Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical...Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical outcomes,extend hospital stays,and increase healthcare costs.Traditional risk prediction models often lack precision,leading to increased interest in artificial intelligence(AI)for improving risk stratification.This review examines the application of AI,particularly machine learning and deep learning,in predicting perioperative complications in CRC surgery.AI models have been employed to predict a variety of postoperative complications,including readmissions,surgical-site infections,anastomotic leakage,and mortality,by analyzing diverse data sources such as electronic health records,medical imaging,and preoperative markers.Despite the promising results,several challenges remain,including data quality,model generalizability,the complexity of clinical data,and ethical and regulatory concerns.The review emphasizes the need for multicenter,diverse datasets and the integration of AI into clinical workflows to improve model performance and adoption.Future efforts should focus on enhancing the transparency and interpretability of AI models to ensure their successful implementation in clinical practice,ultimately improving patient outcomes and surgical decision-making in CRC surgery.展开更多
BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reachedregarding the most optimal surgical approach. Laparoscopic approach has theadvantage of minimally invasive. The risk factors infl...BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reachedregarding the most optimal surgical approach. Laparoscopic approach has theadvantage of minimally invasive. The risk factors influencing perioperativecomplications of laparoscopic surgery are rarely discussed.AIMTo investigate the risk factors for perioperative complications in laparoscopicsurgeries of retrorectal cystic lesions.METHODSWe retrospectively reviewed the medical records of patients who underwentlaparoscopic excision of retrorectal cystic lesions between August 2012 and May2020 at our hospital. All surgeries were performed in the general surgerydepartment. Patients were divided into groups based on the lesion location anddiameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension,the history of abdominal surgery, previous treatment, clinical manifestation,operation duration, blood loss, perioperative complications, and readmission ratewithin 90 d retrospectively.RESULTSSevere perioperative complications occurred in seven patients. Prophylactictransverse colostomy was performed in four patients with suspected rectal injury.Two patients underwent puncture drainage due to postoperative pelvic infection.One patient underwent debridement in the operating room due to incisioninfection. The massive-lesion group had a significantly longer surgery duration,higher blood loss, higher incidence of perioperative complications, and higherreadmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis,and logistic regression showed that lesion diameter was an independent riskfactor for the development of perioperative complications in patients whounderwent laparoscopic excision of retrorectal cystic lesions.CONCLUSIONThe diameter of the lesion is an independent risk factor for perioperative complicationsin patients who undergo laparoscopic excision of retrorectal cystic lesions.The location of the lesion was not a determining factor of the surgical approach.Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and itsuse in retrorectal cystic lesions is safe and feasible, also for lesions below the S3level.展开更多
BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantage...BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.展开更多
Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The nu...Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.展开更多
BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a highe...BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a higher risk of postoperative complications,and there’s no clear consensus on which anastomotic method is preferable.In recent years,our team has developed a new method called inter-locking main pancreatic duct-jejunal(IMPD-J)internal bridge drainage to MP.AIM To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.METHODS Patients who underwent MP in our hospital between October 1,2011 and July 31,2023 were enrolled in this study.Patients were divided into two groups based on their pancreatojejunostomy technique:IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group.Demographic data(age,gender,body mass index,hypertension,diabetes,etc.)and perioperative indicators[operation time,intraoperative bleeding,clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying,etc.]were recorded and analyzed statist-ically.RESULTS A total of 53 patients were enrolled in this study,including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejun-ostomy group.There were no significant differences in demographic or preope-rative characteristics between the groups.Compared to traditional duct-to-mucosa pancreaticojejunostomy,IMPD-J bridge drainage had a significant shorter operation time(4.3±1.3 hours vs 5.8±1.8 hours,P=0.002),nasogastric tube retention days(5.3±1.7 days vs 6.5±2.0 days,P=0.031),lower incidence of delayed gastric emptying(8.7%vs 36.7%,P=0.019),and lower incidence of CR-POPF(39.1%vs 70.0%,P=0.025).Multivariate logistic regression analysis showed that pancreaticojejunostomy type(odds ratio=4.219,95%confidence interval=1.238-14.379,P=0.021)and plasma prealbumin(odds ratio=1.132,95%confidence interval=1.001-1.281,P=0.049)were independent risk factor for CR-POPF.In IMPD-J bridge drainage group,only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.CONCLUSION Compared to traditional duct-to-mucosa pancreatojejunostomy,IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications,with favorable long-term outcomes.展开更多
Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our ...Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early?stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.Methods: A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early?stage cervical cancer were analyzed.Results: Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph?vascular space invasion(LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico?vaginal istula, and ileus(1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.Conclusions: Perioperative complications following RP were common, whereas the incidence of parametrial involve?ment was very low among selected early?stage cervical cancer patients. Based on these results, we thought that patients with very low?risk parametrial involvement(tumor size ≤2 cm, no LVSI, less than 50% stromal invasion, nega?tive lymph nodes) may beneit from omitting RP. Further prospective data are warranted.展开更多
Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challeng...Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.展开更多
Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evalu...Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evaluate the gastric residual volume,safety,and effectiveness of drinking 250 mL of 5%glucose solution 2-3 hours before elective gastric cancer surgery.Methods:We conducted an investigator-initiated,multicenter,randomized-controlled,parallel group,and equivalence trial.Eighty-eight patients with gastric adenocarcinoma were randomized into study or control group.Patients in the control group followed the traditional routine of 6-8 hours preoperative fasting,while those in the study group drank 250 mL of 5%glucose solution 2-3 hours be-fore surgery.Immediately following tracheal intubation,gastric contents were aspirated through gastroscopy.The primary outcome was preoperative gastric residual volume.Results:Eighty-three patients were eventually analysed in the study(42 in the study group and 41 in the control group).Two groups were comparable at baseline characteristics.There were no statistical differences in residual gastric fluid volumes(35.86±27.13 vs 27.70±20.37 mL,P=0.135)and pH values(2.81±1.99 vs 2.66±1.68,P=0.708)between the two groups.Preoperative discomfort was significantly more decreased in the study group than in the control group(thirst score:1.49±1.23 vs 4.14±2.07,P<0.001;hunger score:1.66±1.18 vs 3.00±2.32,P=0.007).There was no statistical difference in the incidence of postoperative complications(19.05%vs 17.07%,P=0.815).Conclusions:Drinking 250 mL of 5%glucose solution 2-3 hours before surgery in elective gastric cancer patients shows benefits in lowering thirst and hunger scores without increasing gastric residual volume and perioperative complications.展开更多
Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ...Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ambulatory ability recovery in individuals with hip fracture, and to determine whether changes could be made to improve treatment outcome. Methods The study included 707 hip fracture patients treated at Beijing Jishuitan Hospital between July 2009 and December 2010. The medical history and perioperative complications were compared between non-diabetic and diabetic groups. Length of stay, days awaiting surgery, and days of hospitalization after surgery were also analyzed. Ambulatory ability was compared at 1-year follow-up using the Chi-square test and Fisher＇s exact test. An independent Student＇s t-test was used to compare normally distributed continuous data. Results Patients with diabetes were more likely than non-diabetic patients to develop cardiac perioperative complications （8.9% vs. 3.0%, P=0.021）, urinary tract infections （12.0% vs. 2.8%, P 〈0.001）, and gastrointestinal symptoms （15.0% vs. 6.8%, P=0.003）. No difference in perioperative complications was observed between the groups. Days awaiting surgery and length of hospital stay were both longer in the diabetic group （（8.0＋5.1） vs. （6.2＋3.7） days and （16.5＋3.8） vs. （13.3＋3.8） days, P 〈0.001, respectively）. Before the occurrence of fracture, patients with diabetes were less likely to be ambulatory outdoors （71.9% vs. 85.9%, P 〈0.001） and had more restricted walking ability. After at least 1-year follow-up, similar proportions of patients in the non-diabetic and diabetic groups （16.1% and 15.9%, respectively）, who were able to ambulate outdoors before the fracture, became housebound till the final follow-up. Conclusions Diabetics are at increased risk of specific complications and have a longer time to surgery and longer in-hospital stay, but generally have similar recovery to non-diabetics thereafter.展开更多
文摘Colorectal cancer(CRC)is a prevalent malignancy,with surgery playing a key role in its treatment.However,perioperative complications,such as anastomotic leaks,infections,and mortality,can significantly affect surgical outcomes,extend hospital stays,and increase healthcare costs.Traditional risk prediction models often lack precision,leading to increased interest in artificial intelligence(AI)for improving risk stratification.This review examines the application of AI,particularly machine learning and deep learning,in predicting perioperative complications in CRC surgery.AI models have been employed to predict a variety of postoperative complications,including readmissions,surgical-site infections,anastomotic leakage,and mortality,by analyzing diverse data sources such as electronic health records,medical imaging,and preoperative markers.Despite the promising results,several challenges remain,including data quality,model generalizability,the complexity of clinical data,and ethical and regulatory concerns.The review emphasizes the need for multicenter,diverse datasets and the integration of AI into clinical workflows to improve model performance and adoption.Future efforts should focus on enhancing the transparency and interpretability of AI models to ensure their successful implementation in clinical practice,ultimately improving patient outcomes and surgical decision-making in CRC surgery.
文摘BACKGROUNDThe incidence of retrorectal lesions is low, and no consensus has been reachedregarding the most optimal surgical approach. Laparoscopic approach has theadvantage of minimally invasive. The risk factors influencing perioperativecomplications of laparoscopic surgery are rarely discussed.AIMTo investigate the risk factors for perioperative complications in laparoscopicsurgeries of retrorectal cystic lesions.METHODSWe retrospectively reviewed the medical records of patients who underwentlaparoscopic excision of retrorectal cystic lesions between August 2012 and May2020 at our hospital. All surgeries were performed in the general surgerydepartment. Patients were divided into groups based on the lesion location anddiameter. We analysed the risk factors like type 2 diabetes mellitus, hypertension,the history of abdominal surgery, previous treatment, clinical manifestation,operation duration, blood loss, perioperative complications, and readmission ratewithin 90 d retrospectively.RESULTSSevere perioperative complications occurred in seven patients. Prophylactictransverse colostomy was performed in four patients with suspected rectal injury.Two patients underwent puncture drainage due to postoperative pelvic infection.One patient underwent debridement in the operating room due to incisioninfection. The massive-lesion group had a significantly longer surgery duration,higher blood loss, higher incidence of perioperative complications, and higherreadmission rate within 90 d (P < 0.05). Univariate analysis, multivariate analysis,and logistic regression showed that lesion diameter was an independent riskfactor for the development of perioperative complications in patients whounderwent laparoscopic excision of retrorectal cystic lesions.CONCLUSIONThe diameter of the lesion is an independent risk factor for perioperative complicationsin patients who undergo laparoscopic excision of retrorectal cystic lesions.The location of the lesion was not a determining factor of the surgical approach.Laparoscopic surgery is minimally invasive, high-resolution, and flexible, and itsuse in retrorectal cystic lesions is safe and feasible, also for lesions below the S3level.
基金Supported by the Shenyang Science and Technology of Liaoning Province,No.22-321-32-15.
文摘BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.
文摘Objectives: To analyze the role of nurse staffing in improving patient safety due to reducing surgical complications in member countries of Organization for Economic Co-operation and Development (OECD).Methods: The number of practicing nurses' density per 1000 population and five surgical complications indicators including foreign body left in during procedure (FBL),postoperative pulmonary embolism (PPE) and deep vein thrombosis (DVT) after hip and knee replacement,postoperative sepsis after abdominal surgery (PSA) and postoperative wound dehiscence (PWD) were collected in crude rates per 100,000 hospital discharges for age group of 15 years old and over within 30 days after surgery based on surgical admission-related and all admission-related methods.The observations of 21 OECD countries were collected from OECD Health Statistics during 2010-2015 period.The statistical technique of panel data analysis including unit root test,co-integration test and dynamic long-run analysis were used to estimate the possible relationship between our panel series.Results: There were significant relationships from nurse-staffing level to reducing FBL,PPE,DVT,PSA and PWD with long-run magnitudes of-2.91,-1.30,-1.69,-2.81 and-1.12 based on surgical admission method as well as-6.12,-14.57,-7.29,-1.41 and-0.88 based on all admission method,respectively.Conclusions: A higher proportion of nurses is associated with higher patient safety resulting from lower surgical complications and adverse clinical outcomes in OECD countries.Hence,we alert policy makers about the risk of underestimating the impact of nurses on improving patient safety as well as the quality of health care services in OECD countries.
文摘BACKGROUND Middle pancreatectomy(MP)is a surgical procedure that removes non-invasive lesions in the pancreatic neck and body,allowing for the preservation of pan-creatic function.However,MP is associated with a higher risk of postoperative complications,and there’s no clear consensus on which anastomotic method is preferable.In recent years,our team has developed a new method called inter-locking main pancreatic duct-jejunal(IMPD-J)internal bridge drainage to MP.AIM To compare perioperative and postoperative outcomes in patients who underwent IMPD-J bridge drainage and those underwent traditional duct-to-mucosa pancreatojejunostomy.METHODS Patients who underwent MP in our hospital between October 1,2011 and July 31,2023 were enrolled in this study.Patients were divided into two groups based on their pancreatojejunostomy technique:IMPD-J bridge drainage group and duct-to-mucosa pancreatojejunostomy group.Demographic data(age,gender,body mass index,hypertension,diabetes,etc.)and perioperative indicators[operation time,intraoperative bleeding,clinically relevant postoperative pancreatic fistula(CR-POPF),delayed gastric emptying,etc.]were recorded and analyzed statist-ically.RESULTS A total of 53 patients were enrolled in this study,including 23 in the IMPD-J Bridge Drainage group and 30 in the traditional duct-to-mucosa pancreatojejun-ostomy group.There were no significant differences in demographic or preope-rative characteristics between the groups.Compared to traditional duct-to-mucosa pancreaticojejunostomy,IMPD-J bridge drainage had a significant shorter operation time(4.3±1.3 hours vs 5.8±1.8 hours,P=0.002),nasogastric tube retention days(5.3±1.7 days vs 6.5±2.0 days,P=0.031),lower incidence of delayed gastric emptying(8.7%vs 36.7%,P=0.019),and lower incidence of CR-POPF(39.1%vs 70.0%,P=0.025).Multivariate logistic regression analysis showed that pancreaticojejunostomy type(odds ratio=4.219,95%confidence interval=1.238-14.379,P=0.021)and plasma prealbumin(odds ratio=1.132,95%confidence interval=1.001-1.281,P=0.049)were independent risk factor for CR-POPF.In IMPD-J bridge drainage group,only one patient experienced recurrent pancreatitis due to the large diameter of the silicone tube and had it removed six months after surgery.CONCLUSION Compared to traditional duct-to-mucosa pancreatojejunostomy,IMPD-J bridge drainage has the advantages of simplicity and fewer perioperative complications,with favorable long-term outcomes.
文摘Background: Occult invasive cervical cancer discovered after simple hysterectomy is not common, radical parame?trectomy(RP) is a preferred option for young women. However, the morbidity of RP was high. The aim of our study is to assess the incidence of parametrial involvement in patients who underwent radical parametrectomy for occult cervical cancer or radical hysterectomy for early?stage cervical cancer and to suggest an algorithm for the triage of patients with occult cervical cancer to avoid RP.Methods: A total of 13 patients with occult cervical cancer who had undergone RP with an upper vaginectomy and pelvic lymphadenectomy were included in this retrospective study. Data on the clinicopathologic characteristics of the cases were collected. The published literature was also reviewed, and low risk factors for parametrial involvement in early?stage cervical cancer were analyzed.Results: Of the 13 patients, 9 had a stage IB1 lesion, and 4 had a stage IA2 lesion. There were four patients with grade 1 disease, seven with grade 2 disease, and two with grade 3 disease. The median age of the entire patients was 41 years. The most common indication for extrafascial hysterectomy was cervical intraepithelial neoplasia 3. Three patients had visible lesions measuring 10–30 mm, in diameter and ten patients had cervical stromal invasions with depths ranging from 4 to 9 mm; only one patient had more than 50% stromal invasion, and four patients had lymph?vascular space invasion(LVSI). Perioperative complications included intraoperative bowel injury, blood transfusion, vesico?vaginal istula, and ileus(1 case for each). Postoperative pathologic examination results did not show residual disease or parametrial involvement. One patient with positive lymph nodes received concurrent radiation therapy. Only one patient experienced recurrence.Conclusions: Perioperative complications following RP were common, whereas the incidence of parametrial involve?ment was very low among selected early?stage cervical cancer patients. Based on these results, we thought that patients with very low?risk parametrial involvement(tumor size ≤2 cm, no LVSI, less than 50% stromal invasion, nega?tive lymph nodes) may beneit from omitting RP. Further prospective data are warranted.
文摘Type 1 diabetes mellitus(T1DM)is one of the important causes of chronic kidney disease(CKD)and end-stage renal failure(ESRF).Even with the best available treatment options,management of T1DM poses significant challenges for clinicians across the world,especially when associated with CKD and ESRF.Substantial increases in morbidity and mortality along with marked rise in treatment costs and marked reduction of quality of life are the usual consequences of onset of CKD and progression to ESRF in patients with T1DM.Simultaneous pancreas-kidney transplant(SPK)is an attractive and promising treatment option for patients with advanced CKD/ESRF and T1DM for potential cure of these diseases and possibly several complications.However,limited availability of the organs for transplantation,the need for long-term immunosuppression to prevent rejection,peri-and post-operative complications of SPK,lack of resources and the expertise for the procedure in many centers,and the cost implications related to the surgery and postoperative care of these patients are major issues faced by clinicians across the globe.This clinical update review compiles the latest evidence and current recommendations of SPK for patients with T1DM and advanced CKD/ESRF to enable clinicians to care for these diseases.
基金supported by the National Natural Science Foundation of China[grant numbers 82172637 and 81702319]the Non-profit Central Research Institute Fund of Chinese Academy of Medical Sciences[grant number 2021-JKCS-004]+1 种基金the Guangdong Provincial Key Laboratory of Digestive Cancer Research[grant number 2021B1212040006]Research startup fund of part-time PI,SAHSYSU[grant number ZSQYJZPI202010].
文摘Background:Carbohydrate drinking 2-3 hours before surgery has been widely adopted in colorectal operations.However,there is lit-tle direct evidence regarding its application in gastric cancer surgery.We aimed to evaluate the gastric residual volume,safety,and effectiveness of drinking 250 mL of 5%glucose solution 2-3 hours before elective gastric cancer surgery.Methods:We conducted an investigator-initiated,multicenter,randomized-controlled,parallel group,and equivalence trial.Eighty-eight patients with gastric adenocarcinoma were randomized into study or control group.Patients in the control group followed the traditional routine of 6-8 hours preoperative fasting,while those in the study group drank 250 mL of 5%glucose solution 2-3 hours be-fore surgery.Immediately following tracheal intubation,gastric contents were aspirated through gastroscopy.The primary outcome was preoperative gastric residual volume.Results:Eighty-three patients were eventually analysed in the study(42 in the study group and 41 in the control group).Two groups were comparable at baseline characteristics.There were no statistical differences in residual gastric fluid volumes(35.86±27.13 vs 27.70±20.37 mL,P=0.135)and pH values(2.81±1.99 vs 2.66±1.68,P=0.708)between the two groups.Preoperative discomfort was significantly more decreased in the study group than in the control group(thirst score:1.49±1.23 vs 4.14±2.07,P<0.001;hunger score:1.66±1.18 vs 3.00±2.32,P=0.007).There was no statistical difference in the incidence of postoperative complications(19.05%vs 17.07%,P=0.815).Conclusions:Drinking 250 mL of 5%glucose solution 2-3 hours before surgery in elective gastric cancer patients shows benefits in lowering thirst and hunger scores without increasing gastric residual volume and perioperative complications.
文摘Background Diabetes has been associated with increased risk of fracture and impaired fracture healing. The aim of this study was to examine the influence of diabetes on perioperative complications, length of stay and ambulatory ability recovery in individuals with hip fracture, and to determine whether changes could be made to improve treatment outcome. Methods The study included 707 hip fracture patients treated at Beijing Jishuitan Hospital between July 2009 and December 2010. The medical history and perioperative complications were compared between non-diabetic and diabetic groups. Length of stay, days awaiting surgery, and days of hospitalization after surgery were also analyzed. Ambulatory ability was compared at 1-year follow-up using the Chi-square test and Fisher＇s exact test. An independent Student＇s t-test was used to compare normally distributed continuous data. Results Patients with diabetes were more likely than non-diabetic patients to develop cardiac perioperative complications （8.9% vs. 3.0%, P=0.021）, urinary tract infections （12.0% vs. 2.8%, P 〈0.001）, and gastrointestinal symptoms （15.0% vs. 6.8%, P=0.003）. No difference in perioperative complications was observed between the groups. Days awaiting surgery and length of hospital stay were both longer in the diabetic group （（8.0＋5.1） vs. （6.2＋3.7） days and （16.5＋3.8） vs. （13.3＋3.8） days, P 〈0.001, respectively）. Before the occurrence of fracture, patients with diabetes were less likely to be ambulatory outdoors （71.9% vs. 85.9%, P 〈0.001） and had more restricted walking ability. After at least 1-year follow-up, similar proportions of patients in the non-diabetic and diabetic groups （16.1% and 15.9%, respectively）, who were able to ambulate outdoors before the fracture, became housebound till the final follow-up. Conclusions Diabetics are at increased risk of specific complications and have a longer time to surgery and longer in-hospital stay, but generally have similar recovery to non-diabetics thereafter.
