BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often lead...BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.展开更多
BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This s...BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.展开更多
BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particu...BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.展开更多
BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized ...BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.展开更多
Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screen...Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.展开更多
BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a ful...BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a full-thickness resection device(FTRD)for neoplastic colorectal lesions.METHODS In this multicenter,retrospective study,EFTR was conducted in unselected realworld patients referred to participating German centers after colonoscopy confirmed EFTR eligibility.The primary outcome was histologically complete resection(R0)of the lesion,including segment-specific outcomes and adverse events(AE).Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days.RESULTS The analysis included 102 patients(64 males,38 females)with a median age of 70 years.EFTR via FTRD was technically successful in all patients.The R0 rate was 81.4%,segment-specifically ranging from 85.0%(rectum),84.6%(descending colon),84.0%(ascending colon),83.3%(cecum),and 76.5%(sigmoid colon)to 73.3%(transverse colon).Examination time was longer in proximal parts compared to the rectosigmoid(non-significant).Overall,33 patients(32.4%)experienced AE,including only one major complication(0.98%;perforation of sigmoid colon).Abdominal postsurgical pain(18.6%),hematochezia(9.8%),and hemoglobin decline(7.8%)were the most frequent minor complications.Transverse colon lesions had the numerically highest rate of AE,with 8 of 15 patients(53.3%)affected.CONCLUSION EFTR is efficacious for neoplastic colorectal lesions,though R0 rates vary by location.This may impact patient education,selection of the operator,and consideration of laparoscopy surgery.展开更多
Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years o...Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.展开更多
Xu et al retrospectively assessed endoscopic resection(ER)for esophageal gastrointestinal stromal tumors(E-GISTs)and reported excellent 5-year survival rates.Although ER shows promise as a minimally invasive procedure...Xu et al retrospectively assessed endoscopic resection(ER)for esophageal gastrointestinal stromal tumors(E-GISTs)and reported excellent 5-year survival rates.Although ER shows promise as a minimally invasive procedure,the 75%R0 resection rate with recurrence observed even after R0 resection warrants further discussion.We highlight the need for careful patient selection based on tumor size,location,and risk,considering endoscopic and thoracoscopic approaches.Future studies should refine ER techniques,optimize patient selection,and establish long-term follow-up to guide E-GIST management.展开更多
Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver sur...Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.展开更多
BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resec...BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resection.In contrast,tumors≥20 mm in size typically require surgical resection.However,the optimal management of intermediate-sized(10-15 mm)rectal NETs remains controversial.AIM To compare the clinical outcomes of endoscopic resection of rectal NETs<1 cm and those 1-1.5 cm in size.METHODS A retrospective study was conducted on 1056 patients with rectal NETs treated at the Samsung Medical Center between January 2005 and June 2021.After propensity score matching(1:10)for age,sex,and type of endoscopic resection,225 patients with tumors<1 cm in size and 27 patients with tumors 1-1.5 cm in size were analyzed.RESULTS Surgical resection was more frequent in the 1-1.5 cm group(37.2%)than in the<1 cm group(10.7%)(P<0.01).Endoscopic submucosal dissection was also more commonly performed in the 1-1.5 cm group(48.1%vs 18.5%,P<0.01).Negative resection margins were achieved in 97.2%of the patients,with no significant difference between the groups(P=0.22).No lymphovascular invasion was observed.During a median follow-up of 54 months,no recurrence occurred in the 1-1.5 cm group,while one case of metachronous recurrence was noted in the<1 cm group(P=1.00).There was no significant difference in recurrence-free survival(P=0.48).CONCLUSION Endoscopic resection of 1-1.5 cm grade 1 rectal NETs yielded comparable outcomes to those<1 cm in size,suggesting its feasibility as a treatment.展开更多
Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significa...Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.展开更多
BACKGROUND Ultra-low rectal cancer(ULRC),defined as a lesion located within 5 cm of the anal verge,poses considerable clinical challenges because the treatment decision must balance oncological eradication with preser...BACKGROUND Ultra-low rectal cancer(ULRC),defined as a lesion located within 5 cm of the anal verge,poses considerable clinical challenges because the treatment decision must balance oncological eradication with preservation of anal function.Historically,abdominoperineal resection(APR)has served as a standard approach for tumor eradication in these patients,but a permanent stoma significantly reduces patients'quality of life.In contrast,intersphincteric resection(ISR)can maintain anal function,thereby improving quality of life;however,the debate surrounding short-term postoperative complications and long-term prognosis has not been fully resolved.Therefore,large-scale multicenter retrospective cohort studies are crucial to address this issue and provide more reliable data.AIM To address a persistent debate in ULRC management,we compared ISR and APR outcomes through rigorous methodology.METHODS A retrospective analysis of patients undergoing surgery at three centers in China between 2012 and 2023 was performed with propensity score matching(PSM).RESULTS A total of 803 patients(435 in the ISR group and 368 in the APR group)met the inclusion criteria,with 289 comprising each of the two groups after PSM.Over a median follow-up of 47.2 months,the absolute 5-year overall survival(OS)improved by 6.7%with ISR(80.8%vs 74.1%,P=0.032).Cox regression analysis confirmed ISR(HR=0.554,95%CI:0.371-0.828,P=0.004)as an independent protective factor for OS and reduced local recurrence(9.5%vs 12.9%,P=0.019).With respect to short-term complications,despite higher anastomotic leakage rates(11.4%vs 1.0%),ISR significantly reduced total complications(29.4%vs 42.2%,P=0.001)and hospitalization duration(9.8 days vs 12.9 days,P<0.001).Moreover,incision infection,urinary retention,circumferential resection margins,and hospitalization time were greater in the APR group(P<0.05).CONCLUSION The long-term prognosis of ULRC treated with ISR is excellent,with no increase in overall surgical complications or hospital stay duration,indicating that ISR is a feasible alternative to APR for managing ULRC.展开更多
BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endosco...BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal mana...While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.展开更多
Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in o...Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.展开更多
Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of...Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of tumor recurrence.Prognostic prediction models with great performance are urgently needed.The present study aimed to establish a novel prognostic nomogram to predict tumor recurrence in HCC patients after LR.Methods:We retrospectively analyzed 726 HCC patients who underwent LR between October 2011 and December 2016.Patients were randomly divided into the training cohort(n=508)and the testing cohort(n=218).The protein expression of 14 biomarkers in tumor tissues was assessed by immunohistochemistry.The nomogram predicting recurrence-free survival(RFS)was established by a multivariate Cox regression analysis model and was evaluated by calibration curves,Kaplan-Meier survival curves,time-dependent areas under the receiver operating characteristic(ROC)curves(AUCs),and decision curve analyses in both the training and testing cohorts.Results:Alpha-fetoprotein[hazard ratio(HR)=1.013,P=0.002],portal vein tumor thrombosis(HR=1.833,P<0.001),ascites(HR=2.024,P=0.014),tumor diameter(HR=1.075,P<0.001),Ecadherin(HR=0.859,P=0.011),EMA(HR=1.196,P=0.022),and PCNA(HR=1.174,P=0.031)immunohistochemistry scores were found to be independent factors for RFS.The 1-year and 3-year AUCs of the nomogram for RFS were 0.813 and 0.739,respectively.The patients were divided into the high-risk group and the low-risk group by median value which was generated from the nomogram,and Kaplan-Meier analysis revealed that the high-risk group had a shorter RFS than the low-risk group in both the training(P<0.001)and testing cohorts(P<0.001).Conclusions:Our newly developed nomogram integrated clinicopathological data and key gene expression data,and was verified to have high accuracy in predicting the RFS of HCC patients after LR.This model could be used for early identification of patients at high-risk of postoperative recurrence.展开更多
The recent study by Chen et al,published in the World Journal of Gastroenterology,introduces a groundbreaking assessment tool-the preoperative systemic immuneinflammation index/albumin(SII/ALB)ratio-for patients with ...The recent study by Chen et al,published in the World Journal of Gastroenterology,introduces a groundbreaking assessment tool-the preoperative systemic immuneinflammation index/albumin(SII/ALB)ratio-for patients with hepatocellular carcinoma(HCC)undergoing curative resection.This study not only establishes the independent prognostic significance of the SII/ALB ratio but also incorporates it into a predictive nomogram,enhancing its utility for clinical decision-making.The SII/ALB ratio,by integrating inflammatory and nutritional biomarkers,offers a novel lens through which the prognosis of HCC patients can be viewed,suggesting a more tailored approach to patient management.The development of the nomogram,validated for its accuracy in predicting patient outcomes,marks a pivotal advance,potentially guiding surgical decisions and postoperative care.However,the study's focus on a single-center cohort prompts the need for validation in a broader,more diverse patient population to ensure its applicability across various clinical settings.Moreover,longitudinal studies could elucidate the dynamic changes in SII/ALB post-surgery,offering insights into its potential as a continuous monitor for recurrence and long-term survival.This abstract aim to underscore the critical findings of Chen et al's study while calling for further research to explore the full potential of the SII/ALB ratio in the global management of hepatocellular carcinoma.展开更多
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these proced...BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these procedures,patients often experience postoperative complications.Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.AIM To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation before hepatic,biliary,or pancreatic cancer resections.All data were analysed using Review Manager Software 5.4,and the metaanalysis was performed with a random-effect model analysis.RESULTS A total of 8 studies were included(n=568),recruiting adult patients undergoing hepatic,biliary,or pancreatic cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation[risk ratio(RR):0.79,95%CI:0.66-0.95,Z=2.52,P=0.01].No statistically significant difference was found in postoperative readmission rate(RR:1.31,95%CI:0.79-2.17,Z=1.05,P=0.29),major complications(RR:1.08;95%CI:0.61-1.92,Z=0.28,P=0.78),length of stay(standardised mean difference:-0.11,95%CI:-0.31 to 0.1,Z=1.05,P=0.29),or mortality(RR:0.28,95%CI:0.01-6.51,Z=0.79,P=0.43).CONCLUSION Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.展开更多
基金Supported by the General Project of the Natural Science Foundation of Chongqing,No.cstc2021jcyj-msxmX0604.
文摘BACKGROUND Laparoscopic liver resection(LLR)can be challenging due to the difficulty of establishing a retrohepatic tunnel under laparoscopy.Dissecting the third hepatic hilum before parenchymal transection often leads to significant liver mobilization,tumor compression,and bleeding from the short hepatic veins(SHVs).This study introduces a novel technique utilizing the ventral avascular area of the inferior vena cava(IVC),allowing SHVs to be addressed after parenchymal transection,thereby reducing surgical complexity and improving outcomes in in situ LLR.AIM To introduce and evaluate a novel LLR technique using the ventral avascular area of the IVC and compare its short-term outcomes with conventional methods.METHODS The clinical cohort data of patients with pathologically confirmed hepatocellular carcinoma or intrahepatic cholangiocarcinoma who underwent conventional LLR and novel LLR between July 2021 and July 2023 at the First Affiliated Hospital of Chongqing Medical University were retrospectively analyzed.In novel LLR,we initially separated the caudate lobe from the IVC using dissecting forceps along the ventral avascular area of the IVC.Then,we transected the parenchyma of the left and right caudate lobes from the caudal side to the cephalic side using the avascular area as a marker.Subsequently,we addressed the SHVs and finally dissected the root of the right hepatic vein or left hepatic vein.The short-term postoperative outcomes and oncological results of the two approaches were evaluated and compared.RESULTS A total of 256 patients were included,with 150(58.59%)undergoing conventional LLR and 106(41.41%)undergoing novel LLR.The novel technique resulted in significantly larger tumor resections(6.47±2.96 cm vs 4.01±2.33 cm,P<0.001),shorter operative times(199.57±60.37 minutes vs 262.33±83.90 minutes,P<0.001),less intraoperative blood loss(206.92±37.09 mL vs 363.34±131.27 mL,P<0.001),and greater resection volume(345.11±31.40 mL vs 264.38±31.98 mL,P<0.001)compared to conventional LLR.CONCLUSION This novel technique enhances liver resection outcomes by reducing intraoperative complications such as bleeding and tumor compression.It facilitates a safer,in situ removal of complex liver tumors,even in challenging anatomical locations.Compared to conventional methods,this technique offers significant advantages,including reduced operative time,blood loss,and improved overall surgical efficiency.
文摘BACKGROUND Gastric cancer(GC)is a prevalent tumor in the digestive system,with around one million new cases reported annually,ranking it as the third most common malignancy.Reducing pain is a key research focus.This study evaluates the effect of nalbuphine on the analgesic effect and the expression of pain factors in patients after radical resection.AIM To provide a reference for postoperative analgesia methods.METHODS One hundred eight patients with GC,admitted between January 2022 and June 2024,underwent radical gastrectomy.They received a controlled analgesia pump and a transverse abdominis muscle plane block,divided into two groups of 54 patients in each group.The control group received sufentanil,while the observation group received nalbuphine as an analgesic.Postoperative analgesic effects,pain factor expression,and adverse effects were compared.RESULTS The resting pain and activity pain scores in the observation group at 6,12,24 and 48 hours were significantly lower than those in the control group.Additionally,the number of presses and consumption of the observation group at 48 hours were lower than those of the control group;and the response rate of the observation group was higher than that of the control group(P<0.05).The prostaglandin E2,substance P,and serotonin levels 24 hours after the observation group were lower than those in the control group,and the incidence of adverse reactions was 5.56%lower than 22.22%in the control group(P<0.05).CONCLUSION The findings suggest that nalbuphine enhances postoperative multimodal analgesia in patients with radical GC,effectively improving postoperative analgesic effect,relieving postoperative resting and active pain,and reducing postoperative pain factor expression,demonstrating its potential for clinical application.
基金Supported by National Natural Science Foundation of China,No.82004298Jiangsu Graduate Research and Practice Innovation Program,China,No.KYCX23_2090.
文摘BACKGROUND Recently,several endoscopic techniques have been used to improve the R0 resection rate of rectal neuroendocrine neoplasms(R-NENs).However,none of these methods can achieve 100%complete resection(CR),particularly in the vertical direction.Endoscopic full-thickness resection(EFTR)has proven to be an effective method for the treatment of submucosal tumors but is seldom utilized in the eradication of R-NENs.AIM To review cases of R-NENs removed using EFTR and to evaluate the safety and efficacy of this technique.METHODS This retrospective cohort study enrolled 160 patients with pathologically confirmed R-NENs,including 132 who underwent endoscopic submucosal dissection(ESD)and 28 who underwent EFTR.Lesions were categorized as<1 cm,1-2 cm,and>2 cm in size.CR rate,en bloc resection rate,operation time,and complications were evaluated.Subgroup analyses and follow-up were also performed.RESULTS EFTR achieved 100%CR rates for lesions<1 cm and 1-2 cm,compared with 67.0%and 50.0%,respectively,in the ESD group.En bloc resection and successful removal of the R-NENs were achieved in all patients.Meanwhile,EFTR showed performance comparable to ESD in terms of operation time,hospitalization cost,and postoperative adverse events,except for a one-day longer hospital stay.We also analyzed the invasion depth of R-NENs based on full-thickness specimens.The data showed that 80%of lesions(<1 cm)and 85.7%of lesions(1-2 cm)had invaded the SM3 level or deeper at the time of resection.For ESD specimens,46.6%(<1 cm)and 89.3%(1-2 cm)of lesions had infiltrated more than 2000μm beneath the muscularis mucosae.CONCLUSION EFTR has shown superior performance in the resection of small R-NENs compared with that of ESD.
文摘BACKGROUND Underwater endoscopic mucosal resection(UEMR)has been shown to be a good treatment option for the management of nonpedunculated polyps≥10 mm since its introduction.However,there is a paucity of randomized controlled trials(RCTs)in Asia.AIM To compare the efficacy and safety of UEMR with those of conventional EMR(CEMR)in treating nonpedunculated colorectal lesions.METHODS We carried out this RCT at a tertiary hospital from October 2022 to July 2024.Patients with nonpedunculated colorectal neoplasms ranging from 10 mm to 30 mm in size were randomly assigned to either the UEMR or CEMR group.The primary outcome was the curative resection(R0)rate.The secondary outcomes included en bloc resection,procedure time,adverse events,and the number of clips used for defect closure.RESULTS A total of 260 patients with 260 lesions(130 in each UEMR and CEMR group)were recruited.The median age was 58(27-85)years,the male/female ratio was 1.74,and the median lesion size was 20(10-30 mm)mm.Compared with CEMR,UEMR was associated with a significantly greater curative resection(R0)rate(98.4%vs 90.3%;P=0.007),greater en bloc resection rate(100%vs 94.6%;P=0.014),shorter procedure time(65 vs 185 seconds;P<0.001),lower rate of bleeding complications(1.5%vs 10%;P=0.003),and fewer clips used(2 vs 3;P<0.001).No perforations were observed in either group.CONCLUSION Compared with CEMR,UEMR has a higher R0 rate,greater en bloc resection rate,shorter procedure time,fewer bleeding complications,and clips used in the management of nonpedunculated colorectal neoplasms.
基金Supported by Nanchang High-Level Scientific and Technological Innovation Talents‘Double Hundred Plan’Project,China,No.2022-312.
文摘Rectal neuroendocrine tumor(rNET)is an indolent malignancy often detected during colonoscopy screening.The incidence of rNET has increased approximately 10-fold over the past 30 years.Most rNETs detected during screening endoscopy are small,measuring<10 mm.Current guidelines recommend endoscopic resection for small,well-differentiated rNET using modified endoscopic submucosal resection(mEMR)or endoscopic submucosal dissection.However,the optimal endoscopic treatment method remains uncertain.This paper summarizes the evidence on mEMR with submucosal stretching,mEMR without submucosal stretching,endoscopic submucosal dissection and endoscopic full-thickness resection.Given that rNETs often exhibit submucosal invasion,achieving adequate resection depth is crucial to ensure histological complete resection.mEMR with submucosal stretching appears favorable due to its high rate of histological complete resection,safety and convenience.Risk factors associated with lymph node and distant metastases are also discussed.A treatment algorithm is proposed to facilitate clinical decision-making.
文摘BACKGROUND Despite growing evidence on endoscopic full thickness resection(EFTR),data on segment-specific outcomes in real-world patients remain limited.AIM To investigate segment-specific outcomes of EFTR using a full-thickness resection device(FTRD)for neoplastic colorectal lesions.METHODS In this multicenter,retrospective study,EFTR was conducted in unselected realworld patients referred to participating German centers after colonoscopy confirmed EFTR eligibility.The primary outcome was histologically complete resection(R0)of the lesion,including segment-specific outcomes and adverse events(AE).Additional efficacy and safety parameters were investigated by colonic topography for up to 30 days.RESULTS The analysis included 102 patients(64 males,38 females)with a median age of 70 years.EFTR via FTRD was technically successful in all patients.The R0 rate was 81.4%,segment-specifically ranging from 85.0%(rectum),84.6%(descending colon),84.0%(ascending colon),83.3%(cecum),and 76.5%(sigmoid colon)to 73.3%(transverse colon).Examination time was longer in proximal parts compared to the rectosigmoid(non-significant).Overall,33 patients(32.4%)experienced AE,including only one major complication(0.98%;perforation of sigmoid colon).Abdominal postsurgical pain(18.6%),hematochezia(9.8%),and hemoglobin decline(7.8%)were the most frequent minor complications.Transverse colon lesions had the numerically highest rate of AE,with 8 of 15 patients(53.3%)affected.CONCLUSION EFTR is efficacious for neoplastic colorectal lesions,though R0 rates vary by location.This may impact patient education,selection of the operator,and consideration of laparoscopy surgery.
文摘Gastrointestinal stromal tumors(GISTs)are the most common mesenchymal tumors of the gastrointestinal tract and arise from the interstitial cells of Cajal.They predominantly affect individuals between 50 and 70 years of age and often carry malignant potential despite being frequently asymptomatic.The stomach and small intestine are the most common locations,while involvement of the esophagus,colon,or rectum is relatively rare.GISTs are often discovered incidentally during endoscopic or radiologic evaluations,and the diagnosis is confirmed through tissue biopsy and immunohistochemical staining,particularly for KIT(CD117),DOG1,and PDGFRA.In the past decade,laparoscopic resection has been considered the standard treatment for localized GISTs smaller than 5 cm.However,recent advances in endoscopic technology have led to a growing role for endoscopic resection as a safe and effective treatment option for selected nonmetastatic GISTs.Endoscopic techniques such as endoscopic submucosal dissection,endoscopic submucosal excavation,submucosal tunneling endoscopic resection,and endoscopic full-thickness resection have demonstrated favorable outcomes,including high complete resection(R0)rates,shorter hospital stays,and quicker recovery compared to traditional surgery.The selection of an appropriate resection method depends on tumor size,location,depth of invasion,and proximity to vital structures.Endoscopic ultrasound has become an essential tool for preprocedural assessment,providing detailed information on tumor characteristics and helping to guide management decisions.While endoscopic resection is a promising minimally invasive approach,it should be performed by skilled endoscopists with appropriate training due to the technical complexity and risk of complications such as bleeding or perforation.This review summarizes recent developments in endoscopic resection of GISTs,with a focus on indications,procedural safety,clinical outcomes,and recommendations for optimal patient selection and procedural planning.
文摘Xu et al retrospectively assessed endoscopic resection(ER)for esophageal gastrointestinal stromal tumors(E-GISTs)and reported excellent 5-year survival rates.Although ER shows promise as a minimally invasive procedure,the 75%R0 resection rate with recurrence observed even after R0 resection warrants further discussion.We highlight the need for careful patient selection based on tumor size,location,and risk,considering endoscopic and thoracoscopic approaches.Future studies should refine ER techniques,optimize patient selection,and establish long-term follow-up to guide E-GIST management.
文摘Various approaches to laparoscopic anatomic liver resection have been described.In this paper,the authors present a technique that utilizes the ventral avascular areas above the inferior vena cava.While many liver surgeons partially adopt this elements of this method,few employ it to the full extent outlined here.Main-taining low central venous pressure during anesthesia is critical to this approach,as demonstrated by the operative images showing collapsed hepatic veins.This technique is particularly advantageous when the patient’s body mass index is low,the tumor is small(or large but deeply embedded within the liver parenchy-ma),and the overlying liver tissue is not excessively bulky or heavy.Nonetheless,following the conventional course along the Glissonean pedicle can be beneficial.The authors demonstrate notable skill in completing these procedures laparosco-pically.However,concerns over margin positivity and tumor recurrence remain,and follow up studies are needed to further validate the approach.
文摘BACKGROUND Rectal neuroendocrine tumors(NETs)smaller than 10 mm and well-differentiated tumors are generally considered to have a low risk of lymph node and distant metastasis,making them suitable for endoscopic resection.In contrast,tumors≥20 mm in size typically require surgical resection.However,the optimal management of intermediate-sized(10-15 mm)rectal NETs remains controversial.AIM To compare the clinical outcomes of endoscopic resection of rectal NETs<1 cm and those 1-1.5 cm in size.METHODS A retrospective study was conducted on 1056 patients with rectal NETs treated at the Samsung Medical Center between January 2005 and June 2021.After propensity score matching(1:10)for age,sex,and type of endoscopic resection,225 patients with tumors<1 cm in size and 27 patients with tumors 1-1.5 cm in size were analyzed.RESULTS Surgical resection was more frequent in the 1-1.5 cm group(37.2%)than in the<1 cm group(10.7%)(P<0.01).Endoscopic submucosal dissection was also more commonly performed in the 1-1.5 cm group(48.1%vs 18.5%,P<0.01).Negative resection margins were achieved in 97.2%of the patients,with no significant difference between the groups(P=0.22).No lymphovascular invasion was observed.During a median follow-up of 54 months,no recurrence occurred in the 1-1.5 cm group,while one case of metachronous recurrence was noted in the<1 cm group(P=1.00).There was no significant difference in recurrence-free survival(P=0.48).CONCLUSION Endoscopic resection of 1-1.5 cm grade 1 rectal NETs yielded comparable outcomes to those<1 cm in size,suggesting its feasibility as a treatment.
基金supported by grants from the National Natural Science Foundation of China (82150 0 04)the National Municipal Key Clinical Specialtythe Clinical Research Project for Major Diseases in Municipal Hospitals (SHDC2020CR1022B)。
文摘Liver transplantation represents a complex surgical procedure and serves as a curative treatment for patients presenting an acute or chronic end-stage liver disease, or carefully selected liver malignancy. A significant gap still exists between the number of available donor organs and potential recipients. The use of an otherwise-wasted resected liver lobe from patients with benign liver tumors is a new, albeit small, option to alleviate the allograft shortage. This review provides evidence that resected liver lobes may be used successfully in liver transplantation.
基金Supported by Natural Science Foundation of Fujian Province,No.2023J011819.
文摘BACKGROUND Ultra-low rectal cancer(ULRC),defined as a lesion located within 5 cm of the anal verge,poses considerable clinical challenges because the treatment decision must balance oncological eradication with preservation of anal function.Historically,abdominoperineal resection(APR)has served as a standard approach for tumor eradication in these patients,but a permanent stoma significantly reduces patients'quality of life.In contrast,intersphincteric resection(ISR)can maintain anal function,thereby improving quality of life;however,the debate surrounding short-term postoperative complications and long-term prognosis has not been fully resolved.Therefore,large-scale multicenter retrospective cohort studies are crucial to address this issue and provide more reliable data.AIM To address a persistent debate in ULRC management,we compared ISR and APR outcomes through rigorous methodology.METHODS A retrospective analysis of patients undergoing surgery at three centers in China between 2012 and 2023 was performed with propensity score matching(PSM).RESULTS A total of 803 patients(435 in the ISR group and 368 in the APR group)met the inclusion criteria,with 289 comprising each of the two groups after PSM.Over a median follow-up of 47.2 months,the absolute 5-year overall survival(OS)improved by 6.7%with ISR(80.8%vs 74.1%,P=0.032).Cox regression analysis confirmed ISR(HR=0.554,95%CI:0.371-0.828,P=0.004)as an independent protective factor for OS and reduced local recurrence(9.5%vs 12.9%,P=0.019).With respect to short-term complications,despite higher anastomotic leakage rates(11.4%vs 1.0%),ISR significantly reduced total complications(29.4%vs 42.2%,P=0.001)and hospitalization duration(9.8 days vs 12.9 days,P<0.001).Moreover,incision infection,urinary retention,circumferential resection margins,and hospitalization time were greater in the APR group(P<0.05).CONCLUSION The long-term prognosis of ULRC treated with ISR is excellent,with no increase in overall surgical complications or hospital stay duration,indicating that ISR is a feasible alternative to APR for managing ULRC.
文摘BACKGROUND Ulcerative colitis(UC)increases the risk of colorectal dysplasia.While colectomy was once standard,advances in polypectomy,endoscopic mucosal resection(EMR),endoscopic submucosal dissection(ESD),and endoscopic full-thickness resection(EFTR)now allow organ-sparing management in selected cases.AIM To summarize current evidence on the feasibility,safety,and outcomes of these techniques in UC-associated neoplasia.METHODS A scoping review was conducted using PubMed and EMBASE(1975-May 2025)with the search:(“endoscopic submucosal dissection”/exp OR“endoscopic mucosal resection”OR“full thickness resection”OR“polypectomy”)AND(“ulcerative colitis”/exp OR“ulcerative colitis”OR“pouch”).Screening followed PRISMA guidelines.Eligible studies included those reporting outcomes,feasibility,or novel techniques in the endoscopic management of UC-associated dysplasia.RESULTS Of 1075 identified records,754 were screened after duplicate removal,and 48 studies were included.Polypectomy was safe and effective for well-demarcated,lifting lesions without adjacent dysplasia.EMR has excellent outcomes for small,polypoid,or right-sided lesions that demonstrated adequate lifting.ESD is ind icated for flat,large,non-polypoid,or fibrotic lesions,particularly in the left colon.ESD achieved en bloc resection in 88%-100%and R0 resection in 73%-96%of cases.The overall complication rate with ESD was approximately 2%-10%,primarily bleeding or perforation.Local recurrence occurred in 0%-6.8%,and metachronous lesions developed in up to 31%of cases over follow-up durations of up to 15 years.Surgical intervention after ESD was required in 10%-20%of patients,typically for non-curative resection or new lesions.Submucosal fibrosis,a common obstacle in UC,limited lifting and increased procedural difficulty.Adjunctive strategies-such as water pressure-assisted dissection,pocket-creation method,self-assembling peptide injectables,and traction systems-enhanced technical success.EFTR,though limited to case series,was effective for non-lifting or anatomically complex lesions,particularly in post-surgical or pouch anatomy,but carried higher procedural risk including rare but serious adverse events.CONCLUSION Endoscopic resection offers a spectrum of curative,minimally invasive options for managing dysplasia in UC.EMR remains appropriate for simple,lifting lesions,while ESD and EFTR broaden the therapeutic landscape for complex or fibrotic pathology.Lesion morphology,lifting characteristics,and operator experience should guide technique selection.Long-term outcomes are favorable with appropriate surveillance,though the risk of metachronous neoplasia necessitates continued monitoring.
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
文摘While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.
基金Clinical Study on Endoscopic Resection of Colorectal Submucosal Tumors Using Underwater Combined with Metal Clip-Assisted Snare,China(Grant No.2441ZF271)。
文摘Objective:To explore the clinical feasibility and safety of modified endoscopic mucosal resection for rectal neuroendocrine tumors(R-NETs).Methods:Seventy cases of R-NETs treated with endoscopic mucosal resection in our hospital between April 2022 and March 2024 were selected and divided into the control group and the observation group using the mean score method,each with 35 cases.In the control group,traditional endoscopic mucosal resection(EMR)was performed,and in the observation group,modified EMR(endoscopic mucosal resection with ligation apparatus[EMR-L])was performed.The operation time,hospitalization time,operation cost,and related complication rate of the two groups of patients were compared.Results:The operation time(20.36±1.46 min)and hospital stay(3.37±0.51 d)of patients in the observation group were shorter than those of the control group(31.44±2.65 min and 4.73±0.49 d).The cost of the operation in the observation group(7,695.85±1,521.42 yuan)was lower than that of the control group(8,418.62±1219.30 yuan),and the difference was statistically significant(P<0.05).The total incidence of postoperative related complications in the observation group was observed to be 11.42%,which was significantly lower than that of 31.42%in the control group,and the difference was statistically significant(P<0.05).Conclusion:The application of modified EMR in R-NETs is remarkable,which can not only effectively shorten the operation time and hospital stay,but also further reduce the risk of related complications,and indirectly save a large amount of hospital costs;thus,it is recommended to be promoted and applied clinically.
基金supported by a grant from the Exploration Project of Zhejiang Provincial Natural Science Foundation of China(LQ22H160031)。
文摘Background:Hepatocellular carcinoma(HCC)is a common malignancy with high mortality.Liver resection(LR)is a curative treatment for early-stage HCC,but the prognosis of HCC patients after LR is unsatisfactory because of tumor recurrence.Prognostic prediction models with great performance are urgently needed.The present study aimed to establish a novel prognostic nomogram to predict tumor recurrence in HCC patients after LR.Methods:We retrospectively analyzed 726 HCC patients who underwent LR between October 2011 and December 2016.Patients were randomly divided into the training cohort(n=508)and the testing cohort(n=218).The protein expression of 14 biomarkers in tumor tissues was assessed by immunohistochemistry.The nomogram predicting recurrence-free survival(RFS)was established by a multivariate Cox regression analysis model and was evaluated by calibration curves,Kaplan-Meier survival curves,time-dependent areas under the receiver operating characteristic(ROC)curves(AUCs),and decision curve analyses in both the training and testing cohorts.Results:Alpha-fetoprotein[hazard ratio(HR)=1.013,P=0.002],portal vein tumor thrombosis(HR=1.833,P<0.001),ascites(HR=2.024,P=0.014),tumor diameter(HR=1.075,P<0.001),Ecadherin(HR=0.859,P=0.011),EMA(HR=1.196,P=0.022),and PCNA(HR=1.174,P=0.031)immunohistochemistry scores were found to be independent factors for RFS.The 1-year and 3-year AUCs of the nomogram for RFS were 0.813 and 0.739,respectively.The patients were divided into the high-risk group and the low-risk group by median value which was generated from the nomogram,and Kaplan-Meier analysis revealed that the high-risk group had a shorter RFS than the low-risk group in both the training(P<0.001)and testing cohorts(P<0.001).Conclusions:Our newly developed nomogram integrated clinicopathological data and key gene expression data,and was verified to have high accuracy in predicting the RFS of HCC patients after LR.This model could be used for early identification of patients at high-risk of postoperative recurrence.
基金Supported by Shandong Province Medical and Health Science and Technology Development Plan Project,No.202203030713Science and Technology Program of Yantai Affiliated Hospital of Binzhou Medical University,No.YTFY2022KYQD06.
文摘The recent study by Chen et al,published in the World Journal of Gastroenterology,introduces a groundbreaking assessment tool-the preoperative systemic immuneinflammation index/albumin(SII/ALB)ratio-for patients with hepatocellular carcinoma(HCC)undergoing curative resection.This study not only establishes the independent prognostic significance of the SII/ALB ratio but also incorporates it into a predictive nomogram,enhancing its utility for clinical decision-making.The SII/ALB ratio,by integrating inflammatory and nutritional biomarkers,offers a novel lens through which the prognosis of HCC patients can be viewed,suggesting a more tailored approach to patient management.The development of the nomogram,validated for its accuracy in predicting patient outcomes,marks a pivotal advance,potentially guiding surgical decisions and postoperative care.However,the study's focus on a single-center cohort prompts the need for validation in a broader,more diverse patient population to ensure its applicability across various clinical settings.Moreover,longitudinal studies could elucidate the dynamic changes in SII/ALB post-surgery,offering insights into its potential as a continuous monitor for recurrence and long-term survival.This abstract aim to underscore the critical findings of Chen et al's study while calling for further research to explore the full potential of the SII/ALB ratio in the global management of hepatocellular carcinoma.
文摘For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
文摘BACKGROUND Hepatobiliary and pancreatic cancers are often associated with high morbidity and mortality.Surgical intervention remains the cornerstone for curative treatment.However,Due to the complexity of these procedures,patients often experience postoperative complications.Prehabilitation has been suggested as a tool to decrease postoperative morbidity and improve recovery by optimising patients preoperatively to handle the stress of surgery.AIM To evaluate the effectiveness of prehabilitation in patients undergoing hepatobiliary and pancreatic cancer resections.METHODS Standard medical databases such as MEDLINE,EMBASE,PubMed,and Cochrane Library were searched to find randomised,controlled trials comparing prehabilitation vs no-prehabilitation before hepatic,biliary,or pancreatic cancer resections.All data were analysed using Review Manager Software 5.4,and the metaanalysis was performed with a random-effect model analysis.RESULTS A total of 8 studies were included(n=568),recruiting adult patients undergoing hepatic,biliary,or pancreatic cancer resections.In the random effect model analysis,prehabilitation was associated with fewer postoperative complications compared to no prehabilitation[risk ratio(RR):0.79,95%CI:0.66-0.95,Z=2.52,P=0.01].No statistically significant difference was found in postoperative readmission rate(RR:1.31,95%CI:0.79-2.17,Z=1.05,P=0.29),major complications(RR:1.08;95%CI:0.61-1.92,Z=0.28,P=0.78),length of stay(standardised mean difference:-0.11,95%CI:-0.31 to 0.1,Z=1.05,P=0.29),or mortality(RR:0.28,95%CI:0.01-6.51,Z=0.79,P=0.43).CONCLUSION Prehabilitation was found to be effective in reducing postoperative complications following surgical intervention for hepatobiliary or pancreatic cancer.
