BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperiton...BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.展开更多
This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024...This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.展开更多
As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is...As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.展开更多
In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in t...In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.展开更多
Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due...Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.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 Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female pat...BACKGROUND Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.展开更多
The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte rati...The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.展开更多
BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safe...BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safety of intraperitoneal RH-endostatin perfusion in treating patients with GC and malignant ascites.METHODS Patients with GC and malignant ascites were divided into the cisplatin intraperi-toneal perfusion(control group)group and the cisplatin combined with RH-endostatin intraperitoneal perfusion group(RH-endostatin group).Efficient ascites control,overall survival(OS),quality of life,and adverse events were observed,and possible influencing factors on prognosis outcomes analyzed.RESULTS We identified no significant differences in baseline characteristics between the control and RH-endostatin groups.The latter group had higher ascites control rates than the control group.Treatment methods were identified as an independent OS factor.Clinically,RH-endostatin-treated patients had significantly improved OS rates when compared with control patients,particularly in those with small and moderate ascites volumes.Quality of life improvements in control patients were significantly lower when compared with RH-endostatin patients.Adverse events were balanced between the groups.CONCLUSION Overall,intraperitoneal RH-endostatin improved treatment efficacy and prolonged prognosis in patients with GC and malignant ascites.This approach may benefit further clinical applications for treating GC.展开更多
In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This r...In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This retrospective cohort study included 133 patients.The findings indicate that patients with high neutrophil-to-lymphocyte ratios(NLRs)or lower hemoglobin(Hb)levels have significantly shorter overall survival(OS)than those with lower NLRs or normal Hb levels,respectively.Furthermore,age,carbohydrate antigen 199 levels,the NLR,Hb,and the peritoneal cancer index were identified as independent prognostic factors for OS.A nomogram was subsequently developed,demon-strating its ability to accurately predict the OS of colorectal cancer patients with peritoneal metastasis.This study introduces a potentially valuable prognostic tool for these patients.However,further validation in multicenter cohorts is needed to confirm its clinical applicability,to assess its limitations,and to elucidate the underlying mechanism of these identified biomarkers.展开更多
BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct p...BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.展开更多
BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy ...BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.展开更多
BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly s...BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.展开更多
Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely availabl...Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.展开更多
Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of p...Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of peritoneal dialysis patients were divided into 47 cases in the control group and 52 cases in the intervention group.In the control group,the routine discharge follow-up model was adopted;in the intervention group,the hospital-led medical unit was adopted as the basis of the“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”quadruple linkage care model,and the patients’systolic blood pressure was compared with those in the control group before and after discharge.The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and sodium were compared between the two groups.Results:The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and blood sodium of patients in the intervention group were significantly better than those of the control group(all P<0.001).Conclusion:Based on the“tertiary hospital-secondary hospital and nursing home-community-family”quadratic care model,the blood pressure control rate of elderly peritoneal dialysis patients can be increased to meet the standard,reduce the symptoms of the disease,and improve the satisfaction.展开更多
Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen r...Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.展开更多
Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such...Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.展开更多
BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(H...BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.展开更多
BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly...BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.展开更多
BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the ...BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the effect is not good.Cell reduction(CRS)combined with intraperitoneal thermoperfusion chemotherapy(HIPEC)has become a new method for the treatment of peritoneal pseudomy-xoma(PMP).AIM To find out if CRS and HIPEC can be used safely and effectively to treat PMP.METHODS This is an observational study.Clinical data of PMP patients treated with CRS+HIPEC at our hospital from January 2013 to June 2023 was collated and analyzed.The main outcome measures were overall survival(OS),and the secondary outcome measures were the incidence of surgical complications and serious adverse events.Complications were graded according to common adverse event evaluation criteria.Peritoneal tumor staging was performed using the peritoneal tumor index(PCI)scoring system,and a cell reduction degree(CCR)score was performed after CRS.CCR-0 and CCR-1 were considered satisfactory CRS.RESULTS A total of 186 patients with PMP were included,with a median age of 56(48-64)years,65(34.9%)years in males,and 121(65.1%)years in females.The median PCI score was 28(20-34)points.The median operative time was 300(211-430)minutes,and no significant complications occurred.91.4%(170/186)were from the appendix,53.2%(99/186)were from the low grade,and 30.6%(57/186)were from the high grade.CCR scores showed that 55 patients(29.6%)achieved satisfactory CRS,and 113 patients(60.8%)did not achieve satisfactory CRS.The fatality rate at 30 days after surgery was 2.7%(5/186),1.6%(3/186)needed a second operation,and the fatality rate at 90 days was 4.3%(8/186).The total incidence of III-IV complications was 43.0%(80/186),among which the higher incidence was mainly anemia(27.4%,51/186),electrolyte disturbance(11.6%,21/181),and albumin decrease(7.5%,14/186).The main compli-cations associated with abdominal surgery were gastrointestinal anastomotic leakage(2.2%,4/186),abdominal hemorrhage(2.2%,4/186),and abdominal infection(4.3%,8/186).The median follow-up was 38.1(95%CI:31.2-45.1)months.The 5-year OS of PMP patients treated with CRS+HIPEC was 50.3%(95%CI:40.7%-59.9%),and the median survival time was 66.1(95%CI:43.1-89.1)months.The results of the survival analysis showed that patients with a low pathological grade,a low PCI,and a satisfactory CCR score had a higher survival rate(all P<0.05).5-year OS was 88.9%(95%CI:68.3%-100.0%)in CCR-0 patients,77.6%(95%CI:62.7%-92.5%)in CCR-1 patients,and 42.0%(95%CI:29.5%-54.5%)in CCR-2/3 patients.CONCLUSION The application of CRS+HIPEC in PMP is safe and feasible,and the survival benefit is high,especially in those who achieve satisfactory CRS,which can significantly extend the OS.展开更多
文摘BACKGROUND Major postoperative complications have proved to be an independent adverse prognostic factor for long-term survival in patients undergoing cytoreductive surgery(CRS)with or without hyperthermic intraperitoneal chemotherapy(HIPEC).C-reactive protein(CRP)is an inflammatory marker that is reportedly a useful tool for the early prediction of postoperative complications,as is the neutrophil-to-lymphocyte ratio(NLR).In patients with peritoneal carcinomatosis,postoperative CRP levels on days 2 to 4 are predictors of early complications after CRS plus HIPEC.AIM To determine the usefulness of CRP and NLR for the early detection of overall postoperative infections(OPIs)after CRS+/-HIPEC.METHODS Patients treated on a peritoneal carcinomatosis program at a tertiary care hospital,in whom complete or optimal cytoreduction was achieved,were analyzed retrospectively.A total of 111 patients were included in this study.CRP and NRL evaluated.RESULTS Of the 111 patients included,19 presented OPI and 8 intra-abdominal infections.Patients with infections had a higher number of digestive anastomoses than those without(1 vs 0.5,P=0.053 and 1.2 vs 0.6,P=0.049)and longer length of stay(19 vs 14.9 days,P=0.022 and 22.3 vs 15.1 days,P=0.006).CRP values above 118 mg/L on POD3 yielded a sensitivity of 66.7%and a specificity of 74.2%to detect OPI.No differences in NLR values were observed.Patients with immunonutrition intake had higher CRP levels regardless of whether they presented OPI.Subsequently,on POD3 and POD4,patients with OPI presented with higher levels of CRP than patients without infection,regardless of the immunonutrition intake.CONCLUSION CRP levels are useful to detect early OPI in patients with peritoneal carcinomatosis undergoing CRS.A cut-off value of 118 mg/L on POD3 yields the best sensitivity and specificity.
文摘This study analyzed the therapeutic effects of continuous ambulatory peritoneal dialysis(CAPD)and automated peritoneal dialysis(APD)on patients with end-stage renal disease.Fifty patients admitted between January 2024 and December 2024 were randomly assigned to two groups,with the observation group receiving APD and the reference group receiving CAPD.Renal function indicators,nutritional indicators,mineral metabolism,urine volume,and ultrafiltration volume changes were compared between the two groups.After treatment,the observation group showed lower renal function indicators,higher nutritional indicators,and better mineral metabolism levels compared to the reference group(P<0.05).While there was no significant difference in urine volume between the two groups(P>0.05),the observation group demonstrated superior ultrafiltration volume(P<0.05).These findings suggest that APD offers better clinical outcomes than CAPD by improving renal function,nutritional status,mineral metabolism regulation,and ultrafiltration efficiency in patients with end-stage renal disease.
基金supported by the National Key R&D Program of China(No.2020YFE0201700)the Liaoning Revitalization Talents Program(No.XLYC1908031)。
文摘As one of the most common gynecological malignancies,peritoneal metastasis is a common feature and cause of high mortality in ovarian cancer(OC).Currently,the standard treatment for OC and its peritoneal metastasis is maximal cytoreductive surgery(CRS)combined with platinum-based chemotherapy.Compared with intravenous chemotherapy,traditional intraperitoneal(IP)chemotherapy exhibits obvious pharmacokinetic(PK)advantages and systemic safety and has shown significant survival benefits in several clinical studies of OC patients.However,there remain several challenges in traditional IP chemotherapy,such as insufficient drug retention,a lack of tumor targeting,inadequate drug penetration,gastrointestinal toxicity,and limited inhibition of tumor metastasis and chemoresistance.Nanomedicine-based IP targeting delivery systems,through specific drug carrier design with tumor cells and tumor environment(TME)targeting,make it possible to overcome these challenges and maximize local therapy efficacy while reducing side effects.In this review article,the rationale and challenges of nanomedicine-based IP chemotherapies,as well as their in vivo fate after IP administration,which are crucial for their rational design and clinical translation,are firstly discussed.Then,current strategies for nanomedicine-based targeting delivery systems and the relevant clinical trials in IP chemotherapy are summarized.Finally,the future directions of the nanomedicine-based IP targeting delivery system for OC and its peritoneal metastasis are proposed,expecting to improve the clinical development of IP chemotherapy.
文摘In this editorial we examine the article by Wu et al published in the World Journal of Gastrointestinal Oncology.Surgical resection for peritoneal metastases from colorectal cancer(CRC)has been gradually accepted in the medical oncology community.A randomized trial(PRODIGE 7)on cytoreductive surgery(CRS)with hyperthermic intraperitoneal chemotherapy(HIPEC)failed to prove any benefit of oxaliplatin in the overall survival of patients with peritoneal metastases from colorectal origin.Nevertheless,isolated systemic chemotherapy for CRC stage IV has demonstrated a reduced response in peritoneal metastases than that obtained in other metastatic sites such as the liver.Another tool is required in those patients to achieve more local control of the disease.Surgical groups in peritoneal surgery continue to use HIPEC in their procedures,using other agents than oxaliplatin for peritoneal cavity infusion,such as mitomycin C.These patients present with complex surgical issues to manage,and consequently a large burden of complications has to be anticipated.Therefore,identifying patients who will benefit from CRS with or without HIPEC would be of great interest.
文摘Patients with inflammatory bowel disease(IBD)have an increased risk of deve-loping colorectal cancer,which may ultimately result in peritoneal metastases(PM).PM in patients with IBD is by nature difficult to treat due to the chronic inflammation and immunosuppression inherent in IBD.This minireview com-piled existing evidence on management approaches to PM in patients with IBD,including surgical procedures,systemic treatment,and novel therapies.A li-terature review was conducted by searching PubMed and Scopus through June 2025 for studies addressing PM in IBD-associated colorectal or small bowel cancer.Literature specific to PM in IBD is sparse,comprising primarily two small retrospective cohort series comparing outcomes of cytoreductive surgery with hyperthermic intraperitoneal chemotherapy(CRS/HIPEC)in patients with and without IBD.These studies indicated that in high-volume centers with careful preoperative optimization perioperative morbidity and mortality rates for patients with IBD undergoing CRS/HIPEC were similar to those without IBD.However,median overall survival(approximately 19.6-24.0 months)and disease-free survival were consistently shorter and rates of early peritoneal recurrence were higher in patients with IBD.Although CRS/HIPEC can be performed safely in selected patients with IBD and PM,long-term oncologic outcomes appear inferior compared to populations without IBD,likely reflecting later-stage pre-sentation,distinct tumor biology,and IBD-related factors.
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 Treating diabetes in dialysis patients remains a challenge,with many hypoglycemic drugs requiring dose adjustments or avoidance in these patients.CASE SUMMARY This report describes an 83-year-old female patient with a 30-year history of type 2 diabetes(T2DM)who had struggled to control her blood sugar for more than a year.She had a history of high blood pressure for 30 years,had undergone continuous ambulatory peritoneal dialysis for more than two years,was 163 cm tall,weighed 77 kg,and had a body mass index of 28.98 kg/m2.Despite intensive insulin therapy at a daily dose of 150 units,adding Dorzagliatin at a dosage of 75 mg orally twice daily led to immediate blood sugar improvement and a gradual reduction in insulin dosage.After one month of follow-up,the fasting plasma glucose was 6-8 mmol/L,and the 2-hour postprandial glucose was 8-12 mmol/L.CONCLUSION To our knowledge,this report is the first to use Dorzagliatin to treat type 2 diabetes peritoneal dialysis patients with challenging glucose control.Dorzagliatin,a novel glucokinase activator primarily metabolized by the liver,exhibits no pharmacokinetic differences among patients with varying degrees of chronic kidney disease.It has a high plasma protein binding rate and may not be cleared by peritoneal dialysis,potentially offering a new glycemic control option for Type 2 diabetic patients on peritoneal dialysis.
文摘The study by Wu et al analyzed the correlation between nutritional and inflam-matory markers and prognosis in patients with colorectal cancer peritoneal metastasis.The authors propose the neutrophil-to-lymphocyte ratio(NLR)as a predictor of overall survival(OS)and developed a nomogram incorporating NLR,hemoglobin(Hb),and peritoneal cancer index(PCI)to estimate 1-and 2-year survival.Although the nomogram shows high accuracy,the group of patients analyzed is heterogeneous with respect to the surgical treatment received,and no clear definitions are given for normal Hb and there is no reason for choosing a very high PCI(≥20).Patient selection for cytoreductive surgery with hyper-thermic intraperitoneal chemotherapy requires a multidisciplinary approach.Over-simplification of the selection pathway may deny access to curative treatments to patients who could benefit.While methodologically sound,the study does not consider the effect of treatment received on OS,thus introducing a potential bias.
基金Supported by Scientific Research Project of Tianjin Municipal Education Commission,No.2018KJ015.
文摘BACKGROUND Studies on the application of recombinant human endostatin(RH-endostatin)intraperitoneal perfusion in gastric cancer(GC)with malignant ascites are limited.AIM To explore the effectiveness,prognosis,and safety of intraperitoneal RH-endostatin perfusion in treating patients with GC and malignant ascites.METHODS Patients with GC and malignant ascites were divided into the cisplatin intraperi-toneal perfusion(control group)group and the cisplatin combined with RH-endostatin intraperitoneal perfusion group(RH-endostatin group).Efficient ascites control,overall survival(OS),quality of life,and adverse events were observed,and possible influencing factors on prognosis outcomes analyzed.RESULTS We identified no significant differences in baseline characteristics between the control and RH-endostatin groups.The latter group had higher ascites control rates than the control group.Treatment methods were identified as an independent OS factor.Clinically,RH-endostatin-treated patients had significantly improved OS rates when compared with control patients,particularly in those with small and moderate ascites volumes.Quality of life improvements in control patients were significantly lower when compared with RH-endostatin patients.Adverse events were balanced between the groups.CONCLUSION Overall,intraperitoneal RH-endostatin improved treatment efficacy and prolonged prognosis in patients with GC and malignant ascites.This approach may benefit further clinical applications for treating GC.
文摘In this article,we critically appraise the study by Wu et al,which investigated the prognostic value of preoperative inflammatory and nutritional markers in colorectal cancer patients with peritoneal metastasis.This retrospective cohort study included 133 patients.The findings indicate that patients with high neutrophil-to-lymphocyte ratios(NLRs)or lower hemoglobin(Hb)levels have significantly shorter overall survival(OS)than those with lower NLRs or normal Hb levels,respectively.Furthermore,age,carbohydrate antigen 199 levels,the NLR,Hb,and the peritoneal cancer index were identified as independent prognostic factors for OS.A nomogram was subsequently developed,demon-strating its ability to accurately predict the OS of colorectal cancer patients with peritoneal metastasis.This study introduces a potentially valuable prognostic tool for these patients.However,further validation in multicenter cohorts is needed to confirm its clinical applicability,to assess its limitations,and to elucidate the underlying mechanism of these identified biomarkers.
文摘BACKGROUND Ampullary adenocarcinomas are a rare disease.They can be classified anatomically or according to their histology into intestinal,pancreatobiliary,and mixed subtypes,with different subtypes having distinct prognoses and potential treatments.We report a clinical case of a patient with mixed type adenocarcinoma of the ampulla of Vater,with predominantly intestinal histology,associated with an isolated and synchronous peritoneal carcinomatosis.It is the only case reported in the literature of duodenal ampulla cancer with synchronous peritoneal metastases,with long-term survival.CASE SUMMARY A 53-year-old male patient with non-insulin-dependent diabetes presented with acute abdominal pain in the right hypochondrium.Images revealed dilatation of the biliary tract and the duct of Wirsung,without a clear obstructive factor.Upper gastrointestinal endoscopy revealed a tumor in the duodenal papilla.Biopsies confirmed an adenocarcinoma.In the first surgical step,a biliodigestive bypass was performed in association with resection of the carcinomatosis.Peritoneal metastases was found during the intraoperative period.Subsequently,chemotherapy with the folinic acid,fluorouracil,and oxaliplatin regimen was administered based on histology,and a favorable response was achieved.After a multidisciplinary discussion,the Whipple procedure was performed.A delayed biopsy showed disease-free margins.The patient achieved 5 years of overall survival in August 2024,and 4 years of disease-free survival in September 2024.CONCLUSION We conclude that an important value of this work is showing individualized treatment for a patient with cancer.
基金Supported by a Research Fund from Dankook University in 2024,No.R202400759.
文摘BACKGROUND Peritoneal metastasis occurs in about 20%of patients with colorectal cancer(CRC)and is associated with a 5-year survival rate of only 6%.Cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy reportedly improves survival in selected patients.Achieving complete cytoreduction,indicated by a low completeness of cytoreduction(CCR)score,is a key factor in extending survival.Here,we present a case in which multimodal therapy yielded long-term survival in a patient,even though she had a CCR score of 3.CASE SUMMARY A 61-year-old female with CRC and extensive peritoneal metastases presented with abdominal distention.Cytoreductive surgery was not completed due to the extent of the disease(CCR score:3).The patient underwent palliative omen-tectomy,followed by hyperthermic intraperitoneal chemotherapy with mitomycin C,and early postoperative intraperitoneal chemotherapy.She subsequently received systemic chemotherapy,which was terminated after 19 cycles and two dose reductions due to side effects.She was in good health without distant metastases or peritoneal recurrence at the 6-year follow-up.CONCLUSION Aggressive multimodal treatment may yield long-term survival and quality of life improvement in patients with advanced disease,even with high CCR scores.
文摘BACKGROUND Internal hernia is a rare complication following abdominal surgery,primarily resulting from structural defects caused by anastomosis.We report a unique case of a late abdominal wall internal hernia highly suspected as resulting from insu-fficient peritoneal closure.CASE SUMMARY A 72-year-old woman presented with symptoms of intestinal obstruction 40 years after undergoing an abdominal hysterectomy.Abdominal computed tomography revealed a suspicious closed loop of intestine;then,a laparotomy was performed for suspected internal hernia.During the procedure,herniation of intestine into the preperitoneal space through a parietal peritoneal defect between rectus abdominis and sigmoid colon was identified.Intestinal reduction,resection of the ischemic segment and closure of the peritoneal defect were performed.The patient recovered well.CONCLUSION Non-closure of peritoneum might lead to late internal hernias.Meticulous peritoneal closure should be considered to prevent this potentially lethal complication.
文摘Peritoneal tuberculosis is the most common digestive location of tuberculosis. Its diagnosis is often based on a combination of clinical and biological arguments, and confirmed by bacteriology which is rarely available. In Congo there is little published data on this entity. Objectives: To describe the epidemiological, diagnostic, and progression characteristics of peritoneal tuberculosis at the university hospital center in Brazzaville. Patients and Methods: This study is a descriptive and retrospective analysis conducted from January 1, 2015, to December 31, 2021, in the Gastroenterology and Internal Medicine department of the CHU of Brazzaville. It included all patients hospitalized during this period with a confirmed diagnosis of peritoneal tuberculosis, encompassing 54 records that met the inclusion criteria. Results: Out of the study period, 54 records that fulfilled the inclusion criteria were analyzed. The annual incidence of peritoneal tuberculosis was 7.7 patients, with a prevalence of 1.4%, showing a male predominance of 61% and an average age of 39.93 ± 14.62 years. The primary symptoms were abdominal bloating and abdominal pain, present in 100% and 74% of cases, respectively. The clinical presentation was primarily characterized by febrile ascites observed in all patients. HIV co-infection was noted in 29.6% of cases. Anemia was present in 79.6% of patients, and an elevated sedimentation rate was observed in 74% of cases. The tuberculin skin test returned positive in 50% of cases. The ascitic fluid was exudative, rich in proteins and white blood cells (exceeding 1000/mm3, predominantly lymphocytes) in the majority of cases (100%, 83.3%, 83.3%, respectively). The diagnosis was deemed highly probable based on the clinical and paraclinical signs and the favorable response to treatment in 79.6% of cases. There were instances of pleural involvement (33.3%) and lymph node involvement (pulmonary 22.2% and lymph node 16.6%). Treatment outcomes were favorable in 37% of cases, with a mortality rate of 9%. Conclusion: Peritoneal tuberculosis is prevalent in Brazzaville, predominantly affecting young males. The diagnosis relies chiefly on a combination of clinical, paraclinical, and progression indicators.
文摘Objective:To explore the application of“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”four-dimensional linkage care model in peritoneal dialysis patients.Methods:99 cases of peritoneal dialysis patients were divided into 47 cases in the control group and 52 cases in the intervention group.In the control group,the routine discharge follow-up model was adopted;in the intervention group,the hospital-led medical unit was adopted as the basis of the“tertiary hospitals-secondary hospitals and nursing care institutions-community-family”quadruple linkage care model,and the patients’systolic blood pressure was compared with those in the control group before and after discharge.The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and sodium were compared between the two groups.Results:The systolic blood pressure,diastolic blood pressure,N-terminal brain natriuretic peptide,and blood sodium of patients in the intervention group were significantly better than those of the control group(all P<0.001).Conclusion:Based on the“tertiary hospital-secondary hospital and nursing home-community-family”quadratic care model,the blood pressure control rate of elderly peritoneal dialysis patients can be increased to meet the standard,reduce the symptoms of the disease,and improve the satisfaction.
文摘Objective Peritoneal carcinomatosis(PC)is a common pattern of recurrence in gastric cancer patients and is associated with a poor prognosis.This study aimed to evaluate the predictive value of the albumin-fibrinogen ratio(AFR)for PC in patients with gastric cancer and to develop two preoperative prediction models.Methods A total of 745 gastric cancer patients were included in this study.Preoperative AFR,along with other serum markers and clinical tumor characteristics,was assessed.Univariate and multivariate logistic regression analyses were performed to determine the odds ratios(ORs)and 95%confidence intervals(CIs)of the independent variables.Propensity score matching(PSM)was used to control for potential confounders,and one-way ANOVA was conducted to evaluate differences in distribution between groups.Two prediction models incorporating the independent predictive indicators were constructed and validated via receiver operating characteristic(ROC)curves.Results Poorly differentiated type(OR 2.679;P=0.001),nondiffuse morphological type(OR 2.123;P=0.040),BMI<23.550 kg/m^(2)(OR 4.635;P=0.001),AFR<11.275(OR 2.895;P=0.003)and CA199≥73.615 U/mL(OR 2.040;P=0.037)were identified as independent risk factors for PC in patients with gastric cancer.After PSM,the AFR remained the only inflammatory marker that was independently associated with PC(P=0.003).AFR demonstrated consistent robustness in predicting PC across multiple sample sets.Among all the independent risk factors,the AFR had the highest area under the curve(AUC)for ROC analysis(AUC 0.648;95%CI 0.580–0.715).Two combination models incorporating the AFR demonstrated enhanced predictive ability:Combination Model 1(AUC 0.759;95%CI 0.699–0.820)and Combination Model 2(AUC 0.801;95%CI 0.744–0.859).Conclusions The preoperative AFR serves as a useful indicator for predicting PC.Two reliable prediction models based on the AFR have been developed.
文摘Introduction: Peritoneal dialysis (PD) is an extra-renal purification technique indicated for patients with end-stage kidney disease (ESKD). Although it has many advantages, it also has a number of complications, such as peritoneo-vaginal leakage of dialysate. Cases Reports: Three male patients, aged 70, 50 and 77 respectively, with ESKD were placed on PD. All three patients presented with inadequate drainage and the progressive appearance of bilateral hydrocele, which occurred one year (late leakage), two and four days (early leakage) respectively after the initiation of exchanges. The etiological investigation led to the conclusion of a peritoneo-vaginal leak associated with an inguinal hernia in only one case. The two cases of early leakage were treated by temporary suspension of PD, with a good response in one case and failure in the second, leading to hisdefinitive transfer to hemodialysis (HD);however, the hernia repair enabled immediate resumption of PD in the third patient. Discussion and Conclusion: Peritoneo-vaginal leakage is a rare mechanical complication in PD. The clinical examination plays an essential role in confirming the diagnosis and in the therapeutic decision. If the diagnosis is uncertain, or if there is a clinical need to show the anatomy of the leak, an imaging approach becomes desirable. This complication should not prevent the progression of PD in the management of patients with ESKD.
文摘BACKGROUND Gastric cancer presenting with peritoneal metastasis is notably associated with diminished survival prospects.The use of cytoreductive surgery in conjunction with hyperthermic intraperitoneal chemotherapy(HIPEC)has been shown to increase survival rates in these patients.Despite these advancements,debates persist regarding the magnitude of survival improvement attributed to this treatment modality.The present investigation examined survival outcomes following HIPEC in individuals diagnosed with gastric cancer and peritoneal metastasis,and it took a comparative analysis of patients exhibiting positive and negative cytological findings.Between April 2013 and March 2020,84 patients with advanced gastric cancer treated at our institution were categorized into three cohorts:HIPEC(20 patients with peritoneal metastasis),cytology-positive(23 patients without peritoneal nodules but with positive wash cytology),and cytology-negative(41 patients with advanced gastric cancer,no peritoneal nodules,and negative wash cytology).The HIPEC cohort underwent gastrectomy with HIPEC,while the cytology-positive and cytology-negative groups received gastrectomy alone.The demographic,pat-hological,and survival data of the groups were compared.RESULTS The HIPEC cohort-predominantly younger females-exhibited relatively extended surgical durations and high blood loss.Nevertheless,the complication rates were consistent across all three groups.Median survival in the HIPEC group was 20.00±4.89 months,with 1-year,2-year,and 3-year overall survival rates of 73.90%,28.70%,and 9.60%,respectively.These figures paralleled the survival rates of the cytology-positive group(52.20%at 1 year,28.50%at 2 years,and 19.00%at 3 years).Notably,47%of patients experienced peritoneal recurrence.CONCLUSION HIPEC may offer a modest improvement in short-term survival for patients with gastric cancer and peritoneal metastasis,mirroring the outcomes in cytology-positive patients.However,peritoneal recurrence remained high.
基金the Chang Gung Medical Foundation,No.CMRPG6L0091,No.CMRPG6L0092,and No.CMRPG6L0093.
文摘BACKGROUND Although cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)offer the potential for long-term survival in peritoneal carcinomatosis,outcomes following CRS/HIPEC vary significantly.AIM To identify the clinical factors associated with progression-free survival(PFS)after complete CRS/HIPEC in patients with colorectal/high-grade appendiceal,ovarian,and gastric cancers.METHODS We retrospectively evaluated the risk of recurrence within 1 year after CRS/HIPEC and its impact on overall survival(OS)in patients recruited between 2015 and 2020.Logistic regression models were used to assess the prognostic factors for the risk of recurrence within 1 year.Kaplan–Meier survival curves and Cox proportional hazards models were used to evaluate the association between recurrence and OS.RESULTS Of the 80 enrolled patients,39 had an unfavorable PFS(<1 year)and 41 had a favorable PFS(≥1 year).Simple logistic models revealed that the patients with a completeness of cytoreduction score of 0(CC-0)or length of CRS≤6 h had a favorable PFS[odds ratio(OR)=0.141,P=0.004;and OR=0.361,P=0.027,respectively].In multiple logistic regression,achieving CC-0 was the strongest prognostic factor for a favorable PFS(OR=0.131,P=0.005).A peritoneal cancer index score>12 was associated with a lower rate of achieving CC-0(P=0.027).The favorable PFS group had a significantly longer OS(median 81.7 mo vs 17.0 mo,P<0.001).CONCLUSION Achieving CC-0 was associated with a lower early recurrence rate and improved long-term survival.This study underscores the importance of selecting appropriate candidates for CRS/HIPEC to manage peritoneal carcinomatosis.
文摘BACKGROUND Pseudomyxoma peritonei is a rare tumor that can produce a biological behavior similar to that of a malignant tumor.Surgical resection combined with chemo-therapy is the traditional treatment method,but the effect is not good.Cell reduction(CRS)combined with intraperitoneal thermoperfusion chemotherapy(HIPEC)has become a new method for the treatment of peritoneal pseudomy-xoma(PMP).AIM To find out if CRS and HIPEC can be used safely and effectively to treat PMP.METHODS This is an observational study.Clinical data of PMP patients treated with CRS+HIPEC at our hospital from January 2013 to June 2023 was collated and analyzed.The main outcome measures were overall survival(OS),and the secondary outcome measures were the incidence of surgical complications and serious adverse events.Complications were graded according to common adverse event evaluation criteria.Peritoneal tumor staging was performed using the peritoneal tumor index(PCI)scoring system,and a cell reduction degree(CCR)score was performed after CRS.CCR-0 and CCR-1 were considered satisfactory CRS.RESULTS A total of 186 patients with PMP were included,with a median age of 56(48-64)years,65(34.9%)years in males,and 121(65.1%)years in females.The median PCI score was 28(20-34)points.The median operative time was 300(211-430)minutes,and no significant complications occurred.91.4%(170/186)were from the appendix,53.2%(99/186)were from the low grade,and 30.6%(57/186)were from the high grade.CCR scores showed that 55 patients(29.6%)achieved satisfactory CRS,and 113 patients(60.8%)did not achieve satisfactory CRS.The fatality rate at 30 days after surgery was 2.7%(5/186),1.6%(3/186)needed a second operation,and the fatality rate at 90 days was 4.3%(8/186).The total incidence of III-IV complications was 43.0%(80/186),among which the higher incidence was mainly anemia(27.4%,51/186),electrolyte disturbance(11.6%,21/181),and albumin decrease(7.5%,14/186).The main compli-cations associated with abdominal surgery were gastrointestinal anastomotic leakage(2.2%,4/186),abdominal hemorrhage(2.2%,4/186),and abdominal infection(4.3%,8/186).The median follow-up was 38.1(95%CI:31.2-45.1)months.The 5-year OS of PMP patients treated with CRS+HIPEC was 50.3%(95%CI:40.7%-59.9%),and the median survival time was 66.1(95%CI:43.1-89.1)months.The results of the survival analysis showed that patients with a low pathological grade,a low PCI,and a satisfactory CCR score had a higher survival rate(all P<0.05).5-year OS was 88.9%(95%CI:68.3%-100.0%)in CCR-0 patients,77.6%(95%CI:62.7%-92.5%)in CCR-1 patients,and 42.0%(95%CI:29.5%-54.5%)in CCR-2/3 patients.CONCLUSION The application of CRS+HIPEC in PMP is safe and feasible,and the survival benefit is high,especially in those who achieve satisfactory CRS,which can significantly extend the OS.
