BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice be...BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.展开更多
BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation intervention...BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.展开更多
BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic...BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.展开更多
Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surger...Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.展开更多
This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging i...This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.展开更多
BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-sca...BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-scale multivariableadjusted risk-factor data remain scarce.AIM To determine the prevalence and predictors of postoperative depression,and propose tailored mitigation strategies.METHODS We enrolled 108 consecutive patients who underwent thyroidectomies at The First Affiliated Hospital of Hebei North University between January 2023 and January 2025.Depression was assessed using the Self-Rating Depression Scale(SDS),while coping styles and social support were evaluated using the Medical Coping Modes Questionnaire and Perceived Social Support Scale.Logistic regression was used to identify independent risk and protective factors.RESULTS The mean SDS score was 52.58±10.20;62 patients(57.4%)met the criteria for depression(mild 32.4%,moderate 15.7%,severe 9.3%).Univariate analyses revealed higher depression rates among patients aged≥60 years,those with≤highschool education,monthly family income<3000 yuan,131I therapy,and avoidance/surrender coping;and lower social support(P<0.05).Multivariate regression showed income<3000 yuan(OR=5.26,95%CI:1.89-14.60),131I therapy(OR=5.70,95%CI:1.91-17.01),and avoidance/surrender coping(OR=4.77,95%CI:1.51-15.11)as independent risk factors,whereas higher social support was protective(OR=0.22,95%CI:0.09-0.54).CONCLUSIONDepression is common after thyroidectomy,and is driven by socioeconomic,treatment-related,and psychosocialfactors.Targeted interventions that address coping skills and bolster social support should be integrated intopostoperative care.展开更多
BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress respon...BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.展开更多
Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectom...Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.展开更多
BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the c...BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the continuous development of medical technology,laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.AIM To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer,and the differences in the risk analysis of unplanned reoperation after operation.METHODS As the research subjects,this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022.Among them,50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group.Data pertaining to clinical indexes,gastrointestinal hormones,nutrition indexes,the levels of inflammatory factors,quality of life,Visual Analog Scale score,and the postoperative complications of the two groups of patients before and after treatment were collected,and the therapeutic effects in the two groups were analyzed and compared.RESULTS Compared with the control group,perioperative bleeding,peristalsis recovery time,and hospital stays were significantly shorter in the research group.After surgery,the levels of gastrin(GAS)and motilin(MTL)were decreased in both groups,and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group.The hemoglobin(Hb)levels increased after surgery,and the level of Hb in the research group was significantly higher compared with the control group.After the operation,the expression levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group.One year after the operation,the quality of life of the two groups was greatly improved,with the quality of life in the research group being significantly better.CONCLUSION Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction;moreover,the quality of life of patients was significantly improved,which warrants further promotion.展开更多
Advancements in machine learning have revolutionized preoperative risk assessment.In this article,we comment on the article by Huang et al,which presents a recent multicenter cohort study demonstrated that machine lea...Advancements in machine learning have revolutionized preoperative risk assessment.In this article,we comment on the article by Huang et al,which presents a recent multicenter cohort study demonstrated that machine learning algorithms effectively stratify recurrence-free survival,providing a robust predictive framework for maximizing surgical outcomes in intrahepatic cholangiocarcinoma.By leveraging interpretable models,the research enhances clinical decision-making,allowing for more precise patient selection and personalized surgical strategies.These findings highlight the growing role of artificial intelligence in optimizing surgical outcomes and improving prognostic accuracy in hepatobiliary oncology.展开更多
Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite pr...Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite prospective,retrospective and randomized trials supporting the role of neoadjuvant therapy in general for PDAC,the long-term benefit specifically for patients with resectable PDAC remains unclear.The phase III PREOPANC trial showed an improvement in overall survival in borderline resectable PDAC with neoadjuvant gemcitabinebased chemoradiation compared to upfront surgery alone,however,no such benefit was observed in the resectable cohort.Notably,three randomized trials(PANACHE01-PRODIGE 48,NORPACT-1,and PREOPANC-2)failed to show a clear improvement in overall survival with a neoadjuvant approach.The ongoing NeoFOL-R,PREOPANC-3,and the Alliance A021806 will help clarify the role of neoadjuvant therapy in resectable PDAC.In this minireview article we summarize the data surrounding neoadjuvant therapy in resectable pancreatic cancer and discuss future considerations of trials in this subgroup.展开更多
BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced...BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced poorly differentiated squamous cell carcinoma(ypT4aN3bN0M0)of the oral floor underwent extensive surgery,including total glossectomy,partial mandibulectomy,and free flap reconstruction.Postoperatively,he developed life-threatening hemorrhage on day 3 due to wound dehiscence.Rapid nursing interventions-prompt suture removal,pressure hemostasis,and multidisciplinary collaboration-controlled bleeding.Postoperative care emphasized hemodynamic monitoring,infection prevention,and rehabilitation.Despite comorbidities(hypertension,diabetes,prior stroke),the patient achieved functional recovery:Oral flap epithelialization,restored swallowing(water swallow test:Grade 1),70% tongue mobility,and 80% preoperative chewing efficiency at 6-month follow-up.This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.CONCLUSION This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery.By integrating meticulous preoperative risk stratification,intraoperative hemostatic collaboration,and vigilant postoperative monitoring(e.g.,timely suture management,pressure hemostasis,blood product administration),the interdisciplinary team achieved rapid hemorrhage control.Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery,enabling the patient to regain swallowing,speech,and mobility despite advanced disease and comorbidities.The findings underscore that standardized nursing workflows,balancing procedural rigor with holistic patient support,are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.展开更多
BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the sta...BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).展开更多
BACKGROUND Fear of cancer recurrence(FCR)is a common psychological problem among patients with cancer,especially elderly patients.For patients with gastric cancer(GC)who have undergone treatments such as surgery,FCR m...BACKGROUND Fear of cancer recurrence(FCR)is a common psychological problem among patients with cancer,especially elderly patients.For patients with gastric cancer(GC)who have undergone treatments such as surgery,FCR may seriously affect their quality of life and psychological well-being.AIM To evaluate the FCR in elderly patients with GC undergoing laparoscopic radical surgery in Hefei City and to explore its related influencing factors.METHODS In this study 264 elderly patients with GC who underwent laparoscopic radical surgery in four hospital districts of The First Affiliated Hospital of Anhui Medical University from June 2021 to January 2024 were recruited.Information on basic characteristics,disease characteristics,psychological status,and social support was collected by a questionnaire.In statistical analysis,the t-test andχ^(2) test were used to analyze the differences between groups.The influencing factors of FCR were analyzed by logistic regression.Based on these influencing factors,a nomogram model was initially constructed to identify patients with GC with high FCR risk.RESULTS Elderly patients with GC generally faced higher FCR levels after laparoscopic radical surgery.Among the 264 patients,168 had clinical symptoms of FCR,and the prevalence rate was 63.64%.Further analysis showed that older age,high mental resilience,and sufficient social support were favorable factors for reducing FCR level,while heavier self-perceived burden,low education level,shorter duration of disease,larger tumor diameter,and more complications were associated with a higher FCR level.CONCLUSION This study demonstrated the significance of psychological interventions and social support strategies in reducing FCR among elderly patients with GC.In the future treatment protocols should be further optimized,and psychological and social support should be enhanced to improve the quality of life for this patient population.展开更多
In the era of precision medicine,the breast cancer surgical treatment field is gradually moving toward a de-escalation model.Through precise preoperative assessments and multidisciplinary decision-making,surgical trau...In the era of precision medicine,the breast cancer surgical treatment field is gradually moving toward a de-escalation model.Through precise preoperative assessments and multidisciplinary decision-making,surgical trauma can be decreased,and patients’quality of life can be improved by ensuring safety.Herein,we explore the axillary de-escalation surgery model for breast cancer.展开更多
Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly ma...Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.展开更多
BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal peri...BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.AIM To evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.METHODS A systematic review and meta-analysis were conducted by searching PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang,VIP Information,and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols.Primary outcomes included time to gastrointestinal function recovery,drainage tube removal time,postoperative complication rates,and length of hospital stay.Review Manager 5.4 was used for statistical analysis,and heterogeneity was assessed using the I2 statistic.RESULTS A total of 21 randomized controlled trials involving 1652 patients were included.Compared with routine abdominal drainage,the ERAS group without drainage showed significantly faster gastrointestinal recovery[standardized mean difference=-1.30,95%confidence interval(CI):-1.66 to-0.94,P<0.00001]and shorter hospital stay(standardized mean difference=-1.37,95%CI:-1.86 to-0.88,P<0.00001).The incidence of total postoperative complications was also significantly lower(odds ratio=0.53,95%CI:0.40-0.70,P<0.00001),particularly for anastomotic leakage and pulmonary infection.No significant differences were observed in surgical site infections or urinary tract infections.Sensitivity and subgroup analyses indicated stability of results,although some heterogeneity was noted.CONCLUSION Avoiding routine abdominal drainage under ERAS could lead to faster recovery,reduced complications,and shorter hospital stay following radical gastrectomy,supporting the selective use of drainage rather than routine.展开更多
BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outc...BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.展开更多
BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient populatio...BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient population.AIM To assess the impact of autonomic nerve-oriented anatomical laparoscopic surgery on recovery and postoperative risks in patients with colorectal cancer.METHODS Data from 116 patients diagnosed with colorectal cancer,treated between January 2016 and May 2024,were randomly divided into 2 groups(n=58 each)according to surgical approach:Control(radical vessel-oriented laparoscopic surgery);and Observation(autonomic nerve-oriented anatomical surgery).Perioperative in-dicators,and postoperative risk for urinary dysfunction and sexual function were compared between the 2 groups.RESULTS Compared with the control group,the observation group experienced less in-traoperative blood loss(P<0.05)and exhibited superior perioperative indicators(P<0.05).At 2 weeks and 3 months postoperatively,the proportion of patients with urinary dysfunction in the observation group was lower than that in the control group(P<0.05).Four months postoperatively,there were significant differences in male erectile dysfunction,female dyspareunia,and sexual pleasure grading between the 2 groups(P<0.05).CONCLUSION The autonomic nerve-oriented anatomical approach to laparoscopic surgery for colorectal cancer accelerates postoperative recovery,with decreased intraope-rative blood loss,lower impact on urinary and sexual functions,and enhances surgical safety.展开更多
BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is c...BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.展开更多
基金Bethune Charitable Foundation Project,No.HZB-20190528-10Natural Science Foundation of Fujian Province,No.2020J011230.
文摘BACKGROUND Colorectal cancer,one of the most common malignancies,is primarily treated through surgery.With the widespread use of laparoscopy,gastrointestinal reconstruction remains a key area of research.The choice between intraperitoneal anastomosis(IA)and extraperitoneal anastomosis(EA)remains a subject of considerable debate.This study uses intraperitoneal isoperistaltic side-to-side anastomosis(IISSA)with hand-sewn closure of the common opening to evaluate its safety and short-term outcomes.It is hypothesized that this technique may offer better short-term outcomes than EA.AIM To investigate the safety and short-term outcomes of IISSA with hand-sewn closure of the common opening compared to EA.METHODS Patients who underwent laparoscopic radical colon cancer surgery between January 2018 and June 2022 at the First Affiliated Hospital of Xiamen University were retrospectively analyzed.Surgical,postoperative,and pathological features of the IA and EA groups were observed before and after propensity score matching.Patients with right-sided and left-sided colon cancer were separated,each further divided into IA and EA groups(R-IA vs R-EA for right-sided,L-IA vs L-EA for left-sided),for stratified analysis of the aforementioned indicators.RESULTS After propensity score matching,63 pairs were matched in each group.In surgical characteristics,the IA group exhibited less blood loss and shorter incisions than the EA group.Regarding postoperative recovery,the IA group showed earlier recovery of gastrointestinal function.Pathologically,the IA group had greater lymph node clearance.Relative to the R-EA group,the R-IA group experienced reduced blood loss,shorter assisted incisions,earlier recovery of gastrointestinal functions and greater lymph node dissection.When compared to the L-EA group,the L-IA group demonstrated earlier postoperative anal exhaust and defecation,along with a reduced length of hospitalization.Regarding postoperative complications,no statistically significant differences were found between the groups either after matching or in the stratified analyses.CONCLUSION Compared to EA,IISSA with hand-sewn closure of the common opening is a safe and feasible option for laparoscopic radical colon cancer surgery.
文摘BACKGROUND Elderly patients undergoing laparoscopic colorectal cancer surgery are at high risk for hypothermia-related complications.This study explores the efficacy of periop-erative composite insulation interventions in maintaining normothermia and reducing postoperative risks in this vulnerable group.AIM To evaluate the efficacy of perioperative composite insulation in older patients undergoing colorectal cancer surgery.METHODS We selected 100 older patients who underwent laparoscopic surgery for colorectal cancer at Huzhou Central Hospital from September 2023 to April 2024.Using a random number table,patients were divided into a control group and inter-vention group of 50 patients each.After returning to the regular ward,the con-ventional group received traditional insulation intervention measures,while the intervention group received composite insulation nursing intervention.We ob-served and recorded postoperative blood pressure and heart rate changes,as well as postoperative anesthesia recovery time and incidence of complications.RESULTS The statistical results showed significant differences(P<0.05)in heart rate changes and systolic blood pressure between the two groups.There was a sig-nificant change in heart rate between the groups immediately after surgery and at 15 and 30 minutes after surgery(P<0.05).The heart rate and systolic blood pressure of the intervention group were significantly lower than those of the control group at 15 and 30 minutes after surgery(P<0.05).The rewarming time of the intervention group was shorter than that of the control group,and the overall incidence of postoperative complications was significantly lower than that of the control group(P<0.05).CONCLUSION For elderly patients undergoing laparoscopic colorectal cancer surgery,a composite insulation intervention during the perioperative period can maintain body temperature,reduce postoperative stress,and significantly reduce the incidence of hypothermia and related complications.
基金Supported by Natural Science Foundation of Xinjiang Uygur Autonomous Region,No.2022D01C297.
文摘BACKGROUND Anastomotic leakage(AL)is a serious complication following rectal cancer surgery and is associated with increased recurrence,mortality,extended hospital stays,and delayed chemotherapy.The Onodera prognostic nutritional index(OPNI)and inflammation-related biomarkers,such as the neutrophil-lymphocyte ratio(NLR)and platelet-to-lymphocyte ratio(PLR),have been studied in the context of cancer prognosis,but their combined efficacy in predicting AL remains unclear.AIM To investigate the relationships between AL and these markers and developed a predictive model for AL.METHODS A retrospective cohort study analyzed the outcomes of 434 patients who had undergone surgery for rectal cancer at a tertiary cancer center from 2016 to 2023.The patients were divided into two groups on the basis of the occurrence of AL:One group consisted of patients who experienced AL(n=49),and the other group did not(n=385).The investigation applied logistic regression to develop a risk prediction model utilizing clinical,pathological,and laboratory data.The efficacy of this model was then evaluated through receiver operating characteristic curve analysis.RESULTS In the present study,11.28%of the participants(49 out of 434 participants)suffered from AL.Multivariate analysis revealed that preoperative levels of the OPNI,NLR,and PLR emerged as independent risk factors for AL,with odds ratios of 0.705(95%CI:0.641-0.775,P=0.012),1.628(95%CI:1.221-2.172,P=0.024),and 0.994(95%CI:0.989-0.999,P=0.031),respectively.These findings suggest that these biomarkers could effectively predict AL risk.Furthermore,the proposed predictive model has superior discriminative ability,as demonstrated by an area under the curve of 0.910,a sensitivity of 0.898,and a specificity of 0.826,reflecting its high level of accuracy.CONCLUSION The risk of AL in rectal cancer surgery patients can be effectively predicted by assessing the preoperative levels of serum nutritional biomarkers and inflammatory indicators,emphasizing their importance in the preoperative evaluation process.
文摘Colorectal cancer(CRC)is a leading cause of cancer-related morbidity and mortality globally,and its management in the emergency setting presents distinct challenges.In addition to its advantages in elective CRC surgery,studies have demonstrated that minimally invasive surgery(MIS)can provide benefits in CRC emergencies,such as reduced morbidity and a shorter length of hospitalization.However,the applicability of MIS in the emergency setting is limited by factors such as compromised patient physiology,resource constraints,and the need for technical expertise.As an alternative to emergency MIS,endoscopic interventions have also been increasingly supported by emerging evidence as a bridge to surgery.This article appraises contemporary guidelines and the evidence behind their recommendations for MIS surgery in CRC emergencies,whilst highlighting the challenges to implementation and the strategies to overcome them.
文摘This article explored the application of dexmedetomidine(Dex),a highly selective alpha-2 agonist,in managing postoperative cognitive dysfunction(POCD)in elderly patients undergoing radical colon cancer surgery.Aging is associated with a progressive decline in physiological functions and an increased risk of adverse surgical outcomes,including POCD,which encompasses many neurocognitive disorders that manifest during the perioperative period.The aging population is at a higher risk for POCD,which can lead to prolonged hospital stays,delayed recovery,and increased healthcare costs.Dex has neuroprotective,opioid-sparing,and sympatholytic properties,which reduces the incidence and severity of POCD.Dex was introduced for sedation in patients receiving mechanical ventilation but has since been adopted in anesthesia due to its multifaceted benefits.Its appli-cation extends to sedation,analgesia,maintenance of anesthesia,and controlling delirium.Its neuroprotective and anti-inflammatory effects have been explored in managing POCD.This article discussed the broad range of patient and procedure-related risk factors for POCD.Early identification and intervention are crucial to prevent the progression of POCD,which can have severe physical,psychological,and economic consequences.The article underscored the importance of a mul-tidisciplinary approach in managing POCD,involving the optimization of comor-bidities,depth of anesthesia monitoring,hemodynamic stability,and cerebral oxygenation monitoring.
基金Supported by Clinical Study on Perioperative Issues Related to Thyroidectomy,No.20241209Risk Factors and Coping Strategies for Postoperative Cough in Thyroid Nodules,No.2322152DResearch on Individualized Surgical Treatment Strategies for Thyroid Tumors Jicai Pre-recovery,No.[2020]397.
文摘BACKGROUND Post-thyroidectomy patients frequently experience depressive symptoms triggered by surgical trauma,fluctuating thyroid hormone levels,and the psychological burden of long-term surveillance;however,large-scale multivariableadjusted risk-factor data remain scarce.AIM To determine the prevalence and predictors of postoperative depression,and propose tailored mitigation strategies.METHODS We enrolled 108 consecutive patients who underwent thyroidectomies at The First Affiliated Hospital of Hebei North University between January 2023 and January 2025.Depression was assessed using the Self-Rating Depression Scale(SDS),while coping styles and social support were evaluated using the Medical Coping Modes Questionnaire and Perceived Social Support Scale.Logistic regression was used to identify independent risk and protective factors.RESULTS The mean SDS score was 52.58±10.20;62 patients(57.4%)met the criteria for depression(mild 32.4%,moderate 15.7%,severe 9.3%).Univariate analyses revealed higher depression rates among patients aged≥60 years,those with≤highschool education,monthly family income<3000 yuan,131I therapy,and avoidance/surrender coping;and lower social support(P<0.05).Multivariate regression showed income<3000 yuan(OR=5.26,95%CI:1.89-14.60),131I therapy(OR=5.70,95%CI:1.91-17.01),and avoidance/surrender coping(OR=4.77,95%CI:1.51-15.11)as independent risk factors,whereas higher social support was protective(OR=0.22,95%CI:0.09-0.54).CONCLUSIONDepression is common after thyroidectomy,and is driven by socioeconomic,treatment-related,and psychosocialfactors.Targeted interventions that address coping skills and bolster social support should be integrated intopostoperative care.
文摘BACKGROUND The use of an ultrasound-guided quadratus lumborum block(QLB)combined with general anesthesia for patients undergoing colorectal cancer surgery serves as a model for reducing the postoperative stress response,preserving metabolic stability,protecting renal function,and alleviating postoperative pain.AIM To compare QLB combined with general anesthesia vs general anesthesia alone in the perioperative stress response,metabolic and renal function,postoperative pain,and recovery outcomes among patients undergoing colorectal cancer surgery.METHODS Clinical data of 116 patients who underwent colorectal cancer surgery at our hospital between July 2023 and August 2024 were collected for retrospective analysis.According to the anesthesia protocol,the patients were divided into the control(general anesthesia,n=58)and experimental groups(QLB combined with general anesthesia,n=58).Physiological indicators such as blood glucose(GLU),lactic acid(LAC),blood urea nitrogen(BUN),and creatinine(CRE)were measured at T0(pre-surgery),T1(post-surgery),T2(6 hours post-surgery),T3(24 hours post-surgery),and T4(48 hours post-surgery).The differences between the two groups for each indicator were evaluated using repeated-measures analysis of variance.RESULTS The GLU levels from T1 to T4 in the experimental group were significantly lower than those in the control group(P<0.001),and the LAC levels were also significantly reduced(P<0.001).The experimental group exhibited superior renal protection based on postoperative BUN and CRE levels(P<0.05).Furthermore,the postoperative pain score in the experimental group was significantly lower than that in the control group[visual analogue scale(VAS)]scores differed significantly from T2 to T4,P<0.05.CONCLUSION Research has shown that QLB combined with general anesthesia can decrease postoperative GLU and LAC by 8%-15%and 10%-20%(P<0.001),respectively.It also enhances renal function markers(BUN,CRE,P<0.05)and lowers VAS scores by 15%-30%(P<0.05).Ultrasound-guided lumbar muscle block with general anesthesia outperforms general anesthesia alone in diminishing stress response,preserving metabolic balance and renal function,and alleviating postoperative pain.This approach offers a more efficient perioperative management strategy for patients undergoing colorectal cancer surgery.It is particularly advantageous for individuals with stress sensitivity,renal impairment,and heightened pain susceptibility.
文摘Gastric cancer with peritoneal carcinomatosis(PC)remains a formidable challenge in oncological care,especially regarding surgical intervention.Integrating enhanced recovery after surgery(ERAS)protocols into gastrectomy with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy has emerged as a promising approach.This minireview explores the influence of ERAS on surgical and oncological outcomes in this multifaceted procedure.Recent evidence suggests that ERAS,comprising multimodal strategies,improves postoperative recovery,reduces complications,and enhances quality of life.It may also contribute to better survival outcomes by minimizing perioperative morbidity and thereby facilitating the timely initiation of adjuvant therapy.Mechanistically,ERAS promotes early mobilization,attenuates postoperative immunosuppression,and supports timely adjuvant therapies,which are crucial in managing carcinomatosis.This minireview underscores the importance of multidisciplinary collaboration and individualized patient care to maximize ERAS benefits.Large-scale,prospective investigations are warranted to validate these findings and refine ERAS protocols for this specialized patient cohort.Further research will facilitate ongoing advancements in oncological surgery and perioperative care,ultimately improving outcomes for patients with gastric cancer and PC.
文摘BACKGROUND Surgery is the first choice of treatment for patients with colorectal cancer.Traditional open surgery imparts great damage to the body of the patient and can easily cause adverse stress reactions.With the continuous development of medical technology,laparoscopic minimally invasive surgery has shown great advantages for the treatment of patients with celiac disease.AIM To investigate the short-term efficacy of laparoscopic radical surgery and traditional laparotomy for the treatment of colorectal cancer,and the differences in the risk analysis of unplanned reoperation after operation.METHODS As the research subjects,this study selected 100 patients with colorectal cancer who received surgical treatment at the Yulin First Hospital from January 2018 to January 2022.Among them,50 patients who underwent laparoscopic radical resection were selected as the research group and 50 patients who underwent traditional laparotomy were selected as the control group.Data pertaining to clinical indexes,gastrointestinal hormones,nutrition indexes,the levels of inflammatory factors,quality of life,Visual Analog Scale score,and the postoperative complications of the two groups of patients before and after treatment were collected,and the therapeutic effects in the two groups were analyzed and compared.RESULTS Compared with the control group,perioperative bleeding,peristalsis recovery time,and hospital stays were significantly shorter in the research group.After surgery,the levels of gastrin(GAS)and motilin(MTL)were decreased in both groups,and the fluctuation range of GAS and MTL observed in the research group was significantly lower than that recorded in the control group.The hemoglobin(Hb)levels increased after surgery,and the level of Hb in the research group was significantly higher compared with the control group.After the operation,the expression levels of tumor necrosis factor-α,interleukin-6,and C-reactive protein and the total incidence of complications were significantly lower in the research group compared with the control group.One year after the operation,the quality of life of the two groups was greatly improved,with the quality of life in the research group being significantly better.CONCLUSION Laparoscopy was effective for colorectal surgery by reducing the occurrence of complications and inflammatory stress reaction;moreover,the quality of life of patients was significantly improved,which warrants further promotion.
文摘Advancements in machine learning have revolutionized preoperative risk assessment.In this article,we comment on the article by Huang et al,which presents a recent multicenter cohort study demonstrated that machine learning algorithms effectively stratify recurrence-free survival,providing a robust predictive framework for maximizing surgical outcomes in intrahepatic cholangiocarcinoma.By leveraging interpretable models,the research enhances clinical decision-making,allowing for more precise patient selection and personalized surgical strategies.These findings highlight the growing role of artificial intelligence in optimizing surgical outcomes and improving prognostic accuracy in hepatobiliary oncology.
文摘Neoadjuvant treatment is being extensively evaluated in pancreatic ductal adenocarcinoma(PDAC).This interest is appropriate given the dismal long-term prognosis for most patients who undergo upfront surgery.Despite prospective,retrospective and randomized trials supporting the role of neoadjuvant therapy in general for PDAC,the long-term benefit specifically for patients with resectable PDAC remains unclear.The phase III PREOPANC trial showed an improvement in overall survival in borderline resectable PDAC with neoadjuvant gemcitabinebased chemoradiation compared to upfront surgery alone,however,no such benefit was observed in the resectable cohort.Notably,three randomized trials(PANACHE01-PRODIGE 48,NORPACT-1,and PREOPANC-2)failed to show a clear improvement in overall survival with a neoadjuvant approach.The ongoing NeoFOL-R,PREOPANC-3,and the Alliance A021806 will help clarify the role of neoadjuvant therapy in resectable PDAC.In this minireview article we summarize the data surrounding neoadjuvant therapy in resectable pancreatic cancer and discuss future considerations of trials in this subgroup.
基金Supported by the First Batch of 2024 Social Welfare and Basic Research Projects in Zhongshan City(General Projects in the Field of Healthcare),No.2024B1100Guangdong Provincial Administration of Traditional Chinese Medicine,No.20241357.
文摘BACKGROUND Post-operative massive hemorrhage is a critical concern in oral cancer surgery,associated with severe complications and heightened morbidity and mortality rates.CASE SUMMARY A 46-year-old male with advanced poorly differentiated squamous cell carcinoma(ypT4aN3bN0M0)of the oral floor underwent extensive surgery,including total glossectomy,partial mandibulectomy,and free flap reconstruction.Postoperatively,he developed life-threatening hemorrhage on day 3 due to wound dehiscence.Rapid nursing interventions-prompt suture removal,pressure hemostasis,and multidisciplinary collaboration-controlled bleeding.Postoperative care emphasized hemodynamic monitoring,infection prevention,and rehabilitation.Despite comorbidities(hypertension,diabetes,prior stroke),the patient achieved functional recovery:Oral flap epithelialization,restored swallowing(water swallow test:Grade 1),70% tongue mobility,and 80% preoperative chewing efficiency at 6-month follow-up.This case underscores the critical role of structured nursing protocols in managing postoperative hemorrhage and optimizing outcomes in high-risk oral cancer surgery.CONCLUSION This case report highlights the pivotal role of structured nursing interventions in managing life-threatening postoperative hemorrhage following complex oral cancer surgery.By integrating meticulous preoperative risk stratification,intraoperative hemostatic collaboration,and vigilant postoperative monitoring(e.g.,timely suture management,pressure hemostasis,blood product administration),the interdisciplinary team achieved rapid hemorrhage control.Comprehensive psychological care and rehabilitation protocols further facilitated functional recovery,enabling the patient to regain swallowing,speech,and mobility despite advanced disease and comorbidities.The findings underscore that standardized nursing workflows,balancing procedural rigor with holistic patient support,are essential for mitigating complications and enhancing outcomes in high-risk head and neck surgical populations.
文摘BACKGROUND Colon cancer is one of the most common malignancies of the digestive tract,often complicated by intestinal obstruction,which can significantly impact patient outcomes.While traditional laparotomy is the standard treatment,it is associated with large wounds,slower recovery,and higher complication rates.Laparoscopic surgery,a minimally invasive approach,may offer better outcomes for these patients.AIM To evaluate the clinical effects and prognosis of laparoscopic surgery in patients with colon cancer complicated by intestinal obstruction compared to traditional laparotomy.METHODS A retrospective analysis was conducted on 100 patients diagnosed with colon cancer and intestinal obstruction who underwent surgical treatment between January 2020 and December 2022.Patients were divided into two groups:The control group(CG),treated with traditional laparotomy,and the observation group(OG),treated with laparoscopic surgery.Clinical effects,surgical indicators,postoperative pain,inflammatory response,complication rates,quality of life,and prognosis were assessed and compared between the two groups.RESULTS The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(numerical rating scale scores)and inflam-matory markers[tumor necrosis factor-alpha(TNF-α),interleukin-6(IL-6),C-reactive protein(CRP)]were lower in the OG(P<0.05).The incidence of complic-ations was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).CONCLUSION The OG showed superior clinical outcomes compared to the CG(P<0.05).Patients in the OG had shorter operation times,reduced intraoperative blood loss,faster recovery of intestinal function,earlier mobilization,and shorter hospital stays(P<0.05).Postoperative pain(NRS scores)and inflammatory markers(TNF-α,IL-6,CRP)were lower in the OG(P<0.05).The incidence of complications was significantly reduced in the OG(6.00%vs 22.00%,P<0.05).Quality of life scores,including physical function,psychological state,social communication,and self-care ability,were significantly higher in the OG(P<0.05).There were no significant differences between groups in abdominal drainage volume,1-year tumor recurrence or metastasis rates,or 1-and 3-year survival rates(P>0.05).
文摘BACKGROUND Fear of cancer recurrence(FCR)is a common psychological problem among patients with cancer,especially elderly patients.For patients with gastric cancer(GC)who have undergone treatments such as surgery,FCR may seriously affect their quality of life and psychological well-being.AIM To evaluate the FCR in elderly patients with GC undergoing laparoscopic radical surgery in Hefei City and to explore its related influencing factors.METHODS In this study 264 elderly patients with GC who underwent laparoscopic radical surgery in four hospital districts of The First Affiliated Hospital of Anhui Medical University from June 2021 to January 2024 were recruited.Information on basic characteristics,disease characteristics,psychological status,and social support was collected by a questionnaire.In statistical analysis,the t-test andχ^(2) test were used to analyze the differences between groups.The influencing factors of FCR were analyzed by logistic regression.Based on these influencing factors,a nomogram model was initially constructed to identify patients with GC with high FCR risk.RESULTS Elderly patients with GC generally faced higher FCR levels after laparoscopic radical surgery.Among the 264 patients,168 had clinical symptoms of FCR,and the prevalence rate was 63.64%.Further analysis showed that older age,high mental resilience,and sufficient social support were favorable factors for reducing FCR level,while heavier self-perceived burden,low education level,shorter duration of disease,larger tumor diameter,and more complications were associated with a higher FCR level.CONCLUSION This study demonstrated the significance of psychological interventions and social support strategies in reducing FCR among elderly patients with GC.In the future treatment protocols should be further optimized,and psychological and social support should be enhanced to improve the quality of life for this patient population.
基金supported by grants from the Natural Science Foundation of Shandong Province(Grant No.ZR2024QH058).
文摘In the era of precision medicine,the breast cancer surgical treatment field is gradually moving toward a de-escalation model.Through precise preoperative assessments and multidisciplinary decision-making,surgical trauma can be decreased,and patients’quality of life can be improved by ensuring safety.Herein,we explore the axillary de-escalation surgery model for breast cancer.
文摘Anastomotic leakage(AL)is a significant complication following rectal cancer surgery,adversely affecting both quality of life and oncological outcomes.Recent advancements in artificial intelligence(AI),particularly machine learning and deep learning,offer promising avenues for predicting and preventing AL.These technologies can analyze extensive clinical datasets to identify preoperative and perioperative risk factors such as malnutrition,body composition,and radiological features.AI-based models have demonstrated superior predictive power compared to traditional statistical methods,potentially guiding clinical decisionmaking and improving patient outcomes.Additionally,AI can provide surgeons with intraoperative feedback on blood supply and anatomical dissection planes,minimizing the risk of intraoperative complications and reducing the likelihood of AL development.
文摘BACKGROUND The clinical necessity of routine abdominal drainage following radical gastrectomy remains controversial,particularly under the enhanced recovery after surgery(ERAS)protocol.ERAS advocates a multimodal perioperative strategy designed to attenuate surgical stress and optimize postoperative convalescence.AIM To evaluate the necessity of abdominal drainage tube placement following radical gastrectomy in the context of ERAS protocols.METHODS A systematic review and meta-analysis were conducted by searching PubMed,EMBASE,Cochrane Library,Web of Science,China National Knowledge Infrastructure,Wanfang,VIP Information,and SinoMed databases for randomized controlled trials comparing outcomes of abdominal drainage vs no drainage after gastrectomy under ERAS protocols.Primary outcomes included time to gastrointestinal function recovery,drainage tube removal time,postoperative complication rates,and length of hospital stay.Review Manager 5.4 was used for statistical analysis,and heterogeneity was assessed using the I2 statistic.RESULTS A total of 21 randomized controlled trials involving 1652 patients were included.Compared with routine abdominal drainage,the ERAS group without drainage showed significantly faster gastrointestinal recovery[standardized mean difference=-1.30,95%confidence interval(CI):-1.66 to-0.94,P<0.00001]and shorter hospital stay(standardized mean difference=-1.37,95%CI:-1.86 to-0.88,P<0.00001).The incidence of total postoperative complications was also significantly lower(odds ratio=0.53,95%CI:0.40-0.70,P<0.00001),particularly for anastomotic leakage and pulmonary infection.No significant differences were observed in surgical site infections or urinary tract infections.Sensitivity and subgroup analyses indicated stability of results,although some heterogeneity was noted.CONCLUSION Avoiding routine abdominal drainage under ERAS could lead to faster recovery,reduced complications,and shorter hospital stay following radical gastrectomy,supporting the selective use of drainage rather than routine.
文摘BACKGROUND Prolonged recovery following colorectal cancer(CRC)surgery can result in physiological discomfort and psychological stress,underscoring the importance of effective perioperative care to enhance patient outcomes.AIM To evaluate the impact of multidisciplinary collaborative enhanced recovery after surgery(ERAS)nursing on patients undergoing CRC surgery.METHODS This study included 100 patients who underwent CRC surgery between August 2022 and August 2024.Patients were divided into two groups based on the perioperative nursing approach.The control group(n=50)received conventional nursing care,whereas the observation group(n=50)received multidisciplinary collaborative ERAS nursing.Postoperative recovery time,disease perception,pain levels,coping strategies,self-management efficacy,and quality of life were compared between the two groups.RESULTS Compared with the control group,the observation group exhibited significantly shorter times to ambulation,gastrointestinal motility,first meal intake,and hospital stay(P<0.05).No significant differences were observed in pre-nursing indicators between the two groups(P>0.05).After nursing,both groups showed improvements in disease perception scores,self-management efficacy,and quality of life scores,along with reductions in pain levels and coping strategy scores,except for the confrontative and venting dimensions.The observation group demonstrated significantly greater improvements in these scores,with significant intergroup and intragroup differences(P<0.05).CONCLUSION Multidisciplinary collaborative ERAS nursing can facilitate postoperative recovery in patients with CRC,enhance disease cognition,alleviate pain,and encourage active coping,thereby improving self-management efficacy and quality of life.
文摘BACKGROUND Implementation of an autonomic nerve-oriented anatomical approach in laparo-scopic surgery for patients with colorectal cancer may provide a new reference for surgical intervention in this patient population.AIM To assess the impact of autonomic nerve-oriented anatomical laparoscopic surgery on recovery and postoperative risks in patients with colorectal cancer.METHODS Data from 116 patients diagnosed with colorectal cancer,treated between January 2016 and May 2024,were randomly divided into 2 groups(n=58 each)according to surgical approach:Control(radical vessel-oriented laparoscopic surgery);and Observation(autonomic nerve-oriented anatomical surgery).Perioperative in-dicators,and postoperative risk for urinary dysfunction and sexual function were compared between the 2 groups.RESULTS Compared with the control group,the observation group experienced less in-traoperative blood loss(P<0.05)and exhibited superior perioperative indicators(P<0.05).At 2 weeks and 3 months postoperatively,the proportion of patients with urinary dysfunction in the observation group was lower than that in the control group(P<0.05).Four months postoperatively,there were significant differences in male erectile dysfunction,female dyspareunia,and sexual pleasure grading between the 2 groups(P<0.05).CONCLUSION The autonomic nerve-oriented anatomical approach to laparoscopic surgery for colorectal cancer accelerates postoperative recovery,with decreased intraope-rative blood loss,lower impact on urinary and sexual functions,and enhances surgical safety.
基金Supported by The National Natural Science Foundation of China,No.82460107Science and Technology Talent Support Program of Shaanxi Provincial People's Hospital,No.2021 LJ-05.
文摘BACKGROUND The surgical management of rectal cancer is continuously advancing,with a current emphasis on minimising the need for a permanent stoma.Understanding the risk factors influencing sphincter preservation is crucial for guiding clinical decision-making and optimising preoperative patient evaluation.AIM To examine the risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery.METHODS A retrospective analysis of the demographics,preoperative and intraoperative data,and pathological findings of 179 patients with rectal cancer who underwent laparoscopic radical rectal cancer surgery at our hospital between January 2022 and December 2023 was conducted.These clinical data were compared between two groups:Patients with sphincter preservation and those without,categorised as the sphincter-preserved and sphincter-unpreserved groups,respectively.RESULTS Of the 179 patients analysed,150 were in the sphincter-preserved group and 29 were in the sphincter-unpreserved group.Tumour height was significantly greater in the sphincter-preserved group compared to the sphincter-unpreserved group.Conversely,elevated levels of carcinoembryonic antigen,carbohydrate antigen 19-9,and plasma D-dimer were significantly higher in the sphincter-unpreserved group.Significant differences were also observed between the two groups in terms of place of residence,presence of colonic polyps,neoadjuvant chemotherapy,preoperative radiotherapy,mucinous adenocarcinoma,nerve invasion,and tumour height.No significant differences were observed for other parameters.Logistic regression analysis identified colonic polyps,mucinous adenocarcinoma,nerve invasion,and tumour height as independent risk factors for sphincter preser-vation.CONCLUSION Several risk factors influencing sphincter preservation in laparoscopic radical rectal cancer surgery were identified.These factors could be valuable tools for guiding clinical decision-making and optimising preoperative patient evaluations.
