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
Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 20...Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 2015 and November 2016,a phase Ⅱ clinical trial was performed.Fifty consecutive patients with LAGC were randomly assigned to two groups:the experimental group(radical gastrectomy+HIPEC with cisplatin+adjuvant chemotherapy)and the control group(radical gastrectomy+adjuvant chemotherapy).Survival rates were closely monitored.Results:The 5-year overall survival(OS)rate of all patients was 80.0%.The 5-year OS rate in the experimental group was lower than that in the control group,at 75.8%and 88.2%,respectively,with no statistical significance.In addition,5-year recurrence-free survival(RFS)rates of patients who underwent HIPEC or not were also 75.8%and 88.2%,respectively.In the multivariate analysis,only pT stage[risk ratio(RR)=7.079,P=0.018]was significantly associated with prognosis.The most common recurrence pattern was peritoneal recurrence in both groups.The experimental group had a lower incidence of peritoneal recurrence than the control group with no statistical significance.Conclusions:This trial clearly revealed that prophylactic HIPEC with cisplatin neither decrease the risk of peritoneal recurrence nor improve the prognosis of patients with LAGC.Thus,HIPEC with cisplatin is not recommended as a prophylactic treatment for peritoneal recurrence of LAGC after radical gastrectomy.展开更多
Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although t...Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.展开更多
BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Ov...BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Over the past decades,hyperthermic intraperitoneal chemotherapy(HIPEC),often combined with cytoreductive surgery(CRS),has emerged as a locoregional strategy to improve peritoneal disease control.Retrospective studies have suggested promising survival benefits(median OS:18.8 months);however,conflicting results from prospective trials have limited its widespread adoption.This systematic review hypothesizes that selected patients with advanced or high-risk GC may benefit from HIPEC and evaluates whether such benefits have been confirmed in recent prospective evidence.AIM To evaluate the role and outcomes of HIPEC in advanced and high-risk GC through a systematic review of prospective trials.METHODS A systematic review of prospective randomized and controlled clinical trials(2010-2024)was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Studies were selected from PubMed,Cochrane,Scopus,and ClinicalTrials.gov.No geographical restrictions were applied in the search process.Eligible studies included patients with advanced GC(T3+,positive peritoneal cytology/PM)receiving HIPEC in either therapeutic or prophylactic settings.Exclusion criteria included retrospective studies,single-arm trials,and those lacking survival outcomes.Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Non-Randomized Studies of Interventions tools;sensitivity and heterogeneity analyses were also conducted.RESULTS Thirteen prospective studies(eight therapeutic,five prophylactic)were included.In therapeutic settings,CRS combined with HIPEC yielded a median OS of 11-24.9 months vs 4-6 months with systemic therapy alone.Completeness of cytoreduction(CC-0)was achieved in 67.3%of cases,and associated with improved disease-free survival.In prophylactic settings,HIPEC significantly reduced peritoneal recurrence,particularly in T4 tumors.Sensitivity analyses confirmed robustness of findings,though benefit was driven by a few key trials.Heterogeneity was moderate across studies;lack of standardized HIPEC protocols and patient selection criteria limited comparability.CONCLUSION HIPEC may improve survival and reduce recurrence in selected GC patients,particularly those with low peritoneal burden and CC-0 resection.Further standardization and prospective trials are needed.展开更多
BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who recei...BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who receive this treatment are different.AIM To investigate whether inflammation and nutritional indicators affect the pro-gnosis of AGC patients undergoing gastrectomy and prophylactic HIPEC,and to develop a novel inflammatory nutritional prognostic index(INPI).Additionally,we aimed to construct a nomogram model to visually predict the prognosis of these patients and provide more accurate guidance for clinical decision-making.METHODS Clinical data from 181 Locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and least absolute shrinkage and selection operator(LASSO)Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were used to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.RESULTS Clinical data from 181 locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and LASSO Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were applied to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.CONCLUSION Inflammation and nutrition indicators are associated with the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC.The nomogram based on the INPI and clinical features supports personalized treatment strategies improving prognosis for AGC patients undergoing gastrectomy and prophylactic HIPEC.展开更多
Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic t...Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.展开更多
Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to corre...Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.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 Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and ga...BACKGROUND Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.展开更多
BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents si...BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury(AKI).Identifying perioperative risk factors plays a critical role in preserving renal function.AIM To evaluate postoperative renal outcomes in patients with PC who underwent CRS+HIPEC.METHODS Patients who underwent CRS+HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study.Demographic data,preoperative estimated glomerular filtration rate,HIPEC agents used(cisplatin,mitomycin C,oxaliplatin),intraoperative fluid management,vasopressor use,and postoperative creatinine levels were recorded.AKI was defined according to the 2012 Kidney Disease:Improving Global Outcomes criteria.Independent predictors were identified through multivariate logistic regression analysis.RESULTS AKI developed in 61 of 445 patients(13.7%).Among them,62.0%were stage I,24.6%were stage II,and 13.1%were stage III.The highest AKI rate was observed in the cisplatin group(21.4%),with lower rates in the oxaliplatin group(9.6%)and the mitomycin C group(6.5%).Independent risk factors included cisplatin use[odds ratio(OR)=2.8;95%confidence interval:1.6-4.9;P<0.001),intraoperative fluid administration<6000 mL(OR=2.1;P=0.02),vasopressor requirement(OR=1.9;P=0.03),and preoperative estimated glomerular filtration rate<75 mL/minute/1.73 m2(OR=2.3;P=0.01).AKI was associated with a prolonged hospital stay.Three patients(0.7%)progressed to chronic kidney disease.CONCLUSION Independent risk factors such as cisplatin use,inadequate fluid replacement,vasopressor requirement,and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS+HIPEC.展开更多
Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel bloc...Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel blockers and cytotoxic drugs.Methods We adopted the method of subcapsular implantation of carcinoma tissues of walker-256 in the left liver lobe as a model of livercarcinoma-bearing rats. All experimental animals were divided into four groups. On the sixth day post implantation, in group A (controlgroup) 6 ml of saline was injected intraperitoneally once a day for 3 days. In group B (single chemotherapy group) 6 ml of 5-Fu 75 mg/kg was injected intraperitoneally once a day for 3 days. In group C (combination of treatment group) both 5-Fu (75 mg/kg) and verapamil(25 mg/kg) were administered simultaneously as in A and B. In group D (simple verapamil group) only 6 ml of verapamil (25 mg/kg)was administered as above.Results Compared with groups A, B and D, The volume of cancer and the contents of liver cancer DNA and protein were significantlyreduced. The rates of inhibiting cancer (89.9% in group C and 35.4% in group B) were significantly increased in group C. Group C hadsignificantly long survival time compared to groups A, B and D ( P < 0.05) . By light microscopy, a number of focal necroses were foundin cancer tissue in group C.Conclusion Calcium channel blockers can enhance the antineoplastic effect of 5-Fu intraperitoneal chemotherapy to liver cancer ; Theuse of verapamil can not increase the toxicity of 5-Fu.展开更多
高校新工科教育背景下对研究生创新创业教育提出更高要求,创新创业课程教学是提升研究生双创能力有效途径之一。而现有创新创业课程还存在内容设置与产业创新创业链不匹配,只关注创业链中的单个或部分环节,未全面覆盖;创新创业课程内容...高校新工科教育背景下对研究生创新创业教育提出更高要求,创新创业课程教学是提升研究生双创能力有效途径之一。而现有创新创业课程还存在内容设置与产业创新创业链不匹配,只关注创业链中的单个或部分环节,未全面覆盖;创新创业课程内容设置与行业特色匹配度不高,专业和行业特色缺乏等问题。本文以移动物联网(Mobile Internet of Things,MIoT)产业为例,探索和创新M2M(Market to Market)端到端全链创新创业课程内容建设模式,实现移动物联网产业调研与选择、产业链与市场分析、产业关键技术、产品研发与管理和产品营销与运营5部分课程内容设计,构建M2M端到端创新创业商业逻辑全链闭环。教学实践表明,创新创业课程内容设计能有效提升研究生、工程实践和学科竞赛培养质量,具有一定的推广和示范意义。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.
基金supported by the National Nature Science Foundation of China(No.81402308)Science Foundation of Peking University Cancer Hospital(No.2021-24)+2 种基金Natural Science Foundation of Beijing Municipal(No.7242020)Science Foundation of Peking University Cancer Hospital(No.BJCH2025GG04)the National Nature Science Foundation of China(No.82173151).
文摘Objective:The trial was designed to evaluate the efficacy of prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)with cisplatin for patients with locally advanced gastric cancer(LAGC).Methods:Between March 2015 and November 2016,a phase Ⅱ clinical trial was performed.Fifty consecutive patients with LAGC were randomly assigned to two groups:the experimental group(radical gastrectomy+HIPEC with cisplatin+adjuvant chemotherapy)and the control group(radical gastrectomy+adjuvant chemotherapy).Survival rates were closely monitored.Results:The 5-year overall survival(OS)rate of all patients was 80.0%.The 5-year OS rate in the experimental group was lower than that in the control group,at 75.8%and 88.2%,respectively,with no statistical significance.In addition,5-year recurrence-free survival(RFS)rates of patients who underwent HIPEC or not were also 75.8%and 88.2%,respectively.In the multivariate analysis,only pT stage[risk ratio(RR)=7.079,P=0.018]was significantly associated with prognosis.The most common recurrence pattern was peritoneal recurrence in both groups.The experimental group had a lower incidence of peritoneal recurrence than the control group with no statistical significance.Conclusions:This trial clearly revealed that prophylactic HIPEC with cisplatin neither decrease the risk of peritoneal recurrence nor improve the prognosis of patients with LAGC.Thus,HIPEC with cisplatin is not recommended as a prophylactic treatment for peritoneal recurrence of LAGC after radical gastrectomy.
文摘Cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are complex surgical procedures that are often used to treat advanced cancers of the abdominal cavity with peritoneal metastasis.Although these treatments can be lifesaving,patients often experience a significant decrease in their overall quality of life(QoL),especially in the early stages of recovery,owing to the physical burden of surgery and the effects of chemotherapy.Many traditional QoL questionnaires have been used to measure CRS and HIPEC.However,these classical current QoL assessment tools often fail to capture the unique challenges faced by this population,including bowel dysfunction,stoma-related distress,and long-term survivorship issues.Therefore,additional parameters that assess bowel function and stoma opening status and especially patient-reported outcome measures would be useful in QoL measurements to provide a more detailed understanding of recovery and general well-being in these patients.
文摘BACKGROUND Peritoneal metastases(PM)represent the most frequent and lethal form of dissemination in advanced gastric cancer(GC),with limited efficacy of systemic chemotherapy[median overall survival(OS):2-9 months].Over the past decades,hyperthermic intraperitoneal chemotherapy(HIPEC),often combined with cytoreductive surgery(CRS),has emerged as a locoregional strategy to improve peritoneal disease control.Retrospective studies have suggested promising survival benefits(median OS:18.8 months);however,conflicting results from prospective trials have limited its widespread adoption.This systematic review hypothesizes that selected patients with advanced or high-risk GC may benefit from HIPEC and evaluates whether such benefits have been confirmed in recent prospective evidence.AIM To evaluate the role and outcomes of HIPEC in advanced and high-risk GC through a systematic review of prospective trials.METHODS A systematic review of prospective randomized and controlled clinical trials(2010-2024)was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines.Studies were selected from PubMed,Cochrane,Scopus,and ClinicalTrials.gov.No geographical restrictions were applied in the search process.Eligible studies included patients with advanced GC(T3+,positive peritoneal cytology/PM)receiving HIPEC in either therapeutic or prophylactic settings.Exclusion criteria included retrospective studies,single-arm trials,and those lacking survival outcomes.Risk of bias was assessed using Risk of Bias 2.0 and Risk of Bias in Non-Randomized Studies of Interventions tools;sensitivity and heterogeneity analyses were also conducted.RESULTS Thirteen prospective studies(eight therapeutic,five prophylactic)were included.In therapeutic settings,CRS combined with HIPEC yielded a median OS of 11-24.9 months vs 4-6 months with systemic therapy alone.Completeness of cytoreduction(CC-0)was achieved in 67.3%of cases,and associated with improved disease-free survival.In prophylactic settings,HIPEC significantly reduced peritoneal recurrence,particularly in T4 tumors.Sensitivity analyses confirmed robustness of findings,though benefit was driven by a few key trials.Heterogeneity was moderate across studies;lack of standardized HIPEC protocols and patient selection criteria limited comparability.CONCLUSION HIPEC may improve survival and reduce recurrence in selected GC patients,particularly those with low peritoneal burden and CC-0 resection.Further standardization and prospective trials are needed.
文摘BACKGROUND Prophylactic hyperthermic intraperitoneal chemotherapy(HIPEC)is one of the methods to prevent peritoneal metastasis of advanced gastric cancer(AGC).However,the prognosis of gastric cancer patients who receive this treatment are different.AIM To investigate whether inflammation and nutritional indicators affect the pro-gnosis of AGC patients undergoing gastrectomy and prophylactic HIPEC,and to develop a novel inflammatory nutritional prognostic index(INPI).Additionally,we aimed to construct a nomogram model to visually predict the prognosis of these patients and provide more accurate guidance for clinical decision-making.METHODS Clinical data from 181 Locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and least absolute shrinkage and selection operator(LASSO)Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were used to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.RESULTS Clinical data from 181 locally AGC patients who underwent gastrectomy and prophylactic HIPEC treatment at The Affiliated Hospital of Qingdao University were retrospectively collected.Multicollinearity analysis and LASSO Cox regression were utilized to construct the INPI.Survival analyses were performed using the Kaplan-Meier method and log-rank test.Both univariate and multivariate Cox proportional hazards regression models were applied to analyze independent prognostic factors,and a prognostic nomogram was generated.And the model was validated using the bootstrap method.CONCLUSION Inflammation and nutrition indicators are associated with the prognosis of AGC patients undergoing gastrectomy and prophylactic HIPEC.The nomogram based on the INPI and clinical features supports personalized treatment strategies improving prognosis for AGC patients undergoing gastrectomy and prophylactic HIPEC.
文摘Since its introduction in 1991,laparoscopic right colectomy has been the standard surgical treatment for benign and malignant right colon diseases.Extracorporeal anastomosis(ECA)is the most commonly used anastomotic technique.However,intracorporeal anastomosis(ICA)has emerged as a promising alternative because of its potential advantages.Recently,Wu et al provided compelling evidence supporting superiority of ICA over ECA,demonstrating reduced blood loss,smaller incisions,and faster postoperative recovery without increased complic-ations.Despite these benefits,ICA presents certain challenges such as longer operative times and technical difficulties.However,advances in minimally in-vasive surgery,including robot-assisted platforms,may facilitate broader adoption of ICA by addressing the technical limitations.Furthermore,meticulous surgical techniques and perioperative infection control strategies are essential for mitigating intra-abdominal infectious complications.Given the increasing adoption of ICA in minimally invasive right hemicolectomy,further studies,including multicenter randomized controlled trials,are necessary to confirm its oncological safety and establish standardized surgical protocols.Overall,ICA has the potential to become the preferred anastomotic approach in both laparoscopic and robotic colorectal surgeries.
文摘Wen-lin Gong1,Chuang Sha2,Gang Du1,Zhong-gui Shan3,Zhong-quan Qi3,Su-fang Zhou1,Nuo Yang1,4,Yong-xiang Zhao1,4.First published:21 June 2017;10(5):454-460.DOI:10.1016/j.apjtm.2017.05.004 The authors would like to correct an error in Figure 3 in which the flow cytometric scattergram of CD4/CD44 for the control group was erroneously used for the scattergram of CD8/CD44 for the PVIDSC group.The correct scattergram of CD8/CD44 for the PVIDSC group is provided below.The error does not affect the conclusion of the study.The authors apologize for the error and the inconvenience it might have caused to readers.
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 Cytoreductive surgery(CRS)combined with hyperthermic intraperitoneal chemotherapy(HIPEC)has become an established treatment for selected patients with peritoneal metastases(PM)from colorectal,ovarian,and gastric cancers,as well as for certain primary peritoneal tumors such as pseudomyxoma peritonei.However,evidence supporting its role in other uncommon indications remains limited,largely due to the rarity and heterogeneity of these malignancies and the absence of standardized treatment protocols.Understanding the potential survival benefit and safety profile of CRS+HIPEC in these contexts may help refine patient selection and guide clinical decision-making.AIM To evaluate surgical and oncologic outcomes,particularly overall survival(OS),in this heterogeneous patient population and assess perioperative morbidity and mortality to better define the safety profile of this aggressive multimodal strategy.METHODS We retrospectively reviewed data from five tertiary cancer centers on patients who underwent CRS+HIPEC between January 2004 and December 2021 for PM from uncommon histologies,defined as any primary tumor other than colorectal,gastric,or ovarian carcinomas,pseudomyxoma peritonei,or malignant peritoneal mesothelioma.Baseline characteristics,operative details,complications(graded by the Clavien-Dindo classification),and survival outcomes were analyzed.OS was estimated using Kaplan-Meier analysis.Prognostic factors were evaluated using univariate and multivariate Cox proportional hazards models.The discriminatory ability and overall fit of the final model were assessed by the concordance index(C-index)and likelihood ratio test,respectively.RESULTS A total of 60 CRS+HIPEC procedures were performed in 60 patients(mean age=58.5 years,78.3%female).The most frequent primary tumors were uterine(35%)and breast cancer(20%).Median operative time was 405 minutes,and 75%of patients required perioperative transfusions.Major complications(Clavien-Dindo≥3)occurred in 21.6%of patients,and 90-day mortality was 1.6%.Median OS for the entire cohort was 28 months.Kaplan-Meier analysis showed that breast cancer patients achieved the longest survival(median OS=75 months)compared with uterine cancer(32 months)and other primaries(17 months).Multivariate analysis confirmed tumor origin as the strongest independent predictor of OS(C-index=0.81;likelihood ratio test=40.07;P<0.001).CONCLUSION Our findings suggest that CRS+HIPEC can be performed safely in highly selected patients with PM from uncommon primary tumors,achieving meaningful long-term survival in subsets such as breast and uterine cancers.Tumor biology,rather than clinical factors,emerged as the key determinant of survival.Given the rarity and heterogeneity of these malignancies,collaborative multicenter efforts and prospective registries are essential to establish standardized selection criteria and optimize outcomes.
文摘BACKGROUND Combining cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)is a promising treatment approach for peritoneal carcinomatosis(PC).However,intraperitoneal chemotherapeutic agents significantly increase the risk of acute kidney injury(AKI).Identifying perioperative risk factors plays a critical role in preserving renal function.AIM To evaluate postoperative renal outcomes in patients with PC who underwent CRS+HIPEC.METHODS Patients who underwent CRS+HIPEC for PC between 2017 and 2024 were included in this retrospective cohort study.Demographic data,preoperative estimated glomerular filtration rate,HIPEC agents used(cisplatin,mitomycin C,oxaliplatin),intraoperative fluid management,vasopressor use,and postoperative creatinine levels were recorded.AKI was defined according to the 2012 Kidney Disease:Improving Global Outcomes criteria.Independent predictors were identified through multivariate logistic regression analysis.RESULTS AKI developed in 61 of 445 patients(13.7%).Among them,62.0%were stage I,24.6%were stage II,and 13.1%were stage III.The highest AKI rate was observed in the cisplatin group(21.4%),with lower rates in the oxaliplatin group(9.6%)and the mitomycin C group(6.5%).Independent risk factors included cisplatin use[odds ratio(OR)=2.8;95%confidence interval:1.6-4.9;P<0.001),intraoperative fluid administration<6000 mL(OR=2.1;P=0.02),vasopressor requirement(OR=1.9;P=0.03),and preoperative estimated glomerular filtration rate<75 mL/minute/1.73 m2(OR=2.3;P=0.01).AKI was associated with a prolonged hospital stay.Three patients(0.7%)progressed to chronic kidney disease.CONCLUSION Independent risk factors such as cisplatin use,inadequate fluid replacement,vasopressor requirement,and preoperative renal function should be considered during perioperative planning to reduce AKI risk following CRS+HIPEC.
文摘Objective To study the antineoplastic effect of the calcium channel blocker verapamil and 5-fluorouracil intraperitoneal chemotherapy onhepatocarcinoma-bearing rats, and examine the action between calcium channel blockers and cytotoxic drugs.Methods We adopted the method of subcapsular implantation of carcinoma tissues of walker-256 in the left liver lobe as a model of livercarcinoma-bearing rats. All experimental animals were divided into four groups. On the sixth day post implantation, in group A (controlgroup) 6 ml of saline was injected intraperitoneally once a day for 3 days. In group B (single chemotherapy group) 6 ml of 5-Fu 75 mg/kg was injected intraperitoneally once a day for 3 days. In group C (combination of treatment group) both 5-Fu (75 mg/kg) and verapamil(25 mg/kg) were administered simultaneously as in A and B. In group D (simple verapamil group) only 6 ml of verapamil (25 mg/kg)was administered as above.Results Compared with groups A, B and D, The volume of cancer and the contents of liver cancer DNA and protein were significantlyreduced. The rates of inhibiting cancer (89.9% in group C and 35.4% in group B) were significantly increased in group C. Group C hadsignificantly long survival time compared to groups A, B and D ( P < 0.05) . By light microscopy, a number of focal necroses were foundin cancer tissue in group C.Conclusion Calcium channel blockers can enhance the antineoplastic effect of 5-Fu intraperitoneal chemotherapy to liver cancer ; Theuse of verapamil can not increase the toxicity of 5-Fu.
文摘高校新工科教育背景下对研究生创新创业教育提出更高要求,创新创业课程教学是提升研究生双创能力有效途径之一。而现有创新创业课程还存在内容设置与产业创新创业链不匹配,只关注创业链中的单个或部分环节,未全面覆盖;创新创业课程内容设置与行业特色匹配度不高,专业和行业特色缺乏等问题。本文以移动物联网(Mobile Internet of Things,MIoT)产业为例,探索和创新M2M(Market to Market)端到端全链创新创业课程内容建设模式,实现移动物联网产业调研与选择、产业链与市场分析、产业关键技术、产品研发与管理和产品营销与运营5部分课程内容设计,构建M2M端到端创新创业商业逻辑全链闭环。教学实践表明,创新创业课程内容设计能有效提升研究生、工程实践和学科竞赛培养质量,具有一定的推广和示范意义。
