Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2735
Barbora Pospisilova, Jaromir Frydrych, Antonin Krajina, Julius Örhalmi, Ivana M Kajzrlikova, Petr Vitek
Background: Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal (GI) bleeding. Here, we present a minimally invasive therapy with selective embolization.
Case summary: A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis. Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas. The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was associated with a high risk of fecal incontinence. Here, we present selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice. The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis.
Conclusion: Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.
{"title":"Anorectal hemangioma, a rare cause of lower gastrointestinal bleeding, treated with selective embolization: A case report.","authors":"Barbora Pospisilova, Jaromir Frydrych, Antonin Krajina, Julius Örhalmi, Ivana M Kajzrlikova, Petr Vitek","doi":"10.4240/wjgs.v16.i8.2735","DOIUrl":"10.4240/wjgs.v16.i8.2735","url":null,"abstract":"<p><strong>Background: </strong>Anorectal hemangioma is a rare and frequently misdiagnosed cause of lower gastrointestinal (GI) bleeding. Here, we present a minimally invasive therapy with selective embolization.</p><p><strong>Case summary: </strong>A 21-year-old male patient experienced painless rectal bleeding since childhood and was treated for ulcerative colitis. Diagnostic studies later revealed specific characteristics for vascular lesions-anorectal hemangiomas. The severity of rectal bleeding caused symptomatic anemia and possible surgical treatment was associated with a high risk of fecal incontinence. Here, we present selective embolization, a minimally invasive therapeutic approach that is proven as an alternative therapeutic method of choice. The patient significantly improved temporarily and had a small ischemic ulcer, which healed with a control colonoscopy and developed no stenosis.</p><p><strong>Conclusion: </strong>Awareness of the clinical and radiological features of GI hemangiomas may help improve diagnostics and avoid inappropriate therapeutic procedures.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142117099","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2494
Na Hong, Wei-Yong Liu, Jin-Long Zhang, Kai Qian, Jie Liu, Xian-Jun Ye, Fei-Yan Zeng, Yue Yu, Kai-Guang Zhang
Background: Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.
Aim: To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity.
Methods: This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (n = 23), low-activity perianal fistulas [n = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (n = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI.
Results: The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, P < 0.001). Significant differences were observed in the blood flow Limberg score (χ2 = 8.903, P < 0.05) and shear wave velocity (t = 2.467, P < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (r = -0.676, P < 0.001), a weak negative correlation with the PDAI score (r = -0.386, P < 0.05), and a weak correlation between the Limberg score and the PDAI score (r = 0.368, P < 0.05).
Conclusion: EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.
背景:肛周瘘给克罗恩病(CD)患者带来了双重挑战。目的:确定肛内超声(EUS)和剪切波弹性成像(SWE)评估肛周瘘CD(PFCD)活动的准确性:这是一项回顾性队列研究。方法:这是一项回顾性队列研究,将 2022 年 8 月至 2023 年 12 月期间确诊为 CD 的 67 例患者分为三组:非肛瘘组(n = 23)、低活动性肛周瘘[n = 19,肛周疾病活动指数(PDAI)≤ 4]、高活动性肛周瘘(n = 25,PDAI > 4)。所有患者均接受了包括 EUS + SWE、盆腔磁共振[盆腔磁共振成像(MRI)]、C 反应蛋白、粪便钙蛋白、CD 活性指数、PDAI 在内的评估:盆腔磁共振成像和 EUS 显示的瘘管比例一致,均为 82%,肛周瘘管分类的一致性很好(Kappa = 0.752,P < 0.001)。第 2 组和第 3 组的血流 Limberg 评分(χ 2 = 8.903,P < 0.05)和剪切波速度(t = 2.467,P < 0.05)差异显著。剪切波速度与CD瘘成像磁共振新指数(Magnifi-CD)评分呈强负相关(r = -0.676,P <0.001),与PDAI评分呈弱负相关(r = -0.386,P <0.05),Limberg评分与PDAI评分呈弱相关(r = 0.368,P <0.05):结论:EUS 联合 SWE 是一种检测和量化 CD 患者肛周瘘活动度的卓越方法。结论:EUS 联合 SWE 是检测和量化 CD 患者肛周瘘活动度的理想方法,是客观评估肛周瘘活动度以制定管理策略的理想工具。
{"title":"Assessment of perianal fistulizing Crohn's disease activity with endoanal ultrasound: A retrospective cohort study.","authors":"Na Hong, Wei-Yong Liu, Jin-Long Zhang, Kai Qian, Jie Liu, Xian-Jun Ye, Fei-Yan Zeng, Yue Yu, Kai-Guang Zhang","doi":"10.4240/wjgs.v16.i8.2494","DOIUrl":"10.4240/wjgs.v16.i8.2494","url":null,"abstract":"<p><strong>Background: </strong>Perianal fistulas pose dual challenges to Crohn's disease (CD) patients. Low patient compliance due to the complexity of existing examination methods plagues the treatment and follow-up management of perianal CD.</p><p><strong>Aim: </strong>To determine the accuracy of endoanal ultrasound (EUS) and shear wave elastography (SWE) for evaluating perianal fistulizing CD (PFCD) activity.</p><p><strong>Methods: </strong>This was a retrospective cohort study. A total of 67 patients from August 2022 to December 2023 diagnosed with CD were divided into three groups: Non-anal fistula group (<i>n</i> = 23), low-activity perianal fistulas [<i>n</i> = 19, perianal disease activity index (PDAI) ≤ 4], high-activity perianal fistulas (<i>n</i> = 25, PDAI > 4) based on the PDAI. All patients underwent assessments including EUS + SWE, pelvic magnetic resonance [pelvic magnetic resonance imaging (MRI)], C-reactive protein, fecal calprotectin, CD activity index, PDAI.</p><p><strong>Results: </strong>The percentage of fistulas indicated by pelvic MRI and EUS was consistent at 82%, and there was good consistency in the classification of perianal fistulas (Kappa = 0.752, <i>P</i> < 0.001). Significant differences were observed in the blood flow Limberg score (<i>χ</i> <sup>2</sup> = 8.903, <i>P</i> < 0.05) and shear wave velocity (<i>t</i> = 2.467, <i>P</i> < 0.05) between group 2 and 3. Shear wave velocity showed a strong negative correlation with magnetic resonance novel index for fistula imaging in CD (Magnifi-CD) score (<i>r</i> = -0.676, <i>P</i> < 0.001), a weak negative correlation with the PDAI score (<i>r</i> = -0.386, <i>P</i> < 0.05), and a weak correlation between the Limberg score and the PDAI score (<i>r</i> = 0.368, <i>P</i> < 0.05).</p><p><strong>Conclusion: </strong>EUS combined with SWE offers a superior method for detecting and quantitating the activity of perianal fistulas in CD patients. It may be the ideal tool to assess PFCD activity objectively for management strategies.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362922/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2702
Qi Sun, Xiao-Ying Wang, Guang-Jin Guo, Lei Wang, Li-Min Meng, Yun-Fei Guo, Tao Sun, Shou-Bin Ning
Background: Peutz-Jeghers syndrome (PJS) has brought significant physical, psychological and economic burdens on the patients and their families due to its early onset, diagnostic and therapeutic challenges and increased recurrence risk.
Aim: To explore the current research status and emerging hotspots of PJS.
Methods: Studies on PJS published during 1994-2023 were gathered based on Web of Science Core Collection. Additionally, a case of PJS-induced intestinal intussusception, successfully treated with endoscopic methods despite three laparotomies, was highlighted. Comprehensive bibliometric and visual analysis were conducted with VOSviewer, R and CiteSpace.
Results: Altogether 1760 studies were identified, indicating a steady increase in the publication number. The United States had the highest influence, whereas the University of Helsinki emerged as the leading institution, and Aaltonen LA from the University of Helsinki was the most prolific author. Cancer Research, Oncogene and Endoscopy were the top three journals based on H-index. Keyword burst direction analysis revealed that "cancer risk", "management", "surveillance" and "familial pancreatic cancer" were the potential hotspots for investigation. Additionally, "early detection", "capsule endoscopy", "clinical management", "double-balloon endoscopy", "familial pancreatic cancer" and "molecular genetic basis" were identified as the key clusters of co-cited references. Endoscopic polypectomy remained effective on resolving intestinal intussusception in patients who underwent three previous laparotomies.
Conclusion: In the last three decades, global publications related to PJS show a steadily increasing trend in number. Endoscopic management is currently a research hotspot.
背景:佩兹-杰格综合征(Peutz-Jeghers syndrome,PJS)由于发病早、诊断和治疗困难以及复发风险增加,给患者及其家庭带来了巨大的生理、心理和经济负担:方法:根据 Web of Science Core Collection 收集 1994-2023 年间发表的有关 PJS 的研究。此外,还重点介绍了一例 PJS 引起的肠套叠病例,尽管该病例进行了三次开腹手术,但仍通过内窥镜方法成功治愈。利用 VOSviewer、R 和 CiteSpace 进行了全面的文献计量和视觉分析:结果:共发现了 1760 项研究,表明发表数量在稳步增长。美国的影响力最大,而赫尔辛基大学则成为领先机构,赫尔辛基大学的 Aaltonen LA 是最多产的作者。根据 H 指数,《癌症研究》、《肿瘤基因》和《内镜》是排名前三的期刊。关键词爆发方向分析显示,"癌症风险"、"管理"、"监测 "和 "家族性胰腺癌 "是潜在的调查热点。此外,"早期检测"、"胶囊内镜"、"临床管理"、"双气囊内镜"、"家族性胰腺癌 "和 "分子遗传学基础 "也被确定为共被引文献的关键集群。结论:内镜下息肉切除术对解决曾接受过三次开腹手术的患者的肠套叠仍然有效:结论:在过去的三十年中,全球有关 PJS 的论文数量呈稳步上升趋势。内镜治疗是目前的研究热点。
{"title":"Global research landscape of Peutz-Jeghers syndrome and successful endoscopic management of intestinal intussusception in patients with recurrent laparotomies.","authors":"Qi Sun, Xiao-Ying Wang, Guang-Jin Guo, Lei Wang, Li-Min Meng, Yun-Fei Guo, Tao Sun, Shou-Bin Ning","doi":"10.4240/wjgs.v16.i8.2702","DOIUrl":"10.4240/wjgs.v16.i8.2702","url":null,"abstract":"<p><strong>Background: </strong>Peutz-Jeghers syndrome (PJS) has brought significant physical, psychological and economic burdens on the patients and their families due to its early onset, diagnostic and therapeutic challenges and increased recurrence risk.</p><p><strong>Aim: </strong>To explore the current research status and emerging hotspots of PJS.</p><p><strong>Methods: </strong>Studies on PJS published during 1994-2023 were gathered based on Web of Science Core Collection. Additionally, a case of PJS-induced intestinal intussusception, successfully treated with endoscopic methods despite three laparotomies, was highlighted. Comprehensive bibliometric and visual analysis were conducted with VOSviewer, R and CiteSpace.</p><p><strong>Results: </strong>Altogether 1760 studies were identified, indicating a steady increase in the publication number. The United States had the highest influence, whereas the University of Helsinki emerged as the leading institution, and Aaltonen LA from the University of Helsinki was the most prolific author. Cancer Research, Oncogene and Endoscopy were the top three journals based on H-index. Keyword burst direction analysis revealed that \"cancer risk\", \"management\", \"surveillance\" and \"familial pancreatic cancer\" were the potential hotspots for investigation. Additionally, \"early detection\", \"capsule endoscopy\", \"clinical management\", \"double-balloon endoscopy\", \"familial pancreatic cancer\" and \"molecular genetic basis\" were identified as the key clusters of co-cited references. Endoscopic polypectomy remained effective on resolving intestinal intussusception in patients who underwent three previous laparotomies.</p><p><strong>Conclusion: </strong>In the last three decades, global publications related to PJS show a steadily increasing trend in number. Endoscopic management is currently a research hotspot.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362939/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112675","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2742
Jin-Shan Zhang
Hepatic recompensation is firstly described in the Baveno VII criteria, which requires the fulfillment of strict criteria. First, a primary cause of cirrhosis must be addressed, suppressed, or cured. Second, complications of liver cirrhosis, including ascites, encephalopathy, and variceal hemorrhage, must disappear without any intervention. Finally, liver function indicators must be improved. Moreover, without addressing/suppressing/curing cirrhosis and improvement in liver synthetic function, complications, including ascites and variceal hemorrhage can be improved by a transjugular intrahepatic portosystemic shunt (TIPS), which is not evidence of hepatic recompensation. Therefore, on the basis of the definition of hepatic recompensation, TIPS does not achieve hepatic recompensation.
Baveno VII 标准首先描述了肝功能代偿,要求满足严格的标准。首先,肝硬化的原发病因必须得到解决、抑制或治愈。其次,肝硬化的并发症,包括腹水、脑病和静脉曲张出血,必须在没有任何干预的情况下消失。最后,肝功能指标必须得到改善。此外,在没有解决/抑制/治愈肝硬化和肝脏合成功能改善的情况下,腹水和静脉曲张出血等并发症可以通过经颈静脉肝内门体分流术(TIPS)得到改善,但这并不是肝功能恢复的证据。因此,根据肝功能恢复的定义,TIPS 并不能实现肝功能恢复。
{"title":"Hepatic recompensation according to the Baveno VII criteria <i>via</i> a transjugular intrahepatic portosystemic shunt: Is this true?","authors":"Jin-Shan Zhang","doi":"10.4240/wjgs.v16.i8.2742","DOIUrl":"10.4240/wjgs.v16.i8.2742","url":null,"abstract":"<p><p>Hepatic recompensation is firstly described in the Baveno VII criteria, which requires the fulfillment of strict criteria. First, a primary cause of cirrhosis must be addressed, suppressed, or cured. Second, complications of liver cirrhosis, including ascites, encephalopathy, and variceal hemorrhage, must disappear without any intervention. Finally, liver function indicators must be improved. Moreover, without addressing/suppressing/curing cirrhosis and improvement in liver synthetic function, complications, including ascites and variceal hemorrhage can be improved by a transjugular intrahepatic portosystemic shunt (TIPS), which is not evidence of hepatic recompensation. Therefore, on the basis of the definition of hepatic recompensation, TIPS does not achieve hepatic recompensation.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362940/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112676","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2484
Rong-Hua Zhu, Peng-Cheng Li, Jie Zhang, Hua-Hua Song
Background: Gastric cancer remains a leading cause of cancer-related mortality globally. Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.
Aim: To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer, focusing on its potential to reduce trauma, accelerate recovery, and achieve comparable oncological outcomes.
Methods: This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023. The patients were divided into two groups: Minimally invasive surgery group (n = 102), who underwent laparoscopic gastrectomy, and open surgery group (n = 101), who underwent traditional open gastrectomy. We compared surgical indicators (surgical incision size, intraoperative blood loss, surgical duration, and number of lymph nodes dissected), recovery parameters (time to first flatus, time to start eating, time to ambulation, and length of hospital stay), immune function (levels of IgA, IgG, and IgM), intestinal barrier function (levels of D-lactic acid and diamine oxidase), and stress response (levels of C-reactive protein, interleukin-6, and procalcitonin).
Results: The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators, including smaller incisions, less blood loss, shorter surgery time, and more lymph nodes dissected (P < 0.05 for all). Recovery was also faster in the minimally invasive surgery group, with earlier return of bowel function, earlier initiation of diet, quicker mobilization, and shorter hospital stays (P < 0.05 for all). Furthermore, patients in the minimally invasive surgery group had better preserved immune function, superior intestinal barrier function, and a less pronounced stress response postoperatively (P < 0.05 for all).
Conclusion: Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function, protecting intestinal barrier function, and mitigating the stress response compared to traditional open surgery. These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.
{"title":"Impact of minimally invasive surgery on immune function and stress response in gastric cancer patients.","authors":"Rong-Hua Zhu, Peng-Cheng Li, Jie Zhang, Hua-Hua Song","doi":"10.4240/wjgs.v16.i8.2484","DOIUrl":"10.4240/wjgs.v16.i8.2484","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer remains a leading cause of cancer-related mortality globally. Traditional open surgery for gastric cancer is often associated with significant morbidity and prolonged recovery.</p><p><strong>Aim: </strong>To evaluate the effectiveness of laparoscopic minimally invasive surgery as an alternative to traditional open surgery for gastric cancer, focusing on its potential to reduce trauma, accelerate recovery, and achieve comparable oncological outcomes.</p><p><strong>Methods: </strong>This study retrospectively analyzed 203 patients with gastric cancer who underwent surgery at the Shanghai Health Medical College Affiliated Chongming Hospital from January 2020 to December 2023. The patients were divided into two groups: Minimally invasive surgery group (<i>n</i> = 102), who underwent laparoscopic gastrectomy, and open surgery group (<i>n</i> = 101), who underwent traditional open gastrectomy. We compared surgical indicators (surgical incision size, intraoperative blood loss, surgical duration, and number of lymph nodes dissected), recovery parameters (time to first flatus, time to start eating, time to ambulation, and length of hospital stay), immune function (levels of IgA, IgG, and IgM), intestinal barrier function (levels of D-lactic acid and diamine oxidase), and stress response (levels of C-reactive protein, interleukin-6, and procalcitonin).</p><p><strong>Results: </strong>The minimally invasive surgery group demonstrated significantly better outcomes in terms of surgical indicators, including smaller incisions, less blood loss, shorter surgery time, and more lymph nodes dissected (<i>P</i> < 0.05 for all). Recovery was also faster in the minimally invasive surgery group, with earlier return of bowel function, earlier initiation of diet, quicker mobilization, and shorter hospital stays (<i>P</i> < 0.05 for all). Furthermore, patients in the minimally invasive surgery group had better preserved immune function, superior intestinal barrier function, and a less pronounced stress response postoperatively (<i>P</i> < 0.05 for all).</p><p><strong>Conclusion: </strong>Laparoscopic minimally invasive surgery for gastric cancer not only provides superior surgical indicators and faster recovery but also offers advantages in preserving immune function, protecting intestinal barrier function, and mitigating the stress response compared to traditional open surgery. These findings support the broader adoption of laparoscopic techniques in the management of gastric cancer.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The abdominal perineal resection (APR), historically referred to as Mile's procedure, stands as a time-honored surgical intervention for rectal cancer management. Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer, including those with ultralow rectal cancer. Despite these improvements, APR maintains its irreplaceable role in the clinical landscape, particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles. Optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient's subsequent long-term prognosis.
Aim: To evaluate the value of Lone-Star retractor (LSR) perineal exposure method in the treatment for laparoscopic APR of rectal cancer.
Methods: We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023, including 20 patients who underwent the APR procedure with a LSR perineal exposure method (LSR group) and 18 patients who underwent the APR procedure with a conventional perineal exposure method (control group). In the LSR group, following incision of the skin and subcutaneous tissue, the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.
Results: A total of 38 patients underwent laparoscopic APR, none of whom were found to have distant metastasis upon intraoperative exploration. Perineal blood loss, the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group. A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group (P < 0.05). The incidence of infection via the perineal incision in the LSR group was significantly lower than that in the control group (P < 0.05). No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.
Conclusion: The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and allow one surgeon to perform the perineal operation.
{"title":"Lone-Star retractor perineal exposure method for laparoscopic abdominal perineal resection of rectal cancer.","authors":"Jun Ma, Dai-Bin Tang, Yu-Quan Tang, Da-Tian Wang, Peng Jiang, Ya-Ming Zhang","doi":"10.4240/wjgs.v16.i8.2528","DOIUrl":"10.4240/wjgs.v16.i8.2528","url":null,"abstract":"<p><strong>Background: </strong>The abdominal perineal resection (APR), historically referred to as Mile's procedure, stands as a time-honored surgical intervention for rectal cancer management. Advancements in surgical techniques and the advent of neoadjuvant therapies have significantly improved the rate of sphincter preservation among patients afflicted with rectal cancer, including those with ultralow rectal cancer. Despite these improvements, APR maintains its irreplaceable role in the clinical landscape, particularly for cases involving low rectal cancer with encroachment on the external anal sphincter or levator ani muscles. Optimal perineal exposure stands as a pivotal phase in APR, given that the precision of this maneuver is directly correlated with both the safety of the surgery and the patient's subsequent long-term prognosis.</p><p><strong>Aim: </strong>To evaluate the value of Lone-Star retractor (LSR) perineal exposure method in the treatment for laparoscopic APR of rectal cancer.</p><p><strong>Methods: </strong>We reviewed the records of 38 patients with rectal cancer at Anqing Municipal Hospital from January 2020 to December 2023, including 20 patients who underwent the APR procedure with a LSR perineal exposure method (LSR group) and 18 patients who underwent the APR procedure with a conventional perineal exposure method (control group). In the LSR group, following incision of the skin and subcutaneous tissue, the LSR was placed and dynamically adjusted according to the surgical plane to fully expose the perineal operative field.</p><p><strong>Results: </strong>A total of 38 patients underwent laparoscopic APR, none of whom were found to have distant metastasis upon intraoperative exploration. Perineal blood loss, the postoperative hospital stays and the wound pain scores in the LSR group were significantly lower than those in the control group. A single surgeon completed the perineal operation significantly more often in the LSR group than in the control group (<i>P</i> < 0.05). The incidence of infection <i>via</i> the perineal incision in the LSR group was significantly lower than that in the control group (<i>P</i> < 0.05). No cases of distant metastasis or local recurrence were found among the patients at the postoperative follow-up.</p><p><strong>Conclusion: </strong>The application of the LSR technique might be helpful for performing perineal exposure during APR for rectal cancer and could reduce the incidence of perineal complications, shorten the postoperative hospital stay, improve postoperative pain, and allow one surgeon to perform the perineal operation.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362942/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112681","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The incidence and mortality rates of primary hepatocellular carcinoma (HCC) are high, and the conventional treatment is radiofrequency ablation (RFA) with transcatheter arterial chemoembolization (TACE); however, the 3-year survival rate is still low. Further, there are no visual methods to effectively predict their prognosis.
Aim: To explore the factors influencing the prognosis of HCC after RFA and TACE and develop a nomogram prediction model.
Methods: Clinical and follow-up information of 150 patients with HCC treated using RFA and TACE in the Hangzhou Linping Hospital of Traditional Chinese Medicine from May 2020 to December 2022 was retrospectively collected and recorded. We examined their prognostic factors using multivariate logistic regression and created a nomogram prognosis prediction model using the R software (version 4.1.2). Internal verification was performed using the bootstrapping technique. The prognostic efficacy of the nomogram prediction model was evaluated using the concordance index (CI), calibration curve, and receiver operating characteristic curve.
Results: Of the 150 patients treated with RFA and TACE, 92 (61.33%) developed recurrence and metastasis. Logistic regression analysis identified six variables, and a predictive model was created. The internal validation results of the model showed a CI of 0.882. The correction curve trend of the prognosis prediction model was always near the diagonal, and the mean absolute error before and after internal validation was 0.021. The area under the curve of the prediction model after internal verification was 0.882 [95% confidence interval (95%CI): 0.820-0.945], with a specificity of 0.828 and sensitivity of 0.656. According to the Hosmer-Lemeshow test, χ2 = 3.552 and P = 0.895. The predictive model demonstrated a satisfactory calibration, and the decision curve analysis demonstrated its clinical applicability.
Conclusion: The prognosis of patients with HCC after RFA and TACE is affected by several factors. The developed prediction model based on the influencing parameters shows a good prognosis predictive efficacy.
{"title":"Nomogram predicting the prognosis of primary liver cancer after radiofrequency ablation combined with transcatheter arterial chemoembolization.","authors":"Hai-Hua Shen, Yu-Rong Hong, Wen Xu, Lei Chen, Jun-Min Chen, Zhi-Gen Yang, Cai-Hong Chen","doi":"10.4240/wjgs.v16.i8.2630","DOIUrl":"10.4240/wjgs.v16.i8.2630","url":null,"abstract":"<p><strong>Background: </strong>The incidence and mortality rates of primary hepatocellular carcinoma (HCC) are high, and the conventional treatment is radiofrequency ablation (RFA) with transcatheter arterial chemoembolization (TACE); however, the 3-year survival rate is still low. Further, there are no visual methods to effectively predict their prognosis.</p><p><strong>Aim: </strong>To explore the factors influencing the prognosis of HCC after RFA and TACE and develop a nomogram prediction model.</p><p><strong>Methods: </strong>Clinical and follow-up information of 150 patients with HCC treated using RFA and TACE in the Hangzhou Linping Hospital of Traditional Chinese Medicine from May 2020 to December 2022 was retrospectively collected and recorded. We examined their prognostic factors using multivariate logistic regression and created a nomogram prognosis prediction model using the R software (version 4.1.2). Internal verification was performed using the bootstrapping technique. The prognostic efficacy of the nomogram prediction model was evaluated using the concordance index (CI), calibration curve, and receiver operating characteristic curve.</p><p><strong>Results: </strong>Of the 150 patients treated with RFA and TACE, 92 (61.33%) developed recurrence and metastasis. Logistic regression analysis identified six variables, and a predictive model was created. The internal validation results of the model showed a CI of 0.882. The correction curve trend of the prognosis prediction model was always near the diagonal, and the mean absolute error before and after internal validation was 0.021. The area under the curve of the prediction model after internal verification was 0.882 [95% confidence interval (95%CI): 0.820-0.945], with a specificity of 0.828 and sensitivity of 0.656. According to the Hosmer-Lemeshow test, <i>χ</i> <sup>2</sup> = 3.552 and <i>P</i> = 0.895. The predictive model demonstrated a satisfactory calibration, and the decision curve analysis demonstrated its clinical applicability.</p><p><strong>Conclusion: </strong>The prognosis of patients with HCC after RFA and TACE is affected by several factors. The developed prediction model based on the influencing parameters shows a good prognosis predictive efficacy.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362921/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2461
Romain Jaquet, Emmanuel Rivkine, Nicole De Souza, Jean Roudié
Background: Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.
Aim: To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.
Methods: Between 2003 and 2017, all patients undergoing gastrectomy for cancer treatment were included retrospectively. A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.
Results: Of the 172 patients included, 60 received jejunostomy. Preoperatively, the two groups were comparable with respect to the nutritional parameters studied (body mass index, albumin, etc.). In the postoperative period, the J + group lost less weight and albumin: 5.74 ± 8.4 vs 9.86 ± 7.5 kg (P = 0.07) and 7.2 ± 5.6 vs 14.7 ± 12.7 g/L (P = 0.16), respectively. Overall morbidity was 25% in the J + group and 36.6% in the J - group (P = 0.12). The J + group had fewer respiratory, infectious, and grade 3 complications: 0% vs 5.4% (P = 0.09), 1.2% vs 9.3% (P = 0.03), and 0% vs 4.7% (P = 0.05), respectively. The 30-day mortality was 6.7% in the J + group and 6.3% in the J - group (P = 0.91).
Conclusion: Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity. A prospective study could confirm our results.
{"title":"Benefits of jejunostomy feeding in patients who underwent gastrectomy for cancer treatment.","authors":"Romain Jaquet, Emmanuel Rivkine, Nicole De Souza, Jean Roudié","doi":"10.4240/wjgs.v16.i8.2461","DOIUrl":"10.4240/wjgs.v16.i8.2461","url":null,"abstract":"<p><strong>Background: </strong>Gastric cancer is associated with significant undernutrition responsible for an increase in morbidity and mortality after gastrectomy.</p><p><strong>Aim: </strong>To evaluate the impact of enteral nutrition by jejunostomy feeding in patients undergoing gastrectomy for cancer.</p><p><strong>Methods: </strong>Between 2003 and 2017, all patients undergoing gastrectomy for cancer treatment were included retrospectively. A group with jejunostomy (J + group) and a group without jejunostomy (J - group) were compared.</p><p><strong>Results: </strong>Of the 172 patients included, 60 received jejunostomy. Preoperatively, the two groups were comparable with respect to the nutritional parameters studied (body mass index, albumin, <i>etc.</i>). In the postoperative period, the J + group lost less weight and albumin: 5.74 ± 8.4 <i>vs</i> 9.86 ± 7.5 kg (<i>P</i> = 0.07) and 7.2 ± 5.6 <i>vs</i> 14.7 ± 12.7 g/L (<i>P</i> = 0.16), respectively. Overall morbidity was 25% in the J + group and 36.6% in the J - group (<i>P</i> = 0.12). The J + group had fewer respiratory, infectious, and grade 3 complications: 0% <i>vs</i> 5.4% (<i>P</i> = 0.09), 1.2% <i>vs</i> 9.3% (<i>P</i> = 0.03), and 0% <i>vs</i> 4.7% (<i>P</i> = 0.05), respectively. The 30-day mortality was 6.7% in the J + group and 6.3% in the J - group (<i>P</i> = 0.91).</p><p><strong>Conclusion: </strong>Jejunostomy feeding after gastrectomy improves nutritional characteristics and decreases postoperative morbidity. A prospective study could confirm our results.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362917/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-08-27DOI: 10.4240/wjgs.v16.i8.2386
Xiao-Wen Xing, Xiao Huang, Wei-Peng Li, Ming-Ke Wang, Ji-Shun Yang
Hepatocellular carcinoma (HCC) presents challenges due to its high recurrence and metastasis rates and poor prognosis. While current clinical diagnostic and prognostic indicators exist, their accuracy remains imperfect due to their biological complexity. Therefore, there is a quest to identify improved biomarkers for HCC diagnosis and prognosis. By combining long non-coding RNA (lncRNA) expression and somatic mutations, Duan et al identified five representative lncRNAs from 88 lncRNAs related to genomic instability (GI), forming a GI-derived lncRNA signature (LncSig). This signature outperforms previously reported LncSig and TP53 mutations in predicting HCC prognosis. In this editorial, we comprehensively evaluate the clinical application value of such prognostic evaluation model based on sequencing technology in terms of cost, time, and practicability. Additionally, we provide an overview of various prognostic models for HCC, aiding in a comprehensive understanding of research progress in prognostic evaluation methods.
{"title":"Clinical application value of long non-coding RNAs signatures of genomic instability in predicting prognosis of hepatocellular carcinoma.","authors":"Xiao-Wen Xing, Xiao Huang, Wei-Peng Li, Ming-Ke Wang, Ji-Shun Yang","doi":"10.4240/wjgs.v16.i8.2386","DOIUrl":"10.4240/wjgs.v16.i8.2386","url":null,"abstract":"<p><p>Hepatocellular carcinoma (HCC) presents challenges due to its high recurrence and metastasis rates and poor prognosis. While current clinical diagnostic and prognostic indicators exist, their accuracy remains imperfect due to their biological complexity. Therefore, there is a quest to identify improved biomarkers for HCC diagnosis and prognosis. By combining long non-coding RNA (lncRNA) expression and somatic mutations, Duan <i>et al</i> identified five representative lncRNAs from 88 lncRNAs related to genomic instability (GI), forming a GI-derived lncRNA signature (LncSig). This signature outperforms previously reported LncSig and TP53 mutations in predicting HCC prognosis. In this editorial, we comprehensively evaluate the clinical application value of such prognostic evaluation model based on sequencing technology in terms of cost, time, and practicability. Additionally, we provide an overview of various prognostic models for HCC, aiding in a comprehensive understanding of research progress in prognostic evaluation methods.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362949/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Anterior cutaneous nerve entrapment syndrome (ACNES) is a condition manifesting with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves. This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.
Case summary: A 66-year-old woman manifested ACNES after a robot-assisted distal gastrectomy. An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar. However, the sudden severe pain, which radiated laterally from the previous site, remained. A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.
Conclusion: In this case, the trocar port was inserted between the rectus and transverse abdominis muscles. The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles. Hence, rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief. To the best of our knowledge, this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.
{"title":"Ultrasound-guided peripheral nerve blocks for anterior cutaneous nerve entrapment syndrome after robot-assisted gastrectomy: A case report.","authors":"Yukiko Saito, Hirohisa Takeuchi, Joho Tokumine, Ryuji Sawada, Kunitaro Watanabe, Tomoko Yorozu","doi":"10.4240/wjgs.v16.i8.2719","DOIUrl":"10.4240/wjgs.v16.i8.2719","url":null,"abstract":"<p><strong>Background: </strong>Anterior cutaneous nerve entrapment syndrome (ACNES) is a condition manifesting with pain caused by strangulation of the anterior cutaneous branch of the lower intercostal nerves. This case report aims to provide new insight into the selection of peripheral nerve blocks for the ACNES treatment.</p><p><strong>Case summary: </strong>A 66-year-old woman manifested ACNES after a robot-assisted distal gastrectomy. An ultrasound-guided rectal sheath block was effective for pain triggered by the port scar. However, the sudden severe pain, which radiated laterally from the previous site, remained. A transversus abdominis plane block was performed for the remaining pain and effectively relieved it.</p><p><strong>Conclusion: </strong>In this case, the trocar port was inserted between the rectus and transverse abdominis muscles. The intercostal nerves might have been entrapped on both sides of the rectus and transversus abdominis muscles. Hence, rectus sheath and transverse abdominis plane blocks were required to achieve complete pain relief. To the best of our knowledge, this is the first report on use of a combination of rectus sheath and transverse abdominis plane blocks for pain relief in ACNES.</p>","PeriodicalId":23759,"journal":{"name":"World Journal of Gastrointestinal Surgery","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11362933/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142112698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}