cases with poor differentiation. The Ktrans, Kep, and Ve in the CRC group were higher than those in the benign tumor group (P < 0.05). The ROC curves indicated that the optimal cutoff values of Ktrans, Kep and Ve for diagnosing CRC were 0.905 minute^-1, 0.225 minute^-1 and 0.585%, respectively. The Ktrans, Kep and Ve as a combined tool to diagnose CRC yielded 0.863 of area under the curve and 82.60% of sensitivity, and both values were higher than those yielded by Ktrans, Kep, or Ve alone (P < 0.05). The Ktrans, Kep and Ve in CRC patients at T3-T4 stage or N1-N2 stage were higher than those at T1-T2 stage or N0 stage (P < 0.05). Results of Spearman correlation analysis showed that the Ktrans, Kep and Ve were correlated with advanced T and N stages in CRC patients (P < 0.05). The ROC results indicated that the Ktrans produced a higher specificity (81.48%) and sensitivity (94.70%) in evaluating preoperative T stage of CRC. The Kep generated a higher specificity (96.00%) and sensitivity (81.00%) in evaluating preoperative N stage of CRC.

Conclusion: The study suggests that the values of Ktrans, Kep and Ve of DCE-MRI exhibit good performance in diagnosing CRC and preoperative assessment of clinical stages. However, relatively small sample size should be considered for data interpretation.