World Journal of Surgical Oncology最新文献

Objective: Social frailty, characterised by insufficient social support, is a significant concern that can adversely affect patients' health. This study aimed to investigate the impact of preoperative social frailty on short-term outcomes in patients with gastrointestinal cancer.

Methods: This multicentre prospective cohort study was conducted in three tertiary hospitals in Jiangsu Province, China (August 2021-February 2025). Patients were categorized into a non-social frailty group (score = 0) and a social frailty group (score ≥ 1) using the Help, Participation, Loneliness, Financial, Talk (HALFT) scale. We performed 1:1 nearest-neighbour propensity score matching to balance covariates including sex, age, residence, marital status, and the tumour node metastasis (TNM) stage, and assessed balance using standardised mean differences (SMD), with an absolute SMD <0.1 considered acceptable. The primary outcomes were overall postoperative complications (Clavien-Dindo grade ≥ II) and major postoperative complications (Clavien-Dindo grade ≥ III). Secondary outcomes included ICU admission, hospitalisation expenses, total hospitalisation duration, and 30- and 90-day mortality. The primary and secondary outcome measures in both groups after PSM were analysed using the chi-squared test (or Fisher's exact test) and Mann-Whitney U test. To quantify the associations, binary logistic regression was further performed for the primary measures.

Results: After PSM, 133 matched pairs were generated, and covariates were well balanced (all |SMD| < 0.1). The social frailty group had a higher rate of overall complications (OR = 2.378; 95% CI 1.342-4.211; P = 0.003). Major complications did not differ significantly between groups (OR = 1.842, 95% CI 0.780-4.349, P = 0.163). The social frailty group also had higher ICU admission (8.3% vs. 2.3%; P = 0.028), greater hospitalisation expenses (61,354 vs. 56,525 RMB; P < 0.001), and longer total hospitalisation duration (17.0 vs. 15.0 days; P = 0.001). There was no statistically significant difference in 30- or 90-day mortality between the groups (3.0% vs. 0%; P = 0.122).

Conclusion: Preoperative social frailty was associated with higher risks of overall postoperative complications, ICU admission, increased hospitalisation expenses, and longer total hospitalisation duration compared with non-frail patients.

Pancreatic cancer (PC) is a highly aggressive malignancy characterized by insidious onset, rapid progression, and poor prognosis, predominantly affecting middle-aged and elderly men. Biomarker detection represents the most widely utilized approach for early PC diagnosis, encompassing both traditional and novel categories. Although traditional biomarkers like CA 19 - 9 are widely employed clinically, they carry a risk of false negatives in Lewis antigen-negative individuals, underscoring the urgent need for multi-parameter detection strategies to enhance accuracy. Integrating core indicators such as CEA and CA 242 can significantly improve the diagnostic effect of early PC and optimize diagnosis and treatment decisions. In recent years, breakthroughs have been made in biomarkers. Novel detection methods such as liquid biopsy and exosomes are entering the scope of clinical application. Due to their non-invasive nature, good sensitivity and specificity, these innovative biomarkers are gradually replacing traditional biomarkers and have become a new research focus. At present, single traditional biomarkers have limitations in diagnosing PC, while novel biomarkers lack extensive clinical verification. Meanwhile, there is no systematic review article specifically for early screening of PC to comprehensively evaluate the value and application prospects of these biomarkers. Therefore, this article provides a narrative review and comprehensive overview of the research progress on biomarkers related to the early diagnosis of PC in recent years.

Pseudomyxoma Peritonei (PMP) is a rare and complex clinical syndrome characterized by the extensive implantation and metastasis of tumor cells from different tissues within the abdominal cavity, accompanied by the continuous secretion of large amounts of jelly-like mucin. PMP primarily originates from appendiceal mucinous tumors, and in rare cases, can also arise from organs or tissues such as the ovary, colon, gallbladder, pancreas, urachus, small intestine, stomach, intestinal duplications, and teratomas. PMP has diverse clinical manifestations and lacks specificity, making diagnosis difficult, and usually requires comprehensive evaluation in combination with imaging, surgery, and pathological examination. At present, Cytoreductive Surgery (CRS) combined with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) has become its standard treatment regimen. Although this comprehensive therapeutic strategy has significantly improved the overall survival rate of PMP patients, the high postoperative recurrence rate remains a critical factor adversely affecting patient prognosis. This article aims to summarize recent research advances in this field through a literature review, exploring its pathogenesis, clinical manifestations, diagnostic methods, and treatment strategies, with the goal of deepening the understanding of this disease and providing a reference for clinical diagnosis and treatment planning.

Background: Postoperative pancreatic fistula (POPF) is the principal cause of morbidity after pancreatoduodenectomy (PD). Omental wrapping of the pancreaticojejunostomy (PJ) has been proposed to reduce fistula risk; however, prior syntheses often pooled arterial and anastomotic targets, obscuring the PJ-specific effect relevant to surgical decision-making.

Methods: This systematic review and meta-analysis was registered in PROSPERO (ID: CRD420251176513) on October 26, 2025. We searched the PubMed, Embase, Web of Science, Cochrane CENTRAL, Scopus, and ClinicalTrials databases. gov, and WHO ICTRP from inception to October 24, 2025, for comparative studies evaluating omental wrapping of the PJ versus no wrap during PD. The primary outcome was clinically relevant POPF (CR-POPF; ISGPS grades B/C). Secondary outcomes included delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, length of stay (LOS), operative time, estimated blood loss (EBL), and time to oral intake. Random-effects meta-analyses were used to calculate risk ratios (RR) and mean differences (MD) with 95% confidence intervals. The risk of bias was assessed using RoB 2 for randomized controlled trials and ROBINS-I for non-randomized studies. The certainty of the evidence was appraised using the GRADE.

Results: Six comparative studies (two RCTs and four cohorts; 254 patients with omental wrapping of the PJ and 275 control patients) were included. Omental wrapping of the PJ significantly reduced CR-POPF (RR 0.44, 95% CI, 0.28-0.71; I²=0%; P = 0.0008; moderate certainty), corresponding to 125 fewer events per 1,000 treated patients than non-wrapped PJ. Wrapping also reduced LOS (MD - 2.56 days, 95% CI, - 4.37 to - 0.76; I²=52%; P = 0.005; moderate certainty), EBL (MD - 103.86 mL, 95% CI - 160.50 - 47.22; I²=0%; P = 0.0003; moderate certainty), and time to oral intake (MD - 2.30 days, 95% CI - 3.60 to - 1.00; P = 0.0005; very low certainty). No significant differences were observed in terms of delayed gastric emptying, post-pancreatectomy hemorrhage, reoperation, or operative time. The leave-one-out sensitivity analysis confirmed the robustness of the results. Geographic subgroup analysis showed consistent benefits in East Asia, with no significant regional interactions.

Conclusion: Omental wrapping of PJ reduces CR-POPF and improves perioperative recovery without prolonging surgery, supporting selective adoption in anatomically high-risk contexts within standardized care pathways.